Barriers to the Uptake of Cataract Surgery and Eye Care After Community Outreach Screening in Takeo Province, Cambodia.

PURPOSE: To assess the barriers influencing eye healthcare seeking behavior after community outreach screening. DESIGN: A concurrent mixed methods study. METHODS: A total of 469 patients screened during the previous 12 months were followed up, of which 354 (75%) from 5 districts were interviewed in person, using a semi-structured questionnaire, in-depth interviews (n = 11), and 16 focus groups (n = 71). SPSS and NVivo were used to analyze response frequency and identify themes. RESULTS: Of the respondents, 98% (350/354) reported they were told they had an eye problem, with 295 individuals (83%) told to attend CARITAS Takeo Eye Hospital (CTEH) and 55 to have their eyes checked at Kiri Vong Vision Centre. Of those 68.9% (244/354) who reported seeking treatment, only 7.4% (18/244) reported they attended CTEH, 54% (n = 132) attended a "local pharmacy," 31.6% (n = 77) "self-treated at home," 11% (n = 27) reported "using steam from boiling rice," and 10.7% (n = 26) attended a "traditional healer." Of those who reported reasons for "not attending," responses included "no time" (47.8%, 86/180), "no one to accompany" (21.7%, n = 39), "fear of losing sight" (17.8%, n = 32), "cannot afford to travel" (16.1%, n = 29), and "eye problem is not serious enough" (15.6%, n = 28). Follow-up of patient records identified that 128 individuals (79 females) attended eye care services. CONCLUSIONS: Socioeconomic factors, personal concerns, and the use of local cultural remedies were reasons for not seeking eye hospital treatment. An integrated community approach to improve awareness and uptake of appropriate treatment is recommended.

Depression screening among older adults attending low-vision rehabilitation and eye-care services: Characteristics of those who screen positive and client acceptability of screening.

AIM: To investigate characteristics associated with screening positive for depressive symptoms among older adults accessing low-vision rehabilitation and eye-care services and to determine client acceptability of depression screening using the Patient Health Questionnaire-2 (PHQ-2) in these settings. METHODS: One-hundred and twenty-four older adults (mean = 77.02 years, SD = 9.12) attending low-vision rehabilitation and eye-care services across Australia were screened for depression and invited to complete a telephone-administered questionnaire to determine characteristics associated with depressive symptoms and client acceptability of screening in these settings. RESULTS: Thirty-seven per cent (n = 46/124) of participants screened positive for depressive symptoms, and the majority considered the new depression screening method to be a 'good idea' in vision services (85%). Severe vision loss (<6/60 in the better eye) was associated with an increased odds of screening positive for depressive symptoms (odds ratio 2.37; 95% confidence interval 1.08-6.70) even after adjusting for potential confounders. Participants who screened positive had a preference for 'talking' therapy or a combination of medication and 'talking therapy' delivered within their own home (73%) or via telephone (67%). CONCLUSION: The PHQ-2 appears to be an acceptable method for depression screening in eye-care settings among older adults. Targeted interventions that incorporate home-based or telephone delivered therapy sessions may improve outcomes for depression in this group.

Integrated depression management: a proposed trial of a new model of care in a low vision rehabilitation setting.

PURPOSE: Depression is a common problem among people with visual impairment and contributes to functional decline. This article presents a study protocol to evaluate a new model of care for those patients with depressive symptoms in which psychological treatment is integrated into low vision rehabilitation services. Low vision staff will be trained to deliver "problem solving therapy for primary care" (PST-PC), an effective psychological treatment developed specifically for delivery by non-mental health care staff. PST-PC is delivered in 8 weekly telephone sessions of 30-45 minutes duration and 4 monthly maintenance sessions. We predict this new integrated model of care will significantly reduce depressive symptoms and improve the quality of life for people with visual impairment. METHODS AND DESIGN: A randomized controlled trial of PST-PC will be implemented nationally across low vision rehabilitation services provided by Vision Australia. Clients who screen positive for depressive symptoms and meet study criteria will be randomized to receive PST-PC or usual care, consisting of a referral to their general practitioner for more detailed assessment and treatment. Outcome measures include depressive symptoms and behaviors, quality of life, coping and psychological adjustment to visual impairment. Masked assessments will take place pre- and post-intervention as well as at 6- and 12-month follow-up. CONCLUSION: We anticipate that this innovative service delivery model will lead to sustained improvements in clients' quality of life in a cost effective manner and provide an innovative service delivery model suitable for other health care areas in which depression is co-morbid.