Social Determinants of Cataract Surgery Utilization in South India

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Abstract
A field trial was conducted to compare the effects of eight health education and economic incentive interventions on the awareness and acceptance of cataract surgery. Cataract screening and follow-up surgery were offered to more than 19,000 residents age 40 years and older in a probability sample of 90 villages in south India. Eight months after intervention, an evaluation was conducted to identify those in need of surgery who had been operated on. Two principal measures of program effectiveness are examined: awareness of cataract surgery and acceptance of the surgery. The type of intervention had a negligible effect on awareness of cataract surgery. A multiple logistic regression analysis revealed that individuals who were aware of surgery tended to be male, literate, and more affluent than those who were unaware of that option. Interventions that covered the complete costs of surgery had higher surgery acceptance rates. One health education strategy, house-to-house visits by a subject with aphakia, increased acceptance of the procedure more than others. In a multiple logistic regression analysis of acceptance rates, persons accepting surgery tended to be male; other factors were not important in explaining variation in acceptance rates.

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