Factors influencing non-attendance to scheduled eye surgery in rural Swaziland
Background: Blindness in low-income countries has significant negative impacts on patients and their communities. The World Health Organization’s ‘Vision 2020’ target requires increased numbers of ophthalmic surgeries targeting avoidable blindness to overcome this. There have been studies on barriers preventing uptake of surgical services; however, no such study has been conducted in Swaziland, sub-Saharan Africa.
Aim: To investigate factors influencing disengagement with surgical services, specifically nonattendance to scheduled eye surgery in the low-income setting. Setting: Rural ophthalmology department, Good Shepherd Hospital, Siteki, Swaziland.
Methods: A retrospective observational study using a structured questionnaire after literature review. A list of non-attending patients was generated from a 6-month period in the ophthalmology department of the hospital. Telephone interviews were used to collect data.
Results: The average attendance of 311 patients over 21 lists was 86.8% (standard deviation [SD] ±10.37). Of the 41 non-attending patients, 23 (56.1%) consented to take part in the study. The reasons given for not attending included expense of the procedure (52.2%), forgetfulness (17.4%), fear (8.7%), illness (8.7%), belief that surgery was not required (4.3%) and bereavement (4.3%). Contributing factors on closed questioning included forgetfulness (30%), fear (22%) and seeking surgery elsewhere (17%). Review for future surgery was accepted by 93.3% of participants.
Conclusion: The findings of this study are consistent to some extent with previous studies carried out in other low-income countries, but also illustrate some key differences. These data provide useful information regarding potential interventions to reduce non-attendance rates, guiding future clinical practice and research.