Barriers to the uptake of eye care services in developing countries: A systematic review of interventions

Abstract

Objective: This research identifies effective and ineffective interventions for reducing barriers to the uptake of eye care services in developing countries. Design: Systematic literature review. Setting: Only research studies done in developing countries were included. Method: The review is restricted to English-language articles published between 1997 and 2007. It includes studies that reported randomized trials (controlled and uncontrolled) and surveys with some form of outcome measure, with or without process evaluation. The literature search was conducted on six electronic databases. Data were extracted and synthesized using a standard data extraction form. A narrative synthesis was carried out for the purpose of this review. The quality of the included trials was assessed by CRD guidelines and Crombie’s checklist. The applicability of research findings was evaluated by the RE-AIM model. Results: One randomized cluster trial and nine surveys were critically appraised. Three multi-faceted interventions were judged effective while another three were found ineffective. Two out of the three effective interventions used service provision and educational input. Two out of the three ineffective interventions also used service provision alongside other methods including screening and counselling. Findings of effective interventions were generalizable. Conclusion: The review suggests that eye health education and service provision lessen the barriers to service uptake and increase the uptake of eye care services. The role of counselling and screening services needs further review by large and good-quality studies.