Factors Influencing Eye Care Seeking Behaviour: Looking Beyond Affordability

Vaishaali Gunalan, M. Optom.

Senior Optometrist, Vision Care Opticians, Lusaka, Zambia

According to the International Agency for the Prevention of Blindness (IAPB) Vision Atlas (2021), an estimated 1.1 billion people live with distance and near Vision Impairment (VI). ⁽¹⁾ Of these VI, 81% are due to a treatable cause. ⁽²⁾ Between 2010 and 2020, the global prevalence of distance and near vision impairment rose from 3.92% to 4.34%. ⁽³⁾ One of the key contributing factors to this rise is poor eye care-seeking behaviour.

Eye care-seeking behaviour is defined as “any action undertaken by individuals who perceive themselves to have an eye problem, to seek appropriate treatment.” ⁽⁴⁾ Despite advancements in service delivery, a variety of personal and system-level barriers continue to limit service uptake. These include cost, lack of access, age, time constraints, reliance on traditional remedies, and low perceived need. ⁽⁵⁾

However, seeking care is not just about access or affordability; it is shaped by individual decision-making processes, household dynamics, community beliefs, and provider-related factors. ⁽⁴⁾

Health Belief Model: A Framework for Understanding Behaviour

The Health Belief Model (HBM) is a well-established psychological framework that explains health behaviour through six key components:

A) Perceived Susceptibility: The belief about the likelihood of acquiring a disease. ⁽⁶⁾ Example: A 52-year-old man considers undergoing cataract screening due to age, smoking history, and long-term exposure to sunlight.
B) Perceived Severity: An assessment of the seriousness of the condition and its potential consequences. ⁽⁶⁾ Example: He reflects on how worsening vision may impact his ability to work and support his family.
C) Perceived Benefits: Belief in the efficacy of the advised action to reduce the risk or seriousness of the condition. ⁽⁶⁾ Example: He recognises the value of early cataract detection, quitting smoking, wearing UV-protective eyewear, and limiting sun exposure.
D) Perceived Barriers: The perceived obstacles that may prevent adoption of a health behaviour. ⁽⁶⁾ Example: Fear of surgery, time off work, travel challenges, or anxiety about the diagnosis might delay his decision.
E) Self-Efficacy: Confidence in the ability of a person to take the necessary actions. ⁽⁶⁾ Example: He feels capable of scheduling and attending an eye screening and following through with treatment if needed.
F) Cues to Action: Specific external or internal factors in the surroundings that trigger health behaviour. ⁽⁶⁾ Example: Participation in a local eye health awareness campaign or recognising vision symptoms prompts him to seek care.

Figure 1: Depicting the Components of HBM

Applying HBM in Eye Care: A Strategic Imperative

The HBM goes beyond health promotion; it also serves as a powerful tool for designing and evaluating effective interventions. ⁽⁶⁾ Eye care-seeking behaviour is prevented not just by affordability and access, but by how individuals perceive their risk, understand the severity of consequences, and believe in the benefits of acting.

Conclusion

To effectively influence behaviour, eye health communication must go beyond generic messages. It should clearly articulate the personal and economic consequences of untreated vision problems, while also highlighting realistic, accessible solutions. When people understand that a specific behaviour can meaningfully reduce their risk, they are far more likely to act.
 

References

1. Voss, J., & Haslam, D. Updated Vision Atlas shows 1.1 billion people have vision loss.
2. Flaxman, S. R., Bourne, R. R., Resnikoff, S., Ackland, P., Braithwaite, T., Cicinelli, M. V., … & Zheng, Y. (2017). Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. The Lancet Global Health, 5(12), e1221-e1234..
3. Bourne, R., Steinmetz, J. D., Flaxman, S., Briant, P. S., Taylor, H. R., Resnikoff, S., … & Tareque, M. I. (2021). Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study. The Lancet global health, 9(2), e130-e143.
4. Oberoi, S., Chaudhary, N., Patnaik, S., & Singh, A. (2016). Understanding health seeking behavior. Journal of family medicine and primary care, 5(2), 463-464.
5. Marmamula, S., Khanna, R. C., Shekhar, K., & Rao, G. N. (2014). A population-based cross-sectional study of barriers to uptake of eye care services in South India: the Rapid Assessment of Visual Impairment (RAVI) project. BMJ open, 4(6), e005125.
6. Alyafei, A., & Easton-Carr, R. (2024). The health belief model of behavior change. StatPearls.