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C. Owsley, G. McGwin, Jr., J. Weston, B. T. Stalvey, C. A. Girkin; Attitudes and Perceived Barriers to Eye Care Among Older African Americans in Rural Alabama. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2508.
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The rural south in the U.S. has high rates of poverty, chronic health conditions, and insufficient access to health care compared to other parts of the country. One population particularly vulnerable to these problems is older African Americans. The purpose of this study was to evaluate the impact of an eye health education program on attitudes and perceived barriers to eye care among older African Americans living in rural Alabama.
InCHARGE® is an eye health education program designed for older African Americans and based on an empowerment model. It promotes eye disease prevention by conveying the personal benefits of annual dilated comprehensive eye care and teaching strategies to remove barriers to eye care (Owsley et al. JNMA 2008;100:1089). Using a pre-post design we evaluated whether InCHARGE imparted knowledge about prevention and strategies for reducing barriers to care. The program was presented at 5 senior centers in Lowndes, Bullock, and Macon Counties in central Alabama. Changes in attitudes about annual eye care were assessed by a questionnaire before and 3 months after InCHARGE.
111 persons participated in the InCHARGE program (M age 74 years, range 61 to 96); ¾ were women. At baseline, 53% reported receiving a comprehensive eye exam by an eye care provider in the past year, 27% within the past 1-2 years, and 16% more than 2 years ago; 5% reported never having an eye exam. 90% of respondents or greater at baseline indicated that they felt comfortable talking to an eye doctor, and believed that annual eye care was important, that eye doctors care about their sight, and that they would be able to find an eye doctor if they wanted to make an appointment. 28% indicated that the cost of the exam and/or new glasses would be a problem. In the post-test interview 3 months after InCHARGE, almost half (47%) reported that they had undergone a comprehensive eye exam since the InCHARGE class or had called to schedule an appointment. In addition, the percentage of persons after InCHARGE saying that the cost for the exam and/or glasses was a problem increased to 44% (p=.0047).
Older African Americans in the rural south have generally positive attitudes about annual comprehensive eye care and reported seeking eye care at high rates in the three months after the program. However, the cost of care and glasses was viewed as problematic for a substantial portion, implying that educational programs must be combined with economic strategies in order to meet the goal of improving eye health in this population.
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