Abstract
Purpose :
Data on barriers to glaucoma treatment adherence in South India is limited; improved knowledge of these barriers is needed to advance disease self-management programs. Patient counseling based on Self-Determination Theory (SDT) has been shown to improve treatment adherence. We aimed to use the theoretical framework of SDT to understand barriers to glaucoma treatment adherence in South India to inform future interventions.
Methods :
Glaucoma patients ≥ 18 years old taking ≥1 glaucoma medication were approached in the waiting rooms at the Aravind Eye Hospital (Madurai, India). Patients were screened with a validated medication adherence tool and those who were non-adherent or >3 months late for follow-up were invited to participate in semi-structured interviews on barriers to glaucoma treatment. Interviews were audio-recorded, transcribed, and translated into English. Two researchers identified themes and coded the transcripts.
Results :
70/167 (42%) did not adhere to drops. The 45 interviewed were 62 ±12 years old and took 1.6 ± 0.7 drops. 42 (93%) were not adherent to glaucoma mediation and 21 (47%) were late for follow-up. Key barriers to medication adherence were difficulty obtaining drops (20, 44%), being busy (18, 40%), and expense (17, 38%). Key barriers to follow-up were distance to hospital (21, 47%), expense (20, 44%), and lack of escort (15, 33%). These barriers can be grouped into the three basic psychological needs of SDT modified for an Indian context: relatedness, competence, and autonomy of the family.
Conclusions :
Previously, only 6% of glaucoma patients surveyed in South India self-reported medication non-adherence; our finding of 42% non-adherence is more in line with glaucoma medication adherence rates around the world. Previous studies identified barriers to glaucoma treatment adherence in South India using surveys and questionnaires; to our knowledge, this is the first study to use semi-structured interviews to elicit rich qualitative data on treatment barriers in this population. We found that complex factors cause high rates of glaucoma treatment non-adherence in South India. In the past, counseling that provided intellectual information about glaucoma did not improve treatment adherence at Aravind. An approach based on SDT modified for an Indian context, in which counseling aims to support patients’ and their families’ motivation for behavior change, may be more impactful.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.