Perceived Barriers to and Facilitators of Low Vision Rehabilitation Services for Older Adults

PURPOSE: This study sought to understand the barriers to and facilitators of access to low vision rehabilitation services (LVRS) for older adults with self-reported visual impairment in high- and low-resource communities throughout Massachusetts. We attempted to better understand how these factors influence access to and provision of LVRS.

Visual impairment (VI) is a serious public health issue that affects 10%–20% of older adults around the world (Dillon et al., 2010). VI is a permanent loss of vision that interferes with a person’s ability to complete activities of daily living. Although no medical intervention can restore the vision lost, services are available to maximize the independence and safety of those with VI. LVRS may assist people with VI to use compensatory strategies to maintain health and independence. Barriers to access to LVRS have been found for all races and VI categories. Lack of visual health knowledge, difficulties of physical access, and inadequate numbers of eye care practitioners all may be significant barriers to access to LVRS from the perspective of older adults with VI (Overbry & Wittich, 2011; Southall & Wittich, 2012; Wittich et al., 2013).

METHOD: This qualitative study used stratified purposeful sampling of high- and low-resource communities. Six focus groups were used to investigate knowledge of VI, social and community supports and barriers, awareness of and access to health and social systems, and beliefs about LVRS. A synthetic estimation of prevalence of VI and available medical and social services by town will be used to identify communities throughout the state with high and low resources for vision-related services that will be used for comparison.

RESULTS: Focus group participants identified lack of knowledge of LVRS by providers and consumers, lack of understanding of VI by family and friends, lack of transportation, personal fear, lack of understanding of eligibility for services, cost, and lack of access to low vision devices as factors decreasing access to care. The significance of each theme varied between high- and low-resource communities.

CONCLUSION: Occupational therapy practitioners need to consider these barriers when designing and providing LVRS.

IMPACT STATEMENT: Results from this study will be used to inform a stakeholder-driven service delivery model for the state of Massachusetts. Redistribution of state resources will increase the need for occupational therapy practitioners to provide LVRS throughout the state.

References

Dillon, C. F., Gu, Q., Hoffman, H. J., & Ko, C.-W. (2010). Vision, hearing, balance, and sensory impairment in Americans aged 70 years and over: United States, 1999–2006 (NCHS Data Brief No. 31). Washington, DC: Centers for Disease Control and Prevention, National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db31.pdf

Overbury, O., & Wittich, W. (2011). Barriers to vision rehabilitation: The Montreal Barriers Study. Investigative Ophthalmology and Visual Science, 52, 8933–8938. https://doi.org/10.1167/iovs.11–8116

Southall, K., & Wittich, W. (2012). Barriers to low vision rehabilitation: A qualitative approach. Journal of Visual Impairment and Blindness, 106, 261–274.

Wittich, W., Canuto, A., & Overbury, O. (2013). Overcoming barriers to low-vision rehabilitation services: Improving the continuum of care. Canadian Journal of Ophthalmology, 48, 463–467. https://doi.org/10.1016/j.jcjo.2013.05.013