|Year : 2008 | Volume
| Issue : 1 | Page : 13-17
Knowledge and attitude for eye diseases and satisfaction for services among urban citizens of Oman: A pilot study
Rajiv Khandekar, Saleh Al-Harby
Eye and Ear Health Care Division, NCD, DGHA, Ministry of Health, Oman
Eye and Ear Health Care, PO: 393, Muscat-113, Oman.
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The eye health care program, Ministry of Health of Oman conducted a pilot survey of Omani people that visited the eye health stall. It was organized on the World Health Day on 7 th April 2005 in Muscat, Oman. The survey aimed at identifying the level of knowledge of blinding eye diseases and the satisfaction among community for the eye services at government hospitals.
Materials and Methods: This was a descriptive study. 156 Omani citizens of more than 12 years of age were given a close ended questionnaire. Their self reported responses were collected. Six questions related to cataract, diabetic retinopathy, refractive error, blindness, home treatment, rehabilitation of visually impaired and perception of eye services at Ministry of Health hospitals were asked with three grades of responses to choose from.
Results: The knowledge about cataract and diabetic retinopathy was found to be good in more than 70% of respondents. 35% of participants agreed for home treatment of minor eye ailments. The importance of using visual aids and the need to give special facilities for the visually impaired was positive in 85%. Two thirds of the respondents were satisfied with type of eye services. Association of knowledge and satisfaction to the gender and age group was not conclusive.
Conclusions: Knowledge regarding cataract surgery and blindness due to diabetes, attitude towards use of spectacles, perceived need for visual rehabilitation and satisfaction with eye care services was positive in more than 60% of the interviewed people in this pilot study. A larger study representing Omani population is recommended.
Keywords: Patient satisfaction, health promotion, eye care, VISION 2020
|How to cite this article:|
Khandekar R, Al-Harby S. Knowledge and attitude for eye diseases and satisfaction for services among urban citizens of Oman: A pilot study. Oman J Ophthalmol 2008;1:13-7
|How to cite this URL:|
Khandekar R, Al-Harby S. Knowledge and attitude for eye diseases and satisfaction for services among urban citizens of Oman: A pilot study. Oman J Ophthalmol [serial online] 2008 [cited 2018 Jan 24];1:13-7. Available from: http://www.ojoonline.org/text.asp?2008/1/1/13/43315
| Introduction|| |
In a consumer driven society, almost nothing can escape the evitable tag of 'Commodity.' Even health is fast achieving this status. It is therefore necessary to keep abreast with the community and its needs to ensure the sound functioning of a health system. The level of knowledge, attitude of the community and level of satisfaction may be good indicators to determine the expectations of the community for eye care in a country.
Oman's efforts to improve the quality of life of its citizens have been rightly projected by endorsing the global initiative of 'Vision 2020 - The Right for Sight.'  The Ministry of Health, being major service provider in the country, has taken leadership in this noble task and through the national eye health care committee, has organized the program approach to combat visual disabilities.  Health education and community participation are important strategies for the eye health care program in Oman.  It will be crucial to assess the level of knowledge and attitude of the citizens regarding blinding eye diseases and get their feedback to improve the service provision.
Oman celebrated the World Health Day on 7th April 2005. The Ministry of Health had organized an exhibition for the citizens.  One of the stalls was for 'Eye Health Care Program.' Health education brochures on different eye diseases were distributed in Arabic to all visiting the stall and posters regarding healthy hygienic practices for eyes were displayed. A study was also conducted to determine the level of knowledge and attitudes of the participants regarding blinding eye diseases and to assess their satisfaction for the eye care services offered in the Ministry of Health Hospitals.
The authors present the outcome of this study and propose recommendations to improve the services.
| Materials and Methods|| |
The Health Committee of the Al Noor Association for the Blind had approved this study. Verbal consent of participants was obtained.
This was a descriptive case series. The target population comprised of participants visiting the exhibition organized by the Ministry of Health on World Health Day. All Omani visitors of 'more than 12 years' of age were requested to participate in this study. One national supervisor of eye care and three nursing staff were the field staff. They explained the objectives of the study and ensured the confidentiality of the participants. Those consenting to participate were given a close ended questionnaire and a pen to fill the form. The form was prepared in Arabic and was tested prior to the study on Ten Arabic speaking health staff. Personal information of age and gender of the participants were noted. The questionnaire comprised of six questions related to important eye diseases and services [Figure 1]. The first question was related to testing the knowledge of the participants about regaining vision following cataract surgery. The next question was to assess knowledge about the need for periodic check ups and the treatment of eye problems due to diabetes. The third question tested the attitude of the participants about using home remedies for minor eye ailments. The forth question covered their attitude for promoting compliance of spectacle wear among children with a refractive error. The fifth question was related to the need for rehabilitative services and special packages for visually disabled in the society. The last question gathered the feedback about satisfaction among the participants regarding the eye care services offered in the Ministry of Health hospitals. If the participants could not understand the question, the field staff explained them but did not prompt their responses. The completed form was placed in a box by the respondent.
Three types of options were given; 'I agree', 'I don't agree' and 'I don't know' to respond. This self reported feedback was collected and computed using EPI data.  The responses were analyzed using Statistical Package for Social Studies (SPSS 9). Univariate type of parametric analysis was carried out to calculate frequencies, percentage proportion of each response and for subgroups. The outcomes of the study were shared with health authorities. Their consent was obtained for undertaking the study as well as distributing the outcome to the scientists.
| Results|| |
Profile of participants
One hundred and fifty six Omani citizens participated in this study. All of them were residents of Muscat region. The gender and age group proportion is given in [Table 1].
Knowledge and attitude about blinding eye diseases and their care
The participants agreed, did not agree or stated that they did not know about the statement made about cataract, diabetes, use of spectacles, using home remedies for eye, special attention to the visually disabled and satisfaction about eye care services in the Ministry of Health. Their responses are given in [Table 2].
Responses by gender
The agreement suggesting correct knowledge and positive attitude and satisfaction was compared by gender [Table 3]. The gender variation of the responses was not significant.
Responses by age-group
The agreement suggesting correct knowledge and positive attitude and satisfaction was compared by age-group [Table 4]. The age-group variation of the responses was not significant.
| Discussion|| |
The participants attending the exhibition are likely to be more health conscious compared to those who did not come. Hence the level of their knowledge and attitude is likely to be better and one should extrapolate the findings of the present study to the community at large with caution.
Self reported responses related to health in presence of health personnel are likely to be affected by social desirability bias. However, ensuring them about confidentiality minimized the effect of this bias in our study.
The role of surgery in reducing blindness due to cataract is known to more than three fourth of the participants. This is a healthy trend and increasing cataract surgery rate as per the 'Vision 2020' plan of Oman would get better cooperation from the community.  A study in Brazil to evaluate the attitude for senile cataract also suggested that 85% of the subjects credited the sight restoration to cataract surgery.  Awareness of cataract and its management was in 69.8% of South Indian population. 
Awareness about diabetes causing blinding eye complications was found in 70% of the participants. A study in Australia suggested that 78.5% of people without diabetes knew that diabetes could be sight-threatening.  This prompts a more intense health education campaign to the diabetics and their relatives in Oman. In view of epidemic proportion of diabetes in the community in Oman, it is crucial that they are aware about the threat to eyes and the need for periodic eye check ups as well as judicious medical care. 
Knowledge of eye diseases and the importance of early detection and inadequate knowledge of the link between the control of systemic disease such as diabetes and ocular complications was poor in Asian community settled in Bradford. 
More than one third of participants consented using traditional herbal medicines at home for treating minor problems of eye. Traditional remedies constituted 7% of all poisoning cases.  Chinese medicines are claimed to be used for treating uveitis and many other conditions.  However, evidence based information on the positive impact of traditional medicine for eye conditions is needed. Till such information is not available, the community should be educated to avoid using traditional medicines for their eye ailments.
The compliance of spectacle wear was evaluated in Oman and the barriers of non-compliance were assessed.  Lack of knowledge was not found to be an important barrier in that study. The present study confirms the findings. An annual screening of school students and health education in schools regarding the importance of using spectacle wears might have resulted in high awareness on this subject in the community. 
The positive attitude towards the visually disabled is an encouraging sign. Initiatives for strengthening blind schools and associations for the visually challenged for special education and vocational training by Ministry of education and Ministry of Social Affairs will have many supporters in the community.
The eye services at Ministry of Health hospitals is accessible to all citizen at a nominal cost (2.5 US$). Nearly 287,300 people availed eye care from the Ministry of Health hospitals in 2004.  In spite of the heavy workload, ophthalmologists attempt to provide high quality eye care services to them. The rate of satisfaction among 66% of the participants in this study needs further evaluation with a larger sample covering different regions. Steps should be taken to identify the underlying causes of dissatisfaction and try to address them. Distance was noted to be a major cause of the 60% dissatisfaction rate in a study in Poland.  While in an Eye Care Expectations Survey in USA four factors; patient involvement in eye care, interpersonal manner, information about diagnosis and prognosis and communication and clinical competence were found to mainly influence the satisfaction for the eye care services.  Although cost and access are unlikely to cause dissatisfaction in Oman, other factors should be critically reviewed.
We attempted to assess the perception of the Omani community regarding blinding eye diseases and eye care offered in the government hospitals. 'Vision 2020 - The Right for the Sight' initiative's main motto which is the partnership of all stakeholders of eye care stresses to include the community in this partnership. Satisfied customers with adequate knowledge about blinding eye diseases could advocate the benefits of eye care services to others in the society. The eye care services at the time of periodic reorganization should address the expectations also.
In conclusion, in our pilot study conducted in Muscat city, the knowledge regarding cataract surgery and blindness due to diabetes, attitude towards use of spectacles perceived need for visual rehabilitation and satisfaction with eye care services was positive in more than 60% of the interviewed people. However, the result should be interpreted with caution as our study had a limited sample and it covered people with health seeking behavior as they visited stall related to blindness and eye care. A larger study representing Omani population is recommended.
| Acknowledgments|| |
The authors thank the authorities of the Ministry of Health both national and of Muscat region for permitting and supporting this study. Commitment and enthusiasm of staff nurses; Ms. Rahma Nassar Al Manji, Ms. Smsa Ahmed Al Ghathy and Ms. Mao Xin Mei is highly appreciable. This resulted in successful conclusion of this study. We thank them and appreciate the participants who spared their valuable time.
| References|| |
|1.||World Health Organization. Prevention of blindness and deafness. Global initiative for the elimination of avoidable blindness. Geneva: WHO; 2000. WHO document WHO/PBL/97.61 Rev2. |
|2.||Report on the conference on 'Vision 2020 Planning for Eastern Mediterranean Region' Dec. 2003, Cairo, Egypt. (WHO/EMR/PBL/03.1) Available from: http://whilibdoc.who.EMR/2003/WHO PBL/03.1 pdf |
|3.||Eye Health Care Program, Ministry of Health, Oman and UNICEF 'Eye Health Care Manual. 1st ed. 1995. p. 2-6. |
|4.||Newsletter of WHO Oman Al. Vol: 4. Madina Printing Press; Muscat: 2005. p. 1-2. |
|5.||Lauritsen JM, editor. EpiData - Data Entry, Data Management and Basic Statistical Analysis System. Odense Denmark, EpiData Association, 2000-2006. Available from: http://www.epidata.dk. |
|6.||Ministry of Health Oman Eye Health Care Manual. 2nd ed. Muscat: Al Zahra Printers; 2000. p. 6-7. |
|7.||Temporini ER, Kara N Jr, Jose NK, Holzchuh N. Popular beliefs regarding the treatment of senile cataract. Rev Saude Publica 2002;36:343-9. [PUBMED] [FULLTEXT]|
|8.||Nirmalan PK, Sheeladevi S, Tamilselvi V, Victor AC, Vijayalakshmi P, Rahmathullah L. Perceptions of eye diseases and eye care needs of children among parents in rural south India: the Kariapatti Pediatric Eye Evaluation Project (KEEP). Indian J Ophthalmol 2004;52:163-7. [PUBMED] |
|9.||Livingston PM, McCarty CA, Taylor HR. Knowledge, attitudes, and self care practices associated with age related eye disease in Australia. Br J Ophthalmol 1998;82:780-5. [PUBMED] [FULLTEXT]|
|10.||Al-Lawati JA, Mohammed AJ, Al-Hinai HQ, Jousilahti P. Prevalence of the metabolic syndrome among Omani adults. Diabetes Care 2003;26:1781-5. [PUBMED] [FULLTEXT]|
|11.||Pardhan S, Mughal N, Mahomed I. Self-reported eye disease in elderly South Asian subjects from an inner city cluster in Bradford: A small-scale study to investigate knowledge and awareness of ocular disease. Eye 2000;14:620-4. [PUBMED] |
|12.||Hanssens Y, Deleu D, Taqi A. Etiologic and demographic characteristics of poisoning: A prospective hospital-based study in Oman. J Toxicol Clin Toxicol 2001;39:371-80. [PUBMED] |
|13.||Li S, Wen S. Application of the treatment combined Western and traditional Chinese medicine in idiopathic uveo-encephalitis. Yan Ke Xue Bao 1999;15:270-1. [PUBMED] |
|14.||Khandekar R, Mohammed AJ, Al Raisi A. Compliance of Spectacle wear and its determinants among schoolchildren of Dhakhiliya region of Oman: A descriptive study. SQU Journal for Scientific Research Medical Sciences 2002;4:39-43. |
|15.||Khandekar RB, Abdu-Helmi S. Magnitude and determinants of refractive error in Omani school children. Saudi Med J 2004;25:1388-93. [PUBMED] |
|16.||Ministry of Health, Oman Annual Health Report 2004. Al Zahra Printers; 2005. p. 8-40. |
|17.||Gerkowicz M, Matysik A, Latalska M, Bak K, Mamcarz P. Evaluations of ophthalmological care expectation in the opinion of countryside dwellers in the example of the Wola Uhruska region. Klin Oczna 2003;105:288-90. [PUBMED] |
|18.||Dawn AG, McGwin G Jr, Lee PP. Patient expectations regarding eye care: Development and results of the Eye Care Expectations Survey (ECES). Arch Ophthalmol 2005;123:534-41. [PUBMED] |
[Table 1], [Table 2], [Table 3], [Table 4]