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\begin{document}

\title{Barriers to accessing eye care among the elderly in Pakistan: A mixed
methods study}



\author[1]{Manal Malik}%
\author[1]{Strang N}%
\author[2]{Aiman Hafeez}%
\author[3]{Mujtaba Shabbir}%
\author[4]{Farah Iftikhar}%
\author[1]{Jonuscheit S}%
\affil[1]{Glasgow Caledonian University School of Health and Life Sciences}%
\affil[2]{City University of London School of Health \& Psychological Sciences}%
\affil[3]{University of Glasgow Adam Smith Business School}%
\affil[4]{Department of Optometry, Trauma Centre, Tehsil Head Quarter Kalarkahar, Chakwal, Pakistan}%


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  \date{May 15, 2024}


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\begin{abstract}
\emph{Purpose:} The provision of accessible eye care services can help
reduce the prevalence of avoidable blindness within a population by
providing timely high-quality interventions to those in need. Our aim
was to identify and quantify barriers to accessing eye care for the
elderly population in Pakistan, which prevent effective eye care
delivery to this group. Patients' experiences with the Sehat Sahulat
(health insurance) programme (SSP) in relation to eye care were also
explored. \emph{Methods:} Using an exploratory sequential mixed methods
design, an initial qualitative phase explored participant experiences
and identified specific barriers. The qualitative study provided the
basis for the development of a customised survey tool. The survey tool
was used in a second phase to obtain quantitative data of barriers and
costs associated with accessing eye care. \emph{Results:} Numerous
considerable barriers were identified, including illiteracy, long travel
times, female gender, old age, mobility issues, and costs, all of which
limited access to eye care in Pakistan. Awareness surrounding the use of
the SSP was poor, with the programme seldom used for eye care costs.
\emph{Conclusions:} This study provides valuable evidence on patient
experience with eye care services in urban and rural areas of Pakistan,
including expenditure, patient priorities, and enablers and barriers to
accessing eye care. Areas for improvement should focus on educating the
public on eye health, increasing the availability of secondary eye care
services in rural areas, improving accessibility within eye care
facilities, addressing gender disparities, and reducing costs associated
with eye care treatments, potentially through advancement of the SSP.%
\end{abstract}%



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