Ahalya Subramanian

Purpose: Long‐term adherence to glaucoma medication is often suboptimal, compromising treatment efficacy and increasing the risk of glaucoma progression. Existing interventions have limited success. This study explored behavioral factors influencing adherence from the perspectives of United Kingdom (UK)‐based patients with glaucoma and eye care professionals (ECPs), using the Theoretical Domains Framework (TDF). Methods: Semi‐structured interviews were conducted with adults prescribed intraocular pressure–lowering eyedrops whose adherence status was classified based on self‐reported medication use and UK‐registered ECPs involved in glaucoma care. Interview data were analyzed using deductive and inductive thematic analysis guided by the TDF to identify key barriers and enablers influencing adherence‐related behaviors. Results: Twenty‐six participants were interviewed (13 patients and 13 ECPs). For patients, adherence was influenced by factors relating to knowledge and understanding of glaucoma, skills required to administer and obtain medication, memory and routine formation, beliefs about treatment necessity, social support, and healthcare system factors such as medication availability. ECPs identified time constraints, limited resources, and uncertainty in assessing adherence as key challenges, whereas communication skills, multidisciplinary support, and tailored decision‐making were viewed as important enablers. Conclusions: Glaucoma medication adherence is shaped by a complex interplay of behavioral, professional and systemic factors. Applying the TDF highlights modifiable influences on adherence and supports the development of targeted, theory‐informed interventions to improve glaucoma outcomes.

Purpose India accounts for a substantial share of the global burden of vision impairment, with moderate to severe impairment especially common among adults over 50, women, and people without formal education. This study aims to identify modifiable barriers and enablers to accessing eye care services in India and to map these factors to the Theoretical Domains Framework (TDF), providing a theory-based understanding of the behaviours influencing service uptake and guiding effective behaviour change interventions. Recent Findings A systematic review of MEDLINE Complete, CINAHL Complete, PsycINFO, and EMBASE identified studies reporting determinants of eye care-seeking in India. English-language studies published up to January 2025 were included. Data were analysed using a four-step approach: (1) data extraction, (2) deductive mapping to TDF domains, (3) inductive thematic synthesis and (4) identification of key domains based on frequency and elaboration. A total of 56 primary studies were included in the analysis. The six most important TDF domains were: Environmental Context and Resources, Social Influences, Beliefs about Capabilities, Knowledge, Emotion and Beliefs about Consequences. Commonly reported barriers included a ‘lack of understanding about eye conditions’, ‘financial constraints’, ‘no one to accompany’, ‘family commitments’, ‘limited access to services’ and ‘able to manage with existing vision’. Enablers included ‘free eye care services’, ‘positive experiences of others and ‘perceived need for vision care. The most salient TDF domains were mapped onto the capability, opportunity, and motivation model of behaviour (COM-B) within the behaviour change wheel (BCW) to guide the design of interventions. Summary This review identified six TDF domains influencing eye-care service uptake in India. By mapping these domains to appropriate intervention functions from the behaviour change wheel, the study offered a structured, evidence-based approach to designing behavioural interventions aimed at increasing the utilisation of eye care services.

Introduction: Understanding barriers to seeking eye care and providing evidence‐based theory‐informed solutions can improve the uptake of eye care services. Therefore, in this cross‐sectional study, we aim to report and analyse barriers to seeking eye care services among individuals with vision impairment in the Akividu region of Andhra Pradesh, India. Methods: Out of the 3000 enumerated participants, a total of 2587 were examined. All participants with vision impairment were asked to report barriers for not seeking eye care despite noticing reduced vision using a validated questionnaire. The reported barriers were mapped to the theoretical domains framework (TDF) to explore potential individual and environmental influences on the uptake of eye care services. Results: Barriers to seeking eye care services are most frequently mapped to the ‘beliefs about capabilities’, ‘environmental context and resources’ and ‘social influences’ domains of the TDF. The most frequently reported barrier was ‘aware of the problem but can manage’ (beliefs about capabilities), expressed by 43.4% ( n = 156) and 55.7% ( n = 337) of participants with distance and near vision impairment, respectively. ‘No one to accompany’ for an appointment (social influences) was a significant barrier for participants with distance vision impairment ( n = 44, 12.2%) in comparison to participants with near vision impairment ( n = 19, 3.1%). Additionally, fear of losing eyesight or operation or consultation (emotion) was a major deterrent for seeking eye care services, particularly among participants with distance vision impairment ( n = 31, 8.6%) when compared with near vision impairment ( n = 17, 2.8%). Conclusion: The uptake of eye care services is influenced by a complex set of interacting factors. Identification of potentially modifiable target behaviours provides an opportunity to develop theory‐informed solutions to improve uptake of services and prevent avoidable vision loss.

「福祉科技與服務管理學刊」創辦於2012年12月，由中華福祉科技與服務管理學會發行，旨在提供老人福祉科技(gerontechnology)及高齡者照護服務與管理之相關學者、產業界和從業人員，以中文發表研發成果或實務經驗之平台，期能促進跨領域知識交流與傳播，提升整體研究水平與相關產業發展，進而為高齡化社會衍生之各種問題提出具體解決方案，提升高齡者之生活品質。

SIGNIFICANCE: Social media is used by >4.48 billion people worldwide. Despite its popularity, vision‐impaired individuals struggle to use social media given visual inaccessibility of content and lack of access to Internet/Wireless‐Fidelity–enabled devices. Our study explores visually impaired adult's use of social media in comparison to a control group. PURPOSE: This study aimed to report the demographic profile and patterns of social media use among adults with vision impairment (VI) aged 18 to 35 years and compare it with an age‐matched normally sighted group in India. In addition, we explored barriers to use of social media among adults with VI. METHODS: Vision‐impaired and normally sighted adults (controls) aged 18 to 35 years at L V Prasad Eye Institute, Hyderabad, India, answered a questionnaire about social media use (e.g., platform used). RESULTS: Four hundred twenty‐two individuals (201 VI, 221 controls) participated. Normally sighted adults (98%) used social media more than the VI group (81%; p<0.001). Vision‐impaired users were predominantly male (85%) and unemployed (57%; p<0.00001 for both). There was no significant difference in educational level between groups (p=0.17). Smartphones were the most popular device used (VI, 161 [99%]; control, 206 [95%]), with tablet PC/iPad being the least popular (VI, 5 [3%]; control, 12 [6%]). Adults with VI and controls commonly used WhatsApp as communication platforms, and Facebook and Twitter as networking platforms. Approximately one‐third of individuals across both social media user groups reported barriers to use (VI, 48 [30%]; control, 74 [34%]; p<0.001). Vision‐impaired individuals cited accessibility issues of having to rely on audio over vision to navigate social media, whereas controls reported having to share a phone. CONCLUSIONS: The proportion of social media usage among VI adults is high (81%) and is substantially higher than the 33% reported in the general Indian population. Vision‐impaired adults who used social media were male with moderate VI and were less likely to be employed compared with controls.

Purpose: To examine the prevalence of loneliness and associated factors in young adults with vision impairment (VI), including quality of life (QoL) in India. Methods: Two hundred and three VI young adults (18–35 years) and 219 age‐matched non‐VI (controls) adults completed the loneliness scale, WHOQOL‐BREF, Social Network Index (SNI) (network diversity, people in network size and number of embedded network subscales) and questions regarding sociodemographic characteristics and independent mobility. Rasch analysis was used to validate the questionnaires and interval‐level scores were generated. Generalised linear models were used to estimate independent associations of sociodemographic factors, VI characteristics, social networks and QoL with loneliness. Results: The prevalence of moderate and severe loneliness in the VI group was 10% (95% CI: 6.5, 15.4) and 4.4% (95% CI: 2.0, 8.2), respectively, and higher than that of controls. The VI group had a worse loneliness score than controls (−1.66 ± 2.25 vs. −2.13 ± 1.85 logits; p = 0.03). Those with ≤12 years and >12 years of education had loneliness scores of −1.58 ± 2.45 and −1.82 ± 1.99 logits, respectively ( p = 0.01). Compared with controls, the VI group reported fewer extended family members, neighbours and friends leading to significantly smaller networks and network diversity (all p < 0.001). Loneliness scores demonstrated a significant correlation with only two SNI subscales for both groups: people in network size ( r = −0.28 for VI; r = −0.30 for non‐VI; p < 0.001 for both) and number of embedded networks ( r = −0.22 for VI; r = −0.21 for non‐VI; p = 0.002 for both). Both education (β = 0.45; p = 0.04) and QoL (β = −0.27, p = 0.02) were predictors of loneliness. Conclusions: Loneliness was commonly experienced by young VI adults and was higher among those with lower levels of education. Loneliness decreased with the presence of a larger number of people in network, suggesting that interventions to increase social activity and participation may be valuable in young VI adults.

Purpose: Nonadherence to medication reduces treatment effectiveness, and in chronic conditions it can significantly reduce health outcomes. In glaucoma, suboptimal adherence can lead to sight loss, which places a greater financial burden on society and reduces patients' quality of life. Interventions to improve adherence have so far had limited success and lack robust theoretical underpinnings. A better understanding of the determinants of medication adherence behaviour is needed in order to develop interventions that can target these factors more effectively. This systematic review aims to identify modifiable barriers and enablers to glaucoma medication adherence and identify factors most likely to influence adherence behaviour. Recent Findings: We searched CINAHL, MEDLINE, PsycINFO, EMBASE, the Cochrane Library and sources of grey literature up to August 2022 for studies reporting determinants of glaucoma medication adherence. Data describing modifiable barriers/enablers to adherence were extracted and analysed using the Theoretical Domains Framework (TDF), a behavioural framework consisting of 14 domains representing theoretical factors that most likely influence behaviour. Data were deductively coded into one of the TDF domains and inductively analysed to generate themes. Key behavioural domains influencing medication adherence were identified by frequency of study coding, level of elaboration and expressed importance. Eighty‐three studies were included in the final synthesis. Four key domains influencing glaucoma medication adherence were identified: ‘Environmental Context and Resources’, ‘Knowledge’, ‘Skills’ and ‘Memory, Attention and decision processes’. Frequently reported barriers included complex eyedrop regimens, lack of patient understanding of their condition, forgetfulness and difficulties administering eyedrops. Whereas simplified treatments, knowledgeable educated patients and good patient–practitioner relationships were enablers to adherence. Summary: We identified multiple barriers and enablers affecting glaucoma medication adherence. Four theoretical domains were found to be key in influencing adherence behaviour. These findings can be used to underpin the development of behaviour change interventions that aim to improve medication adherence.

Purpose: Children with cerebral visual impairment (CVI) present with delayed developmental milestones. Pediatricians and pediatric neurologists are usually the first point of contact, and eye exam largely remains referral based. This study documented the visual concerns reported by parents of children with CVI visiting a pediatric neurology clinic. Additionally, we investigated the association between visual concerns, functional vision measures and visual functions. Patients and Methods: A cross-sectional study was undertaken in children with CVI (chronological age range: 7 months-7 years). Visual concerns reported by the parents/caregivers were documented as open-ended statements. Additionally, a functional vision assessment was conducted using the CVI Range instrument with phase 1, 2 and 3 indicating low, moderate and high visual functioning, respectively. Grating acuity and contrast sensitivity were measured using Teller acuity cards-II and Ohio contrast cards respectively. Results: A total of 73 children (mean age of 2.84 ± 1.87 years) were recruited. Sixty-eight parents reported visual concerns that were broadly grouped into 14 unique concerns. Nineteen parents (27.9%) reported more than one visual concern. Difficulty maintaining eye contact and recognizing faces were the top two visual concerns in phases 1 and 2. Missing objects in the lower visual field was the top concern in phase 3. A larger number of visual concerns were reported in phase 1 (43%) than phase 2 (40.6%) and phase 3 (16.2%). Multiple regression analysis revealed that grating acuity, contrast sensitivity and chronological age were able to predict the functional vision, F (3, 55) = 63.0, p < 0.001, r² = 0.77. Conclusion: Targeted questions enquiring about eye contact and face recognition can be included in history elicitation in children with CVI in pediatric neurology clinics. In the presence of visual concerns, it will be important to assess grating acuity and contrast sensitivity. A poor functional vision score requires referral for eye examination and vision rehabilitation services.