Understanding why patients with cataract refuse free surgery: the influence of rumours in Kenya.

OBJECTIVES To understand the reasons that hinder people from uptake of sponsored cataract surgery. METHODS A mixed methods (qualitative and quantitative) approach was used. During routine screening activities at Kwale District, Kenya, local residents with visually impairing cataract were clinically assessed and offered free surgery. Interviews were conducted using a semi-structured guide that covered different aspects related to acceptance of cataract surgery including knowledge of others who underwent surgery and their outcome. Analysis focused on differences between people accepting and people refusing surgery and the reasons for non-acceptance of surgery. RESULTS Ninety interviews were conducted, 48 with people accepting and 42 with people refusing free surgery. Those who accepted surgery generally reported good outcome in others, while people who refused surgery often reported to know someone who worsened or even become blind after surgery. Many of these 'failed cases' were prominent figures in the local community, and most of them had already died. Glaucoma was the single most common underlying medical condition. On being re-interviewed, several people admitted that they had actually never met someone who had unsuccessful surgery but only heard rumours. CONCLUSION In Africa, a rumour of blinding eye surgery is not uncommonly being used by patients to justify their refusal to have cataract surgery. Underlying reasons appear to be related to shame, fear of surgery or missing social support. Improved awareness of the general population regarding eye conditions and their management, involvement of the family and local community in decision making, good surgical outcomes and appropriate counselling are possible methods to enhance acceptance.