Impact Of Language Barriers And Financial Constraints On Visual Rehabilitation Access Among Low Vision Patients In Kolkata
DOI:
https://doi.org/10.63682/jns.v14i19S.5602Keywords:
Low Vision Rehabilitation, Language Barriers, Financial Constraints, Urban Eye Health, Psychosocial ImpactAbstract
Low vision presents a significant public health concern in India, particularly in urban contexts like Kolkata were socio-economic disparities complicate access to rehabilitation. Despite the availability of tertiary eye care services, many patients continue to face substantial barriers to functional recovery. This study aimed to assess the challenges encountered by low-vision patients in accessing visual rehabilitation, with a specific focus on the roles of language barriers and financial constraints. A cross-sectional, descriptive survey was conducted among 461 individuals identified as low-vision patients within the Kolkata metropolitan area. Data were collected using a structured questionnaire covering demographic details, psychosocial factors, and perceived barriers. Quantitative analyses included frequency distributions, chi-square tests, correlation matrices, and linear regression modelling. Results revealed that financial constraints and language mismatches significantly hinder access to low-vision devices and services, and both were found to be strong predictors of depression and anxiety. Regression analysis showed financial barriers had the highest impact on depressive symptoms (B = 0.3866, p < 0.001). The findings underscore the urgent need for integrated, multilingual, and economically inclusive rehabilitation policies. Addressing both structural and psychosocial dimensions of care is essential for building equitable low-vision support systems in India.
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Ahmad KS. Vision loss, access to eye care and quality of cataract surgery in a marginalised population: the Karachi marine fishing communities eye and general health study [dissertation]. University of New South Wales; 2015. Available from: https://unsworks.unsw.edu.au/bitstreams/79595bce-78a4-48ef-bba9-e95b6149c4b5/download
Amritanand A, Paul P, Nagarajan SG. Community-based rehabilitation volunteers in identification and appropriate referral of adults with perceived visual disability in an urban slum setting in southern India. Disabil Rehabil. 2020;42(21):3031–3039.
Das M. Culture of health care in urban slums: a comparative study of metropolitan cities of Bangalore and Kolkata [PhD thesis]. Maastricht University; 2022. Available from: https://cris.maastrichtuniversity.nl/ files/120921224/p7760.pdf
Hazra A, Majumdar S, Mukherjee S. Quality of life among geriatric population living with functional disabilities in urban slum dwellers of Kolkata, India. Semant Scholar. 2023. Available from: https://pdfs.semanticscholar.org/ac99/ 0d6045d7fcbb2f08a59b7fef131b3e8c7906.pdf
Jaiswal A, Aldersey H, Wittich W. Factors that influence the participation of individuals with deafblindness: a qualitative study with rehabilitation service providers in India. Br J Vis Impair. 2022;40(1):41–57.
Kulkarni S, Lawande DD. Exploring the barriers for eye care among transgenders and commercial sex workers in Pune, Maharashtra. Indian J Ophthalmol. 2021;69(9):2435–2440.
Maitra C. WhatsApp in health communication: the case of eye health in deprived settings in India [dissertation]. Manchester Metropolitan University; 2021. Available from: https://e-space.mmu.ac.uk/id/eprint/627599
Sarika G, Venugopal D, Sailaja MVS. Barriers and enablers to low vision care services in a tertiary eye care hospital: a mixed method study. Indian J Ophthalmol. 2019;67(4):578–583.
Sen R, Goldbart J. Partnership in action: introducing family‐based intervention for children with disability in urban slums of Kolkata, India. Int J Disabil Dev Educ. 2007;52(2):133–148.
World Health Organization (WHO). World report on vision. Geneva: WHO; 2019.
Christy B, Keeffe JE, Nirmalan PK. A randomized controlled trial assessing the effectiveness of strategies delivering low vision rehabilitation: design and baseline characteristics of study participants. Ophthalmic Epidemiol. 2010;17(3):170–177.
Kumar SG, Roy G, Kar SS. Disability and rehabilitation services in India: issues and challenges. J Fam Med Prim Care. 2012;1(1):69–73.
Senjam SS, Tandon R, Vashist P. Guidelines for setting up low vision and rehabilitation services in India. Indian J Ophthalmol. 2024;72(1): Article 9.
van Munster EPJ, van der Aa HPA, Verstraten P. Barriers and facilitators to recognizing and discussing depression and anxiety. BMC Health Serv Res. 2021;21(1):Article 256.
Wallace S, Alao R, Kuper H. Multidisciplinary visual rehabilitation in LMICs: a systematic review. Disabil Rehabil. 2022;44(2):177–187.
Bhardwaj RK. Exploring the role of digital technology in learning for visually impaired students. J Educ Technol. 2022. Available from: https://www.emerald.com/insight/content/doi/10.1108/jet-04-2021-0021/full/html
Gothwal VK, Kanchustambam J. Social stigma and rehabilitation among visually impaired youth in urban India. Ophthalmic Physiol Opt. 2024;44(1). https://doi.org/10.1111/opo.13317
Marmamula S, Yelagondula VK. Population-based assessment of barriers for uptake of eye care services in India. Indian J Ophthalmol. 2022;70(5):780–785.
Sivakumar P, Vedachalam R, Kannusamy V. Barriers in utilisation of low vision assistive products. Eye. 2020;34:880–885.
Fletcher AE, Donoghue M, Devavaram J. Low uptake of eye services in rural India: a challenge for programs of blindness prevention. JAMA Ophthalmol. 1999;117(10):1431–1435.
Rishi P, Rishi E, Maitray A, Agarwal A. Hospital anxiety and depression scale assessment of 100 patients before and after using low vision care. Indian J Ophthalmol. 2017;65(11):1106–1111.
Singh RR, Shri N, Singh S. Understanding the pathways linking visual impairment and depression among older Indian adults. Indian J Psychiatry. 2024. Available from: https://www.sciencedirect.com/science /article/pii/S2950307824000572
Khimani KS, Battle CR, Malaya L, Zaidi A. Barriers to low‐vision rehabilitation services for visually impaired patients in a multidisciplinary ophthalmology outpatient practice. Int J Clin Pract. 2021;2021:Article 6122246.
Kuriakose RK, Khan Z, Almeida DRP. Depression and burden among the caregivers of visually impaired patients: a systematic review. Int Ophthalmol. 2017;37(5):1129–1136.
Matti AI, Pesudovs K, Daly A, Brown M. Access to low‐vision rehabilitation services: barriers and enablers. Clin Exp Optom. 2011;94(2):181–186.
Atlantis E, Baker M. Obesity effects on depression: systematic review of epidemiological studies. Int J Obes (Lond). 2008;32(6):881–891.
Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Soc Sci Med. 2000;51(6):843–857.
Bookwala J, Lawson B. Poor vision, functioning, and depressive symptoms: a test of the activity restriction model. Gerontologist. 2011;51(6):798–808.
Bourne RRA, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, et al. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. Lancet Glob Health. 2017;5(9):e888–e897.
Casten R, Rovner BW, Leiby BE, Tasman W. Depression despite anti-vascular endothelial growth factor treatment of age-related macular degeneration. Arch Ophthalmol. 2010;128(4):506–508.
Ciechanowski P, Wagner E, Schmaling K, Schwartz S, Williams B, Diehr P, et al. Community-integrated home-based depression treatment in older adults: a randomized controlled trial. JAMA. 2004;291(13):1569–1577.
Cosh S, von Hanno T, Helmer C, Bertelsen G, Delcourt C, Schirmer H, et al. The association amongst visual, hearing, and dual sensory loss with depression and anxiety over 6 years: the Tromsø Study. Int J Geriatr Psychiatry. 2018;33(4):598–605.
Crews JE, Campbell VA. Vision impairment and hearing loss among community-dwelling older Americans: implications for health and functioning. Am J Public Health. 2004;94(5):823.
Sarika G, Venugopal D, Sailaja MV, Evangeline S, Kumar RK. Barriers and enablers to low vision care services in a tertiary eye care hospital: A mixed method study. Indian journal of ophthalmology. 2019 Apr 1;67(4):536-40.
Das S, Halder PK, Ray S, Vadeo A, Paul K, Sarkar S. Evaluation of the etiologies and rehabilitation status of patients with blindness: A prospective observational study. Journal of Integrative Nursing. 2023 Oct 1;5(4):286-91.
Kameswaran V. Help Facilitates Accessibility: Understanding the Social and Technology-mediated Experiences of People with Visual Impairments in India (Doctoral dissertation).
Kulkarni S, Lawande DD, Dharmadhikari S, Deshpande CM. Exploring the barriers for eye care among transgenders and commercial sex workers in Pune, Maharashtra. Indian journal of ophthalmology. 2021 Sep 1;69(9):2277-81.
Khimani KS, Battle CR, Malaya L, Zaidi A, Schmitz-Brown M, Tzeng HM, Gupta PK. Barriers to low‐vision rehabilitation services for visually impaired patients in a multidisciplinary ophthalmology outpatient practice. Journal of Ophthalmology. 2021;2021(1):6122246.
Maitra C. WhatsApp in health communication: the case of eye health in deprived settings in India (Doctoral dissertation, Manchester Metropolitan University).
Srivastava P, Kumar P. Disability, its issues and challenges: Psychosocial and legal aspects in Indian scenario. Delhi Psychiatry Journal. 2015 Apr;18(1):195-205.
Malik S, Gopidas N. A Study on Assessment of the Quality of Life and Associated Factors among Patients with Gynecological Cancers Undergoing Gyneco-Oncological Therapy in a Selected Tertiary Care Hospital in Kolkata. International Journal of Science and Research (IJSR). 2019;8(6):1407-34.
Mukherjee SB, Mukherjee S, Ghosh S, Singh A. Providing services for Indian children with developmental delay and disabilities in the community: Rashtriya Bal Suraksha Karyakram. Indian Pediatrics. 2021 Oct;58:73-9.
Narayanan J, Xavier A, Evans J, Kapur N, Wilson B. Neuropsychological Consequences of COVID-19: Life After Stroke and Balint's Syndrome. Taylor & Francis; 2024 Mar 20.
Kochgaway L, Jain S, Mandal M, Roy R, Bhargava S, Singh M. Commentary: Causes of delayed presentation of pediatric cataract: A questionnaire-based prospective study at a tertiary eye care center in central rural India. Indian Journal of Ophthalmology. 2020 Apr 1;68(4):607-10.
Srivastava P, Kumar P. Disability, its issues and challenges: Psychosocial and legal aspects in Indian scenario. Delhi Psychiatry Journal. 2015 Apr;18(1):195-205.
Madison SB. A Comparative Study of Perceptions of Service Needs Between Service Providers and Consumers Who Are Blind and Visually Impaired in the State of North Carolina (Doctoral dissertation, South Carolina State University).
Friedner M, Ghosh N, Palaniappan D. “Cross-Disability” in India?: On the limits of Disability as a Category and the Work of Negotiating Impairments. South Asia Multidisciplinary Academic Journal. 2018 Apr 5.
Bhaskar AU, Baruch Y, Gupta S. Drivers of career success among the visually impaired: Improving career inclusivity and sustainability in a career ecosystem. Human Relations. 2023 Oct;76(10):1507-44.
ROY M, BAG R. Effectiveness of Structured Teaching Programme on the Knowledge about Rehabilitation of Stroke Patients among Caregivers in a Selected Hospital, Kolkata, India. Journal of Clinical and Diagnostic Research. 2019 Jul 1;13(7).
Das S, Hazra A, Ray BK, Ghosal M, Banerjee TK, Roy T, Chaudhuri A, Raut DK, Das SK. Burden among stroke caregivers: results of a community-based study from Kolkata, India. Stroke. 2010 Dec 1;41(12):2965-8.
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