Barriers in older adults’ decision-making process to use routine eye examinations in Hong Kong

The decision to have a routine eye examination involves individual- and service-level judgement. A deeper understanding of patient access barriers and expectations could facilitate the design of better-aligned service models in optometric practice, improving the utilisation rate of an important facet of primary healthcare services. Routine eye examinations achieve several health objectives, including mitigation of sight-threatening risk factors. However, there are barriers to service uptake. Through the qualitative approach, a deeper understanding of these barriers can be realised and enhanced strategies designed to improve the uptake of the routine eye examination. A qualitative study was conducted to identify the factors influencing the decision-making process of older adults to use the routine eye examination service. This study was guided by the grounded theory approach. Participants were purposively recruited from six community elderly centres. Semi-structured interviews were conducted with 25 community-dwelling adults aged 65 years or above in Hong Kong. Data were transcribed and constant comparison techniques were used for data analysis. Difficulty in prioritising and including the routine eye examination in the existing health service utilisation was the central theme associated with its lower use. Four sub-themes were identified to explain this phenomenon: (1) previous health care service utilisation as a reference for judging primary eye care; (2) low perceived primary eye care service needs; (3) low perceived self-efficacy on routine eye care utilisation; (4) service expectations. Multiple modifiable factors influence decision-making by older adults, suggesting that their routine eye care seeking behaviour might be altered through behaviour change intervention. The context in which services are delivered requires further study, with a focus on exploring the factors influencing service experience and its subsequent impact on regular eye care seeking behaviour.是否接受常规眼科检查的决策，需兼顾个体与服务两个层面的判断。深入了解患者的就诊障碍与预期需求，可助力优化眼科诊疗实践中适配性更强的服务模式，提升初级医疗保健体系中这一核心服务的利用率。常规眼科检查可达成多项健康目标，其中包括缓解致盲性危险因素。但该服务的推广仍存在诸多阻碍。通过质性研究方法，可深化对这些障碍的认知，并设计针对性优化策略以提升常规眼科检查的服务接受度。本研究采用质性研究范式，旨在明确影响老年人选择常规眼科检查服务的决策因素，研究以扎根理论（grounded theory）为指导框架。研究人员从6家社区老年中心开展目的性抽样，招募25名居住于中国香港社区、年龄65岁及以上的成年人，并对其开展半结构化访谈（semi-structured interviews）。对访谈转录文本采用持续比较分析法（constant comparison techniques）开展数据分析。研究发现的核心主题为：在现有医疗服务利用体系中，难以将常规眼科检查纳入优先诊疗序列，这是导致其使用率偏低的核心原因。研究共识别出4个子主题以阐释该现象：（1）以既往医疗服务利用经历作为初级眼保健服务的判断依据；（2）对初级眼保健服务的需求感知水平较低；（3）对常规眼科检查的利用自我效能感（self-efficacy）不足；（4）服务预期。多项可干预因素会影响老年人的决策过程，这提示可通过行为改变干预手段，调整老年人的常规眼科就诊行为。关于服务提供的具体场景仍需开展进一步研究，重点应聚焦于探索影响服务体验的各类因素，及其对规律眼科就诊行为的后续影响。