Report on Knowledge, Attitudes and Practices Survey

Report on Knowledge, Attitudes and Practices Survey

Assessing Potential for Establishing Vision Centres in Sohawa, Sanghoi and Lalamusa

Volume I: Findings of the Survey

2012

Conducted and Compiled By / Technical and Financial Support by
Civil Society Human and Institutional Development Programmes (CHIP)
CHIP House # 5, Street # 9, G-8/2, Islamabad, 44000, Pakistan, www.chip-pk.org / International Centre for
Eye Care Education (ICEE)
55 A, Bhitai Road, Sector F-7/1, Islamabad 44000, Pakistan, www.icee.org

Table of Contents

1 Introduction 4

1.1 Context 4

1.2 Introduction to the Project 4

1.3 Rationale 4

1.4 Objectives 5

1.5 Methodology 5

1.5.1 Sample 5

1.5.2 Instruments 5

2 Demographic Profile of Respondents 6

2.1 Tehsil and Union Council Wise Distribution of Respondents 6

2.2 Gender Wise Distribution of Respondents 7

2.3 Status of Education of Respondents 7

2.4 Age Wise Distribution of Respondents 8

2.5 Profession of Respondents 9

3 Eye Diseases and Refractive Errors 10

3.1 Knowledge about Eye Diseases and Refractive Errors 10

3.2 Knowledge of Eye Diseases and Refractive Error Issues 11

3.3 Status of Suffering from Eye Disease or Refractive Error 13

3.4 Time Spent with the Knowledge of Eye Disease or Refractive Error 15

3.5 Knowledge of Causes of Eye Diseases or Refractive Error 16

3.6 Perception about the Precautions to Avoid Eye Disease 18

3.7 Perception of Implications If Eye Diseases and Refractive Errors Are Not Managed Timely 19

3.8 Status of Visiting Eye Health Care Facility for Eye Diseases or Refractive Error 21

3.9 Perceptions of Method of Treatment of Eye Diseases And Management of Refractive Error 22

3.10 Types of Reasons for Not Having Medical Checkup 23

3.11 Types of Preferred Medical Facility for Eye Check Up 24

3.12 Distance Levels of Medical Facilities from Home 25

3.13 Time Elapsed Since Last Visit to Medical Facilities 26

3.14 Costs Incurred To Have the Eyes Checked Up 27

3.15 Level of Satisfaction with Eye Care Facility for Refractive Error Checkup 28

3.16 Types of Reasons for Having Dissatisfactory Experience 29

3.17 Perceptions of Solutions Regarding the Methods to Resolve Dissatisfaction from Eye Diseases Checkup 31

4 Findings Related to Refractive Services 32

4.1 Knowledge about Refractive Correction 32

4.2 Knowledge of Methods of Refractive Error Correction 33

4.3 Use of Refractive Correction 34

4.4 Types of Refractive Correction in Use 35

4.5 Types of Reasons for Not Using the Refractive Correction 36

4.6 Perceptions about Solution of Problems Regarding Not Using Refractive Correction 38

4.7 Perceptions about the Person Who Wears Glasses 39

4.8 Frequency Levels of Using Refractive Correction 40

4.9 Cost Spent On Preferred Spectacles from Preferred Place 41

4.10 Distance Levels of Optical Shop from Home 42

4.11 Frequency Levels of Buying New Glasses 43

4.12 Types of Problems While Acquiring New Glasses 44

4.13 Intentions of Using New Glasses or Contact Lenses In Future 45

4.14 Types of Refractive Correction Preferred In Future 46

4.15 Preferred Amount the Respondents Are Willing To Spend On Refractive Correction In Future 47

5 Sunglasses 48

5.1 Status of Using Sun Glasses 48

5.2 Frequency Levels of Using the Sun Glasses 49

5.3 Types of Reasons for Not Using the Sun Glasses 50

5.4 Interest in Using Sun Glasses In Future If Not Used Currently 52

5.5 Ranges of Preferred Amount that the Respondents Are Willing To Spend On Sun Glasses 53

5.6 Knowledge about Importance of Using Sun Glasses 54

5.7 Types of Perceptions about Advantage of Using Sun Glasses 55

6 Blood Pressure 56

6.1 Knowledge about Blood Pressure 56

6.2 Status of Suffering from Blood Pressure 57

6.3 Time Elapsed Since Last Experience of Irregular Blood Pressure 58

6.4 Perceptions of Symptoms of Blood Pressure 59

6.5 Time Spent With the Knowledge of Blood Pressure 60

6.6 Perceptions of Reasons of Blood Pressure 61

6.7 Perceptions about Precautions to Be Taken to Avoid Blood Pressure 62

6.8 Perceptions of Implications If Blood Pressure Is Not Controlled Timely 63

6.9 Types of Available Blood Pressure Checkup Facility 64

6.10 Ranges of Distance of Blood Pressure Checkup Facility from Home 65

6.12 Frequency Levels of Blood Pressure Checkup 66

6.13 Range of Cost Incurred on Blood Pressure Checkup 67

6.14 Types of Problems Faced in Blood Pressure Checkup 68

6.15 Willingness to Spend Money for Blood Pressure Checkup In Future 69

6.16 Ranges of Money the Respondents Are Willing To Spend For Blood Pressure Checkup 70

7 Diabetes 71

7.1 Knowledge about Diabetes 71

7.2 Perceptions of Symptoms of Diabetes 72

7.3 Status of Suffering from Diabetes 73

7.4 Time Spent With the Knowledge of Having Diabetes 74

7.5 Perceptions of Reasons of Diabetes 75

7.6 Perceptions of Precautions Observed To Avoid Diabetes 76

7.7 Perceptions about Implications If Diabetes Is Not Controlled Timely 77

7.8 Types of Preferred Available Diabetes Checkup or Treatment Facilities 78

7.9 Ranges of Distance of Preferred Facility from Home 79

7.10 Frequency Levels of Routine Diabetes Checkup 80

7.11 Ranges of Cost Incurred On Diabetes Checkup 81

7.12 Types of Problems Faced In Diabetes Checkup 82

7.13 Willingness to Spend Money for Diabetes Checkup In Future 83

7.14 Ranges of Money the Respondents Are Willing To Spend For Diabetes Checkup 84

8 Analysis 85

8.1 Observations in Tehsil Sohawa 85

8.2 Observations in Tehsil Jhelum 86

8.3 Observations in Tehsil Kharian 87

9 Recommendations 89

1 Introduction

1.1  Context

The prevalence of blindness and visual impairment in Pakistan, according to the Situation Analysis of Refractive Services in Pakistan, 2006, is 0.9% of which 3% can be attributed to refractive errors. Despite the fact that refractive errors are easily diagnosable and treatable with corrective spectacles, they are the most common cause of irreversible blindness and permanent low vision. In Pakistan, there are about 6.3 million refractions done per year and approximately 2 million spectacles dispensed per year. Albeit this suggests that the refractive needs of the country are being met, there is still unmet need for high quality services in rural and less developed areas of Pakistan.

Other than refractive errors, high blood pressure and diabetes also contribute significantly to loss of vision and eye diseases such as hypertensive retinopathy, diabetic retinopathy and cataracts. Individuals with uncontrolled blood pressure and blood sugar levels for long periods of time are at a great risk of contracting such eye diseases and vision problems. Statistics reveal that the overall prevalence of hypertension in Pakistani’s aged 15 years and over was 19%. It was even more alarming that with such high prevalence rates, more than 70% of the population was unaware of their condition and not even 3% of those with hypertension had sufficiently controlled blood pressure. Further, it has been estimated that by 2020, Pakistan will be the 4th most heavily populated country in the world in terms of diabetes.

Faced with such a scenario, there is much scope for work to be done to treat and prevent problems with visual acuity and eye diseases. ICEE and CHIP exchanged ideas about importance of sustainable enterprises, particularly, at the community level for the provision of spectacles which is the most cost-effective intervention in eye care and can significantly reduce the negative consequences of refractive errors, in terms of lost education, employment opportunities, and impaired quality of life. The project idea stems from this discussion and this knowledge, attitudes and practices survey was conducted as part of the preparation of the feasibility plan. Initially, three vision centres and optical labs in each of Sohawa, Sanghoi and Lalamusa will be established.

1.2  Introduction to the Project

Civil Society Human and Institutional Development Programme (CHIP) is a leading not for profit national organization of Pakistan. CHIP has been working on human and institutional development of local communities in various parts of Pakistan since 1993. It has extensive experience of working on integrated development approaches, rehabilitation and inclusion of people with blindness, low vision and cross disability. It has developed its expertise in rehabilitation of people with disabilities, gender, livelihoods, human rights, health, natural resource management, water and sanitation.

CHIP in partnership with ICEE has designed a project on ‘Enterprise for Sight’. The project proposes to address the challenge of a huge unmet need for quality refractive services at community and household level through a social enterprise approach. This innovative approach will provide quality eye health care while using business principles to sustain and grow uplifting communities and enhancing their socio-economic status. The project aims to develop a social enterprises approach to provide community responsive eye health services leading to sustainable economic development.

1.3  Rationale

The knowledge attitudes and practices survey has been conducted in order to assess the level of market demand in Tehsils Sohawa, Jhelum and Kharian and prepare the financial feasibility for the establishment, running and management of the vision centres. This report should be read in conjunction with the market research report for each of the different tehsils to obtain a fuller picture. For the village profiles of the different tehsils, reference should be made to volume II of this report which gives a detailed outline of the various villages and the social maps that were drawn before the survey was conducted.

1.4  Objectives

The specific objectives of the report on Knowledge, Attitudes and Practices survey are as follows:

a.  To assess the knowledge of the people regarding eye diseases, refractive errors and services, sunglasses, blood pressure and diabetes;

b.  To analyze the demand for the services being offered by the vision centres in the three tehsils;

c.  To identify gaps in the services currently being provided and the needs of the community;

d.  To provide suggestions and recommendations for the vision centre services in light of the gaps identified in (c).

1.5  Methodology

1.5.1  Sample

All villages within a radius of 40 km from the three target locations of Sohawa, Sanghoi and Lalamusa for the vision centre were listed and randomly selected set of villages. Social maps were prepared for each of the villages to identify people with eye care issues. It was targeted that approximately 300 respondents from each tehsil would be interviewed and therefore, surveys were conducted amongst those available from the list until the target number was reached. 295 respondents were selected from Tehsil Sohawa, 297 from Tehsil Jhelum and a total of 300 from Tehsil Kharian to participate in the survey. A heterogeneous sample was selected from all the three different tehsils which included people from different genders, ages, professions and education levels.

1.5.2  Instruments

A single questionnaire was used for obtaining information pertaining to the knowledge, attitudes and practices of the people in the target tehsils regarding eye diseases, refractive errors and services, sunglasses, blood pressure and diabetes. Quantitative data was extracted from the responses based on these questionnaires and presented in tabular form as can be seen below. The findings have then been organized tehsil wise to assess the varying levels of market demand in each of the three tehsils.

2 Demographic Profile of Respondents

The KAP survey was conducted in the tehsils Sohawa, Jhelum and Kharian in 44 villages falling in 18 different union councils. A total of 892 respondents across the three tehsils participated in the survey. An overview of the profile of the respondents in terms of their location, gender, status of education, age and type of profession has been given in the next few subsections.

2.1 Tehsil and Union Council Wise Distribution of Respondents

The distribution of respondents in the three different tehsils was uniform with approximately 33% respondents from each of Sohawa, Jhelum and Kharian. A detailed distribution of respondents in each of the tehsils has been given in the table as follows:

Table 1: Tehsil and Union Council Wise Distribution of Respondents
Tehsil / Union Council / # of Villages / Total Respondents in Each Village / Total %
Sohawa / Jajial Pur / 1 / 3 / 0.34%
Lehri / 2 / 46 / 5.16%
Mand Malho / 1 / 7 / 0.78%
Paghray Sedan / 2 / 42 / 4.71%
Pail Bannay Khan / 1 / 10 / 1.12%
Pind Matay Khan / 8 / 150 / 16.82%
Sohawa / 2 / 37 / 4.15%
Total / 17 / 295 / 33.07%
Jhelum / Chota Leh / 1 / 16 / 1.79%
Chumbail / 1 / 1 / 0.11%
Dara Pur / 4 / 107 / 12.00%
Janjail / 1 / 11 / 1.23%
Nakakhurd / 6 / 112 / 12.56%
Nara / 2 / 38 / 4.26%
Sanghoi / 1 / 12 / 1.35%
Total / 16 / 297 / 33.30%
Kharian / Chakori Sher Ghazi / 4 / 112 / 12.56%
Dilawar Pur / 2 / 59 / 6.61%
Haji Muhammad / 4 / 109 / 12.22%
Karnana / 1 / 20 / 2.24%
Total / 11 / 300 / 33.63%
Total U/Cs / Total Villages / Total Respondents
18 / 44 / 892

1. Tehsil Sohawa:

In Tehsil Sohawa, 295 respondents from a total of 17 villages in 6 Union Councils were surveyed. Almost half of the respondents were from UC Pind Matay Khan.

1. Tehsil Jhelum:

In Tehsil Jhelum, 297 respondents from a total of 16 villages falling in 7 different Union Councils participated in the survey with a significant majority of the respondents from the UCs Dara Pur and Nakakhurd.

1. Tehsil Kharian:

300 respondents from 11 villages in 4 Union Councils participated in the survey. Most of the respondents were from the UCs Chakori Sher Ghazi and Haji Muhammad.

2.2 Gender Wise Distribution of Respondents

Gender wise distribution of respondents shows that a greater proportion of females than males were surveyed. Gender wise distribution of the respondents for each of the tehsils has been given as follows:

Table 2: Gender Wise Distribution of Respondents
Tehsil / Union Council / Male / Female / Total
Sohawa / Total / 131 / 44.41% / 164 / 55.59% / 295
Jhelum / Total / 120 / 40.40% / 177 / 59.60% / 297
Kharian / Total / 120 / 40% / 180 / 60% / 300
Total U/Cs / Total Males / Total Females / Total Respondents
18 / 371 / 41.59% / 521 / 58.41% / 892

1. Tehsil Sohawa:

Out of the total participants surveyed 55.59% were female as opposed to 44.41% males.

1. Tehsil Jhelum:

In Tehsil Jhelum, the proportion of females interviewed was even greater than that in Tehsil Sohawa with 59.60% female participants.

1. Tehsil Kharian:

A similar trend as that in Tehsil Jhelum was observed in Tehsil Kharian with 60% of the participants surveyed as females and only 40% male participants.