Vulnerable peoples' lived experience of eyecare

The UK’s General Optical Council (GOC) has published new qualitative research on vulnerable patients’ inequalities in access to, and their experience of, eyecare services.

Carried out by Explain Market Research, the lived experience research included 38 in-depth interviews with patients and non-patients (who had not had a sight test in the past two years). All had at least one vulnerability, ie. a disability, a low annual household income or going through a difficult life circumstance.

The research identified some of the challenges people with vulnerabilities face when accessing eyecare services, including:

• Low importance of maintaining eye health – participants were often unaware of the benefits or recommended frequency of sight tests in maintaining good vision and eye health.

• High tolerance for, and self-management of, symptoms related to sight or eye health – participants had a high tolerance for symptoms related to worsening vision (ie. headaches, blurry vision and eye strain) and self-managed by buying off-the-shelf ready readers rather than going for a test.

• Psychological barriers – the open nature of the retail environment, seeing multiple people, concerns over length of the wait and feeling uncomfortable trying on glasses in front of others were some of the barriers mentioned, particularly by those with mental health difficulties.

• Cost-related barriers and pressure to buy – the cost of the sight test and glasses were seen as inhibiting for the majority of participants. They also worried about the pressure to buy eyewear, with many unaware of any potential financial support available.

Participants also discussed having specific needs influencing their sense of satisfaction with their experiences of having a sight test/eye examination. These included:

• Recognising and catering to hidden vulnerabilities and concerns – participants with more visible forms of physical disabilities discussed needing care that was more accommodating to their needs. Patients with more hidden vulnerabilities discussed more complex and problematic interactions with eyecare services.

• Feeling a ‘thorough job’ has been done – for many, a sense of dissatisfaction was rooted in feeling they had been ‘rushed through’ their appointment, which led to a sense of being poorly cared for, not listened to and, in some cases, concern that their test had not been performed thoroughly.

• An empathetic approach – the ability to support people with vulnerabilities and quickly identify their needs was viewed as an important skill among professionals.

• Continuity of care – some respondents wished to develop a sense of connection to their optometrist. Others were concerned there was a lack of communication between hospitals and different optometrists involved in their care, resulting in delays in diagnosis.

• Transparency on costs and less pressure to buy.

Participants suggested it would be helpful to improve awareness and knowledge of eye health and the benefits of routine sight tests; increase transparency around costs; consider ways to provide care for patients with both visible and hidden vulnerabilities, eg. by asking about additional needs when booking or offering more tailored appointments; where possible, provide greater continuity of care so patients and professionals can build relationships and address concerns more easily.

“The voices in this research provide powerful examples of some of the challenges the most vulnerable in our society face when accessing eyecare, including very real worries about the cost of treatment and eyewear and the severe impact that living with hidden disabilities can have on access to and experiences of treatment,” said Steve Brooker, GOC director of regulatory strategy.

“Importantly, the research also shows some of the things the sector could do to improve patient experiences, including raising awareness of the benefits of regular tests, reducing pressure to buy, providing greater cost transparency and better adapting services for patients with a disability or mental health issues,” he said.