Exploring eye care pathways, patient priorities and economics in Pakistan: A scoping review and expert consultation study with thematic analysis

Abstract

Purpose: As the prevalence of eye diseases increases, demand for effective, accessible and equitable eye care grows worldwide. This is especially true in lower and middle-income countries, which have variable levels of infrastructure and economic resources to meet this increased demand. In the present study we aimed to review the literature on eye care in Pakistan comprehensively, with a particular focus on eye care pathways, patient priorities and economics.

Methods: A systematic scoping review was performed to identify literature relating to eye care in Pakistan. Searches of relevant electronic databases and grey literature were carried out. The results were analysed through a mixed methods approach encompassing descriptive numerical summary and thematic analysis. To consolidate results and define priority areas for future study, expert consultation exercises with key stakeholders were conducted using qualitative semi-structured interviews.

Results: One hundred and thirty-two papers (published and unpublished) were included in the final review. The majority (n = 93) of studies utilised a quantitative design. Seven interlinked themes were identified: eye care pathways, burden of eye disease, public views on eye-related issues, workforce, barriers to uptake of eye care services, quality of eye care services and economic impact of blindness. Research priorities included investigating the eye care workforce, the quality and efficiency of current eye care services, eye care services available in rural Pakistan and the costs and benefits related to eye care provision and sustaining eye care programmes.

Conclusions: To the best of our knowledge, this is the first review to synthesise evidence from papers across the field relating to eye care in Pakistan. As such, this work provides new insights into the achievements of the national eye health programme, challenges in eye care in Pakistan and priority areas for future research.

Keywords: Pakistan; blindness; eye care services; scoping review; thematic analysis; visual impairment.

FIGURE 1

Adapted preferred reporting items for systematic reviews and meta‐analyses (PRISMA) study flow diagram. Detailed flow of information through different phases of study selection maps the number of papers identified, including reasons for exclusion.

FIGURE 2

Map of Pakistan. Yellow bubbles represent distribution of the papers and are accompanied by the number of papers carried out in each province. KPK = Khyber Pakhtunkhwa, AJK = Azad Jammu and Kashmir

FIGURE 3

Histogram showing distribution of papers published from 1994 to 2020

FIGURE 4

Histogram showing distribution of frequency of quality summary scores using the QualSyst tool on 112 studies

FIGURE 5

Bar chart showing the frequency of different professions which were mentioned across 79 papers. The category ‘Other Specialised Doctor’ includes oncologists, diabetologists, paediatricians, neonatologists and endocrinologists. The category ‘other profession’ includes a statistician, histopathologist, social worker and counsellor. LHW: Lady health worker; GP: General medical practitioner

FIGURE 6

Bar chart showing frequency of age groups investigated across 71 papers

FIGURE 7

Radar chart showing seven major themes which were identified, and the frequency at which they were reported across 132 papers

FIGURE 8

Framework showing relationships between seven themes identified from the scoping review. The theme economic impact of blindness is directly related to the five themes encompassed within the black dotted line. These six themes feedback and affect the burden of eye disease theme

FIGURE 9

Research priorities identified from scoping review substituted into the framework outlined in Figure 8. Priorities within the black dotted line are influenced directly and/or indirectly by associated costs and finances, which have an effect on the eye care pathway's long‐term sustainability. The prevalence of endemic eye conditions is influenced by all six priorities