Changing barriers to use of eye care services in Timor-Leste : 2005 to 2010

Purpose: To determine barriers to seeking eye care services in Timor-Leste in 2010, and compare this to similar analyses undertaken 5 years previously. Methods: An interview-based questionnaire used in a 2005 survey was re-administered as part of a population-based cross-sectional survey of adults selected by multistage random sampling from those aged ≥ 40 years in Timor-Leste in 2010. Results: The participation rate for the 2010 survey was 89.5% (n = 2014). The sex-age-domicile-adjusted prevalence of a history of at least one previous or current ophthalmic problem in the population aged ≥ 40 years was 92.6% (95% confidence interval [CI], 91.4-93.7%). Of these, 75.4% (95% CI 73.4-77.3%) had not consulted a care provider. In multivariate analysis, rural domicile, illiteracy and subsistence farming were associated with having not sought care for an eye problem. The most frequently cited reasons were "service too far away" (36.3%), "no time/other priorities" (21.7%) and "unaware of eye care service" (20.7%). More people reported a history of an eye problem in 2010 than in 2005, but the proportion seeking care was no different. Social barriers became more prevalent for urban dwellers in 2010, while attitudinal barriers decreased. For rural residents, social and service-related barriers increased and awareness and attitudinal barriers decreased. Conclusion: Barriers to eye health service use in Timor-Leste are not universal or static. Monitoring the extent and nature of barriers, as well as the prevalence and causes of vision impairment, will help plan appropriate interventions for vulnerable groups.