Patients’ Awareness and Knowledge of Their Ophthalmic Condition at Lagos University Teaching Hospital (LUTH)

Olubanke Theodora Ilo^1*, Olufemi Emmanuel Babalola², Adetunji Olusesan Adenekan¹, Olufemi Oduneye¹, Folashade Akinsola¹

¹Department of Ophthalmology, Lagos University Teaching Hospital, Nigeria
²Rachel Eye Centre Garki, Abuja

*Corresponding Author: Ilo Olubanke Theodora, Department of Ophthalmology, Lagos University Teaching Hospital, Lagos, Nigeria; Email: [email protected]

Published Date: 14-01-2023

Copyright^© 2023 by Theodora IO, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Purpose: To assess patient’s awareness of their ophthalmic conditions following their clinic visits with the aim of improving communication between patients and health practitioners and enhancing care.

Methods: A hospital-based cross-sectional quantitative survey carried out in subjects over 18 years of age, attending the Guinness Eye Centre Clinic (Lagos University Teaching Hospital) over a four week period in 2019.

Results: A total of 250 subjects were surveyed. Male:Female 1:1.7 Age range 41-80 years. 42.4% had at least tertiary education. Although the majority of subjects (>70%) had enough time to ask questions from their doctors/nurses, 76.8% did not know the diagnosis of their ophthalmic conditions, 43.8% didn’t know their treatment options, and 62% did not know the names of their eye drops. 95.2% of subjects, however agreed that a simple information leaflet explaining their ophthalmic condition and treatment will increase their understanding. Patients with tertiary education or higher are three times more likely to have knowledge of the condition and treatment compared with patients with lesser education. Odds ratio 3.07 CI:1.82 to 5.19 P < 0.0001.

Conclusion: Clinics should have counsellors who can spend more time to discuss with patients about their ophthalmic conditions. Information leaflets (in different languages) on different common medical conditions which include; Cataract, Glaucoma, Pterygium, should be printed in the simplest of language for patients to not only hear but also read to assimilate and enhance awareness in patients.

Keywords: Awareness; Knowledge; Information Leaflets; Ophthalmic Condition

Introduction

Patients all over the world, attend hospitals to get an understanding of their medical conditions and for treatment options which will enable them to make informed decisions on the treatment regimen to pursue. Modern trends in patient’s management have placed emphasis on Patient’s Reported Outcome (PRO) in the assessment of medical or surgical intervention1. It is a well-known fact that patient satisfaction is a pillar of treatment efficiency, thus providing information to patients about their medical conditions and treatment options cannot be over emphasized [1-7].

Ley, et al., reported that 8-92% of patients (Median 44%) did not comply with their doctor’s instruction due to poor communication of their disease state. Patients were more satisfied with the management of their disease conditions when improved communications led to a greater understanding of their illness [2]. A meta-analysis on the relationship between the patient’s satisfaction with treatment and compliance by Barbosa, et al., also concluded that patients are more likely to have better compliance when they are satisfied with their management [2].

Eye disorders are one of the most easily ignored illnesses and can have a major impact on the     quality of one’s life [3]. Awareness of eye conditions helps promote health and leads health and leads to better outcomes. However, in a developing country like Nigeria, some patients have poor knowledge of their disease processes. This could be as a result of poor communication or impatience on the part of health workers as a result of high patients load and shortage of manpower.

In a community-based study conducted in Singapore, 80% of patients with common eye diseases were unaware of their condition [4]. The lack of awareness of eye conditions could result in delayed treatment [3].

In this era of medical litigation, it is important for health care professionals to ensure patients are carried along on the diagnosis, treatment options and entire management regimen. This study assessed patient’s awareness of their ophthalmic conditions following their clinic visits with the aim of improving communication between patients and health practitioners and enhancing care.

Materials and Methods

This was a hospital-based cross-sectional quantitative survey carried out in subjects over 18 years of age, attending the Guinness Eye Centre Clinic (Lagos University Teaching Hospital) over a period of one month. This was after Ethical approval was obtained from the Health Research Ethics committee of Lagos University Teaching Hospital. In addition, the study strictly adhered to the tenets of the Declaration of Helsinki and was conducted in accordance with good clinical practices (ADM/DCST/HREC/APP/3528). Consecutively consenting subjects who met the inclusion criteria completed the structured (self-administered) questionnaire after Informed consent was obtained.

Inclusion criteria- Subjects above 18 years who gave consent. Exclusion criteria – Subjects below 18 years, individuals with mental challenge and individuals who did not give consent to participate in the study.

Data entry and analysis was carried out using the Statistical Package for Social Sciences (SPSS) software version 23 (IBM SPSS Inc., Chicago, IL, USA). Categorical data was presented using frequency and percentage, while numerical data was presented using mean and standard deviation or median or interquartile range. Kolmogorov Smirnov test was used to assess normality assumptions. Association between categorical data was carried using chi square and Fischer’s exact test as appropriate. The level of statistical significance was set at p-value <0.05. Charts, including histograms, were used for data presentation.

Results

A total of 250 respondents were enrolled with a 100% study completion rate.

Majority were between the ages of 41 to 80 years of age with Male:Female ratio1: 1.7 with three quarters of the respondents having had tertiary level of education 106 (42.4%) [Table 1,2]. Two-third of respondents 153 (61.2%) spent an average of 4-6 hours in each clinic visit.  With a large percentage attesting  to having had enough time to ask questions about their ocular conditions from their health care provider [Table 2]. However, very few (23.3%) had an understanding of their diagnosis. And practically all (95.2 %) agreeing on the need for a simple leaflet explaining their ocular conditions. There is a statistically significant association (p< 0.005) between higher level of education of the respondents and knowledge of available treatment options/ knowledge of names of specifc drugs commenced [Table 3,4].

Table 5 shows Likelihood ratios assessing knowledge of disease by educational attainment. The likelihood increased with age and exceeds one only after tertiary education. Patients with tertiary education or higher are three times more likely to have knowledge of the condition and treatment compared with patients with lesser education. Odds ratio 3.07 CI:1.82 to 5.19 P < 0.0001 [Table 5,6].

Table 1: Socio-demographic characteristics of respondents.

Table 2: Respondents’ feedback responses.

Table 3: Association between level of education and treatment options known.

Table 4: Association between level of education and known names of eye drops.

Table 5: Likelihood ratios table assessing knowledge of disease by educational attainment.

Table 6: Bivariate analysis assessing likelihood of knowledge with educational attainment.

Discussion

Lagos State is a major metropolitan city in Nigeria and so it was not surprising that majority (42.4%) of respondents in this study are reasonably well educated. This however, did not seem to improve the number of respondents that knew the diagnosis of their ocular conditions, as only 23.2% understood the diagnosis of their ocular conditions. This is similar to a study by Sudesh, et al., at Birmingham on the audit of patient’s awareness of ophthalmic diagnosis, where just 12% of the respondents understood the diagnosis of their ocular disease [5].

Despite the fact that health workers communicate with patients, patients apparently do not assimilate much of what is said to them at the clinic regardless of their educational status. Higher levels of education have been linked to higher awareness, but this has not been translated into accurate understanding of ocular diseases, as there could be substantial misconceptions6. Health education content needs to be reviewed with a view to reducing the dangerous misconception of ocular diseases and targeting the lower socio-economic population.

There was an association between increased level of education of the respondents and knowledge of available treatment options which was found to be statistically significant (P <0.005). The same trend was also noticed between level of education and the ability to remember the names of the eye drops that they were using. Even though the respondents didn’t know the diagnosis of their ocular conditions they however knew the various treatment options which could be either medical or surgical options. The respondents also remembered the names of the eye drops they were using, probably because they routinely buy these eye drops.

The majority of patients (61.2%) confirmed that they spent 4-6 hours/ clinic time /day, while 13.6% attested to spending over 6hrs in the clinic/day. This could be due to the time spent in clinics receiving a large number of patients, arranging patients, health talks by the nurses and eventual clinic consultation by the doctors, however the majority of respondents (82%) and (74.4%) acknowledged having been given enough time by the doctors and nurses respectively to ask questions about their ocular conditions. These findings of long patient waiting time was similar to a the findings in a study by Ayeni EA, et al., on the service uptake in University College Hospital, Ibadan, Nigeria, where 78.5% of patients spent 1-3 hours or more just waiting to see the consultant ophthalmologists [7].

Over ninety five percent (95.2%) of respondents in this study agreed that additional learning aids, like information leaflets after clinic consultation would improve the knowledge of their ocular conditions. This could be invaluable in shortening the amount of clinic hours spent by the patients [8].

Conclusion

Clinics should have counsellors who can spend more time outside of clinic time to discuss with the patients about their ophthalmic conditions. Information leaflets (in different languages) on different medical conditions should be printed in the simplest language for patients to take home so that they can read, assimulate and enhance awareness of their ophthalmic condition. These steps will possibly shorten clinic visit time, heighten the pillar of treatment efficiency and prevent avoidable vision loss. We also need a detailed training program for the practising health care professionals on the efficient yet empathic strategy in handling more delicate and complex issues in clinic like breaking bad news and various reactions by the patients and their relatives.

Conflict of Interest

The authors have no conflict of interest to declare.

References

1. Varma R, Richman EA, Ferris FL, Bressler NM, Bressler NM. Use of patient-reported outcomes in medical product development: a report from the 2009 NEI/FDA clinical trial endpoints symposium. Invest Ophthalmol Vis Sci. 2010;51(12):6095-103.
2. Barbosa CD, Balp MM, Kulich K, Germain N, Rofail D. A literature review to explore the link between treatment satisfaction and adherence, compliance, and persistence. Patient Prefer Adherence. 2012;6:39-48.
3. Lee H, Jang YJ, Lee HK, Kang HY. Patient awareness of cataract and age-related macular degeneration among the korean elderly: a population-based study. Korean J Ophthalmol. 2017;31(6):557.
4. Huang OS, Zheng Y, Tay WT, Chiang PP-C, Lamoureux EL, Wong TY. Lack of awareness of common eye conditions in the community. Ophthalmic Epidemiol. 2013;20(1):52-60.
5. Sudesh S, Downes SM, Mcdonnell PJ. Audit of patient’s awareness of ophthalmic diagnosis. 1993;2:175-8.
6. Nkum G, Lartey S, Frimpong C, Micah F, Nkum B. Awareness and knowledge of glaucoma among adult patients at the eye clinic of a teaching hospital. Ghana Med J. 2015;49(3):195-9.
7. Ayeni E, Bekibele C, Baiyeroju A. Service uptake in UCH, Ibadan: a time flow study. Niger J Ophthalmol. 2006;13(2):49-53.
8. Rajashree KC. Training programs in communication skills for health care professionals and volunteers. Indian J Palliat Care. 2011;17(4):S12.

References

1. Varma R, Richman EA, Ferris FL, Bressler NM, Bressler NM. Use of patient-reported outcomes in medical product development: a report from the 2009 NEI/FDA clinical trial endpoints symposium. Invest Ophthalmol Vis Sci. 2010;51(12):6095-103.
2. Barbosa CD, Balp MM, Kulich K, Germain N, Rofail D. A literature review to explore the link between treatment satisfaction and adherence, compliance, and persistence. Patient Prefer Adherence. 2012;6:39-48.
3. Lee H, Jang YJ, Lee HK, Kang HY. Patient awareness of cataract and age-related macular degeneration among the korean elderly: a population-based study. Korean J Ophthalmol. 2017;31(6):557.
4. Huang OS, Zheng Y, Tay WT, Chiang PP-C, Lamoureux EL, Wong TY. Lack of awareness of common eye conditions in the community. Ophthalmic Epidemiol. 2013;20(1):52-60.
5. Sudesh S, Downes SM, Mcdonnell PJ. Audit of patient’s awareness of ophthalmic diagnosis. 1993;2:175-8.
6. Nkum G, Lartey S, Frimpong C, Micah F, Nkum B. Awareness and knowledge of glaucoma among adult patients at the eye clinic of a teaching hospital. Ghana Med J. 2015;49(3):195-9.
7. Ayeni E, Bekibele C, Baiyeroju A. Service uptake in UCH, Ibadan: a time flow study. Niger J Ophthalmol. 2006;13(2):49-53.
8. Rajashree KC. Training programs in communication skills for health care professionals and volunteers. Indian J Palliat Care. 2011;17(4):S12.

Article Type

Research Article

Publication History

Received Date: 08-12-2022
Accepted Date: 07-01-2023
Published Date: 14-01-2023

Copyright© 2022 by Theodora IO, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation: Theodora IO, et al. Patients’ Awareness and Knowledge of Their Ophthalmic Condition at Lagos University Teaching Hospital (LUTH). J Ophthalmol Adv Res. 2023;4(1):1-6.

Table 1: Socio-demographic characteristics of respondents.

Table 2: Respondents’ feedback responses.

Table 3: Association between level of education and treatment options known.

Table 4: Association between level of education and known names of eye drops.

Table 5: Likelihood ratios table assessing knowledge of disease by educational attainment.

Table 6: Bivariate analysis assessing likelihood of knowledge with educational attainment.