FACTORS INFLUENCING CATARACT SURGERY UPTAKE AMONG ADULTS IN RURAL SETTINGS: A SYSTEMATIC REVIEW

Leading cause of avoidable blindness worldwide is cataract and strangely affects adults living in rural and underserved areas. Despite surgery for cataract being the safest and most affordable medical interventions, the uptake of surgery among diagnosed patients in rural communities remains low. The study meant to identify, analyze and synthesize evidences on the factors affecting uptake of cataract surgery among adult patients in rural areas. The review was anchored on the Socio-Ecological Model (SEM), which explains health-seeking behaviors as a result of interactions among individual, interpersonal, community, organizational and broader structural factors. The framework guided the synthesis of factors influencing cataract surgery uptake, including patients' knowledge and perceptions, family and social support, cultural beliefs, socioeconomic circumstances, geographical accessibility, transportation, availability and quality of eye-care services and health-system factors. A systematic search of published literature conducted using electronic databases including; PubMed, Scopus, Google Scholar and Web of Science for studies published the year 2007 to 2026. The review included quantitative, qualitative, and mixed-method studies that investigated determinants, barriers and facilitators of cataract surgery uptake among adults in rural populations. Relevant studies were screened based on predefined inclusion and exclusion criteria. The review found that uptake of cataract surgery in rural settings is influenced by multiple related factors. Common challenges identified across studies are; financial constraints, transportation difficulties, long distance to surgical facilities, lack of awareness about cataract and its treatment, fear of surgery, poor understanding importance of surgery, gender disparities, cultural beliefs and lack of family support. Health system related barriers included shortage of trained eye care personnel, limited outreach services, long waiting times and concerns about surgical quality and outcomes. The study concludes that the uptake of cataract surgery among adults in rural settings is affected by socio-economic, cultural, demographic and health-system factors. Addressing these barriers through affordable eye care services, strengthened outreach programs, improved accessibility, health education and community engagement is essential to improve cataract surgery uptake and reduce avoidable blindness in rural populations. Further research is recommended to evaluate context-specific interventions that can enhance utilization of cataract surgical services in underserved communities.