Paradoxes in Eye Health Care in Low-Income Countries and Design Strategies for Mobile Health Technology to Overcome them

INTRODUCTION: Low income countries bear 90% of the burden of avoidable blindness. In particular, glaucoma is one of the major causes of visual impairment. Early detection is critical to avoid irreversible blindness due to this underdiagnosed disease. Mobile and connected technologies yield potential to support early detection. However, to realize this potential, they should be designed from a deep understanding of the needs of the local population, and the challenges unique to lowincome countries.

OBJECTIVES: To gain a contextualized understanding of eye health care needs, and the challenges and opportunities for designing mobile health solutions for screening of glaucoma.

METHODS: We conducted a qualitative user study at three different healthcare centres in Southwest Ethiopia, including semi-structured interviews with eight eye care health professionals and observations and informal interviews with 125 patients, at three different locations. Interview transcripts were analysed through inductive thematic analysis involving three iterations.

RESULTS: Seven themes were initially identified after two iterations. The themes provided insight into the organization of eye health care and highlighted the challenges faced by eye care professionals and patients. An additional of three themes were identified in the third iteration which were formulated as paradoxes (“Money is not an issue, yet there is no money for glaucoma”, “Shortage of eye health care, yet the work is repeated over and over”, “The willing but uncooperative patient tested by the willing but unexperienced nurse”).

CONCLUSION: Findings from this research bear the potential to inspire future designs of mobile health solutions targeting rural communities in Ethiopia and other LICs.