Barriers and Enablers to Seeking Eye Care Among the Adult Indian Population: A Systematic Review

India accounts for a substantial share of the global burden of vision impairment, with moderate to severe impairment especially common among adults over 50, women, and people without formal education. This study aims to identify modifiable barriers and enablers to accessing eye care services in India and to map these factors to the Theoretical Domains Framework (TDF), providing a theory-based understanding of the behaviours influencing service uptake and guiding effective behaviour change interventions.

A systematic review of MEDLINE Complete, CINAHL Complete, PsycINFO, and EMBASE identified studies reporting determinants of eye care-seeking in India. English-language studies published up to January 2025 were included. Data were analysed using a four-step approach: (1) data extraction, (2) deductive mapping to TDF domains, (3) inductive thematic synthesis and (4) identification of key domains based on frequency and elaboration. A total of 56 primary studies were included in the analysis. The six most important TDF domains were: Environmental Context and Resources, Social Influences, Beliefs about Capabilities, Knowledge, Emotion and Beliefs about Consequences. Commonly reported barriers included a 'lack of understanding about eye conditions', 'financial constraints', 'no one to accompany', 'family commitments', 'limited access to services' and 'able to manage with existing vision'. Enablers included 'free eye care services', 'positive experiences of others and 'perceived need for vision care. The most salient TDF domains were mapped onto the capability, opportunity, and motivation model of behaviour (COM-B) within the behaviour change wheel (BCW) to guide the design of interventions. This review identified six TDF domains influencing eye-care service uptake in India. By mapping these domains to appropriate intervention functions from the behaviour change wheel, the study offered a structured, evidence-based approach to designing behavioural interventions aimed at increasing the utilisation of eye care services.