Barriers and enablers to low vision service delivery: a systematic review informed by the Theoretical Domains...

Understanding barriers and enablers to low vision service delivery, particularly through a theoretical lens, offers optometrists and other eyecare practitioners insights to improve access and outcomes in vision rehabilitation.

Vision impairment impacts daily functioning, quality of life, and social participation. Low vision rehabilitation services can enhance independence and well-being, yet few eyecare practitioners provide them, limiting access for those in need. This systematic review aimed to synthesise healthcare provider-perceived barriers and enablers to low vision service delivery across the world, using a theory-informed approach.

Five online databases were searched for empirical studies on barriers and enablers to low vision services. Pairs of reviewers independently screened studies against inclusion/exclusion criteria and assessed quality using the Mixed Methods Appraisal Tool. Data extracted included participant quotes, themes, statistical analyses, and author interpretations. A combined inductive-deductive analysis was conducted, guided by the Theoretical Domains Framework. The review was registered in PROSPERO (CRD42023439041).

This review included sixteen studies capturing perspectives from 2,918 low vision professionals. Common barriers included limited access to devices/services (reported in n = 14 studies), poor practitioner knowledge (n = 13), patient-related factors (n = 12), care process limitations (n = 11), and resource/workload issues (n = 11). Key enablers were enhancing practitioner knowledge/skills (n = 6) through education/training (n = 5) and improving the availability of devices and services (n = 5). These barriers and enablers were related to theoretical domains of environmental context/resources (n = 15), knowledge/skills (n = 14), and beliefs about consequences (n = 12). Improvement recommendations included practitioner training, patient awareness, improved service availability, and revised care models, which map to the intervention functions of education and training, environmental restructuring, enablement, persuasion, and incentivisation.

Low vision rehabilitation service delivery is influenced by practitioner capacity, motivation, and the surrounding social and practice environment. Addressing these influences through targeted, theory-based interventions that are tailored to the local context may enhance service delivery and ultimately improve patient access to rehabilitation.