Postoperative cataract surgery satisfaction in a rural Kenyan clinic.

PURPOSE: To assess prospectively the factors influencing patient satisfaction following intracapsular cataract extraction (ICCE) surgery in a rural eye unit in Kenya.

SETTING

Nakuru Eye Unit, Rift Valley Provincial General Hospital, Nakuru, Kenya, and Johns Hopkins School of Public Health, Department of International Health, Baltimore, Maryland, USA.

METHODS

Starting in November 1992, 232 consecutive blind or visually impaired rural patients, over age 40, with simple senile cataract were offered free standard ICCE. Only 70% agreed to surgery. An interviewer-administered questionnaire and a brief interview were performed postoperatively on day 2, completing an extensive preoperative analysis that was part of the Kenya Rural Cataract Project. A satisfaction level indicator composed from the most important factors, applying a logistic regression model, is suggested as a predictive index for a patient to become a motivator in his or her community.

RESULTS

Most patients were happy with their decision to have cataract surgery, even though 92% of the operations were done by clinical officers. Patients were overwhelmingly willing to have their fellow eye operated on or to recommend the operation to another "blind" friend (83.4%). The proposed model correctly classified 87.1% of operated patients, with high sensitivity (88.2%) and specificity (81.5%).

CONCLUSIONS

Cultural differences are paramount in determining health behavior priorities and satisfaction. The post ICCE satisfaction in developing countries must be better evaluated to achieve higher self-referral of cataract-blind patients for surgery in Africa. Hospital conditions, although appreciated, did not play a major role in patients' satisfaction. The immediate surgical outcome was the key factor.