Publication:

A Study on Challenges and Attitudes towards Implementing Primary Eye Care Services among Optometrists in Malaysian Private Sector

ABSTRACT Optometrists are qualified to carry out the primary eye care (PEC) examination; however, their roles are still under-utilized and mainly limited to refractive services. It is the first study conducted in the Malaysian and Asian regions to explore the perceived challenges of optometrists in the private sector in implementing PEC examinations. This research is a mixed- methods with an exploratory sequential design. It contains three phases: phase 1 is qualitative interviews, phase 2 consists of the development and validation of the questionnaire, and the last phase is the administration and analysis of the questionnaire. The inclusion criteria were optometrists working in private retail with at least a year of experience. Phase 1: This phase aimed to explore the challenges and attitudes towards implementing PEC services among optometrists in Malaysian private sector. In-depth interviews were conducted using purposive sampling among 15 respondents. The interview protocol was developed, and a pilot study was conducted before the interviews. Data were transcribed and analyzed using thematic analysis. The main themes of the challenges are 'working environment,' 'support and recognition,' 'self-sufficiency,' and 'customer influence,' while the main themes of the attitudes are 'motivation' and 'sense of responsibility.' Phase 2: Phase 2 aims to develop and validate a questionnaire on the "Challenges and Attitudes to Practice PEC among Optometrists in Private Practice, Malaysia" (CAPEC). The qualitative study findings were utilised to design questionnaire items, which were then pre-tested, piloted, and validated using the content validity index (CVI) and exploratory factor analysis (EFA). The validated questionnaire consists of 34 items with four domains of challenges ('working environment,' 'support and recognition,' 'self-sufficiency,' and 'customer influence') and two domains of attitudes ('motivation' and 'sense of responsibility'). Phase 3: This phase aimed to assess the prevalence of the challenges and attitudes in implementing PEC and their associated factors among optometrists in the Malaysian private sector. A total of 291 optometrists participated in the survey using the Google Forms link distributed online. The data were analyzed using SPSS for both descriptive and inferential statistics. The findings showed that 'support and recognition' recorded the highest mean of 3.57 (SD =0.53) among the challenges domains. For attitudes, the optometrists in this study reported a high 'motivation' (mean=3.74, SD=0.48) and 'sense of responsibility' (mean= 4.58, SD=0.42). Factorial MANOVA singled out 'support and recognition' as the only challenge significant (p=0.003), with the owners of the private practice felt significantly more challenged (p=0.027) (EMM=3.72, 95% CI=3.58, 3.86) than staff (EMM=3.47, 95% CI=3.36, 3.47). The final equation of Multiple Linear Regression (MLR) showed a significant contribution from 'support and recognition' (p<0.001), 'self-sufficiency' (p<0.001), and 'customer influence' (p<0.001) towards the attitudes in implementing PEC. Conclusion: This study found that the highest challenges come from the lack of 'support and recognition.' Nonetheless, the attitudes towards PEC remain high despite the challenges. Thus, it demonstrates that private sector optometrists are resilient and ready to incorporate PEC into their practices. It is recommended that the authorities galvanize all of the resources behind the profession to carry out PEC.