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The Impact of Psychosocial Factors on Adaptation & Quality of Life with Visual Impairment
[Thesis]. Manchester, UK: The University of Manchester; 2011.
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Abstract
Quality of life (QoL) questionnaires have been suggested as the most appropriate way to measure the effectiveness of low vision rehabilitation. However, several research studies have not been able to detect differences in effectiveness between rehabilitation strategies. The hypothesis of this study is that there are other factors, unrelated to vision, influencing the scores obtained in these questionnaires and masking the changes achieved by rehabilitation. The suggestion is that patients’ realistic acceptance of, and successful adaptation to, their visual loss is influenced by psychosocial factors such as; personality, religious beliefs, social support, general health (i.e. mental and physical), understanding of their eye condition, level of education, and financial status. Concurrently, a parallel study was conducted with children. As with the adult arm, the aim of the study was to understand whether quality of life, and social behaviour and relationships in children with a visual impairment were related to the vision loss, vision rehabilitation, or non-visual factors.Patients attending the Manchester Royal Eye Hospital low vision clinic between May 2009 and August 2010, were recruited: 448 patients between 18 and 96 years old, with best-corrected binocular visual acuity ≤6/18, and 62 children between 5 and 16 years old. Telephone delivery of previously validated questionnaires was used with adult patients and parents of child patients; face-to-face interviews were completed by children. Both studies showed how psychosocial factors were stronger determinants of quality of life in people with low vision, than traditional low vision rehabilitation using optical aids. In the case of adults, physical and mental health appeared to be major predictors of quality of life, adaptation to the vision loss and participation restriction. In the case of children, visual acuity at distance and near, contrast sensitivity (CS), age, and parents’ coping strategies appeared to determine quality of life and children behaviours. The final element of this work was a pilot study to attempt to address issues causing poor quality of life. Seventy-one participants who scored low in the Low Vision Quality of Life Questionnaire (LVQOL-25) (i.e. below 62.5) were given the opportunity to enrol for the Expert Patient Programme, which is a self-management programme aimed at adults with chronic health problems or disabilities. Only 2 participants expressed an interest in the programme, and none of them actually took part.