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ORIGINAL ARTICLE
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A study on the perception, knowledge, attitude, and practices of eye donation among fresh medical graduates in India


 Department of Ophthalmology, KVG Medical College and Hospital, Sullia, Karnataka, India

Date of Submission24-Jul-2021
Date of Decision04-Sep-2021
Date of Acceptance20-Nov-2021
Date of Web Publication16-Sep-2022

Correspondence Address:
Mahesh Babu,
Quarter No. B-26, KVG Doctors' Apartment, Kurunjibhag, Sullia - 574 327, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ojo.ojo_225_21

   Abstract 


OBJECTIVE: The objective of the study was to assess the perception, knowledge, attitude, and practices of eye donation among fresh medical graduates in India.
MATERIALS AND METHODS: Responses to a semi-structured questionnaire were collected from 410 respondents using an online Google Form which were analyzed using IBM SPSS software version 21.
RESULTS: First information source about eye donation was textbooks (31%), while ophthalmologists accounted for 10.7%. Forty-two respondents had pledged their eyes, 116 were willing to pledge their eyes. Majority had “adequate” knowledge (74.1%). The knowledge levels were directly related to the practice of motivation for eye donation (P = 0.032). Around 62% had “poor” eye donation practices. Significant relationship between practice and knowledge levels (P = 0.004) was noted. Participants who graduated from institutions with eye banks were more likely to have good practice (P = 0.005).
CONCLUSIONS: A curriculum focusing on practical exposure to eye donation and eye banking services would address the current deficits in eye donation. Reinforcing knowledge of eye banking among non-ophthalmologist doctors can enhance the eye donation trend. Timely counseling of patients and bystanders by well-informed sensitized doctors is hence of utmost importance.

Keywords: Attitude, cornea transplant, eye bank, eye donation, medical graduates, organ donation



How to cite this URL:
Robert R, Abhilash B, Babu M, Sudhakar N A. A study on the perception, knowledge, attitude, and practices of eye donation among fresh medical graduates in India. Oman J Ophthalmol [Epub ahead of print] [cited 2022 Oct 5]. Available from: https://www.ojoonline.org/preprintarticle.asp?id=356255




   Introduction Top


Corneal blindness is the leading cause of blindness across the world, with Asia having a prevalence of 0.4%.[1],[2] According to Indian Statistics based on the National Blindness and Visual Impairment Survey (2015–2019), the overall prevalence of blindness was 0.36%; however, nontrachomatous corneal blindness accounted for 7.4% of the total blindness in the population aged ≥50 years and 37.5% in the population aged between 0 and 49 years.[3] Globally, there is a shortage of corneal graft tissue, with only one donor tissue available for 70 patients waiting for a graft.[4] This deficit in eye donation practices is directly related to the lack of knowledge and awareness of the potential donors and their families.[5]

Fresh medical graduates are invariably the primary point of contact with patients and their bystanders. Various studies conducted among students revealed a lack of awareness about eye donation and in those studies where the students were adequately informed, there was a huge disproportion between knowledge and willingness to donate eyes.[6],[7],[8],[9] A study among medical and paramedical staff showed a disparity between the eye donation awareness levels and willingness to pledge eyes.[10] A study on medical students' perception on eye donation showed that about 99.4% of students were aware that eyes can be donated after death but only 87.2% of participants were willing to donate eyes.[7]

With fresh medical graduates being a crucial part of rural health care in India, their attitude towards eye donation is imperative for both increasing willingness to donate the eyes and to educate the public about eye banking services. Extensive search of literature showed that no similar surveys have been done on fresh medical graduates regarding eye donation. This study hence aims to analyze the perception, knowledge, attitude, and practice of eye donation among fresh medical graduates in India.


   Materials and Methods Top


We conducted a cross-sectional study on the perception, knowledge, attitude, and practices about eye donation among 410 fresh medical graduates across India, who have completed compulsory rotatory residential internship not more than 6 months ago at the time of the study. The sample size was calculated using the formula , considering a 50% of the population to have good knowledge about eye banking, P = 50 and allowable error L = 5, the sample size calculated was 400. Convenience sampling method was used.

The study was conducted using a semi-structured questionnaire using a Google Form, which was circulated through online platforms, namely, WhatsApp, Facebook, and Telegram as a Google Form link in June 2021 after obtaining an Institutional Ethics Committee Clearance, and responses collected over a period of 2 weeks. The questionnaire was prepared in English, using questions based on eye donation literature. After an online informed consent, the participant was directed to the rest of the questionnaire. The questionnaire was pretested on five fresh medical graduates and after confirming that there were no ambiguities, data collection was done.[11]

The participants submitted their responses through Google Forms online. There were eight knowledge-based questions which were scored as “1” for correct and “0” for wrong response, with total score ranging from 0 to 8. The total knowledge scores were then categorized into “poor,” “adequate,” and “good” Knowledge levels using cutoff scores at 33rd and 66th percentiles. Attitude was assessed using five questions and practice using six questions with multiple answers. The responses were scored from 0 to 2 for each question based on the favorable answers and computed for total scores, the maximum being “11” for attitude and “7” for practice. The scores above and below the median scores were categorized into “good” and “poor” practice levels, and “positive” and “negative” attitude levels.

Data were entered into an Excel sheet and analyzed using IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Frequencies and percentages were used for descriptive statistics. Chisquare test and Fisher's exact test for univariate analysis were used for inferential statistics. P < 0.05 was taken as the level of statistical significance.


   Results Top


A total of 430 participants responded, of which only 422 gave consent and completed the questionnaire. After excluding missing values, 410 responses were analyzed. Among 410 fresh medical graduates from different states and union territories [Figure 1] across India, the mean age of respondents was 23.3 ± 1.356 years. Females accounted for 55.85% (229) (95% confidence interval [CI] [0.51,0.61]). Forty percent (164) (95% CI [0.35,0.44]) of the respondents graduated from institutions that had an associated eye bank, however, 106 (25.9%) (95% CI [0.21,0.30]) participants were unaware if the institutions had eye banks or not. Approximately 239 (58%) (95% CI (053, 0.63]) stated that keratoplasty/cornea services were available in their graduating institutions and 193 (47%) (95% CI [0.42,0.52]) respondents were unaware of the procedure to donate/pledge eyes.
Figure 1: State-wise distribution of respondents

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First source of information about eye donation was from textbooks (31%) (95% CI [0.26,0.35]), while ophthalmologists accounted for 10.7% (95% CI [0.077, 0.13]). The other sources are shown in [Figure 2]. However, high school was the first point of reception of information about eye donation in 72% (95% CI [0.68, 0.76]) [Figure 3].
Figure 2: First major source of information about eye donation

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Figure 3: Time of first information eye donation

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Among the respondents, 150 (36.5%) (95% CI [0.32, 0.41]) knew someone who had pledged/donated their eyes while 50 (12.2%) (95% CI [0.09, 0.16]) knew someone who had received a donor eye. Of the 410, 79 (19.3%) (95% CI [0.16, 0.23]) were enquired about eye donation by someone, out of which 19 (24.1%) (95% CI [0.16, 0.34]) were unable to adequately guide them. Forty-two respondents (10.23%) (95% CI [0.07, 0.14]) had already pledged their eyes, 116 (28.3%) (95% CI [0.24, 0.33]) were willing to pledge their eyes, whereas 42.2% (173) (95% CI [0.38, 0.47]) had not thought about pledging their eyes till now. The major motivation to pledge eyes [Table 1] was the thought of putting the body to good use after death. There were 56 (13.65%) (95% CI [0.11, 0.17]) respondents willing to donate/pledge eyes if they received more information, however, the rest were unwilling to pledge eyes citing the reasons as shown in [Table 2]. There was no significant relationship between knowledge and willingness to donate eyes.
Table 1: Major motivation to pledge eyes

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Table 2: Reasons for unwillingness to donate eyes

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Knowledge assessment regarding eye donation [Table 3] among fresh medical graduates revealed that 362 (88.3%) (95% CI [0.85, 0.91]) were aware that cornea was the part that had to be transplanted, whereas only 214 (52.2%) (95% CI [0.47, 0.57]) were aware that there was no cost for retrieving donor's eyes. The mean knowledge score was 4.24 ± 1.35 and median score was 4 (interquartile range [IQR] 3–5). Majority of them had “Adequate” knowledge (74.1%), 304 (95% CI [0.69,0.78]) while 73 (17.8%) (95% CI [0.14, 0.21]) had “Good” knowledge about eye donation, the rest grouped under “Poor” knowledge 33 (8.05%) (95% CI [0.05, 0.11]).
Table 3: Percentage of right answers for knowledge-based questions

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Mean attitude score was 4.86 ± 1.99 and median score of 5 (IQR 3–6). “Negative” attitude toward eye donation was observed in 277 (67.56%) (95% CI [0.63,0.72]). There was no statistically significant relationship between the presence of eye banks in graduating institutes and knowledge (P = 0.08) or attitude (P = 0.75). Awareness of the nearest eye banks/eye donation centers was seen in 140 (34.14%) (95% CI [0.29, 0.39]) and ophthalmologists were cited as the source of information in 30% (95% CI [0.25, 0.34]).

Six percent of the respondents were unwilling/unsupportive of a family member willing to pledge/donate eyes, although 74.6% (95% CI [0.70, 0.79]) were supportive. Information about eye donation and eye banking during MBBS training was opined to be adequate by 69 (16.8%) (95% CI [0.13, 0.20]) respondents, however, 340 (82.9%) (95% CI [0.79, 0.87]) participants opined for increased and more frequent classes/workshops/seminars regarding eye donation. Sixty-four participants were successful in motivating someone to pledge/donate eyes. Major reasons for failed attempts at motivation were “resistance to the idea of eye donation” (68.42%, 95% CI [0.64, 0.73]) and a “lack of complete information about eye donation” (31.5%, 95% CI [0.27, 0.36]). The knowledge levels were directly related to the practice of trying to motivate others for eye donation χ2 (2, N = 410) =6.89, P = 0.032.

Median practice score was 2 (IQR 2–3), 62.9% of them had “poor” practices with respect to eye donation. Significant relationship between practice and knowledge levels χ2 (2, N = 410) =10.96, P = 0.004 was noted. Participants who graduated from institutions with eye banks were more likely to have good practice levels, χ2 (1, N = 410) =7.898, P = 0.005.


   Discussion Top


Among 410 fresh medical graduates across India, textbooks were quoted as a primary source of information about eye donation followed by social media 21.3% and 14% through electronic media. Our study results contrasted with Singh et al. study results on the 1st year medical students, where television (N = 180, 77.8%) was claimed to be the most common source of information while Priyadarshini et al. observed publicity campaigns as the major source of awareness.[7],[12] Possible explanation for this would be the widespread prevalence of television advertisement campaigns on eye donation in the nineties and early 2000s. Three-fourths (72%) of respondents first received information about eye donation during high school. Access to eye donation literature has been gradually stepped up in most textbooks in the Indian high school curriculum which is a beneficial precursor in the long run.

Only 10.2% of the respondents had already pledged their eyes. In a study among nursing students, 7.7% had pledged their eyes and it was much lower in a study by Dandona et al. in the urban population.[13],[14] The willingness to pledge eyes was 28.3% in our current study. This was in stark contrast to the 1999 Kannan report, in which 83% of medical students were willing to donate eyes.[15] This declining trend over two decades needs attention and necessitates analysis. It must be assessed if the decline in willingness to pledge eyes is postinternship or if it is due to lesser emphasis on curriculum directed toward eye donation and eye banking services.

Major reasons for unwillingness to pledge eyes were religious beliefs, apprehension about the thought of eye removal, and delay of funeral. However, in a telephonic survey, Verble et al. observed a reluctance to donate eyes among 13% of participants because they were unaware of the potential donor's wishes, whereas some wished to be buried as whole (8%), while others had concerns about age and prior health status (7%) and while some families consented, there was a concern about delay in funeral.[5] The major incentive to pledge eyes were the idea of putting the body to good use after death followed by eye donation campaigns and motivation by health-care professionals while the major reason for unwillingness was religious beliefs. Hence, large-scale eye donation campaigns, education of patients regarding eye donation in daily practice by health-care professionals, and involvement of religious leaders in campaigns could improve donation rates.

In our study, students who graduated from institutions with eye banks were more likely to have better practices and more likely to motivate someone. Exposure to the needs and demands witnessed in the eye banks during their undergraduate training or during their internship could explain this.

Among the graduates, 47.7% of them were familiar with the procedure to donate/pledge eyes. In the survey by Zhao et al., the observation was that close to half of the respondents (47.2%) were interested in becoming eye donors, however, most of them were unaware of the procedure to donate eyes.[16] The lack of knowledge among medical graduates about the procedure to donate/pledge eyes could prove detrimental to the consent rates as they are the first point of contact with patients or bystanders who give consent for eye donation of deceased. A greater emphasis on the procedure and guidelines to pledge eyes in the undergraduate medical training and in internship could be particularly valuable currently. In a study by Tandon et al., the consent rate for eye donation by families was 44.3% among those aware of eye donation,[17] while Hulme et al. recorded a consent rate of 58% for organ donation,[18] while 60.5% of fresh medical graduates in our study were certain that family members could consent for eye donation of the deceased.

In our study, 26.43% cited social media as their source of information about the closest eye banks/eye donation centers. The social media “Facebook” effect of allowing its users to display their “organ donor” status on their profiles in the United States and being directed to organ donation registries saw a 21-fold increase in online registrations on day 1.[19] Social media and media campaigns can, hence, be a potential player in creating awareness among general public as well as medical professionals on online medical forums. A study on key opinion leaders promoting organ donation on social media opined that well-informed medical professionals can through their active participation in social media campaigns influence followers.[20] Non-ophthalmologists' contribution as a source of information about eye banks was low. However, family physician was the preferred source of information for seniors (47.8%) although youngsters preferred internet.[21] Hence, counseling and patient education by non-ophthalmologists and primary care physicians could be a game changer in improving the current eye donation statistics.

The presence of eye banks in graduating institutes was a major factor in good eye donation practices in our study. Greater exposure to the demands and shortage of corneas, the eye banking processes, and pledging procedures could be a major reason for better practices. Hence, having mandatory eye bank postings during MBBS and internship could improve eye donation practices among graduating doctors.

Limitations of the study include skewed representation from different states and small sample size. Further large-scale similar studies are essential to analyze and evaluate gaps in the eye donation and eye banking services.


   Conclusions Top


Majority of fresh medical graduates had just “adequate” knowledge on eye donation, however, the attitude and practice were lacking. Hence, curriculum focusing on practical exposure to eye donation and eye banking services would greatly address the current deficits. Reinforcing knowledge of eye banking and sensitizing primary health-care providers and other non-ophthalmologist doctors through seminars, workshops, and media campaigns can enhance the attitude and practices toward eye donation. Timely counseling of patients and bystanders by attending well-informed sensitized doctors is hence of utmost importance to improve eye donation activities.

Acknowledgment

We would like to thank Dr. Dinesh Peraje Vasu, Department of Preventive and Social Medicine, KVG Medical College and Hospital, for his support related to biostatistics.

Financial support and sponsorship

Nil.

Conflicts of interest

Nil.



 
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