Experiences of older adult Filipino-Americans surrounding eye surgery and factors in health decision-making: a qualitative study.

backgroundThe greater San Francisco metropolitan bay area is home to 270,000 Filipino immigrants and the second largest Filipino-American population in the United States. Despite this, Filipino-Americans are aggregated with the general "Asian-American" category, making it a challenge to obtain accurate population health data on social determinants of health. One area that is concerning is the lack of research on Filipino-American eye health experiences. The Filipino-American population is an older community with a median age of 48 years old that experiences a high prevalence of diabetes and hypertension. Preserving sight in high risk patients against age-related eye disease depends on routine eye examinations and timely treatment. Therefore, it is important to explore older adult Filipino-American eye surgery experiences and factors in eye health decision-making.

methodsAn exploratory qualitative study was conducted with thirteen Filipino-American adults residing in the nine San Francisco Bay Area counties who had a history of eye surgery (cataract, glaucoma, or retinal). Data were collected through semi-structured in-depth interviews. A thematic analysis was performed informed by critical race theory and PEN3 cultural model. Standard methods of coding followed by determination of themes were conducted and consensus was reached among the three coders.

resultsThe mean participant age was 73.3 years old (95% CI 69.7-76.9). All participants were born in the Philippines, and 85% identified as female. Four themes emerged: the value of social networks and self-efficacy in decision-making; the importance of informed communication; the integral role of trust and the physician-patient relationship; and the impact of cultural humility, beliefs, and concordance on ocular care. Communication with trusted peers, clinicians and clinical staff prior to surgery was a key factor in alleviating worries and misconceptions, yet interpreter services were inconsistently offered. Many saw clinicians as experts, which dampened their agency in asking questions or elicited shame in obtaining a professional second opinion.

conclusionsHow clinicians convey information is crucial. Filipino-Americans patients can interpret eye surgery expectations through a cultural lens, which may result in lasting impressions about the surgical experience and outcomes. Expanding cultural humility training and improved incorporating interpreter services can help patients feel supported.