Stakeholder Perspectives on Enhancing Eye Health Behaviors Among Thai Older Persons: An Application of the PRECEDE Model.

introductionEye health is an increasing concern among older populations dwelling in the community. Promoting positive eye health behaviors is essential not only for maintaining vision but also for preventing avoidable blindness. Understanding the factors that influence these behaviors is crucial for developing effective and sustainable interventions.

objectivesThis descriptive qualitative study explored key stakeholders' perspectives on improving eye health behaviors among older persons in a Thai community, using the PRECEDE model as a framework. The findings offer insights into contextual factors that can guide the development of culturally appropriate and sustainable interventions.

methodsThis descriptive qualitative study was conducted using focus group discussions with 8 key stakeholders involved in primary eye care services. Participants were purposively selected to provide diverse perspectives on eye health behaviors including primary eye care services among older persons in the community. Data from the focus groups were audio-recorded, transcribed verbatim, and analyzed using thematic analysis to identify key factors influencing eye health practices. The reliability of the research instrument, based on the constructs of the PRECEDE model, was tested by calculating the Index of Item-Objective Congruence (IOC). To ensure trustworthiness, credibility was enhanced through prolonged engagement and member checking. Transferability was supported by clear descriptions of the context and participants. Dependability was addressed by maintaining an audit trail, and confirmability was ensured through reflexive journaling and peer discussions to reduce bias.

resultsAnalysis of the focus group discussions, guided by the PRECEDE model to identify administrative and policy factors and align interventions, revealed 4 key themes influencing eye health behaviors among older persons. These themes emerged from 4 main categories, which were derived from 10 main categories, 17 subcategories, and 26 corresponding codes: current policy, problems and obstacles, suggestions and needs, and resource management. The first theme emphasized primary eye care efforts, including vision screening for cataracts and glaucoma by ophthalmologists in cooperation with private hospitals. Cataract surgeries are funded by the National Health Security Office and state welfare, alongside a program providing prescription glasses to those aged 60 years and over. The second theme addressed financial barriers for older persons, who frequently pay for eye health beyond government support. Participants noted policy gaps and emphasized the need for careful planning and timely funding. Human resource issues, such as staff burnout and limited training of village health volunteers, were also identified as factors affecting service quality and screening accuracy. The third theme involved stakeholder engagement, where participants noted unclear roles limiting collaboration and emphasized the need for stronger social support. Despite these challenges, they highlighted the value of community engagement and proposed solutions such as eye health education for older persons, training village health volunteers in prevention and vision screening, and strengthening intersectoral collaboration. Finally, effective resource management was highlighted as essential to support the eye health promotion program, encompassing infrastructure, equipment, materials, and financial oversight.

conclusionThis study offers valuable insights into the factors influencing eye health behaviors among older persons in a Thai community, based on perspectives from key stakeholders. Guided by the PRECEDE model, it highlights the importance of health education, training, funding, service accessibility, and community collaboration. The findings underscore the need for community-based interventions that address both behavioral and environmental determinants. These insights can support the development of sustainable strategies to promote eye health and prevent avoidable blindness among community-dwelling older people. Future research should directly involve older persons and caregivers to enhance the depth and applicability of findings.