{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T17:55:46Z","timestamp":1758045346439,"version":"3.44.0"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013885","name":"Kementerian Kesihatan Malaysia","doi-asserted-by":"publisher","award":["91000984"],"award-info":[{"award-number":["91000984"]}],"id":[{"id":"10.13039\/501100013885","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background\/Aims<\/jats:title>\n<jats:p>In 2014, Malaysia conducted National Eye Survey II (NES II) using the World Health Organization (WHO)-recommended Rapid Assessment of Avoidable Blindness (RAAB) methodology across six administrative regions. The survey revealed significant discrepancies in key national eye care indicators, including prevalence of blindness, cataract surgery outcome, and effective Cataract Surgical Coverage (eCSC). In response, the Ministry of Health (MOH) launched the <jats:italic><jats:italic>Klinik Katarak Kementerian Kesihatan Malaysia<\/jats:italic><\/jats:italic> (<jats:italic>KK-KKM<\/jats:italic>) initiative, which includes mobile cataract surgical services to improve equitable access in the underserved areas in Sarawak and the Eastern Region. Despite endorsement and consistent operational funds, variations in cataract surgery uptake between regions persisted. We postulate that this disparity could be due to community-related factors and their interactions. In 2023, follow-up surveys were conducted in both regions to compare outcomes over time. The eligible subjects were consecutively recruited for a questionnaire interview. This study aims to identify the factors influencing cataract surgery uptake in Malaysia, specifically in Sarawak and Eastern Region.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A cross-sectional survey was carried out in 2023 using RAAB methodology, targeting individuals aged 50 years and above. Subjects with operable cataract with Pinhole Visual Acuity worse than 6\/18, or a history of cataract surgery, were interviewed using the validated 22-item CatSurg-U questionnaire focused on Knowledge, Perception, Attitude and Practice. A total of 1,119 respondents (Sarawak: 408; Eastern 711) were recruited from 203 clusters. Binary logistic regression was used to identify demographic, socioeconomic and other predictors associated with non-uptake of cataract surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The identified factors that influenced individuals with unilateral operable cataracts to have \u201cno surgery\u201d in Sarawak included their \u201cperception to own sight\u201d [AOR: 0.67, 95% CI (0.53, 0.84) <jats:bold><jats:italic><jats:italic>P<\/jats:italic><\/jats:italic><\/jats:bold>\u2009=\u20090.001] and \u201cattitude towards treatment\u201d [AOR:1.47, 95% CI (1.17, 1.85) <jats:bold><jats:italic><jats:italic>P<\/jats:italic><\/jats:italic><\/jats:bold>\u2009=\u20090.001]. Meanwhile, in the Eastern region, the factors were \u201cperception to own sight\u201d [AOR: 0.80, 95% CI (0.69, 0.92) <jats:bold><jats:italic><jats:italic>P<\/jats:italic><\/jats:italic><\/jats:bold>\u2009=\u20090.002], \u201cattitude towards treatment\u201d [AOR:1.15, 95% CI (1.03, 1.29) <jats:bold><jats:italic><jats:italic>P<\/jats:italic><\/jats:italic><\/jats:bold>\u2009=\u20090.016], and \u201cpractice towards information\u201d [AOR: 1.23, 95% CI (1.01, 1.50) <jats:bold><jats:italic><jats:italic>P<\/jats:italic><\/jats:italic><\/jats:bold>\u2009=\u20090.042]. For subjects with bilateral operable cataract in Sarawak, the factors that influenced them to have \u201cno surgery\u201d were \u201cknowledge on surgery\u201d [AOR: 0.35, 95% CI (0.25, 0.50) <jats:bold><jats:italic><jats:italic>P<\/jats:italic><\/jats:italic><\/jats:bold>\u2009&lt;\u20090.001], \u201cperception to own sight\u201d [AOR: 1.48, 95% CI (1.15, 1.89) <jats:bold><jats:italic><jats:italic>P<\/jats:italic><\/jats:italic>\u2009<\/jats:bold> =\u20090.002], ethnicity (Chinese compared to Malays) [AOR: 0.19, 95% CI (0.04, 0.88) <jats:bold><jats:italic><jats:italic>P<\/jats:italic><\/jats:italic><\/jats:bold>\u2009=\u20090.033] and education level (primary school compared to secondary school or above) [AOR: 5.54, 95% CI (1.49, 20.69) <jats:bold><jats:italic><jats:italic>P<\/jats:italic><\/jats:italic>\u2009<\/jats:bold> =\u20090.011]. Additionally, for the Eastern region, the factors identified were \u201cknowledge on surgery\u201d [AOR: 0.35, 95% CI (0.26, 0.48) <jats:bold><jats:italic><jats:italic>P<\/jats:italic><\/jats:italic><\/jats:bold>\u2009&lt;\u20090.001] and \u201cpractice on surgery\u201d [AOR: 0.72, 95% CI (0.62, 0.84) <jats:bold><jats:italic><jats:italic>P<\/jats:italic><\/jats:italic><\/jats:bold>\u2009&lt;\u20090.001]. <\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>\u201cPerception to own sight\u201d, \u201cattitude towards treatment\u201d, and \u201cknowledge on surgery\u201d were key factors in both regions. Additional barriers in Sarawak include ethnicity and education levels, while in the Eastern Region, \u201cpractice towards information\u201d and \u201cpractice on surgery\u201d were key factors. Addressing these factors through targeted strategies such as enhancement of mobile outreach programs, public education, and service capacity expansion is essential. Collaborative efforts are needed to improve eye care delivery and ensure equitable access nationwide.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0319123","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T17:45:54Z","timestamp":1757699154000},"page":"e0319123","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Identifying the influencing factors for cataract surgery uptake in Malaysia"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8152-1198","authenticated-orcid":true,"given":"Mohamad Aziz","family":"Salowi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8308-5625","authenticated-orcid":true,"given":"Nyi Nyi","family":"Naing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ju Fan","family":"Tay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wan Radziah","family":"Wan Nawang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siti Nurhuda","family":"Sharudin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norasyikin","family":"Mustafa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nor Fariza","family":"Ngah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"pone.0319123.ref001","volume-title":"Sixty-sixth World Health Assembly: Resolutions and Decisions Annexes","author":"World Health Organization","year":"2013"},{"key":"pone.0319123.ref002","volume-title":"Universal eye health: a global action plan 2014-2019","author":"World Health Organization","year":"2013"},{"issue":"6","key":"pone.0319123.ref003","article-title":"Estimates of visual impairment and its causes from the National Eye Survey in Malaysia (NESII)","volume":"13","author":"FLM Chew","year":"2018","journal-title":"PLoS One"},{"key":"pone.0319123.ref004","volume-title":"Bringing high-impact, good-quality and low-cost eye care closer to home: A case study of Klinik Katarak-Kementerian Kesihatan Malaysia","year":"2023"},{"issue":"10","key":"pone.0319123.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0299768","article-title":"Prevalence of visual impairment and its causes in adults aged 50 years and older: Estimates from the National Eye Surveys in Malaysia","volume":"19","author":"MA Salowi","year":"2024","journal-title":"PLoS One"},{"issue":"1","key":"pone.0319123.ref006","article-title":"Changing trend of cataract blindness and visual outcomes after cataract surgery in adults aged 50 years and older: findings from the national eye surveys in Malaysia","volume":"9","author":"MA Salowi","year":"2024","journal-title":"BMJ Open Ophthalmol"},{"issue":"1","key":"pone.0319123.ref007","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1186\/s12889-025-21602-0","article-title":"Improvement in the effective cataract surgical coverage in Malaysia: evidence of impact from a mobile cataract outreach program","volume":"25","author":"MA Salowi","year":"2025","journal-title":"BMC Public Health"},{"key":"pone.0319123.ref008","unstructured":"Salowi MA, Mokhtar A, Anita N, Omar C, Rahmat J, Yen CL, et al. 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