{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:30:51Z","timestamp":1753893051813,"version":"3.41.2"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Eye care service utilization (ECSU) is vital for preventing and managing visual impairment, yet its uptake remains suboptimal in many low- and middle-income countries, including Ethiopia. Visual impairment imposes significant economic and social burdens, much of which is preventable with timely screening and treatment. Despite previous studies on ECSU, gaps remain in understanding individual- and community-level factors influencing its use in specific regions. This study aimed to determine the magnitude and associated factors of eye care service utilization (ECSU) among older adults in the Andabet District, Northwest Ethiopia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A community-based cross-sectional study was carried out among older adults from May 1\u201330, 2024 in Andabet District, Northwest Ethiopia. Multistage systematic random sampling was employed to reach 570 older adults. A multilevel mixed-effect logistic regression analysis was employed to assess both individual and community-level factors associated with ECSU. We fitted both random-effect and fixed-effect analysis. Finally, variables with <jats:italic>p<\/jats:italic> &amp;lt; 0.05 in the multivariable multilevel mixed-effect analysis were claimed to be significantly associated with ECSU.<\/jats:p><\/jats:sec><jats:sec><jats:title>Result<\/jats:title><jats:p>In this study, the good level of ECSU was found to be 16.14% (95% CI: 13.11, 19.16). In the multilevel mixed-effect logistic regression analysis, aged \u2265 65 years (AOR = 4.59; 95% CI: 1.38, 15.21), having health insurance (AOR = 1.98, 95% CI: 1.51, 2.58), living nearer to eye care facility (AOR = 6.42, 95% CI: 1.95, 21.15), and having awareness about regular eye checkups (AOR = 1.63; 95% CI: 2.88, 9.70) were significantly associated with good level of ECSU.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this study, the magnitude of eye care service utilization was lower than in other studies. Age, health insurance, distance from the eye care facility, and awareness were independent determinants of ECSU. Therefore, policymakers should prioritize accessible health insurance and expand eye care facilities, especially in rural areas. Integrating routine eye exams into primary care and launching widespread awareness campaigns can promote preventive eye health. A unified, multi-sectoral strategy focused on access, integration, and education is key to enhancing ECSU.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1536068","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T06:57:21Z","timestamp":1742885841000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Unveiling community-level factors: a multilevel mixed-effect analysis of eye care service utilization and associated factors in Andabet, Northwest Ethiopia"],"prefix":"10.3389","volume":"13","author":[{"given":"Zufan Alamrie","family":"Asmare","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sintayehu Simie","family":"Tsega","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tilaye Arega","family":"Moges","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Getachew Yitayew","family":"Tarekegn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dejen Gedamu","family":"Damtie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bayih Endalew","family":"Bitew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sisay Sitotaw","family":"Anberbr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beminate Lemma","family":"Seifu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fisseha Nigussie","family":"Dagnew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"B1","first-page":"1001","article-title":"Health care utilization","volume":"22","author":"Carrasquillo","year":"2013","journal-title":"Encycl Behav Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"204","DOI":"10.4314\/ejhd.v21i3.10050","article-title":"Prevalence and causes of blindness and low vision in Ethiopia","volume":"21","author":"Berhane","year":"2007","journal-title":"Ethiop J Health Dev."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1001\/jamaophthalmol.2019.1927","article-title":"Self-reported eye care use among US adults aged 50 to 80 years","volume":"137","author":"Ehrlich","year":"2019","journal-title":"JAMA Ophthalmol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1046\/j.1365-2788.2001.00348.x","article-title":"Visual impairment in adult people with intellectual disability: literature review","volume":"45","author":"Warburg","year":"2001","journal-title":"J Intellect Disabil Res."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2415-12-5","article-title":"Eye care utilization by older adults in low, middle, and high income countries","volume":"12","author":"Vela","year":"2012","journal-title":"BMC Ophthalmol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"306","DOI":"10.18502\/jovr.v18i3.13779","article-title":"Eye care utilization among older subjects with visual impairment in Northwest Ethiopia","volume":"18","author":"Assaye","year":"2023","journal-title":"J Ophthalmic Vis Res."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e082612","DOI":"10.1136\/bmjopen-2023-082612","article-title":"Level of eye healthcare utilisation and associated factors in Gamo and Gofa Zones, Southern Ethiopia: a community-based, cross-sectional study","volume":"14","author":"Alemu","year":"2024","journal-title":"BMJ Open."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1440357","DOI":"10.3389\/fpubh.2024.1440357","article-title":"Eye care service utilization and associated factors among adults in Debre Berhan Town, North Shewa, Ethiopia, 2023","volume":"12","author":"Bekele","year":"2024","journal-title":"Front Public Health."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e0231616","DOI":"10.1371\/journal.pone.0231616","article-title":"Eye care service utilization and associated factors among older adults in Hawassa city, South Ethiopia","volume":"15","author":"Morka","year":"2020","journal-title":"PLoS ONE."},{"key":"B10","doi-asserted-by":"publisher","first-page":"23","DOI":"10.3368\/aoj.60.1.23","article-title":"Evidence-based medicine: the value of vision screening","volume":"60","author":"Beauchamp","year":"2010","journal-title":"Am Orthopt J."},{"key":"B11","doi-asserted-by":"publisher","first-page":"101354","DOI":"10.1016\/j.eclinm.2022.101354","article-title":"The economics of vision impairment and its leading causes: a systematic review","volume":"46","author":"Marques","year":"2022","journal-title":"EClinicalMedicine"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1954","DOI":"10.1080\/13603116.2022.2036830","article-title":"Challenges inherent in the academic endeavours of students with visual impairment","volume":"28","author":"Vanderpuye","year":"2024","journal-title":"Int J Inclus Educ."},{"key":"B13","doi-asserted-by":"publisher","first-page":"P1","DOI":"10.1016\/j.ophtha.2020.10.024","article-title":"Comprehensive adult medical eye evaluation preferred practice pattern\u00ae","volume":"128","author":"Chuck","year":"2021","journal-title":"Ophthalmology."},{"key":"B14","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1097\/APO.0000000000000391","article-title":"Challenges in eye care in the Asia-Pacific region","volume":"10","author":"Yusufu","year":"2021","journal-title":"Asia Pac J Ophthalmol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"3916","DOI":"10.3390\/ijerph19073916","article-title":"Barriers to accessing eye health services in suburban communities in Nampula, Mozambique","volume":"19","author":"Sengo","year":"2022","journal-title":"Int J Environ Res Public Health."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e888","DOI":"10.1016\/S2214-109X(17)30293-0","article-title":"Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis","volume":"5","author":"Bourne","year":"2017","journal-title":"Lancet Glob Health."},{"key":"B17","doi-asserted-by":"publisher","first-page":"123","DOI":"10.9734\/OR\/2013\/5543","article-title":"Utilization of eye care services among Ghanaian elderly population: evidence from a peri-urban community","volume":"2","author":"Ocansey","year":"2013","journal-title":"Am Orthopt J."},{"key":"B18","doi-asserted-by":"publisher","first-page":"21237","DOI":"10.1038\/s41598-024-69921-3","article-title":"Health checkup practice and its associated factors among adults in South Gondar zone Ethiopia","volume":"14","author":"Yirga","year":"2024","journal-title":"Sci Rep."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1002\/asi.20448","article-title":"Telemedicine in sub-Saharan Africa: the case of teleophthalmology and eye care in Ethiopia","volume":"57","author":"Kifle","year":"2006","journal-title":"J Am Soc Inf Sci Technol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"58","DOI":"10.3390\/vision7030058","article-title":"An exploratory assessment of self-reported satisfaction with infrastructure and out-of-home activities for people with vision impairments","volume":"7","author":"Hamed","year":"2023","journal-title":"Vision."},{"key":"B21","doi-asserted-by":"publisher","first-page":"96","DOI":"10.4103\/0974-9233.164621","article-title":"Determinants of utilization of eye care services in a rural adult population of a developing country","volume":"23","author":"Olusanya","year":"2016","journal-title":"Middle East Afr J Ophthalmol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.jcjo.2014.11.014","article-title":"Socioeconomic factors associated with visual impairment and ophthalmic care utilization in patients with type II diabetes","volume":"50","author":"Hwang","year":"2015","journal-title":"Can J Ophthalmol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1097\/00005650-200006000-00005","article-title":"Demographic predictors of eye care utilization among women","volume":"38","author":"Schaumberg","year":"2000","journal-title":"Med Care."},{"key":"B24","first-page":"647","article-title":"Poor eye care service utilization among adults in Gondar City, Northwest Ethiopia","volume":"9","author":"Adimassu","year":"2018","journal-title":"EC Ophthal."},{"key":"B25","first-page":"4","article-title":"Access to and utilization of eye care services in Ghana","volume":"21","author":"Ilechie","year":"2013","journal-title":"PLoS ONE."},{"key":"B26","doi-asserted-by":"publisher","first-page":"64","DOI":"10.13140\/RG.2.2.24493.74724","article-title":"Barriers to accessing eye care services in the federal capital territory, Abuja, Nigeria","volume":"20","author":"Ibeneche","year":"2018","journal-title":"J Niger Optom Assoc."},{"key":"B27","doi-asserted-by":"publisher","first-page":"435606","DOI":"10.1155\/2015\/435606","article-title":"Inconsistencies exist in national estimates of eye care services utilization in the United States","volume":"2015","author":"Wilson","year":"2015","journal-title":"J Ophthalmol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1111\/ceo.13035","article-title":"Utilization of eye health-care services in Australia: the national eye health survey","volume":"46","author":"Foreman","year":"2018","journal-title":"Clin Experiment Ophthalmol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"e0308294","DOI":"10.1371\/journal.pone.0308294","article-title":"Barriers to the uptake of eye care services: a cross-sectional survey from rural and urban communities","volume":"19","author":"Owusu-Afriyie","year":"2024","journal-title":"PLoS ONE."},{"key":"B30","first-page":"2992","article-title":"A review of the determinants that influence the use of eye care servic","volume":"6","author":"Devi","year":"2022"},{"key":"B31","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1111\/j.1365-3156.2004.01205.x","article-title":"Indirect costs associated with accessing eye care services as a barrier to service use in Ethiopia","volume":"9","author":"Melese","year":"2004","journal-title":"Trop Med Int Health."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e114","DOI":"10.1016\/j.ophtha.2022.07.012","article-title":"Improving access to eye care: a systematic review of the literature","volume":"129","author":"Solomon","year":"2022","journal-title":"Ophthalmology."},{"key":"B33","doi-asserted-by":"publisher","first-page":"58","DOI":"10.3341\/kjo.2017.31.1.58","article-title":"Prevalence and factors associated with the use of eye care services in South Korea: Korea national health and nutrition examination survey 2010\u20132012","volume":"31","author":"Park","year":"2017","journal-title":"Korean J Ophthalmol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2415-6-4","article-title":"Eye care utilization patterns in Tehran population: a population based cross-sectional study","volume":"6","author":"Fotouhi","year":"2006","journal-title":"BMC Ophthalmol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.ajo.2017.01.018","article-title":"Self-reported use of eye care among adult Chinese Americans: the Chinese American eye study","volume":"176","author":"Jiang","year":"2017","journal-title":"Clin Exp Ophthalmol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1662","DOI":"10.1111\/j.1532-5415.2004.52458.x","article-title":"Hyperkyphotic posture predicts mortality in older community-dwelling men and women: a prospective study","volume":"52","author":"Kado","year":"2004","journal-title":"J Am Geriatr Soc."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1016\/j.ophtha.2012.12.030","article-title":"Attributes associated with eye care use in the United States: a meta-analysis","volume":"120","author":"Wagner","year":"2013","journal-title":"Ophthalmology."},{"key":"B38","doi-asserted-by":"publisher","first-page":"3371","DOI":"10.3390\/ijerph16183371","article-title":"Utilization of secondary eye care services in western Kenya","volume":"16","author":"Rono MMed","year":"2019","journal-title":"Clin Exp Ophthalmol"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1536068\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T06:57:31Z","timestamp":1742885851000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1536068\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,25]]},"references-count":38,"alternative-id":["10.3389\/fpubh.2025.1536068"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1536068","relation":{},"ISSN":["2296-2565"],"issn-type":[{"type":"electronic","value":"2296-2565"}],"subject":[],"published":{"date-parts":[[2025,3,25]]},"article-number":"1536068"}}