Study design: community-based and cross-sectional descriptive study.

Methods: We conducted a community-based cataract screening from 24 towns in Pucheng county, Shaanxi province, northwest of mainland China. Those identified with operable cataract were informed to attend to the hospital for the low price surgeries (240 RMB) after being given a detailed explanation of their eye problems and the procedure of the surgery. After two months of the screening, the cataract patients not present in the local hospital were interviewed with a structured questionnaire to determine the reasons for poor uptake of cataract surgery. A previously validated questionnaire was designed to determine the main reason for potential barriers to uptake of cataract surgery in each of the following five areas: knowledge (K) of cataract and its treatment; perception of the quality (Q) of local services; the subject’s access to transportation (T); the family support including escort and time available(F); direct and indirect surgery costs (C); and detailing subjects’ willingness to pay for surgery.

Results: Interviews were completed on 74.8% (323 subjects) of the 432 eligible subjects who were not present in the local hospital during the screening outreach. The two major barriers mentioned were “worry about the surgery outcomes or the quality (Q) of local services”(27.8%) and ``no family support including no one to accompany or no time (26.2%) for the surgery respectively . Knowledge (K) of cataract and its treatment (23.6%) was the third barriers. Of this knowledge section, ``Need not felt due to ``one eye operated or one eye’s good vision (65.9%) and “believes it to be destiny for old age”(25.9% ) were very common although the local doctors gave a detailed explanation during the previous screening outreach. As expected, ocular comorbidities (8.0%) and ill health or other contraindications to surgery due to old age (6.2%) were also given as barriers. Only 5.6% patients thought that the cost (240 RMB) was still too expensive to afford. ``No convenient transportation (T) services(0.3%) was  less frequently indicated as barriers, against the expected trend.

 Conclusion: Lack of family support such as escort and available time, concerns about the quality of local services, and lack of knowledge about cataract appear to be the principal barriers to cataract surgery after the implementation of free screening and low-price high quality surgery in rural China.