# Factors Influencing Patient Preference for Surgical Intervention Versus Medical Therapy Among Cambodian Adults With Advanced Glaucoma: A Health Belief Model-Based Analysis

## TL;DR

This study explores why Cambodian adults with advanced glaucoma prefer surgery or medical treatment, using a psychological model to identify key influencing factors.

## Contribution

The study applies the Health Belief Model to understand treatment preferences for glaucoma in a low-resource setting like Cambodia.

## Key findings

- Only 28.13% of participants preferred surgical intervention over medical therapy.
- Perceived benefits, severity, and self-efficacy were strong predictors of surgical preference.
- Low perceived barriers and higher knowledge scores were associated with a preference for surgery.

## Abstract

Objectives

Glaucoma is the major cause of irreversible blindness globally and ranks as the sixth leading cause of avoidable blindness in Cambodia. Recent advancements in glaucoma treatment techniques have emerged; yet, patient treatment preferences, particularly within low-resource environments, remain poorly understood. We are using the Health Belief Model (HBM) to identify factors that influence the preference for surgical versus medical therapy in adults with advanced glaucoma in Cambodia.

Methods

A hospital-based cross-sectional study was conducted at Preah Ang Duong Hospital, Phnom Penh, Cambodia, between January and June 2024. A structured, validated questionnaire evaluated sociodemographic characteristics, clinical data, glaucoma awareness, and HBM constructs (susceptibility, severity, benefits, barriers, self-efficacy, and cues to action). Logistic regression was used to determine the independent factors of surgical preference.

Results

Among the 487 participants, merely 138 of them (28.13%) favored surgical intervention. Patients who chose surgery had fewer perceived barriers, stronger perceptions of severity, susceptibility, benefits, and self-efficacy, and considerably higher knowledge scores (p=0.048). Multivariable analysis indicated that perceived benefits (AOR=1.51; 95% CI: 1.16-1.94), perceived severity (AOR=1.71; 95% CI: 1.17-2.51), low perceived barriers (AOR=0.61; 95% CI: 0.49-0.77), and high self-efficacy (AOR=1.46; 95% CI: 1.11-1.93) were independent predictors of surgical preference.

Conclusion

Psychological and contextual factors significantly influence treatment decisions among Cambodian patients with advanced glaucoma in our clinical setting. Enhancing knowledge, addressing misconceptions about surgery, and improving access to glaucoma services may increase acceptance of surgical intervention, promote better disease management, and subsequently help prevent blindness in our community.