Psychological changes among working-age adults with acquired vision impairment: The need for psychological intervention?

Abstract

This study investigates the psychological impacts of acquiring a vision impairment during working-age phase of adulthood and the potential negative effect on participation in community activities were highlighted. Adopting a qualitative and interpretive phenomenological approach, eight semi-structured in-depth interviews were conducted with eight adult users of vision rehabilitation services. Three broad themes were identified: (1) reduced participation in education, employment, and community activities, (2) feelings of hopelessness and depression from vision loss, and (3) psychological adjustment to vision loss over time. Findings are discussed in the context of the international literature, and recommendations that may enhance the vision rehabilitation services are made.

Keywords

Adults Nigeria psychological changes psychological intervention qualitative vision impairment vision rehabilitation working age

Introduction

Living with good vision is an integral part of many important life experiences, such as, education, employment, and social interaction (Kuyk et al., 2008; Politzer, 2013; Stelmack, 2001). Therefore, losing the sense of sight is often most feared sensory loss (Baker & Winyard, 1998; De Leo et al., 1999). When vision loss occurs, it can negatively influence an individual’s psychological wellbeing and quality of life (Baker & Winyard, 1998; Karlson, 1998; Stephens, 2007; Thurston et al., 2010). Many researchers in various cultural and regional contexts have reported that the onset of vision impairment in adulthood has had a profound impact on an individual’s daily life and lifestyle (Boerner et al., 2006; Burmedi et al., 2002; Faye, 2000; McCabe et al., 2000; Mitchell & Bradley, 2006; West et al., 2002). This is evidenced in loss of or diminished functional ability (Bassey et al., 2019a); diminished social relationships (Bassey et al., 2019b; Evans et al., 2007; Wang & Boerner, 2008), psychological distress (Garnefski et al., 2010; Pinquart & Pfeiffer, 2011), mobility difficulties (Burmedi et al., 2002; Hassell et al., 2006), and social isolation and feelings of loneliness (Burmedi et al., 2002; Tuttle & Tuttle, 2004; Verstraten et al., 2005). Common daily vision-dependent tasks that an individual was able to undertake prior to the loss of or impairment of vision may, and often do, become challenging, difficult, and at times, completely impossible. These daily functional activities might include reading, dressing, eating, personal care, and activities of self-care, cooking, writing, movement from place to place, walking, cycling and driving, employment, and general individual independence (Faye, 2000; Gertrudis et al., 2012; Stelmack, 2001).

Nigeria is categorised among a range of low- and middle-income countries, in which 90% of the global estimated 285 million people with vision impairment reside (Pascolini & Mariotti, 2012). Empirical evidence suggests that 4.25 million adults in Nigeria of working age (between 18 and 64 years) are living with a vision impairment, and most impairments are acquired during this main phase of employment age range (Dineen et al., 2008; Kyari et al., 2009). With the aim of providing support for these individuals, the Nigerian government established vocational rehabilitation centres for people with vision impairment (Ajobiewe & Ayena, 2012). These centres were in different parts of the country and training people with vision impairment, including adults with acquired vision impairment within their working years in activities of daily living, self-care, communication skills, and vocational skills, such as typing, cane-work, tie and dye, leatherwork, farming, art, and decorations (Ajobiewe & Ayena, 2012). However, it appears vision rehabilitation practice in Nigeria is a lacking in support element that might be necessary to address the psychological distress experience by working-age adults with acquired vision impairment.

Acquiring a vision impairment or losing vision completely during one’s working years can be devastating (Bassey et al., 2019a; Nyman et al., 2010). Evidence suggests that acquired vision impairment can cause drastic life changes among working-age adults who have more impact than among older people no longer of working age (Boerner & Wang, 2010; Horowitz et al., 2005; Nyman et al., 2010). The occurrence of vision impairment while of working age is clearly untimely and non-normative (Boerner & Wang, 2012). It can interfere with an individual’s psychosocial functioning, social participation, and achievement of aspirational life goals that are common during the adult life stage, such as, developing a career, maintaining employability, and financially and socially supporting a family (Boerner, 2004; Nurmi, 1992; Popivker et al., 2010). Individuals of working age generally have multiple responsibilities and life goals (Boerner & Cimarolli, 2005; Popivker et al., 2010). These might include progressing or maintaining one’s career, having multiple family responsibilities, raising children, having children leave home, and preparing for one’s retirement (Popivker et al., 2010).

Achieving normative milestones while being of working age appears to be an essential motivational factor that contributes to overall health and wellbeing including psychological wellbeing (Boerner & Wang, 2010). Being unable to achieve or maintain these goals in life domains, such as participation in education, work, domestic/caring tasks, social relationships, and leisure activities can result in negative health impacts, including psychological and emotional stress and distress, and mental illness (Cimarolli et al., 2006; Crewe et al., 2011; Wong et al., 2009). For instance, studies have shown that employment is associated with reduced psychological distress, whereas unemployment is associated with increased psychological distress (Thomas et al., 2005). Thus, working-age adults with acquired vision impairment, whose life aspirations have been disrupted by the acquisition of vision impairment are likely to experience diminishment in overall wellbeing including psychological wellbeing (Nyman et al., 2012; Thurston et al., 2010; Tuttle & Tuttle, 2004).

Psychological changes and acquired vision impairment

International studies have reported that acquired vision impairment can cause psychological distress, such as depression, shock, anxiety, denial, grief, perceptions of unhappiness, shame, resentment, low self-esteem, inadequacy, self-derogation, and lack of hope (Burmedi et al., 2002; Chou, 2008; Crewe et al., 2011; Horowitz et al., 2005; Horowitz & Reinhardt, 2000; Karlsson, 1998; Nyman et al., 2012; Wong et al., 2009). It is believed that individuals who have lived with vision impairment from infancy (i.e., congenital vision impairment) might not experience the same level of psychological distress in comparison with individuals with later onset vision impairment; because they often do not have to adjust and transition to living with a new condition (Tuttle & Tuttle, 2004). Thus, the work of Horowitz and Reinhardt (2000); Karlson (1998); Pinquart and Pfeiffer (2011); and Wong et al. (2009) revealed that individuals with vision impairment reported diminished psychological wellbeing in comparison with individuals without a vision impairment because they are required to adjust to the new experience of living with a vision impairment. In addition, studies linking vision-specific psychological distress (e.g., depression) to acquired vision impairment, have also indicated that working-age adults are at higher risk of developing mental health problems than people who are faced with the problems of acquired vision impairment when they are older beyond working age (Boerner, 2004; Brennan & Cardinali, 2000; Popivker et al., 2010).

In the broader sense, the prevalence of depressive symptoms has been shown to be highest during the working-age phase of the life span and working-age adults with acquired vision impairment are no exception (Boerner, 2004; Boerner & Wang, 2010; Brennan & Cardinali, 2000), and it has been linked with more complications, such as suicidal thoughts and attempted suicide, and mortality (De Leo et al., 1999; Eskin et al., 2008). In view of these adverse psychological effects, there is an urgent need to identify interventions to optimise vision rehabilitation for working-age adults with acquired vision impairment in Nigeria.

Psychological interventions, vision rehabilitation, and social model of disability

Studies in other human services sectors have demonstrated the effectiveness of various forms of psychological intervention utilised as treatment for various psychological conditions, such as depression (Eskin et al., 2008). In recent literature, working-age adults with acquired vision impairment are emerging as a new population for whom psychological intervention appears warranted (Nyman et al., 2010; Ueda & Tsuda, 2013). However, few studies have emphasised the need for psychological intervention for individuals with vision impairment who might be experiencing vision-specific psychological distress (Dodds et al., 1994; Margrain et al., 2012; Needham & Ehmer, 1980; Rees, Xie, et al., 2013; van der Aa et al., 2015; van der Aa, Margrain, van Rens, Heymans, & van Nispen, 2016). Examples of such intervention include: grief strategy, which is based on the loss model (Dodds et al., 1993; Tuttle & Tuttle, 2004); individual cognitive therapy (Dodds et al., 1994; Ueda & Tsuda, 2013); and group counselling strategies (Ueda & Tsuda, 2013).

The value of psychological intervention is supported by the work of Ueda and Tsuda (2013) who demonstrated the valuable impact of psychological intervention, that is, individual cognitive therapy and group counselling among individuals with acquired vision impairment in Japan. They found that individuals with high psychological distress undertaking skills training in a vision rehabilitation setting, who participated in individual cognitive therapy and group counselling showed low levels of depression, tension–anxiety, and fatigue. These participants also showed significant increased acceptance of their vision impairment. In addition, studies have found that psychological intervention, such as self-management programmes, problem-solving treatment, and stepped-care treatment have been shown to alleviate depression among older adults with acquired vision impairment (van der Aa et al., 2015, 2016). Thus, it is shown that effective psychological intervention can significantly reduce depressive symptoms among working-age adults with acquired vision impairment.

The significance of focussing vision rehabilitation interventions towards addressing mental health problems among individuals with acquired vision impairment is increasingly becoming of great importance. In recent years, many recommendations have been made in the literature to focus vision rehabilitation intervention on the psychological responses of individuals with acquired vision impairment, to improve mental wellbeing in this cohort (Garnefski et al., 2010; van der Aa et al., 2015, 2016). Providing psychological intervention that might be deemed significant for this working-age adult with acquired vision impairment is consistent with the concept of social model of disability. This concept indicated that people are disabled by barriers in society and it focusses on the need of people with disabilities (Goering, 2015). In this regard, extending vision rehabilitation services to include support element targeted to address the psychological needs of these individuals can remove barriers and facilitate social participation. However, in Nigeria, research studies connecting psychological intervention to optimal vision rehabilitation services or how vision rehabilitation intervention can support individuals to maintain and/or enhance psychological wellbeing have not received a lot of attention, particularly among working-age adults with acquired vision impairment.

This article does not attempt to review and critique each of the psychological intervention strategies utilised for individuals with vision impairment. Rather, it seeks to provide extant perspectives for current vision rehabilitation practice in Nigeria to include psychological intervention strategies to address the psychological distress experienced among working-age adults with acquired vision impairment. In a separate investigation using the current dataset, researchers found evidence that the occurrence of vision impairment negatively influenced the psychological wellbeing of working-age adults with acquired vision impairment in Nigeria owing to the demonstrated significance of psychological interventions among individuals with vision impairment elsewhere in the literature. Researchers decided to demonstrate that vision rehabilitation practice can be optimised, if part of support services and intervention is focussed on addressing the psychological problems experienced by working-age adults living with acquired vision impairment in Nigeria.

Method

A qualitative methodology and an interpretative phenomenological approach were adopted for the study findings presented in this article. The interpretative phenomenological approach focusses on the meaning participants attributed to their personal experiences (Crotty, 1996; Flood, 2010). As Smith et al. (1999) note, the interpretive phenomenology approach aims to ‘explore in detail how participants are making sense of their personal and social world’ (p. 51). Hence, the aim was, therefore, not necessarily to create interpretations that might be generalisable to other populations, but rather to gain new perspectives and deeper insights into the specific Nigerian context and phenomena under investigation (Lopez & Willis, 2004).

Participants

Eight participants were selected from a pool of 70 adults living with vision impairment in Nigeria through the Nigeria Association of the Blind (NAB). All participants were members of the NAB, the umbrella organisation serving people living with vision impairment in Nigeria. A letter of permission was sent to the President of NAB and, upon gaining this permission, a letter of introduction was sent to the NAB which presented an overview of the research, highlighting the rationale for the study. NAB distributed the letter of introduction via email to adults with acquired vision impairment who had had vision rehabilitation training with the organisation. As a result, 13 potential participants contacted the researchers, via email, to indicate their willingness to participate in the study. Upon receipt of their email, each participant was contacted by the primary researcher, and potential participant eligibility determined during a screening telephone interview. A total of 11 participants met all recruitment criteria, and the consent form and participant information sheet were sent via email to them.

Purposive sampling was used to ensure an equal gender mix (four males and four females). Criteria for inclusion were that the participant should: be aged between 18 and 59 years (working age); have acquired vision impairment at the age of 18 years or later; and have an absence of other forms of disability. Eight participants aged between 24 and 54 years agreed to take part in this study (four males and four females) with an average age of 37 years. The participants all lived in urban areas in four of the six geopolitical regions of Nigeria. Four were married and lived with their spouses, and the remaining four had never been married and lived with their parents. As noted in NAB’s record and which was confirmed by each participant, seven were living with complete vision loss, and one was living with significant low vision. Of the eight participants, five acquired vision impairment from glaucoma, two from trauma, and one from retinitis pigmentosa.

Of the eight participants, one was a secondary school graduate, five had undergraduate degrees, and two were undertaking undergraduate studies. Three participants were employed by federal agencies, one was employed by a private agency, two were unemployed, and two were university students. The occupations of the participants included account officer, medical practitioner, education administrator, and vocational rehabilitation instructor.

All study procedures and materials were approved by the Flinders University Social and Behavioural Ethics Committee, and formal consent to participate was provided by participants. Data were collected via in-depth interviews. Interviews were conducted via telephone, lasted between 35 and 45 minutes and were audio recorded using a digital recorder. The interviews were semi-structured with the application of an interview protocol, enabling participants to talk about their experiences of living with vision impairment. The interview protocol was formulated by the researchers using concepts derived from the research literature around vision impairment and vision rehabilitation interventions. Probes were used to prompt additional detail and clarify meaning, as required. The interviews focussed on experience of living with a vision impairment, use of vision rehabilitation services, and whether the service was targeted to address psychological distress. Transcripts were de-identified to maintain confidentiality, access to transcripts was limited to the research team, and member checking was adopted to validate data. Quotes from participants are referred to in this article by pseudonym.

Data analysis

Audio data from the interview were transcribed verbatim into text. Manual thematic analysis began with the first interview and proceeded concurrently with data collection. Initially, interview transcripts were read to obtain a general understanding of each personal story, then transcripts were compared with identify similarities and differences in experiences and practices (Creswell, 2013, 2014; Punch & Oancea, 2014). Preliminary analysis of the interviews identified major themes and variations within the participants’ stories that described their experiences of living with a vision impairment. As the data were synthesised, themes that represented the experience of living with a vision impairment and corresponded to the implications of acquiring a vision impairment were identified deductively. Data were organised or reduced into themes by identifying words or phrases that best described the common experiences of participants. Illustrative quotes were arranged under codes and, finally, sub-themes were grouped to form three broad themes that are discussed in the next section of the current article. Although only one of the research team (E.B.) collected the data, each member of the research team independently analysed transcripts in the initial stages of data analysis to identify, discuss, and reach agreement on themes.

Results

During the initial data analysis, nine key themes were identified. Owing to the frequency at which themes were mentioned, three overarching themes were developed from participants’ accounts, which reflected their experiences of living with a vision impairment and of receiving vision rehabilitation intervention in Nigeria. These were as follows: (1) reduced participation in education, employment, and community activities, (2) feelings of hopelessness and depression from vision loss, and (3) psychological adjustment to vision loss over time.

Theme 1: reduced participation in education, employment, and community activities

For all participants, the occurrence of a vision impairment negatively impacted on their ability to function in various life domains and this disrupted their life goals and aspirations in domains, such as education, vocation, or employment, as well as their mobility and activities of daily living. Mr A’s goal was to complete his university education, but when he could no longer read and write due to acquired vision impairment, his hope of completing his education was gone.

Similarly, Miss B reported:

Everything was crumbling before me, my academics was seriously affected, and my career was gone.

Dr C highlighted the impact of acquired vision impairment on his medical career:

I can’t read. In fact, at work, when they bring lab result, I will want to write it down; it was difficult for me, and patient will be complaining. I can’t even see what I am putting down.

Mr G also noted: ‘I couldn’t do those things that I love to do, and I couldn’t read. Ah! I couldn’t read my books, my favourite books, I couldn’t read them. I couldn’t do the other things I liked doing, like sporting activities’.

Mrs D also found her vocational performance was significantly impacted by her vision loss as she could no longer use the computer at her work place:

When I was returning to work . . . I then realised I really couldn’t function the way I had done normally . . . I couldn’t use the computer anymore, I will spend so much time on the computer and achieve little.

Therefore, for these participants, the functional limitations resulting from the acquisition of a vision impairment negatively impacted on their participation in education and decreased their productivity and capacity to contribute in their workplaces. For other participants, the decrement of functional abilities negatively influenced their participation in community activities. For example, Dr C reported that he had to relinquish his leadership position in his church due to the acquisition of a vision impairment:

I took some leadership role in the church. I dropped most of them because then I discovered that my vision is no longer strong. I can’t read the Bible, so I can’t do the readings in church.

Therefore, Dr C’s vision loss impacted on his ability to participate in his church community and resulted in the loss of social standing as a church leader.

Living with a vision impairment also had a significant impact on the mobility of participants. Dr C noted:

I could move around by myself in the past. But nowadays, at times I must depend on people to take me to some places, because the retinitis pigmentosa was affecting my night vision, and now that it is affecting my day vision I now I have to depend on people occasionally to go to places.

Miss B also noted her loss of independence due to diminished mobility:

I asked myself, is it that I will go to the street and someone will be leading me because I can’t move on my own?

Being able to move around independently was a major concern for participants, with each reporting that the acquisition of a vision impairment resulted in mobility difficulties. Overall, the acquisition of a vision impairment was associated with reduced participation in education and vocational opportunities as well as reduced community participation for the cohort studied.

Each of the participants in the study experienced varying degrees of functional limitation as a result of acquiring a vision impairment in adulthood. However, some of these limitations were addressed through participation in vision rehabilitation services. Mrs D related the positive benefits of computer training with assistive technology (a screen reader), which improved her functional capacity and independence at work: ‘It’s the only way I’m able to function now. Without it, I wouldn’t be able to do a thing’.

For Mrs D, participation in the vision rehabilitation programme supported her to regain function and re-establish herself in economic participation activities.

Theme 2: feelings of hopelessness and depression from vision loss

The impact of living with a vision impairment caused participants in the study to perceive that achievement of their life goals were now impossible. Participants described their initial reactions to vision loss as traumatic: ‘I was hopeless’; ‘I was devastated’; ‘I didn’t know what to do’; ‘Everything crumbled before me’; and ‘I was depressed and attempted suicide’.

Miss B recalled her conversations with her mother when she acquired a vision impairment:

I even told my mother that it [would be] better for me not to be in this world. Where will I start from? Where will I go, or what will I do? I was confused but my mother kept advising me that I shouldn’t talk like that, I should not think of it. There is no single day that I did not cry.

In a similar way, Mr A recalled his concerns about achieving his educational goals in the face of his vision loss:

After my vision loss, there is nothing I could do because my ambition and everything was focused on my education. As a human being, I was hopeless, and I was thinking that it’s all over.

Mr E noted that he was devastated, hopeless and was in shock when the doctor told him he cannot see again. He noted:

There was that shock, just thinking of my family and other responsibilities I had already carried and would have to keep carrying. I thought of myself as now I’m going to live a completely new life, finding myself in this new world, a world of visual impairment and how I’m going to go about it. I also knew that it was going to affect my job greatly, perhaps even losing it entirely. And with all those things going through my mind there was that shock. I was devastated and hopeless.

Another participant, Mrs D noted:

. . . after I lost my sight I could not go close to anybody because I was shy. And I couldn’t relate with people because I felt really bad and I was down . . . infact I was gone, and I felt I wasn’t going to make it in life again.

Miss B was so traumatised by the occurrence of vision impairment that she attempted suicide:

I was devastated, I couldn’t believe that it was me that couldn’t see anymore, I didn’t believe that I will be led as one that is blind. Everything was crumbling before me, my academics was seriously affected, and I also attempted suicide twice. I saw no reason to live, and I didn’t know how to handle it, so I attempted suicide.

The statements from these participants highlight the impact on their mental health and psychological wellbeing and experience of increased vision-specific psychological distress. This is evident by the expressed feelings of hopelessness, high levels of depression, and reported suicide attempt.

Theme 3: psychological adjustment to vision loss over time

Psychological responses varied even among participants who had lost their vision due to degenerative conditions, such as glaucoma. So, regardless of a diagnosis of the same or similar form of impairment, each individual expressed a unique experience. While some were devastated and even suicidal, others felt psychologically prepared for the loss over time having previously observed the impact of glaucoma on family members, as in the case of Mrs F who had been living with a significant low vision:

I have members of my family who have glaucoma to the extent where a lot of them actually have no vision at all, so I knew what the disease was capable of doing, and I’ve also seen them overcome that challenge in various ways. So, I knew that I had this situation . . . that needs to be managed.

Similarly, Dr C noted his gradual adjustment as he gradually lost vision and, therefore, had a more measured psychological response to his vision loss:

It was something that started at my young age; it was not something that started suddenly. So, it was part of me, and I got used to it. Because of that it’s like I was part of it. I think my reaction was normal.

For some participants, their religious faith helped them cope with their changed circumstances. For example, Mr G frames his vision loss as divine intervention and God’s will:

I felt bad because I couldn’t do those things that I love to do but I still believe that I will get my sight back so when this thing happened, I said to myself that God was in control . . . I believe in the healing power of God, and I believe that I will get my sight back . . . maybe I didn’t do what I’m supposed to do, maybe God wants to restrict me from doing what I’m not supposed to do or maybe [my vision loss] is a way to refine me.

Similarly, Miss H noted:

I think it did not take me a long time to readjust and find myself in a proper balance. For me, may be my personal and Christian orientation gave me the balance, also to know that while in this world you have a greater helper. Having said so, 6 I pin my hope on that and trying to encourage myself, like the bible said that David encourage himself in the Lord.

This current investigation suggests that the psychological consequences of acquiring a vision impairment can be devastating and but that the degree of psychological response positive or negative varied among the study participants. This seems to be attributed to individual differences in previous experience of vision impairments as well as the rate of onset of vision loss, religious faith, and family experiences. Those reporting a sudden onset of vision loss expressed less satisfactory adjustment and transition to living with vision impairment.

Discussion

The study presented in this article examined the impacts of acquired vision impairment on a group of working-age adults in Nigeria. For all participants, psychological wellbeing was negatively impacted following the occurrence of a vision impairment. The psychological responses identified in this study align with findings from previous studies, that the occurrence of a vision impairment during the working-age phase of adulthood can disrupt an individual’s life aspirations, which can result in depression, shock, anxiety, denial, grief, perceptions of unhappiness, shame, resentment, low self-esteem, inadequacy, and lack of hope (Chou, 2008; Crewe et al., 2011; Dodds et al., 1993, 1994; Hinds et al., 2003; Horowitz, 2003; Horowitz et al., 2005; Karlsson, 1998; Nyman et al., 2010, 2012; Stephens, 2007; Wong et al., 2009). Evidence gathered in this current study indicates that acquiring a vision impairment later in life, in these cases, in the working-age phase of adulthood, is associated with increased levels of depression, suicidal thoughts, and contemplation, and even attempted suicide.

In addition, the findings of this study indicate decreased functional ability following the occurrence of a vision impairment and a resultant impact on participants’ mobility and daily living activities as identified elsewhere in the international literature (Burmedi et al., 2002; Crews & Luxton, 1992; Evans et al., 2007; Faye, 2000; McCabe et al., 2000; Mitchell & Bradley, 2006; Vu et al., 2005; West et al., 2002). These functional limitations in turn can lead to reduced participation in educational and vocational opportunities as well as community participation, further contributing to social isolation and reduced economic participation which can compound negative psychological impact.

Despite psychological and functional implications due to acquired vision impairment, the findings also demonstrate that some working-age adults living with acquired vision impairment in Nigeria can regain psychological stability and adjust to their loss over time. For these participants, previous experience of a family member with vision impairment, religious belief, and gradual progression of their vision impairment appears to foster a positive psychological state, that is, preparedness for the actual vision loss. This finding is consistent with the grief work, which indicates that the individual with a vision impairment might cope or adjust to the new condition over time (Dodds et al., 1993, 1994; Tuttle & Tuttle, 2004). This is as well in line with the concept of loss model which also indicates that previous experience can facilitate acceptance of the vision impairment (Tuttle & Tuttle, 2004).

In addition, these participants regained functional skills through participation in vision rehabilitation intervention. This finding is consistent with the concept and aims of vision rehabilitation services, that is, to facilitate and support people in acquiring compensatory skills to enable them to be productive and self-reliant (Crews & Luxton, 1992; Luxton et al., 1997). Some of the specific positive elements of vision rehabilitation intervention included basic life skills in specific areas, such as home management, activities of daily living, assistive computer technology, and orientation and mobility (Bassey et al., 2019a; Boerner & Cimarolli, 2005).

Therefore, the authors’ findings demonstrate the significance of optimising vision rehabilitation services in Nigeria to address psychological changes in working-age adults with acquired vision impairment. It is suggested that the application of psychological interventions, such as individual cognitive therapy that have been applied elsewhere in vision rehabilitation settings might be beneficial for working-age adults with acquired vision impairment who may appear to have high levels of depression following vision loss. Furthermore, the researchers’ findings in the study here under consideration, demonstrated the importance of vision rehabilitation intervention in supporting working-age adults with acquired vision impairment to regain functions in various life domains, such as education, employment, and activities of daily living.

The authors, therefore, suggest that vision rehabilitation services in Nigeria may benefit from the addition of a ‘psychological intervention’ component to specifically support clients in maintaining and/or improving their psychological wellbeing, which might have been significantly negatively influenced by the occurrence of a vision impairment (Dodds et al., 1993, 1994; Rees, Mellor, et al., 2013; Ueda & Tsuda, 2013; van der Aa et al., 2015, 2016). Any such intervention should be tailored to the individual psychological and lifestyle goals and aspirations of each client. Such interventions, as demonstrated by Ueda and Tsuda (2013), will be targeted to address the negative psychological impacts arising in the individual from experiencing vision impairment, and to enhance psychological wellbeing that might facilitate acceptance/adaptation to vision impairment among working-age adults with acquired vision impairment in Nigeria. This ‘psychological intervention’, if provided as a support service in vision rehabilitation for working-age adults with acquired vision impairment, would focus on their unique needs and not on their condition, is in alignment with the social model of disability which highlight that the disability result from attitudinal (e.g., stereotyping, stigma, prejudice, and discrimination) and environmental (e.g., unemployment, low income, inaccessible education and community activities) barriers (Goering, 2015). Thus, an important aspect of societal contribution is assisting these individuals to overcome attitudinal and environmental barriers.

The study presented in this article was not without its limitations. Researchers acknowledge that there is potential for recall bias, given that for some participants it might have been close to 2 years post their rehabilitation programme, hence the ‘accuracy’ of their recollections may be called into question. In terms of reflexivity, because of the researchers’ experiences of working with people with disabilities, including the experience of one of the researchers working with people with vision impairment in Nigeria (E.B.), the authors sought to address concerns relating to bias and pre-conceptions in relation to the central phenomenon being studied. Thus, the process of ‘bracketing’ was adopted for this current study, whereby the researchers attempted to put aside pre-conceptions and assumptions about the phenomenon being studied and remained open to participants’ descriptions of their lived experiences and the effect of vision rehabilitation services (Tufford & Newman, 2012).

Conclusion

Acquiring a vision impairment in adulthood can result in functional limitations and psychological changes among working-age adults in Nigeria. These psychological changes include depression, anxiety, shock, shame, feelings of inadequacy, resentment, and lack of hope. Also experienced are functional limitations, such as difficulty to move around and diminished ability to undertake daily living tasks. These consequences can result in a reduced economically productive life and reduced opportunity for participation in education, the labour market and the community among working-age adults with acquired vision impairment in Nigeria. Experiences of reduced participation and engagement may be associated with reduced psychological wellbeing.

Even though the participants in the study under consideration viewed vision rehabilitation services as a support programme that had contributed to restoration of their functional ability, some participants still experienced high levels of depression and suicidal ideation. Therefore, it is suggested that vision rehabilitation services in Nigeria should be tailored to each individual’s psychological goals, beginning from the point of rehabilitative counselling, and the application of psychological intervention.

Expanding vision rehabilitation services in Nigeria to include psychological intervention could be reasonably expected to facilitate improved psychological wellbeing among the cohort and improved adaptation to the experience of living with working-age onset of vision impairment.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Emmanuel Bassey

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