The Triple Burden: A Biopsychosocial Impact of Visual Impairment in South Africa
DOI:
https://doi.org/10.51137/wrp.ijarbm.659Keywords:
Visual Impairment, Biopsychosocial Model, Impact, South AfricaAbstract
Visual impairment has become a significant health concern, presenting challenges beyond mere sight loss. This study aimed to examine the impact of visual impairment in the Eastern Cape Province of South Africa through a biopsychosocial lens, considering the interconnected biological, psychological, and social dimensions. The research question that this paper addresses is: What are the biopsychosocial impacts of visual impairment on the lives of individuals in South Africa? A qualitative research methodology using the interpretivist research paradigm was employed. A sample of people with visual impairments participated in the study and shared their lived experiences. Semi-structured, one-on-one, in-depth interviews were conducted between June and December 2020. Data were analysed using thematic analysis. The concepts of visual impairment, social support, empowerment, and their application to the biopsychosocial model were reviewed. The results were categorised into themes: biological challenges, psychology, and the social impact of visual impairment. This approach is essential to promoting independence, well-being, and full societal participation for people with visual impairment. Applying the biopsychosocial model, this paper highlights the need for comprehensive interventions beyond medical treatment, including psychological support and inclusive social policy.
References
Abd Elsatar, E.l.,, Said Zair, A., Tawfik Ahmed, S., & Abdallah Mohamed Abdulmutalib, I. (2024). Biopsychosocial and Educational Needs of Patients with Glaucoma. Egyptian Journal of Health Care, 15(3), 1049-1060. https://doi.org/10.21608/ejhc.2024.383751
Adler, R. H. (2009). Engel's biopsychosocial model is still relevant today. Journal of psychosomatic research, 67(6), 607-611. https://doi.org/10.1016/j.jpsychores.2009.08.008
Akuffo, K. O., Sewpaul, R., Darrah, S., Dukhi, N., Kumah, D. B., Agyei-Manu, E., ... & Reddy, P. (2021). Vision loss, vision difficulty and psychological distress in South Africa: results from SANHANES-1. BMC psychology, 9(1), 66. https://doi.org/10.1186/s40359-021-00558-x
Bakker, K., Steultjens, E., & Price, L. (2019). The lived experiences of adults with a visual impairment who experience fatigue when performing daily activities. British Journal of Occupational Therapy, 82(8), 485-492. https://doi.org/10.1177/0308022619841491
Bhattacharyya, D. K. (2006). Research methodology. Excel Books India.
Binder, K. W., Wrzesińska, M. A., & Kocur, J. (2020). Anxiety in persons with visual impairment. Psychiatr Pol, 54(2), 279-288. https://doi.org/10.12740/pp/onlinefirst/85408
Bolton, D., & Gillett, G. (2019). The biopsychosocial model of health and disease: New philosophical and scientific developments Cham (CH): Palgrave Pivot. https://doi.org/10.1007/978-3-030-11899-0
Botha, M. (2021). Blindness, rehabilitation and identity: A critical investigation of discourses of rehabilitation in South African non-profit organisations for visually impaired persons. (Doctoral Thesis: University of Cape Town). http://hdl.handle.net/11427/33440
Botha, M., & Watermeyer, B. (2025). Discourses of blindness in visual impairment rehabilitation: An exploration of the ideological assumptions embedded in rehabilitation practice in South Africa. International Journal of Disability, Development and Education, 72(2), 307-320. http://dx.doi.org/10.1080/1034912x.2024.2355343
Calvès, A. E. (2009). Empowerment: The history of a key concept in contemporary development discourse. Revue Tiers Monde, 200(4), 735-749. https://doi.org/10.1177/10778012261422239
Chaudhuri, A. (2016). Understanding ‘empowerment’. Journal of Development Policy and Practice, 1(2), 121-141. https://doi.org/10.1177/2455133315612298
Chu, H. Y., & Chan, H. S. (2022). Loneliness and social support among the middle-aged and elderly people with visual impairment. International journal of environmental research and public health, 19(21), 14600. https://doi.org/10.3390/ijerph192114600
Cimarolli, V. R., & Boerner, K. (2005). Social support and well-being in visually impaired adults. Journal of Visual Impairment & Blindness, 99(9), 521-534. https://doi.org/10.1177/0145482X0509900904?urlappend=%3Futm_source%3Dresearchgate.net%26utm_medium%3Darticle
Frankel, R. M., Quill, T. E., & McDaniel, S. H. (Eds.). (2003). The biopsychosocial approach: Past, present, and future. University of Rochester Press. https://doi.org/10.1176/appi.ajp.162.7.1398
Gottlieb, B. H., & Bergen, A. E. (2010). Social support concepts and measures. Journal of psychosomatic research, 69(5), 511-520. https://doi.org/10.1016/j.jpsychores.2009.10.001
Jaganjac, A., Hadžiomerović, A. M., Katana, B., Trtak, N., Kaljić, E., Konjo, H., & Redžović, A. (2020). Daily activities of employed persons with visual impairment. Journal of Health Sciences, 10(2), 157-169. https://orcid.org/0000-0001-7349-5890
Ishtiaq, R., Chaudhary, M. H., Rana, M. A., & Jamil, A. R. (2016). Psychosocial implications of blindness and low vision in students of a school for children with blindness. Pakistan Journal of Medical Sciences, 32(2), 431. https://doi.org/10.12669/pjms.322.8737
Jones, N., Bartlett, H. E., & Cooke, R. (2019). An analysis of the impact of visual impairment on activities of daily living and vision-related quality of life in a visually impaired adult population. British Journal of Visual Impairment, 37(1), 50-63. https://doi.org/10.1177/0264619618814071?urlappend=%3Futm_source%3Dresearchgate.net%26utm_medium%3Darticle
Khorrami-Nejad, M., Sarabandi, A., Akbari, M. R., & Askarizadeh, F. (2016). The impact of visual impairment on quality of life. Medical hypothesis, discovery and innovation in ophthalmology, 5(3), 96-102. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347211/
Köberlein, J., Beifus, K., Schaffert, C., & Finger, R. P. (2013). The economic burden of visual impairment and blindness: a systematic review. BMJ open, 3(11), e003471. https://doi.org/10.1136/bmjopen-2013-003471
Lehman, B. J., David, D. M., & Gruber, J. A. (2017). Rethinking the biopsychosocial model of health: Understanding health as a dynamic system. Social and personality psychology compass, 11(8), e12328. https://doi.org/10.1111/spc3.12328?urlappend=%3Futm_source%3Dresearchgate.net%26utm_medium%3Darticle
Leissner, J., Coenen, M., Froehlich, S., Loyola, D., & Cieza, A. (2014). What explains health in persons with visual impairment? Health and quality of life outcomes, 12(1), 65. https://doi.org/10.1186/1477-7525-12-65
Maake, M. M., & Oduntan, O. A. (2015). Prevalence and causes of visual impairment in patients seen at Nkhensani Hospital Eye Clinic, South Africa. African Journal of Primary Health Care and Family Medicine, 7(1), 1-6. https://doi.org/10.4102/phcfm.v7i1.728
Manitsa, I., & Doikou, M. (2022). Social support for students with visual impairments in educational institutions: An integrative literature review. British Journal of Visual Impairment, 40(1), 29-47. https://doi.org/10.1177/0264619620941885?urlappend=%3Futm_source%3Dresearchgate.net%26utm_medium%3Darticle
McDowell, N. (2021). Power is knowledge: empowering parents of children with cerebral visual impairment. Disability & Society, 36(4), 596-617. https://doi.org/10.1080/09687599.2020.1751586
McKenzie, T., & Hanass-Hancock, J. (2017). People with disabilities and income-related social protection measures in South Africa: Where is the gap? African Journal of Disability, 6(1), 1-11. https://doi.org/10.4102/ajod.v6i0.300
Miles, E. (2020). Biopsychosocial model. In Encyclopedia of Behavioural Medicine (pp. 259-260). Cham: Springer International Publishing. https://pmc.ncbi.nlm.nih.gov/articles/PMC1466742/
Naipal, S., & Rampersad, N. (2018). A review of visual impairment. African Vision and Eye Health, 77(1), 1-4. https://doi.org/10.4102/aveh.v77i1.393
Osaba, M., Doro, J., Liberal, M., Lagunas, J., Kuo, I. C., & Reviglio, V. E. (2019). Relationship between legal blindness and depression. Medical Hypothesis, Discovery and Innovation in Ophthalmology, 8(4), 306. https://pmc.ncbi.nlm.nih.gov/articles/PMC6778679/
Papadopoulos, K., Papakonstantinou, D., Koutsoklenis, A., Koustriava, E., & Kouderi, V. (2015). Social support, social networks, and happiness of individuals with visual impairments. Rehabilitation Counseling Bulletin, 58(4), 240-249. https://doi.org/10.1177/0034355214535471?urlappend=%3Futm_source%3Dresearchgate.net%26utm_medium%3Darticle
Pinquart, M., & Pfeiffer, J. P. (2013). Perceived social support in adolescents with and without visual impairment. Research in Developmental Disabilities, 34(11), 4125-4133. https://doi.org/10.1016/j.ridd.2013.08.004
Rai, A., Constantinides, P., & Sarker, S. (2019). Next generation digital platforms: Toward human-AI hybrids. MIS quarterly, 43(1), iii-ix. https://misq.org/misq/downloads/
Retief, M., & Letšosa, R. (2018). Models of disability: A brief overview. HTS Teologiese Studies/Theological Studies, 74(1). https://doi.org/10.4102/hts.v74i1.4738
Riddle, C. A. (2020). Why do we not need a ‘stronger’social model of disability? Disability & Society, 35(9), 1509-1513. https://doi.org/10.1080/09687599.2020.1809349
Sabel, B. A., Wang, J., Cárdenas-Morales, L., Faiq, M., & Heim, C. (2018). Mental stress as consequence and cause of vision loss: the dawn of psychosomatic ophthalmology for preventive and personalised medicine. EPMA journal, 9(2), 133-160. https://doi.org/10.1007/s13167-018-0136-8
Silva, M. R. D., Nobre, M. I. R. D. S., Carvalho, K. M. D., & Montilha, R. D. C. I. (2014). Visual impairment, rehabilitation and international classification of functioning, disability and health. Revista Brasileira de Oftalmologia, 73(5), 291-301. https://dx.doi.org/10.5935/0034-7280.20140063
Steinman, B. A., & Vasunilashorn, S. (2011). Biological risk of older adults with visual impairments. The journal of nutrition, health & aging, 15(4), 296-302. https://doi.org/10.1007/s12603-010-0296-2
Stevelink, S. A., Malcolm, E. M., Gill, P. C., & Fear, N. T. (2015). The mental health of UK veterans with a combat-related or a non-combat-related visual impairment: does the cause of visual impairment matter? British journal of ophthalmology, 99(8), 1103-1108. https://doi.org/10.1136/bjophthalmol-2014-305986
Sri Takshara, K., & Bhuvaneswari, G. (2025). Empowering visually impaired individuals: The transformative roles of education, technology, and social connections in fostering resilience and well-being. British Journal of Visual Impairment, 02646196241310995. https://doi.org/10.1177/02646196241310995
Thakkar, H., & Anaikkutti, M. (2024). Empowering through inclusion: Challenges and solutions for
economic empowerment of visually impaired persons in the state of Gujarat. Available at SSRN 4992828. https://ssrn.com/abstract=4992828
Tambala-Kaliati, T., Adomako, E. B., & Frimpong-Manso, K. (2021). Living with albinism in an African community: Exploring the challenges of persons with albinism in Lilongwe District, Malawi. Heliyon, 7(5). https://doi.org/10.1016/j.heliyon.2021.e07034
Taylor, S. E. (2011). Social support: A review. The Oxford handbook of health psychology, 1, 189-214. https://doi.org/10.1093/oxfordhb/9780195342819.013.0009
Yekta, A., Hooshmand, E., Saatchi, M., Ostadimoghaddam, H., Asharlous, A., Taheri, A., & Khabazkhoob, M. (2022). Global prevalence and causes of visual impairment and blindness in children: a systematic review and meta-analysis. Journal of Current Ophthalmology, 34(1), 1-15. https://doi.org/10.4103/joco.joco_135_21
van Nispen RM, Virgili G, Hoeben M, Langelaan M, Klevering J, Keunen JE, van Rens GH. (2020) Low vision rehabilitation for better quality of life in visually impaired adults. Cochrane Database Syst Rev. 2020 Jan 27;1(1):CD006543. https://doi.org/10.1002/14651858.cd006543.pub2
Vervloed, M. P., Janssen, N., & Knoors, H. (2006). Visual rehabilitation of children with visual impairments. Journal of Developmental & Behavioral Pediatrics, 27(6), 493-506. https://doi.org/10.1097/00004703-200612000-00008
Watermeyer, B., Botha, M., Lourens, H., & Hunt, X. (2024). Visual impairment, inclusion and citizenship in South Africa. Annals of global health, 90(1), 28. https://doi.org/10.5334/aogh.4245
Watermeyer, B., & Botha, M. (2025). Disability, trauma, and the place of affect in identity: Examining performativity in visual impairment rehabilitation. Feminism & Psychology, 35(2), 138-154. https://doi.org/10.1177/09593535231200728
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