A comparative study of urban and rural perspectives on eye donation in India: Discovering challenges and pathways to improvement

PURPOSE: To compare the association between sociodemographic factors and community views on eye donation in urban and rural Uttar Pradesh. METHODS: A sequential explanatory mixed-methods study was conducted among 150 adults (75 urban, 75 rural) recruited purposively from the catchment areas of one Urban Health Training Centre and one Rural Health Training Centre in Kanpur district, Uttar Pradesh. All participants completed a structured interviewer-administered questionnaire assessing awareness, myths, procedural knowledge, emotional barriers, and institutional distrust related to eye donation. Subsequently, 40 participants underwent in-depth interviews and 90 participated in 15 focus group discussions. Quantitative data were analyzed using adjusted binary logistic regression, while qualitative data underwent inductive thematic analysis. RESULTS: Rural participants had significantly lower educational attainment and socioeconomic status compared with urban participants ( P < 0.001). Four major themes emerged from qualitative analysis: awareness gaps, sociocultural myths, emotional/familial barriers, and systemic distrust. In adjusted logistic regression analysis, low educational status independently predicted myth endorsement (adjusted OR = 3.9, 95% CI: 2.2-6.8, P < 0.001), while rural residence predicted procedural knowledge gaps (adjusted OR = 3.5, 95% CI: 1.9-6.4, P < 0.001). Emotional barriers showed no significant association with measured sociodemographic factors. CONCLUSION: Tailored, locality-specific interventions are required. Rural areas need basic awareness campaigns, while urban areas require trust-building initiatives. Educational attainment emerged as a key modifier of donation attitudes.