Factors Associated with the Spectacle Wear Compliance among Primary School Students with Refractive Error in Rural China

ABSTRACT

Purpose

To study the factors determining spectacle-wear compliance and reasons for non-wear among students in rural China.

Methods

This study was based on a spectacle intervention trial among 162 schools in rural China. Students with refractive errors were randomly assigned to either a free or voucher group to receive spectacles at baseline. Spectacle-wear compliance was assessed through an unannounced follow-up 7 months after spectacles were distributed. Students not wearing spectacles were also asked their reasons for non-wear. The collected data underwent descriptive, bivariate, and logistic regression analyses.

Results

A total of 1904 students received spectacles at baseline, 1826 (95.9%) of whom were present at the 7-month follow-up. Among those students, 41.7% wore their spectacles. There was no significant difference in compliance rates between the free and voucher groups. Predictors of wearing spectacles at follow-up included older age (Odds ratio = 1.56, 95% CI: 1.12–2.19), the severity of refractive error (3.68, 2.23–6.07), wearing spectacles before baseline (3.91, 2.53–6.04) and having friends who wore spectacles (1.87, 1.32–2.63). When students could see the blackboard from their seats (0.68, 0.51–0.89) and thought that wearing spectacles was bad looking (0.76, 0.57–1.00), they were reluctant to wear spectacles. The two main reasons for non-wear were the widespread perception that wearing spectacles would weaken eyesight (32.8%) and the inconvenience of wearing spectacles during activities (23.6%).

Conclusions

The main reason that accounts for the low compliance of spectacle wear was misconceptions around spectacle. School-based spectacle programs should consider enhancing the compliance rates to maximize the benefits of spectacle wear.

KEYWORDS:

• Spectacle-wear
• compliance
• refractive error
• rural China

This paper has not been published previously, and it is not under consideration for publication elsewhere. Its publication is approved by all authors. No conflict of interest was confirmed.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data sharing

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Role of the funding source

The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Contributors

KD, JQZ, HYG, YYZ, TLY, HW, DCW and YJS designed the study. KD, JQZ, HYG, YYZ, TLY and HW collected the data. KD, JQZ, HYG performed the statistical analyses. KD, JQZ and HYG drafted the manuscript. All authors interpreted the results, made critical revisions and provided intellectual content to the manuscript, approved the final version, and agree to be accountable for all aspects of this work. We would also like to acknowledge Matthew Boswell, Fei He, Wenting Liu and the great effort of 300 enumerators from the Center for Chinese Agricultural Policy at the Chinese Academy of Sciences; Renmin University of China; Northwest University; and Shaanxi Normal University. We give special thanks to the staff from Zhongshan Ophthalmic Center at Sun Yat-sen University for their invaluable guidance and advice.

Ethics approval

Ethical approval was provided by Stanford University Institutional Review Board (Registration number: ISRCTN03252665, registration site: http://isrctn.org) and Sun Yat-Sen University (Registration number: 2013MEKY018). Permission was received from the local Board of Education and the principals of all schools involved. The principles of the Declaration of Helsinki were followed throughout.

Data sharing statement

Data are available and can be accessed by contacting HYG.

Additional information

Funding

The authors are supported by the National Natural Science Foundation of China, grant number 71803107; the 111 Project, grant number B16031; Fundamental Research Funds For the Central Universities, grant number 2020TS085 and 18SZYB22.