Development and evaluation of an intervention to promote the use of eyeglasses among Romani families in Bulgaria

Objective

Uncorrected refractive error (i.e., lack of eyeglasses for the treatment of refractive error) is one of the leading causes of visual impairment in Eastern Europe. Limited information is available on how to promote the use of eyeglasses among Romani families in Bulgaria. In step 1, the objective was to obtain suggestions by Romani mothers on how to promote the use of eyeglasses among children. In step 2, the objective was to evaluate an intervention to promote the use of eyeglasses based on suggestions received during step 1.

Methods

During step 1, 5 focus groups with Romani mothers took place in one neighborhood in Bulgaria. During step 2, the intervention used a one-group pre-test, post-test design. Families received eye examinations. Those who needed eyeglasses chose attractive eyeglasses. Parents received education on how to encourage their children to wear eyeglasses.

Results

During step 1, 54 mothers participated. Mothers suggested that the whole family should receive eye examinations and eyeglasses. During step 2, of 33 family members, 14 did not have refractive errors and 19 did. Of the 19 family members with refractive error, none had eyeglasses at pre-test. Approximately 6 months following the end of the intervention, 11 of the 19 family members (57.9%) wore eyeglasses and the remaining 8 (42.1%) did not.

Conclusion

Romani family members needed eyeglasses but did not have any at pre-test of the intervention. Future interventions that offer education on the importance of eye examinations may increase receipt of eye examinations and adherence to wearing eyeglasses.

Teacher and school staff perspectives on their role in school-based vision programs

OBJECTIVE

School-based vision programs (SBVPs) are one approach to increase access to vision care by providing vision screenings, eye examinations, and eyeglasses directly in schools. Few studies report on the perspectives of teachers and staff, who are important stakeholders, on SBVPs. We examined teacher and staff perspectives on their involvement in SBVPs.

DESIGN

Qualitative study using focus groups.

PARTICIPANTS

Teachers and staff at Baltimore and Chicago public schools served by SBVPs between 2016 and 2018.

METHODS

We conducted 21 semistructured focus groups with 117 teachers and staff in 10 Baltimore and 11 Chicago public preK-12 schools that participated in SBVPs. Sessions were recorded, transcribed, and coded using inductive thematic analysis.

RESULTS

Participants identified 2 main themes regarding teacher and staff involvement in SBVPs: (i) program outreach, including using multiple communication modalities to engage parents, explaining program details to families, and helping with program consent form return and (ii) promoting vision health, including identifying vision problems in the classroom, encouraging eyeglasses wear, and supporting eyeglasses maintenance. Participants also discussed limitations in capacity to partake in these activities.

CONCLUSION

Teachers interact with parents and students throughout the SBVP process, undertaking important roles in outreach and health promotion to ensure uptake of SBVP services. SBVPs and other school-based health programs should explore strategies to support teachers in the roles they fill to optimize program impact.

An Intervention to Promote Adherence to Glasses Wearing Among Urban Public Elementary School Students: Associations With Classroom Behavior

Glasses wearing at school remains low even when glasses are provided. This study investigated whether a classroom intervention to promote glasses wearing was associated with increased glasses wearing and improved classroom behavior. A pretest, posttest design was implemented with 44 students in Grades 1-4 at an urban public elementary school. Over 5 weeks, teachers encouraged eyeglass wearing through a classroom tracker, verbal reminders, and incentives. Glasses wearing and student behavior were monitored using the Direct Behavior Rating Scale of academic engagement and behavior for 13 weeks, including 4 weeks before and after the intervention. Glasses wearing increased from 56% to 73% (95% confidence interval [CI] = [0.08, 0.26]) in the first 2 weeks of the intervention, but not after a spring recess. The intervention was associated with significantly improved academic engagement (4.31%, 95% CI [2.17, 6.45]), respect (3.55%, 95% CI [1.77, 5.34]), and disruption (-4.28%, 95% CI [-6.51, -2.06]) compared to baseline. Higher academic engagement and disruption persisted 4 weeks after the intervention ended. A classroom-based glasses tracking and incentive system is associated with improved eyeglass wearing and classroom behavior among elementary students. A longer term randomized trial is needed to confirm these promising results.

A Nationwide Study of Myopia in Taiwanese School Children: Family, Activity, and School-Related Factors

The purpose of the study was to explore how fixed and modifiable family, activity, and school factors affect a student's myopia risk and severity. We used national cross-sectional data from Taiwanese children in Grades 4-6. Bivariate and multivariate analyses, including logistic and ordinary least squares regression, examined factors related to children's myopia status and severity. Age, parent myopia, and school district were associated with risk of myopia. One hour or more per day of near work (OR = 1.26) increased the odds of myopia. The same amount of time in outdoor activities (OR = 0.85) or moderate or vigorous physical activities (OR = 0.82) was associated with lower risk. Near work (β = 0.06), outdoor activity (β = -0.04), and outdoor recess (β = -0.03) predicted myopia severity. To promote healthy vision, nurses should advocate for and implement interventions that increase school children's time outdoors and in physical activities and reduce their time on near work.

Teachers' influence on purchase and wear of children's glasses in rural China: The PRICE study

IMPORTANCE

Uncorrected refractive error causes 90% of poor vision among Chinese children.

BACKGROUND

Little is known about teachers' influence on children's glasses wear.

DESIGN

Cohort study.

PARTICIPANTS

Children at 138 randomly selected primary schools in Guangdong and Yunnan provinces, China, with uncorrected visual acuity (VA) ≤6/12 in either eye correctable to >6/12 in both eyes, and their teachers.

METHODS

Teachers and children underwent VA testing and completed questionnaires about spectacles use and attitudes towards children's vision.

MAIN OUTCOME MEASURES

Children's acceptance of free glasses, spectacle purchase and wear.

RESULTS

A total of 882 children (mean age 10.6 years, 45.5% boys) and 276 teachers (mean age 37.9 years, 67.8% female) participated. Among teachers, 20.4% (56/275) believed glasses worsened children's vision, 68.4% (188/275) felt eye exercises prevented myopia, 55.0% (151/275) thought children with modest myopia should not wear glasses and 93.1% (256/275) encouraged children to obtain glasses. Teacher factors associated with children's glasses-related behaviour included believing glasses harm children's vision (decreased purchase, univariate model: relative risk [RR] 0.65, 95% CI 0.43, 0.98, P < 0.05); supporting children's classroom glasses wear (increased glasses wear, univariate model: RR 2.20, 95% CI 1.23, 3.95, P < 0.01); and advising children to obtain glasses (increased free glasses acceptance, multivariate model: RR 2.74, 95% CI 1.29, 5.84, P < 0.01; increased wear, univariate model: RR 2.93, 95% CI 1.45, 5.90, P < 0.01), but not teacher's ownership/wear of glasses.

CONCLUSIONS AND RELEVANCE

Though teachers had limited knowledge about children's vision, they influenced children's glasses acceptance.

Use of Eyeglasses among Children in Elementary School: Perceptions, Behaviors, and Interventions Discussed by Parents, School Nurses, and Teachers during Focus Groups

Purpose.

To investigate the perceptions, behaviors, and recommendations that parents, school nurses, and teachers have regarding children's use of eyeglasses.

Approach.

Focus groups with parents, school nurses, and teachers were conducted.

Setting.

The study took place in one Southern California school district.

Participants.

There were 39 participants, including 24 parents, seven school nurses, and eight teachers.

Method.

An experienced moderator guided the focus group discussions. Transcripts were analyzed using grounded theory techniques.

Results.

Participants perceive visual impairment as a serious problem in the development of children. The lack of eyeglasses may lead to problems such as tiredness, headaches, inability to focus on school work, and decreased reading speed. Participants experienced disappointment, unhappiness, worry, and concern when they realized they needed eyeglasses at a young age. Negative societal perceptions toward eyeglasses, lack of eye doctors in minority communities, parental perceptions that children do not need eyeglasses, and peer bullying of children wearing eyeglasses are key obstacles to children's use of eyeglasses. Participants suggest school and national campaigns featuring respected public figures who wear eyeglasses to promote positive attitudes toward eyeglasses.

Conclusion.

Parents and teachers who closely follow the academic development of children have observed that visual impairment has negative consequences for the scholastic achievement of children. They recommend interventions to promote the attractiveness of eyeglasses in society. The participants discuss the need for a national preventative message for eye care similar to the message for dental care. The public health message should emphasize the importance of embracing and respecting differences among individuals.

The Effect of an On-Site Vision Examination on Adherence to Vision Screening Recommendations

Vision screenings are intended to efficiently identify students with possible visual impairment and initiate a referral for diagnosis and treatment. In many cases, at-risk students do not access the recommended care or experience delays in receiving care. The purpose of this article is to report the effect on adherence to vision screening recommendations by providing the eye examination at the students’ school and at no cost. Of the 1,306 students screened, 382 (29.2%) were identified with possible visual impairment. Parental consent for examination was obtained for 198 (51.8%) students. Our vision screening and examination program yielded similar adherence to follow-up as stand-alone vision screening programs. Future program considerations should address perceptual barriers that may be contributing to parental nonadherence to vision screening recommendations.