A coalition partnership of vision health through a health-promoting school program for primary school students in Taiwan

Effects of health-promoting school strategy on dental plaque control and preventive behaviors in schoolchildren in high-caries, rural areas of Taiwan: a quasi-experimental design

Background

We evaluated the effects of health-promoting school (HPS) strategy on plaque control and behavior change in high-caries schoolchildren in Taitung, Taiwan.

Methods

A quasi-experimental design was adopted; six intervention schools (intervention group [IG]) and six comparison schools (comparison group [CG]) were selected from elementary schools with higher-than-average caries rates (> 68%). The IG was selected using cluster sampling, and the CG was selected to match the IG. In total, the IG and CG groups included 166 and 174 children each. The selected schools implemented the HPS framework for 3 months in the 2019 academic year. An oral examination of dental plaque was administered, and a self-administered questionnaire regarding knowledge, attitude, self-efficacy, and behaviors was distributed at baseline and at 2-week follow-up. A linear and logistic regression model using generalized estimating equations (GEEs) was used to analyze the differences between baseline and the follow-up data.

Results

Compared with the CG, the IG had a greater reduction in plaque index among second graders (β =  − 0.36) and plaque control record scores among second, fourth, and sixth graders (β =  − 27.48, − 26.04, and − 18.38, respectively). The IG also exhibited a greater increase at follow-up with respect to oral health–related knowledge among second graders and fourth graders (β = 1.46 and β = 0.92, respectively), attitude toward oral hygiene behaviors among sixth graders (β = 1.78), and self-efficacy regarding flossing for sixth graders (β = 1.43). Sixth graders in the IG were significantly more likely to brush before sleeping (adjusted odds ratio [aOR] = 2.99) and use fluoride toothpaste (aOR = 5.88) than those in the CG.

Conclusions

The HPS strategy was effective in reducing dental plaque and promoting preventing behaviors in rural high-caries schoolchildren.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01927-z.

Compliance with orthokeratology care among parents of young children in Taiwan

OBJECTIVES

To evaluate compliance with orthokeratology (Ortho-K) care and its influencing factors among parents of 6-13-year-old myopic children in Taiwan.

METHODS

Parents who are responsible for the care of the Ortho-K lenses of their myopic children were recruited through a closed Facebook peer support group to answer an online compliance questionnaire, including the wear and care behaviours and follow-up visits of Ortho-K.

RESULTS

A total of 253 online questionnaires were analysed after excluding those with wrong information. Most participants (89.7%) were mothers and had university-level or higher education (72.3%); 67.6% of them could achieve a score equal or higher than 60% correct rate on knowledge items. In addition, 39.3% of participants had high myopia (spherical equivalent ≦ 6.0 diopters). The mean age at onset of myopia was 7.75 years for children, and 57.4% wore Ortho-K lenses for less than a year. Full compliance rate was 22.8%, as reported by fathers or mothers. The compliance rate for follow-up visits significantly increased with provision of axial length information in follow-up visits, knowledge of axial length changes as an effect of myopia control, and Ortho-K use for less than 6 months. The compliance rate for wear and care was significantly associated with high myopia in one of parents, high education level, early onset of myopia in children, knowledge of Ortho-K and myopia control, and Ortho-K use for less than 6 months.

CONCLUSION

These results indicate the need for a comprehensive education programme for parents with young myopic children to ensure strict adherence to fitting and wear protocols and good follow-up of Ortho-K lenses.

Trajectories of myopia control and orthokeratology compliance among parents with myopic children

SIGNIFICANCE

This study set out to illustrate the trajectories of myopia control in time sequence and explore orthokeratology compliance for parents with myopic children in the first fitting within one year. Profiling these results is crucial to improving myopia control and orthokeratology care.

PURPOSE

To obtain a better understanding of myopia control and orthokeratology care that could promote compliance with orthokeratology (ortho-K) lenses for parents with myopic children.

METHODS

We conducted semi-structured qualitative interviews and pre-interview questionnaire surveys of the parent who is mainly responsible for complying to ortho-K lens care for their myopic children aged 7-12 years, including 16 mothers and 4 fathers. A framework analytical approach that involved gaining familiarity with the data to identify a thematic framework was used for data analysis. It was written in line with the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist.

RESULTS

Five themes and twelve subthemes depicted the parents' trajectory during myopia diagnosis, treatment, and compliance with ortho- K for their children in the first fitting within one year. Myopia control and the convenience of outdoor activities were important reasons for parents to actively ask for ortho-K lenses for their children. Parents have non-compliance behaviors after the children wore the lenses for three months, including not scheduling follow-up visits, simplifying cleaning procedures, not replacing accessories. The degree of parents' non-compliance differed based on the uncomfortable feelings of their child's eyes. In general, clear, unaided vision (visual acuity > 0.9) during the day was an indicator of ortho-K's effectiveness, according to parents.

CONCLUSIONS

Although parents play a passive role when a child is diagnosed with myopia, they take on a proactive role when deciding on ortho-K treatment. Myopia treatment for children is a long-term process. Understanding the course of treatment and non-compliance helps eye care professionals provide parents with the necessary assistance and resources, and enables myopia treatment to yield maximum effects.

Comparison of the pediatric vision screening program in 18 countries across five continents

Purpose

Incorporating mass pediatric vision screening programs as part of a national agenda can be challenging. This review assessed the implementation strategy of the existing pediatric vision screening program.

Methods

A search was performed on PubMed, EBSCO host MEDLINE Complete, and Scopus databases encompassing the past ten years for mass pediatric screening practice patterns that met the selection criteria regarding their objectives and implementation. Results were analyzed from 18 countries across five continents.

Results

Eight countries (44%) offered screening for distance visual acuity only, where the majority of the countries (88%) used either Snellen or Tumbling E chart. High-income countries initiated screening earlier and applied a more comprehensive approach, targeting conditions other than reduced vision only, compared with middle-income countries. Chart-based testing was most commonly performed, with only three countries incorporating an instrument-based approach. Lack of eyecare and healthcare practitioners frequently necessitated the involvement of non-eyecare personnel (94%) as a vision screener including parent, trained staff, and nurse.

Conclusions

Implementation of a vision screening program was diverse within countries preceded by limited resources issues. Lack of professional eyecare practitioners implied the need to engage a lay screener. The limitation of existing tests to detect a broader range of visual problems at affordable cost advocated the urgent need for the development of an inexpensive and comprehensive screening tool.

Vision Improvement and Compliance With the Use of Orthokeratology Lenses in School Children: A Sample From Five Primary Schools in Northern Taiwan

PURPOSE

To assess the visual acuity and compliance with the use of orthokeratology lenses (OrthoK) in school children.

METHODS

A retrospective study was conducted to determine the education-related factors influencing the improvement in visual acuity in myopic students using OrthoK in five primary schools in Taiwan.

RESULTS

Of the 5,173 eligible students from five primary schools, 1906 (36.8%) students were diagnosed with myopia. Among 201 (10.6%) students wearing OrthoK, 69.7% had used them for at least 1 year, 53.2% achieved visual acuity greater than 0.8 (6/7.5, log of minimal angle of resolution 0.1) in school, and 49.8% had received health education related to OrthoK care. Multiple logistic regression analysis showed that a higher possibility to achieve visual acuity greater than 0.8 was associated with more than 1-year use of OrthoK, good compliance, and receiving health education from an ophthalmologist.

CONCLUSION

It is important that children wearing OrthoK receive education and comply with the use of OrthoK for visual acuity improvement.

Computer/Mobile Device Screen Time of Children and Their Eye Care Behavior: The Roles of Risk Perception and Parenting

This study assessed the computer/mobile device screen time and eye care behavior of children and examined the roles of risk perception and parental practices. Data were obtained from a sample of 2,454 child-parent dyads recruited from 30 primary schools in Taipei city and New Taipei city, Taiwan, in 2016. Self-administered questionnaires were collected from students and parents. Fifth-grade students spend more time on new media (computer/smartphone/tablet: 16 hours a week) than on traditional media (television: 10 hours a week). The average daily screen time (3.5 hours) for these children exceeded the American Academy of Pediatrics recommendations (≤2 hours). Multivariate analysis results showed that after controlling for demographic factors, the parents with higher levels of risk perception and parental efficacy were more likely to mediate their child's eye care behavior. Children who reported lower academic performance, who were from non-intact families, reported lower levels of risk perception of mobile device use, had parents who spent more time using computers and mobile devices, and had lower levels of parental mediation were more likely to spend more time using computers and mobile devices; whereas children who reported higher academic performance, higher levels of risk perception, and higher levels of parental mediation were more likely to engage in higher levels of eye care behavior. Risk perception by children and parental practices are associated with the amount of screen time that children regularly engage in and their level of eye care behavior.