This study found that parents of primary school students had inadequate knowledge, positive attitude, and proactive practice regarding myopia, which might provide valuable insights for future intervention studies to enhance myopia education and promoting better eye health for children.
McCrann et al. reported that 76% of parents of school children recognized the potential health risk of digital technology on the eye [11]. One study conducted in rural China by Li et al highlighted that some parents have no clear idea of what myopia was and only a small number knew the anatomical definition of the condition [18], another study comparing myopia control perceptions between parents in the United Kingdom and Hong Kong also found low awareness of the effects of myopia, especially in the United Kingdom [19], which were consistent with the finding in the present study. In the present study, the knowledge among parents was suboptimal, they correctly understood the impact of electronic devices and indoor lighting, but they have poorer knowledge of the cause of myopia and the impact of outdoor exercises. The vast majority agreed that wearing glasses is one of the best ways to control myopia, however, in Li’s study, parents had the misconception that glasses-wearing should be delayed in children, and it might be harmful to the eyes[18]. This discrepancy can be explained by that the study was conducted in an urban region and parents might have had higher awareness.
He et al.’s study on parents of primary school students also revealed that family income and parents’ education level significantly affected their myopia knowledge [20]. Furthermore, parents with myopia might have more related knowledge through their experience and they might have more opportunities to seek information from professionals. Therefore, educational interventions need to focus on parents with no myopia history and those whose children have no myopia, as well as parents with lower income and education levels.
One similar survey study conducted in Ireland found parental attitudes to myopia were nonchalant [11]. Only 14% of parents of school children expressed that they would be concerned if their children were diagnosed with myopia, and 46% considered myopia presents a health risk to their children [11]. The lack of parental concern in the previous study might be due to the low myopia prevalence in Ireland: only 10% of the children had myopia, compared to around 40% in the present study. McCrann et al. also found that myopic parents considered myopia as more of an inconvenience and were more likely to consider limiting screen time [11]. Parents’ attitudes toward children’s visual care were associated with a lower risk of myopia in children, and it is of great importance to enhance their attitude toward myopia [21].
Jiang et al.’s study on parents’ intention toward preschool children’s myopia-prevention behaviors also found that parental attitude was associated with their myopia-preventive behaviors [22]. Parental beneficial behaviors (e.g., spending less time on near work and electronic device use) are positively associated with children’s myopia [23]. The practice score was adequate in this study. Furthermore, a higher attitude score was significantly associated with better practice scores. This finding reaffirmed the relationship between knowledge, attitude and practice, and that adequate knowledge can lead to a positive attitude to inform better practice [24, 25]. This study also found significant correlations between knowledge-attitude, knowledge-practice, and attitude-practice. In the practice dimension, most parents answered positively, except on the items of outdoor activities and reading while lying down.
However, there were several limitations in this study. First, this study was conducted in a single school in China and the results might not be generalized other cities. Second, due to the self-reporting nature of the study, the results might deviate from the actual practice. Furthermore, most participants provided positive answers in the attitude and practice dimensions, and the results might be affected by the social desirability bias. Third, 44% of the parents in the selected school returned a valid survey, and there might be non-response bias.