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) and276 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.