Empirical evidence and Practice on Prevention and Treatment of Myopia in Children

Autor: Ciao-Lin Ho, 何巧琳
Rok vydání: 2019
Druh dokumentu: 學位論文 ; thesis
Popis: 107
OBJECTIVE The purpose of this study is to clarify the context and facilitators of, as well as barriers to, myopia prevention and treatment from the perspective of child caregivers. From their point of view, this study explores myopia prevention and treatment strategies interactively based on child caregivers’ experiences of 5 items: electronic product management, outdoor activities, visual screening, visual re-examination and diagnosis, and atropine treatment. Three English journal articles were finished based on the results and literature review, including 1. Context of Atropine Adherence in Preschool Children with Early-Onset Myopia: A Qualitative Study (Sub-study 1); 2. Breaking the Perplexity to Reproduce Light - Experience of Corrected Myopia on Children and Adolescents: A meta-synthesis on qualitative research (Sub-Study 2); and 3. Dose–Response Relationship of Outdoor Exposure and Myopia Indicators: A Systematic Review and Meta-Analysis of Various Research Methods (Sub-study 3). METHODS In main dissertation, qualitative in-depth interviews for Chinese papers were conducted to guide 60 caregivers (parents, teachers, and nurses) of urban and rural children from the northern, central, southern, and eastern parts of Taiwan in presenting their experiences in the prevention and treatment of myopia. The objective of the interviews was to determine the context of the implementation of myopia prevention and control strategies and to gradually identify the barriers to and causes of failure for the implementation of myopia prevention and control strategies in small to larger myopia prevention systems. After the drafting of a verbatim, the interview data were coded and sent to respondents by letter or e-mail for them to confirm the content. The researcher then transcribed the interviews in a verbatim corresponding to the subject, identified the key concepts from them, and aggregated the concepts into subthemes and themes. Sub-study 1 used interviews with qualitative interviews to interview 60 caregivers (parents, kindergarten teachers and nurses) in four areas of North, Central, South and East Taiwan. In sub-study 2, a systematic literature search identified through English and Chinese databases, covering the period was between 1960 and 2018, and nine studies included in quantitative synthesis. Sub-study 3 was a systematic review and meta-analysis to evaluate the effects of outdoor light exposure on myopia. RESULTS Main dissertation 1. The barriers to the implementation of electronic product management included different types of attitudes from the family members, children being spoiled by their grandparents, different parenting concepts from gender roles, a busy double-income family situation, difficulty to change bad habits, and slippery generations to impact eye health. Facilitators to the implementation of electronic product management included strict restrictions of the use of electronic products, reasonable rules and regulations, the application of time management methods, activity development, and parental companionship. 2. The barriers to visual screening included affecting the validity of the visual examination on children's maturity, the screening environment interference with children's cooperation, the difference in screening processes and their insufficient quality. 3. The barriers to visual re-examination referral were the difference in processes of visual re-examination and diagnoses, parents' unwillingness to take their children for re-examination, conflicts caused by false positive and false negative results, divergent processes of diagnosis and treatment strategies, lack of follow-up, case management, and tracking mechanism, and caregivers' lack of attention to myopia-induced problems and to prevention and treatment awareness. 4. This study explores the barriers and facilitators for the four dimensions involved in atropine treatment namely children, parents, schools, and hospitals & society. At the child level, the barrier was parents struggling with curative effects and children's complaints; the facilitator was that the side effects could be overcome by learning life practices. At the parental level, barriers included the action parents neglect of myopia and do not need special treatment, expectation to get rid of the disease immediately. The facilitators were acceptance of the physician's opinion on atropine treatment and parents’ agreement with atropine treatment by improve of the myopia. At the school level, the barrier was the fact that the school did not create an effective environment for myopia treatment; the facilitators were the teachers are obedient to the students in school and the nurses play a case management role in promoting and tracking the effectiveness of atropine. At the hospital and social level, the barrier was the lack of personalized and friendly medical services. The facilitators were that doctor as a navigation, and model learning from significant others is an adherence determinant. 5. The barriers to outdoor activities were the inadequate quality of the outdoor activities, a lack of space to conduct the activities or of hardware and software equipment, ignorance of the mechanism of myopia prevention and treatment through outdoor activities. The facilitators included the construction of software and hardware, kindergarten curriculum activities toward outdoor activities, and the enhancement of knowledge, behavior, and habits regarding outdoor activities. Sub-study In sub-study 1 is the English journal writing for the fourth study in main dissertation. In sub-study 2, this study found four meta-syntheses included uncorrected myopia obscured learning development and caused negative emotions; the long confusing way to seek medical treatment; struggling with stigma of wearing glasses and the reproducing vision; and parents evolved from negligence to life wisdom that coexists with myopia. In sub-study 3, according to research data from 13 studies of 15,081 children aged 4-14 at baseline, outdoor light exposure significantly reduced myopia incidence/prevalence (odds ratio [OR] = 0.85, 95% confidence interval [CI]: 0.80–0.91, p < 0.00001; I2 = 90%), spherical equivalent refractive error (SER) by 0.15 D/year (0.09–0.27, p < 0.0001), and axial elongation by 0.08 mm/year (−0.14 to −0.02, p = 0.02). The benefits of outdoor light exposure intervention, according to pooled overall results, included decreases in three myopia indicators: 50% in myopia incidence, 32.9% in SER, and 24.9% in axial elongation for individuals in Asia. Daily outdoor light exposure of more than 120 min was the most effective intervention, and weekly intervention time exhibited a dose–response relationship with all three indicators. Subgroup comparisons revealed that interventional studies report greater benefits from outdoor light exposure compared with cohort and cross-sectional studies, and individuals with myopia in intervention studies experienced slightly greater benefits than individuals without, in terms of SER and axial elongation. CONCLUSIONS This study links the problem to the gap between empirical strategies and real practices in myopia prevention and treatment from the perspective of child caregivers and based on the cultural context as evidenced through in-depth interviews conducted with schools and families. To understand the barriers and facilitators encountered by child caregivers when dealing with children's electronic product management, outdoor activities, visual screening, visual re-examination and tracking, and atropine treatment in the context of myopia prevention and treatment. There is a gap between empirical strategies and practices. Health policies from children, their families, schools, hospitals and society affect the practice of myopia prevention and treatment. To avoid a long and confusing experience during the diagnosis and treatment of myopia, we recommend that medical staff provide the latest empirical guidance and most support possible to patients. The results of this study will help clinical staff understand better the problems and emotional experience that families undergo, overcome the barriers, and understand the facilitators when dealing with these families. This study should also inspire dialogue between medical staff and families as early as possible in the diagnosis process, from negligence to eye-care behavior life. The continuous intervention, discussion, and cooperation between the various levels formed a robust mobile network and created a myopia prevention and control environment in Taiwan.
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