Predictors of early acceptance of free spectacles provided to junior high school students in China

Objective: To examine factors influencing adherence to spectacle wear and perceived value within a prospective 1-month trial of ready-made and custom spectacles in school-aged children with uncorrected refractive error in urban China. Methods: A total of 428 students aged 12 to 15 years with at least 1 diopter of uncorrected refractive error were given free spectacles and evaluated 1 month later at an unannounced visit. Demographic factors, vision, optical effects, and perceptions were modeled as predictors of observed use and perceived value using logistic regression adjusted for spectacle allocation. Results: Of 415 students, 388 (93.5%) planned to use their spectacles, 227 (54.7%) valued their spectacles highly, 204 (49.2%) had their spectacles on hand, and 13 (3.0%) were lost to follow-up. Female students were 1.72 times (95% confidence interval [CI], 1.10-2.68), students from lower income households were 1.78 times (1.32-2.39), and those not concerned over appearance were 2.04 times (1.25-3.36) more likely to have spectacles on hand. Students with a pupil size of 4 mm or greater were 2.55 times (95% CI, 1.61-4.03) and students with spectacle vision worse than 20/20 were 2.06 times (1.20-3.49) more likely to have spectacles on hand. Self-report of high perceived value was 2.23 times (95% CI, 1.30-3.80) more likely with 20/20 spectacle vision, 1.63 times (1.06-2.52) more likely with base-in prismatic effects of 0.5 prism diopters or more, 3.52 times (2.03-6.13) more likely when students would not tolerate blur to avoid wearing spectacles, and 2.16 times (1.24-3.76) more likely with disbelief that spectacles would make vision worse. Spectacle type had no effect. Conclusions: Although most students planned to use their spectacles, only half were observed using them. Day-to-day use might increase if students were less concerned over appearance. Optical factors and beliefs surrounding spectacles are also predictive of acceptance. These findings provide further understanding of spectacle acceptance in teenagers.