Tjiam A M, Vukovic E, Asjes-Tydeman W L, Holtslag G, Loudon S E, Sinoo M M, Simonsz H J
Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, the Netherlands.
Strabismus. 2010 Dec;18(4):146-66. doi: 10.3109/09273972.2010.529983.
We previously found that compliance with occlusion therapy for amblyopia is poor, especially among children of non-native parents who spoke Dutch poorly and who were low educated. We investigated conception, awareness, attitude, and actions to deal with noncompliance among Dutch orthoptists.
Orthoptists working in non-native, low socioeconomic status (SES) areas and a selection of orthoptists working elsewhere in the Netherlands were studied. They were observed in their practice, received a structured questionnaire, and underwent a semi-structured interview. Finally, a short survey was sent to all working orthoptists in the Netherlands.
Nine orthoptists working in non-native, low-SES areas and 23 working elsewhere in the Netherlands participated. One hundred and fifty-one orthoptists returned the short survey. Major discrepancies existed in conception, awareness, and attitude. Opinions differed on what should be defined as noncompliance and on what causes noncompliance. Some orthoptists found noncompliance annoying, unpleasant, and hard to imagine, others were more understanding. Many pitied the noncompliant child. Almost all thought that the success of occlusion therapy lies both with the parents and the orthoptist, but one third thought that noncompliance was not solely their responsibility. Patients' compliance was estimated at 69.3% in non-native, low-SES areas (electronically, 52% had been measured), at 74.1% by the other 23 orthoptists, and at 73.8% in the short survey. Actions to improve compliance were diverse; some increased occlusion hours whereas others decreased them. In non-native, low-SES areas, 22% spoke Dutch moderately to none; the allotted time for a patient's first visit was 21'; the time spent on explaining to the parents was 2'30" and to the child 10". In practices of the other 23 orthoptists, 6% spoke Dutch moderately to none (P<0.0001), the time for a patient's first visit was 27'24" (P=0.47), and the periods spent explaining were 2'51" (P=0.59) and 26" (P=0.17), respectively.
Conception, awareness, attitude, and actions to deal with noncompliance varied among orthoptists. In non-native, low-SES areas, time spent on explanation was shorter, despite a lower fluency in Dutch among the parents.
我们之前发现，弱视遮盖疗法的依从性较差，尤其是在父母非荷兰本土人、荷兰语水平差且受教育程度低的儿童中。我们调查了荷兰眼科视光师对不依从情况的认知、意识、态度及应对措施。
对在非荷兰本土、社会经济地位低（SES）地区工作的眼科视光师以及在荷兰其他地区挑选出的视光师进行研究。观察他们的工作情况，向他们发放结构化问卷，并进行半结构化访谈。最后，向荷兰所有在职视光师发送一份简短调查。
9名在非荷兰本土、低SES地区工作的视光师和23名在荷兰其他地区工作的视光师参与了研究。151名视光师回复了简短调查。在认知、意识和态度方面存在重大差异。对于何为不依从以及不依从的原因，意见各不相同。一些视光师觉得不依从令人烦恼、不快且难以想象，另一些则更能理解。许多人同情不依从的孩子。几乎所有人都认为遮盖疗法的成功既取决于家长也取决于视光师，但三分之一的人认为不依从不全是他们的责任。在非荷兰本土、低SES地区，患者的依从率估计为69.3%（通过电子方式测量，已测量的为52%），其他23名视光师估计的依从率为74.1%，简短调查中的依从率为73.8%。提高依从性的措施多种多样；一些增加了遮盖时间，而另一些则减少了。在非荷兰本土、低SES地区，22%的视光师荷兰语水平一般至不会说；患者首次就诊的预约时间为21分钟；向家长解释的时间为2分30秒，向孩子解释的时间为10秒。在其他23名视光师的诊所中，6%的视光师荷兰语水平一般至不会说（P<0.0001），患者首次就诊时间为27分24秒（P=0.47），解释时间分别为2分51秒（P=0.59）和26秒（P=0.17）。
视光师在应对不依从的认知、意识、态度及措施方面存在差异。在非荷兰本土、低SES地区，尽管家长的荷兰语流利程度较低，但解释时间较短。
