Bruce Alison, Sanders Tom, Sheldon Trevor A
Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK.
School of Health and Related Research (ScHARR), Section of Public Health, University of Sheffield, Sheffield, UK.
BMJ Paediatr Open. 2018 Sep 14;2(1):e000307. doi: 10.1136/bmjpo-2018-000307. eCollection 2018.
To explore in depth parents' experiences and understanding of their children's eye care in order to better comprehend why there is relatively low uptake of services and variable adherence to treatment.
Semistructured interviews, informed by the Health Belief framework, were conducted with parents of children who had failed vision screening at age 4-5 years. Four were parents of children who never attended follow-up, 11 had children who attended but did not adhere to spectacle wear and 5 parents of children who had attended and adhered. Interviews were recorded and transcribed verbatim; thematic analysis based on the constant comparative method was undertaken.
Parents' beliefs led to uncertainty about the benefit of treatment, with parents testing their children to confirm the presence of a vision deficit and seeking advice from other family and community members. The stigma of spectacle wear explained the resistance of some to their child's treatment with the maintenance of 'normality' often more important than clinical advice. The combination of parents' own health beliefs, stigma and the practicalities of attending appointments together influenced parental decisions. Attendance following vision screening and the decision to adhere to spectacle wear were primarily based on the perceived severity of the visual reduction with the perceived benefit of spectacle wear outweighing any negative consequences.
Healthcare professionals require a greater understanding of parents' decision-making processes in order to provide personalised information. Knowledge of the cues to attendance and adherence provides policy makers a framework with which to review the barriers, develop strategies and redesign children's eye care pathways.
深入探究家长对其子女眼部护理的经历和理解，以便更好地理解为何服务利用率相对较低以及治疗依从性存在差异。
采用基于健康信念框架的半结构式访谈，对象为4至5岁视力筛查未通过儿童的家长。其中4位家长的孩子从未接受随访，11位家长的孩子接受了随访但未坚持佩戴眼镜，5位家长的孩子接受了随访并坚持佩戴眼镜。访谈进行了录音并逐字转录；采用基于持续比较法的主题分析。
家长的观念导致对治疗益处存在不确定性，家长通过测试孩子来确认视力缺陷的存在，并向其他家庭成员和社区成员寻求建议。佩戴眼镜带来的耻辱感解释了一些家长抵制孩子接受治疗的原因，维持“正常状态”往往比临床建议更重要。家长自身的健康观念、耻辱感以及共同就诊的实际情况共同影响了家长的决策。视力筛查后的就诊情况以及坚持佩戴眼镜的决定主要基于对视力下降严重程度的感知，认为佩戴眼镜的益处大于任何负面后果。
医疗保健专业人员需要更深入地了解家长的决策过程，以便提供个性化信息。了解就诊和依从的提示因素为政策制定者提供了一个框架，用以审视障碍、制定策略并重新设计儿童眼部护理路径。
