Stanford University

Impact of a Teacher Incentive on Children’s Use of Eyeglasses: A Cluster-Randomized Controlled Trial

Purpose: The impact of school-time wear of glasses on children’s education has been shown to be limited by lack of regular compliance in half or more of children, even when free glasses are given. We sought to study the impact of free glasses combined with teacher incentives on in-school use of glasses among Chinese urban migrant children.

Methods: Children in a single randomly-selected fifth grade class in each of 94 randomly chosen primary schools in migrant communities in urban China, underwent measurement of visual acuity (VA) and assessment of spectacle wear and answered questionnaires. Children with VA <= 6/12 in either eye correctable to > 6/12 in both eyes underwent randomization by school to receive free glasses together with a teacher incentive (Incentive), or to Control. In the Incentive group, teachers were told that if >= 80% of children given glasses were wearing them at the time of two un-announced class visits, the class would receive a tablet computer. The Incentive group also received a previously-tested educational intervention promoting glasses use. Control children received prescriptions for glasses and a note to their parents. Self-reported and observed spectacle wear were assessed at 6 weeks and 6 months after distribution, with randomization groups compared by intention to treat using multiple regression.

Results: Among 4376 children, 728 (16.7%, mean age 10.9 years, 51.0% boys) met enrollment criteria and were randomized, 358 (49.2%, at 47 schools) to Incentive and 370 (50.8% at 47 schools) to Control. Among these, 693 children (95.2%) completed the study. Unadjusted and adjusted rates of spectacle wear were significantly higher at 6 weeks and 6 months among Incentive group children compared to Controls (P < 0.001 for observed and reported wear). (Table). In a previous study (Ma et al., BMJ, 2014) in western China, observed wear at six months in a group of similar-aged children receiving glasses and the identical education intervention without teacher incentives was significantly lower at 44.0% (P < 0.001).

Conclusions: Teacher incentives can significantly improve in-school use of glasses among children in this setting, and when combined with free spectacle distribution can maintain wear in two-thirds of children needing them over the course of a school year. Low wear among Controls demonstrates the need for such interventions.

 

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