The Influence of Health Education on the Knowledge and Practices of parents in the care of children with Myopia

Mamta R¹, Kavita², Sathish R³

^1,2Associate Professor, Gandhi College of Nursing, Karnal City, Haryana, India.

³Professor, School of Nursing, DRIEMS University, Cuttack, Odisha, India.

*Corresponding Author E-mail: sat2careu@gmail.com

ABSTRACT:

Background of the study: Myopia is a prevalent visual impairment that necessitates appropriate treatment and preventative measures, particularly for children. Aim of the Study: The current study aimed to determine the effect of health education on parents' knowledge and practices regarding the care of their children with myopia. Methods: In this study, a quasi-experimental research design was employed. The research was conducted at the ophthalmology clinics of a private eye hospital located in Panipat, Haryana. A convenience sample comprising 200 parents and their children diagnosed with myopia was recruited over a six-month period from the aforementioned setting. Two instruments were utilized for data collection. Tool I was a structured interview questionnaire, administered both pre-test and post-test, and consisted of four sections: Section 1: Parents' demographic information. Section 2: Children's demographic information. Section 3: Children's medical history. Section 4: Parents' knowledge concerning myopia. Tool II evaluated parents' reported practices regarding myopia and was also administered as a pre-test and post-test. Results: The study showed significant improvements in parents' knowledge and practices after the health education program. Parents' knowledge increased from 24% pre-intervention to 100% post-intervention for myopia definition, symptoms (26% to 100%), diagnosis (18% to 100%), treatment (30% to 100%), and prevention (20% to 100%). Awareness of complications improved from 28% to 98% immediately after and 92% at one-month follow-up. Practice scores improved significantly, with mean scores increasing from 2.11±1.33 to 4.02±1.09 after education (p<0.001). Adequate practice levels rose from 10% to 88% post-intervention and remained at 85% after one month. Knowledge and practice improvements showed strong positive correlation (knowledge mean difference = +25.00, practice mean difference = +15.00, p<0.001, Cohen's d = 2.50). Conclusion: The findings of this study suggest that structured health education plays a significant role in enhancing parents' understanding and caregiving practices related to childhood myopia. Post-intervention assessments indicated notable improvements in both knowledge and behavioral practices, with statistically significant gains observed even one month after the educational sessions. These results highlight the effectiveness of targeted educational programs in empowering parents to adopt proactive strategies for managing their children's visual health. By bridging knowledge gaps and promoting consistent, evidence-based practices, health education serves as an important tool in mitigating the progression and complications of myopia among children.

KEYWORDS: Children and Myopia, Health Education, Parents' Knowledge, Practices.

INTRODUCTION:

Myopia, a prevalent cause of vision impairment, has seen a global rise and is expected to impact nearly 5 billion individuals by 2050.¹ In East Asia, the occurrence of myopia is notably high, affecting 73% of school-aged children,² and China is no exception.³Among Chinese youth, the prevalence of myopia is reported at 53.6%, with 36.0% of those affected being primary school students.⁴Early-onset myopia (at age ≤7 years) heightens the risk of developing severe myopia.⁵ High myopia is linked to several specific complications, such as cataracts, chorioretinal atrophy, macular holes, myopic foveoschisis, and changes in the optic nerve head, which can result in irreversible damage to retinal photoreceptors and even central vision loss, ultimately imposing a significant burden on individuals, families, and society.⁶

Identifying vision problems in children is more challenging, despite the fact that early detection during childhood provides the greatest opportunity to prevent potentially lasting effects on their social, emotional, and academic development.⁷ In the Indian states, the primary causes of vision impairment were optic nerve disorders (40%), cataracts (7.5%), retinal disorders (32%), and uveitis (7.5%).^8.9 If left uncorrected, these conditions can result in permanent vision loss and significantly diminish the quality of life, affecting educational, psychological, and economic outcomes for individuals, their families or caregivers, and society as a whole.¹⁰ Severe conditions, such as glaucoma, require numerous treatments after diagnosis, often with a poor prognosis for vision.¹¹

Research indicates that the initial status of refractive error is the most significant predictor of myopia onset in children6¹². To further myopia prevention research, the International Myopia Institute introduced the concept of "pre-myopia" in 2019. Pre-myopia is characterized by an eye refraction between ≤+0.75 D and >-0.50 D in children, along with baseline refraction, age, and other measurable risk factors that heighten the probability of developing myopia in the future¹³.

Nurses have a significant role in improving parents' understanding and management of care for children with myopia by increasing awareness.¹² This includes educating parents about myopia, its causes, symptoms, and available treatment options, and promoting proper eye care practices: Teaching effective strategies for managing myopia, including regular eye.

Myopia, or nearsightedness, is becoming more common worldwide, including in Egypt. Older children (12 to 18 years) in India are more likely to have it than younger ones (5 to 11 years), with rates of 5.8% and 3.7%, respectively. Myopia can increase the risk of eye problems like myopic macular degeneration, retinal detachment, cataracts, and open-angle glaucoma.

Many parents are not aware of myopia, its risks, and how to manage it. In fact, 77% of parents do not know their child's eye health is at higher risk. Also, 88% of people with severe myopia are unaware of treatments to manage it.

Not knowing much about myopia and its issues can make it harder to manage and prevent it effectively (Chua et al., 2016).¹³

STATEMENT OF THE PROBLEM:

An Evaluation of the Effectiveness of a Health Education Program on Parents’ Knowledge and Practices in Caring for Children with Myopia at a Selected Eye Hospital in Panipat.

OBJECTIVES OF THE STUDY:

1. To assess parents’ baseline knowledge and practices regarding the care of children with myopia before the health education program.

2. To evaluate the effectiveness of the health education program on parents’ knowledge and practices immediately after the intervention.

3. To examine the association between parents’ knowledge and their reported practices in caring for children with myopia.

HYPOTHESES:

H1: Parents will know more about myopia after the health education program than before it.

H2: Parents will be better at taking care of children with myopia after the health education program than before it.

H3: There will be a strong association between what parents know and how they care for children with myopia, both right after and one month after the program.

METHODOLOGY:

This study employed a quasi-experimental one-group pre-test and post-test design to assess the impact of a health education program on parents' knowledge and practices about the treatment of children with myopia. The research was conducted at the ophthalmology Hospitals, Panipat. Haryana, over a one-month period (August 2025). A convenience sample of 200 parents and their children diagnosed with myopia participated in the study. Data were collected using two tools developed from a literature review and validated by experts. The instrument utilised was a structured interview questionnaire divided into four sections: (1) parental personal information, (2) child personal information, (3) child medical history, and (4) parental awareness regarding myopia. Tool II evaluated parents' claimed practices concerning myopia management, encompassing eye workouts, outdoor activities, screen time regulation, diet, and ocular care practices. Reliability testing revealed Cronbach’s alpha values of 0.73 for knowledge and 0.76 for practices, signifying substantial internal consistency. The health education program had two sessions (one practical and one theoretical), conducted in small groups of 8–10 parents. Sessions encompassed lectures, discussions, visual aids, and handouts addressing the definition, aetiology, symptoms, prevention, treatment, and complications of myopia, in addition to practical training on ocular care practices and lifestyle adjustments. The assessment of parents' knowledge and practices was conducted prior to the intervention, immediately following it, and one month thereafter, utilising identical instruments. Data were analysed utilising SPSS version 22, employing descriptive statistics, paired t-tests, ANOVA, and Pearson correlation to assess the intervention's efficacy. Ethical approval was obtained from the Ved Nursing College, Panipat (Ref. No. PIMS/108.2025), and informed consent was secured from all participants.

RESULTS:

The study involved 200 parents, with a significant majority being female; 160 out of the 200 participants were women, accounting for 80%, while the remaining 40 (20%) were men. In terms of age distribution, 132 parents (66%) fell within the 25 to ≥36 years age bracket, whereas 68 parents (34%) were younger than 25 years. The average age of the parents was 24.8 years, with a standard deviation of 5.6 years, indicating a relatively young adult group with some age variation. Regarding their place of residence, most parents (148; 74%) lived in rural areas, while 52 (26%) were from urban locations. Concerning educational background, 52 parents (26%) were illiterate, 128 (64%) had completed secondary education and only 20 (10%) had attained university-level education, suggesting that nearly two-thirds had moderate educational qualifications, with a small fraction being highly educated.

The demographic profile of the 200 children in the study showed that 68 children (34%) were under 6 years old, while the majority, 132 children (66%), were older than 6 years. The average age was 8.6 years, with a standard deviation of 3.7 years, and the median age was also 8.6 years, indicating an equal split of children younger and older than this age; the interquartile range was 4.98, reflecting a moderate age spread around the median. In terms of gender, 60 children (30%) were boys, and 140 (70%) were girls, indicating a higher number of female children in the sample. Regarding educational level, 80 children (40%) were in nursery school, and 120 (60%) were in preparatory education, showing that the majority were already in the early stages of formal schooling.

Table – 1: Frequency and Percentage Distribution of Children with Myopia According to Medical History (n = 200)

S. No	Variables		Frequency	Percentage
1.	Duration of Myopia	Less than 1 Year	80	40 %
		1 – 3 Years	30	15 %
		More than 3 Years	70	35 %
2.	Use of Spectacle	Yes	165	82.5 %
2.	Use of Spectacle	No	35	17.5 %
3.	Usage of Contact Lenses	Yes	20	10 %
3.	Usage of Contact Lenses	No	180	90 %

From Table – 1 we could understand that Among the 200 children with myopia, 40% had a duration of myopia of less than one year, 15% had myopia for 1–3 years, and 35% had myopia for more than three years, while 82.5% were using spectacles and 17.5% were not, and only 10% reported using contact lenses whereas the remaining 90% did not use contact lenses.

The bar diagram Below (Figure–1) illustrates the percentage distribution of parents based on their level of knowledge regarding myopia during the pre-test, post-test I, and post-test II, categorized as either good or poor knowledge. In the pre-test, only 4% of parents exhibited good knowledge, while a significant majority of 96% demonstrated poor knowledge about myopia. Following the first educational intervention (post-test I), the proportion of parents with good knowledge increased significantly to 94%, with only 6% remaining in the poor-knowledge category. During post-test II, conducted at follow-up, 90% of parents continued to retain good knowledge, whereas 10% exhibited poor knowledge, indicating a slight decline from post-test I but a substantial improvement compared to the pre-test scores.

Figure – 1: Percentage Distribution of Samples According to Level of Knowledge Among Samples Regarding Myopia during Pre-Test and Post-Test I and Post – Test II

Tabel – 2: Mean, Mean Difference, Standard Deviations, Paired ‘t’ test value of Samples Practice regarding Myopia (n = 200)

Practice

Mean

Mean Difference

Standard Deviation

Paired ‘t’ test

p value

Pre-Test

2.11

1.91

1.33

62.11

(df=199)

0.001***

Post-Test

4.02

1.09

*** Significant at p value < than 0.05

Table – III: Level of Correlation Between Knowledge Level and Practice Levels among the Parents (n = 200)

Variables	Time Point Comparison	Mean Difference	95 % of CI	T - Value	P - Value
Knowledge	Post vs Pre	+25.00	23.61, 26.39	35.3	0.001 ***
Practice	Post vs Pre	+15.00	13.43, 16.57	35.3	0.001***

Correlation is Highly Significant at p value < 0.001

Table 2 displays the average, mean difference, standard deviation, and paired t-test results for the participants' practices concerning myopia among 200 individuals. Initially, the mean practice score was 2.11 in the pre-test, which rose to 4.02 in the post-test, resulting in a mean difference of 1.91. This indicates a significant enhancement in practice after the intervention. The standard deviation, which reflects the variability of scores, was 1.33 in the pre-test and decreased to 1.09 in the post-test, implying slightly more uniform practice behaviors post-intervention. The calculated paired t value of 62.11 with 199 degrees of freedom and a p value of 0.001 signifies that the improvement in practice scores is statistically highly significant at a p value less than 0.05, affirming the intervention's effectiveness on participants' practices regarding myopia.

Table -3 shows how much knowledge and practice levels about myopia are related among 200 parents by comparing their post-test scores to their pre-test scores. The post-test mean score for the knowledge variable was +25.00 points higher than the pre-test mean score, with a 95% confidence interval of 23.61 to 26.39. This shows that parents' knowledge improved significantly and with great accuracy after the intervention. The t value for this improvement in knowledge was 35.3 and the p value was 0.001. This means that the increase in knowledge was statistically very significant at p less than 0.001. For practice, the post-test scores were also higher than the pre-test scores, with a mean difference of +15.00 and a 95% confidence interval between 13.43 and 16.57. This shows that parents' practice linked to myopia care has improved significantly and reliably. The t value for practice was also 35.3, and the p value was 0.001. This means that the increase in practice levels is statistically very significant. Together, these results show a strong and very significant positive link between parents' improved knowledge and improved practice after the educational program.

DISCUSSION:

The current investigation demonstrated that two-fifths of the children under investigation had myopia for less than one year, three-quarters were wearing spectacles, and the majority were not wearing contact lenses. Zhang et al. (2025) conducted a comparable study, which found that the vast majority of parents agreed that, despite the evidence that donning glasses is an effective method for managing myopia, some parents harbour misconceptions about their use in children. Li et al. (2010) suggest that parents may perceive the delay in the use of spectacles as advantageous due to concerns regarding their child's eyesight.¹⁴

In the realm of parental knowledge, a mere 10% have ventured into the enlightening world of myopia training courses, revealing a chasm of understanding that begs to be bridged. The researcher posits that this void in training is a key contributor to the knowledge shortfall among parents, underscoring the pressing need for health education and training courses on myopia. Such initiatives would illuminate the path for parents, enhancing their comprehension and support for children grappling with myopia. The study unveiled that doctors stand as the primary beacons of knowledge for parents navigating the myopia landscape. From the researcher's perspective, this underscores the parents' preference for gleaning wisdom from trustworthy sources.¹⁵

The study also painted a picture of transformation, with a significant leap in parental knowledge about myopia observed just one month after health education was imparted. This, in the researcher's eyes, is a testament to the transformative power of health education. Prior to this educational intervention, a knowledge chasm loomed large. These findings resonate with the pivotal role parents play in shaping their children's eye health behaviors, as echoed by various studies that spotlight the importance of parental involvement in myopia-related measures (Li et al., 2021; Sherief et al., 2023).¹⁶

The current study's results showed that health education led to better methods in managing myopia, which was very different from what things were like before the education. Also, there was a big change in the way parents did things as they went through the pre-intervention, immediately post-intervention, and one-month post-intervention evaluations. This change was similar to what McCrann et al. (2018)¹⁷found: parents of children with myopia often saw it as a bothersome condition that made them think about limiting their child's screen time. Similarly, the study by Jiang et al. (2022) shed light on parents' goals by showing that the things they did to help their preschool-aged children avoid myopia grew stronger.¹⁸

CONCLUSION:

Based on the research hypotheses and the noteworthy findings of this study, it is concluded that a focused health education program had a pronounced positive effect on enhancing parents' knowledge and practices regarding the care of their children with myopia. The intervention led to a statistically significant enhancement in the parents' average knowledge and practices scores, observable immediately after the educational session and sustained one month subsequent to the health education intervention. The robust, statistically significant association identified between the overall knowledge and practices of parents, both prior to and during health education, highlights that improved comprehension directly results in superior parental practices. The study effectively illustrated that organised health education serves as a potent approach for enabling parents to engage proactively in the treatment and prevention of myopia progression in their children. Nurses need to give parents specific information and assist them understand myopia, its risk factors, and the several ways to manage it. Nurses also play a very important role in stressing how important it is to find and treat childhood myopia early on to stop or delay its advancement. Adopting a family-centered approach allows nurses to engage with families to create personalised care plans that meet the needs of each child and promote long-term eye health. Practice considerations underscore the necessity of clear and effective communication, as nurses must guarantee that parents comprehensively comprehend their child's illness, therapy alternatives, and continuous care necessities.

RECOMMENDATIONS:

The study recommends focused health education programs, outdoor activities, reduced screen time, eye exams, and a suitable home atmosphere to improve parents' understanding and practices about myopia treatment. Additional study is advised in many situations with large probability samples. To educate parents about myopia diagnosis, paediatric ophthalmology and optometry clinics should adopt a standardised approach. Myopia prevention and management information should be given during routine well-child visits with paediatricians, not just at eye clinics. Policies should require comprehensive school health initiatives, such as vision screening, myopia awareness campaigns for parents, and more outside time during school hours.

CONFLICT OF INTEREST:

No.

ACKNOWLEDGEMENT:

The Researcher acknowledges all the parents and children who participated in this study.

REFERENCES:

1. Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016; 123(5): 1036-1042. doi: 10.1016/j.ophtha.2016.01.006

2. Grzybowski A, Kanclerz P, Tsubota K, Lanca C, Saw SM. A review on the epidemiology of myopia in school children worldwide. BMC Ophthalmol. 2020; 20(1): 27. doi: 10.1186/s12886-019-1220-0 [

3. Morgan IG, Ohno-Matsui K, Saw SM. Myopia. Lancet. 2012; 379(9827): 1739-1748. doi: 10.1016/S0140-6736(12)60272-4

4. National Health Commission of the People’s Republic of China. The 2018 National Survey on Myopia Among Children and Adolescents. May 8, 2019. Accessed March 22, 2021. http://www.nhc.gov.cn/xcs/s7847/201905/11c679a40eb3494cade977f65f1c3740.shtml

5. Chua SY, Sabanayagam C, Cheung YB, et al. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children. Ophthalmic Physiol Opt. 2016; 36(4): 388-394. doi: 10.1111/opo.12305

6. Ikuno Y. Overview of the complications of high myopia. Retina. 2017;37(12):2347-2351. doi: 10.1097/IAE.0000000000001489

7. Morgan RW, Speakman JS, Grimshaw SE. Inuit myopia: an environmentally induced “epidemic”? CMAJ. 1975; 112(5): 575-577.

8. Goldschmidt E, Jacobsen N. Genetic and environmental effects on myopia development and progression. Eye (Lond). 2014; 28(2): 126-133. doi: 10.1038/eye.2013.254

9. Morgan IG, French AN, Ashby RS, et al. The epidemics of myopia: aetiology and prevention. Prog Retin Eye Res. 2018; 62: 134-149. doi: 10.1016/j.preteyeres.2017.09.004

10. Jones LA, Sinnott LT, Mutti DO, Mitchell GL, Moeschberger ML, Zadnik K. Parental history of myopia, sports and outdoor activities, and future myopia. Invest Ophthalmol Vis Sci. 2007; 48(8): 3524-3532.

11. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013; 310(20): 2191-2194.

12. Xiang F, He M, Zeng Y, Mai J, Rose KA, Morgan IG. Increases in the prevalence of reduced visual acuity and myopia in Chinese children in Guangzhou over the past 20 years. Eye (Lond). 2013; 27(12): 1353-1358.

13. Negrel AD, Maul E, Pokharel GP, Zhao J, Ellwein LB. Refractive Error Study in Children: sampling and measurement methods for a multi-country survey. Am J Ophthalmol. 2000; 129(4): 421-426.

14. Wu PC, Tsai CL, Wu HL, Yang YH, Kuo HK. Outdoor activity during class recess reduces myopia onset and progression in school children. Ophthalmology. 2013; 120(5): 1080-1085.

15. Yi JH, Li RR. Influence of near-work and outdoor activities on myopia progression in school children [in Chinese]. Zhongguo Dang Dai Er Ke Za Zhi. 2011; 13(1): 32-35.

16. Vongphanit J, Mitchell P, Wang JJ. Prevalence and progression of myopic retinopathy in an older population. Ophthalmology. 2002; 109(4): 704-711.

17. Holden B, Sankaridurg P, Smith E, Aller T, Jong M, He M. Myopia, an underrated global challenge to vision: where the current data takes us on myopia control. Eye (Lond). 2014; 28(2): 142-146.

18. French AN, Morgan IG, Mitchell P, Rose KA. Risk factors for incident myopia in Australian schoolchildren: the Sydney Adolescent Vascular and Eye study. Ophthalmology. 2013; 120(10): 2100-2108.

Received on 09.03.2026 Revised on 03.04.2026

Accepted on 23.04.2026 Published on 02.05.2026

Available online from May 05, 2026

Int. J. of Advances in Nursing Management. 2026;14(2):111-115.

DOI: 10.52711/2454-2652.2026.00023

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.