To determine whether provision of free spectacles to rural-dwelling Chinese secondary school students with visually-significant refractive error, together with a teacher-based incentive to promote their use, increases the proportion of children going on to academic high school, as opposed to dropping out or pursuing a vocational track.
The investigators propose in the current trial to significantly expand the evidence base for spectacle distribution as the most-effective health intervention to improve educational opportunities for China's under-served rural children and adolescents by assessing impact on school attainment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
1,980
Children will receive free spectacles
He Eye Specialist Hospital
Shenyang, China
Attendance at academic high school
This will be assessed by systematically contacting parents, teachers and students to ascertain enrolment status, which REAP has used to obtain \> 97% follow-up in previous studies of high school accession. In the event of inconsistent responses, priority will be given to responses of parents, then teachers and finally students
Time frame: In July following completion of Year 3 of Middle School. This occurs after 32 months of participant followup.
Compliance with spectacle wear
Actual presence of spectacles on the child's face (rather than having glasses at school)at the time of an unannounced examination.
Time frame: After 12 months of participant followup
Classroom use of blackboards versus textbooks
Frequency of blackboard versus textbook use in the major subjects (Maths Chinese, English) on a questionnaire administered to teachers, and answered as "all", "most", "about half", little" or "none" of teaching.
Time frame: After 12 months of participant followup
Cost effectiveness of intervention.
Calculated as ratio of incremental cost to proportion of children who continue to academic high school as opposed to vocational high school or no schooling. Incremental cost is the difference of costs between implementation of intervention and control, Intervention costs will comprise the screening test glasses (including replacements).
Time frame: At study closeout, after 32 months of participant follow up
Depression and Anxiety
Depression and anxiety score measured with Anxiety Stress Scale (DASS). The score range for depression, anxiety and stress are 0-42, with higher score indicates more severe mental health problems.
Time frame: At baseline and 12 months post-treatment
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Self Esteem
Self-esteem score measured with the Rosenberg Self-esteem Scale. The scores range from 0-30, with higher scores indicate higher self-esteem.
Time frame: At baseline and 12 months post-treatment
Emotional and behavioral problems
Emotional and behavioral problems score using the Strengths and Difficulties Questionnaire (SDQ), with difficulties score ranges from 0 to 40, Prosocial scale ranges from 0-10,with higher score indicates severe mental health and behavioral problems.
Time frame: At baseline and 12 months post-treatment
Progression of Shortsightedness
Progression of Shortsightedness will be measured using change in refraction over time
Time frame: At baseline and 12 months post-treatment