A quasi-experimental design study on myopia preventive intervention based on the MMHEM health promotion model

Childhood myopia, driven by modifiable environmental factors like insufficient outdoor exposure, remains a global challenge. Existing interventions often lack frameworks bridging theory to practice. This study evaluated the Multidimensional Model of Health Education and Management (MMHEM)—a novel model integrating cultural, artistic, and scientific elements—to design a school-based myopia intervention in Yunnan’s minority areas. We conducted a quasi-experimental study based at the school, employing the difference comparison analysis method. A total of 136 students from two middle schools were assigned by convenience sampling to either an MMHEM-based intervention group (n = 83) or a control group (n = 53). The experimental group consisted of first-grade students from an ethnic middle school, while the control group was composed of first-grade students from another middle school in the same city with similar economic conditions and student sources. Refractive error was measured using non-cycloplegic autorefraction. Outcome measures included myopia prevalence and incidence, spherical equivalent (SE), and axial length (AL), which were tracked over a three-year period (from 2020 to 2023). The DID analysis revealed a significant intervention effect: the myopic shift (SE) was reduced by 0.18 D (95% CI: 0.05 to 0.31, P = 0.007), and axial elongation (AL) was slowed by 0.08 mm (95% CI: 0.02 to 0.14, P = 0.012) in the intervention group relative to controls. Consistent with this, the cumulative incidence of myopia was significantly lower in the intervention group (29.4%) than in the control group (56.6%; P < 0.01). A similar protective effect was observed for moderate/high myopia incidence (21.3% to 42.6%; P < 0.05). Furthermore, outdoor activity scores improved significantly in the intervention group (from 10.31 to 11.23, P < 0.05), although no significant changes were noted in screen time or close-range eye habits. A school-based comprehensive intervention, guided by the MMHEM and integrating strategies across the art, culture, and science fields, was associated with a lower incidence of myopia and slower axial elongation over two years compared to a control school. These research results indicate that the intervention measures with cultural customization attributes formulated based on the MMHEM model in this study have initially achieved the set goals, providing methodological references for behavioral intervention in ethnic minority areas. In the future, random controlled trials (RCTs) can be incorporated to further verify the effectiveness of the intervention measures and ensure their wider applicability.