Beyond access: subjective correlates of vision correction among rural primary school children in China

Uncorrected myopia is highly prevalent among school-aged children in rural China, yet many children who need refractive correction do not receive eye examination, own spectacles, or wear them regularly. Although access limitations remain important, variation in corrective behavior within the same schools suggests that demand-side factors may also be associated with uptake. This study examined whether vision health knowledge, benefit expectation of correction, and intertemporal preference were associated with willingness to correct vision and actual corrective behaviors among rural primary school students. We used cross-sectional survey and vision screening data from 1,889 students in grades 4–6 across 21 schools in Q County, Gansu Province, China. A positive screening result was defined as uncorrected visual acuity of 6/12 or worse in either eye (989 students, 52.4%). After excluding students with missing information, 981 screening-positive students constituted the analytic subsample. The primary outcome in the full sample was willingness to correct vision. Among screening-positive students, outcomes were eye examination, spectacle ownership, and regular spectacle wear. Ordered logit and logit models were estimated with school fixed effects and adjustment for individual and household covariates. Among the 981 screening-positive students included in the behavioral analyses, 67.9% had undergone eye examination, 50.9% owned spectacles, and 35.6% wore spectacles regularly. Per one-standard-deviation increase, knowledge was associated with a 6.0-percentage-point higher probability of being very willing to wear spectacles and with 4.8- to 7.2-point higher probabilities of the three corrective behaviors; benefit expectation was associated with 3.9- to 5.1-point higher probabilities of the three behaviors. Benefit expectation was associated with willingness when entered alone, but not after adjustment for knowledge. Present bias was not significantly associated with willingness or any corrective behavior. Knowledge deficits and low benefit expectation appear to be important correlates of under-correction among rural children with reduced uncorrected visual acuity. Interventions to improve spectacle uptake may need to combine misconception correction with messages that make the practical benefits of correction more salient. General measures of time preference may be less informative for explaining childhood spectacle-related decisions, which are embedded in household and school contexts.