农村儿童视力健康服务寻求行为干预策略与评估：基于随机干预实验的研究

The prevalence of myopic in rural China is the highest in the world. Myopia rate in rural primary and secondary school students is 25% and 50%. Wearing spectacles is the simplest and most effective solution to children's myopia, improving vision and significantly improving results. However, in China's rural areas, the proportion of children wearing spectacles is low, the spectacles wearing rate of myopic primary and secondary school students is only 17% and 30% respectively. Concerning the insufficient demand for health care in rural areas, previous studies have often attributed this to institutional level, budget constraints, or technical factors, while ignoring individual cognitive factors...The overall goal of this proposed project is to explore an effective intervention strategy to improve the children's vision health-care and increase the spectacles wearing rate of spectacles for children with myopia in rural areas. Starting from the individual cognitive level, based on the large sample survey data of northwest rural area, we will first characterize the children's vision health care seeking cognition and behavior in rural areas; Then using randomized controlled trial method, we will design two different interventions of providing first pair spectacles, free distribution or cost-sharing--charging a subsidized positive price, and in-depth evaluate the short-term and long-term impacts (and its mechanism) of the interventions on the children's vision health care seeking behavior in rural areas.We wish to provide empirically-based evidence to help government to better design strategies to solve the rural children vision crisis, and thus to improve the vision health policy and management in rural China.

我国农村儿童近视患病率居世界之首，农村小学和初中学生近视比例高达25%和50%。配戴眼镜是解决儿童近视最为简单有效方案，能够改善视力并显著提高成绩。然而，在中国农村地区儿童配戴眼镜矫正视力的比例较低，近视小学生和初中生眼镜配戴率仅为17%和30%。围绕农村地区健康卫生服务需求不足问题，以往研究常常将此归因于制度层面、预算约束或技术层面因素。.本项目旨在从个体认知层面探索改善农村地区儿童视力健康服务需求不足、提高农村近视儿童眼镜配戴率的有效策略。基于西北农村地区大样本调研数据，刻画农村地区儿童视力健康认知与寻求行为特征。采用随机干预实验方法，分析采用"免费发放"和"费用分摊"方式提供第一副眼镜的干预策略对农村儿童视力健康服务寻求行为的短期影响、长期影响及影响机理，以期为完善我国农村地区儿童视力保障体系提供具有实证基础的管理决策依据及可操作的政策建议。

我国农村儿童近视患病率居世界之首，农村小学和初中学生近视比例高达25%和50%。配戴 眼镜是解决儿童近视最为简单有效方案，能够改善视力并显著提高成绩。然而，在中国农村地 区儿童配戴眼镜矫正视力的比例较低，近视小学生和初中生眼镜配戴率仅为17%和30%。围绕农村地区健康卫生服务需求不足问题，以往研究常常将此归因于制度层面、预算约束或技术层面因素。.本课题旨在探索改善农村地区儿童视力健康服务、提高农村近视儿童眼镜配戴率的有效策略。基于西北农村地区大样本调研数据，刻画农村地区儿童视力健康认知与寻求行为特征。采用随机干预实验方法，设计补贴干预为农村儿童提供第一副眼镜，深入分析不同干预策略对农村儿童视力健康服务寻求行为的短期影响、长期影响及影响机理，以期为完善我国农村地区儿童视力保障体系提供具有实证基础的管理决策依据，以及可操作的政策建议。. 围绕上述目标和内容，本课题多期多地区数据结果显示，整体上农村地区学生的视力健康问题仍然呈现高发病率、低矫正率的特点，需要重点关注。为农村学生提供视力保护干预具有积极作用，尤其是对留守儿童群体影响更为显著，且干预存在长期影响——对于提高近视儿童后期主动就诊有显著效果。免费或提供高额补贴的干预方式对于类似眼镜这种其健康收益价值被严重低估的健康产品及服务的推广和使用，具有重要作用，人们对这一健康产品和健康服务高强度的使用会通过学习效应，增加被干预对象对不熟悉的或存在误区的健康产品的使用率和长期需求水平。