[[alternative]]Factors influencing vision healthcare behavior among junior high school students with high myopia

[[abstract]]近視是台灣學生首要的健康問題。高度近視不僅對學生健康造成威脅，促成日後失明的風險，也會對學童學習與生活品質造成影響，更可能會擴大增加社會經濟與財政負擔。而良好的視力保健行為是延緩近視惡化的重要關鍵，但至今成效仍無法彰顯。故本研究旨在探討影響高度近視國中學生採取視力保健行為之相關因素。本研究採橫斷式描述相關性研究設計，以方便取樣進行收案，總共選取132位某臺北市立國民中學七、八、九年級高度近視學生。透過自填匿名結構式問卷(包括基本資料表、課業壓力量表以及學生視力保健行為自評表)進行研究資料收集。研究結果顯示高度近視以女生居多且大多於7歲跟8歲被診斷近視，而開始配戴眼鏡矯正視力則以9歲為最多數。這群高度近視學生普遍認為高度近視是嚴重的，且高度近視已對其健康造成一定程度的威脅，但視力保健行為對其視力健康的幫助有限。且學生左眼近視度數(r = .194)、自覺高度近視威脅性(r = .204)、自覺視力保健行為嚴重性(r = .205)以及自覺視力保健行為利益性(r = .306)與視力保健行為呈顯著正相關(p<.05)，而以課業枯燥壓力與視力保健行為呈顯著負相關(r = -.273、p<.05)。基本屬性、課業壓力、自覺高度近視嚴重性與自覺視力保健行為利益性，可聯合解釋視力保健行為34.9%的變異量。以逐步迴歸分析探討預測因子，結果顯示課業枯燥壓力最能預測視力保健行為，其次則為自覺視力保健行為利益與左眼近視度數。雖然自覺高度近視威脅性與研究對象採取視力保健行為兩者呈顯著的正相關，但自覺高度近視威脅性之解釋力與預測力偏低而無法有效預測視力保健行為。本研究發現教育部推廣之視力保健政策與學生實際執行有所落差，多數學生仍無法達成近距離用眼每30分鐘休息10分鐘或每天到戶外遠眺總時間超過120分鐘等目標。學生雖有足夠的視力保健知識，了解高度近視的嚴重性與威脅性，但學生仍有困難感受到視力保健行為的利益，而致缺乏行動力。故建議政府有關單位重新訂定合宜且有效的規律用眼時間。另外，國中學童視力保健受台灣教育體制與環境所限制，短期內較難改變，且基於研究結果可知嚴重性認知及威脅性認知與學生之視力保健行為呈顯著正相關，而課業枯燥壓力則可有效預測學生視力保健行為。故本研究建議可透過生動的眼疾示意圖或影片，或矇眼活動的視障體驗，讓學生體會近視的嚴重性與威脅，也期望藉這些生動、活潑的護理指導內容能降低學生課業枯燥的壓力，進一步協助促成學生採取視力保健的健康行為。[[abstract]]Myopia is the major health problem among junior high students in Taiwan. High myopia not only threatens students’ health by increasing the risk of blindness, but affects their learning and quality of life. Moreover, this issue becomes a large social financial burden. Well vision care is the key to delaying myopia worsening. However, it still remains ineffective. Therefore, this study is to explore the factors influencing the vision healthcare behavior among junior high school students with high myopia.The descriptive cross-sectional correlation research design was used for this study. A total of 132 students in 7th, 8th and 9th grade with high myopia in Taipei were recruited by convenience sampling. A demographic data, academic stress inventory and self-report vision care behavior questionnaire were used for data collecting.The results revealed that females are the majority of high myopia students. They were mostly diagnosed at the age of 7 and 8 and began to wear glasses at 9. Students widely accepted that high myopia is a severe problem and threatens their health, but vision care was not so effective in their vision health. Students’ left eye diopter (r=.194), perceived benefits from vision healthcare behavior (r=.306), perceived severity from high myopia (r=.205) and perceived threats from high myopia (r=.204) were significantly positive correlated with their vision healthcare behavior (p<.05), while academic stress from boring schoolwork was negative correlated (r= -.273, p<.05). The base attributes, academic stress, perceived severity from high myopia and perceived benefits from vision care could explain 34.9% of variance in vision healthcare behavior. In the stepwise regression analysis, the academic stress from boring schoolwork found to be the best predictor, followed by perceived benefits from vision healthcare behavior and left eye diopters. Although perceived threats from high myopia has a positive correlation with vision healthcare behavior, which still could not predict it well. We found that the gap exists between vision care policies from the Ministry of Education and what students actually behave. Most of the students cannot rest 10 minutes after near work for 30 minutes or outdoor overlooking for over 120 minutes every day. Though students have enough knowledge about vision care to sense the severity and threats from high myopia, it's still hard for them to realize the benefits from vision healthcare, which makes them lack of action. So we recommend government to redefine a feasible and effective rest period after use of eyes.Besides, junior high students' vision care cannot be improved rapidly due to limitation of the education system and environment in Taiwan. Additionally, we know that the perceived severity and threats have impact on vision healthcare behavior of students, and it is predictable from academic stress. Thus, we suggest to let students realize the severity and threats from myopia through vivid and vigorous images and videos of ophthalmological diseases, or experience the inconvenience of the visually impaired. In the meanwhile, we expect these instructions can decrease the academic stress and motivate them to take actions to protect their vision health