线上线下近视防控健康教育对小学生干预效果评估

Effectiveness of online and offline health education myopia intervention on primary school students

目的针对未近视小学生,基于可穿戴行为监测工具,前瞻性地评估实施线上线下近视防控健康教育干预的效果,为公共卫生实践提供循证医学依据。方法于2021年5—6月在江苏省同区县内选择2所小学各6个班级的非近视二年级学生,学校1为在线上线下父母健康知识教育(干预组,111人),学校2为仅开展线下健康教育活动(传统干预组,122人)。2所学校学生均接受可穿戴行为监测工具的监测(眼距离、用眼时长、环境光照和户外暴露时间),反馈结果报告,并开展传统健康教育干预,组织发放宣传用品和展板;干预组添加微信群,开展线上健康父母行动(解答与反馈父母提出的近视防控相关健康知识并进行近视防控科普宣传等)。评估指标包括近视率、散瞳后的屈光度和眼轴长度,追踪时间为2年(2021—2023年)。同时收集2所学校12个班级中未参加可穿戴工具监测非近视学生(自然观察组,56人)的屈光参数。结果基线结果显示,干预组屈光度、父亲近视率、母亲近视率、平均每天用眼(视近)时长、平均用眼(视近)距离、预测每天户外活动时间、平均用眼(视近)光照强度(夜)与传统组相比差异均无统计学意义(t/Z/χ^(2)值分别为1.94,1.17,0.58,0.40,0.80,0.69,0.32,P值均>0.05)。随访发现,第1年干预组近视率(11.4%)低于传统干预组(26.2%);第2年干预组近视率(29.7%)低于传统干预组(50.9%);且干预组屈光度变化值为0.63(0.38,1.19)D,低于传统干预组变化值0.91(0.40,1.50)D,差异均有统计学意义(χ^(2)/Z值分别为4.93,10.37,2.29,P值均<0.05)。参加可穿戴工具监测传统组学生的随访2年近视率均低于自然观察组,差异无统计学意义(P>0.05)。第2年传统干预组眼轴变化值[0.35(0.20,0.65)mm]低于自然观察组变化值[0.55(0.30,0.75)mm],差异有统计学意义(Z=1.92,P<0.05)。结论线上线下近视防控健康教育干预可有效降低近视率。可穿戴行为监测工具和线上健康教育相结合的干预模式可能效果更佳,尚需大样本、多中心的研究论证。

Objective To assess the effectiveness of online and offline myopia prevention and control health education interventions using wearable behavior monitoring tools for non-myopic elementary school students,so as to provide evidence-based medical support for public health practices.Methods From May to June in 2021,two schools were selected within the same county in Jiangsu Province.School 1 conducted online and offline parental health education(n=111),while school 2 exclusively conducted offline health education activities,representing the traditional intervention group(n=122).Students from both schools underwent monitoring through wearable behavior-tracking tools,with feedback reports provided(eye distance,eye duration,ambient light,and outdoor exposure time).Both schools relied on activities to carry out health education interventions,and organized the distribution of promotional materials and display boards.The intervention group also established WeChat groups to conduct online"Healthy Parents Action"(answering and providing feedback on health knowledge related to myopia prevention and control,myopia prevention and control,science popularization,etc.raised by parents).Evaluation criteria included myopia rates,post-dilation refractive error,and axial length,with a tracking period of two years(from 2021 to 2023).Additionally,the study collected refractive parameters from non-myopic students who did not participate in wearable tool monitoring in the 12 classes across the two schools.Results The baseline results indicated that there were no significant differences between the two groups in terms of refractive parameters and wearable tool monitoring results(including screen time,viewing distance,outdoor exposure time,and homework light exposure)(t/Z/χ^(2)=1.94,1.17,0.58,0.40,0.80,0.69,0.32,P>0.05).After a two-year follow-up,in the first and second year,the myopia rate of the online Healthy Parents Action group(11.4%,29.7%)were lower than that of the traditional group(26.2%,50.9%),and the degree of refractive change in the intervention group[0.63(0.38,1.19)D]was lower than that of the traditional group[0.91(0.40,1.50)D],and all the differences were statistically significant(χ^(2)/Z=4.93,10.37,2.29,P<0.05).However,there were no significant differences(P>0.05)in axial length changes between the two groups over the two-year intervention period.Nevertheless,in the second year,the axial length change in the traditional group[0.35(0.20,0.65)mm]was lower than that in the natural observation group[0.55(0.30,0.75)mm],and this difference was statistically significant(Z=1.92,P<0.05).Conclusions Online and offline myopia prevention and control health education can effectively reduce myopia rates.The intervention mode combining wearable behavior monitoring tools with online health education may have better effects,but further large-sample and multi-center studies are needed to provide additional evidence and confirmation.