Understanding barriers to spectacle wear compliance among schoolchildren in Calabar Nigeria: A qualitative study

Abstract

Peer reported modifiable factors: • Parents’ concern that children could get too used to the spectacles. • Spectacle is like a disability and attract unwanted questions. • I wear my spectacles because I chose my frames. • Our parents and teachers need to be informed on the importance of wearing spectacles. Despite the availability of free spectacles, many schoolchildren in Africa do not wear them regularly. This study explores the factors affecting compliance with spectacle wear among schoolchildren in Nigeria, aiming to inform targeted eye health education strategies and future interventions. A qualitative study using Focus group discussion with 42 participants including 34 schoolchildren. Participants for the focus group discussions (FGD) were selected from a cluster-randomized controlled trial that assessed spectacle compliance between September 2017 and June 2018. Out of 4241 schoolchildren aged 10 to 18 recruited for the study, 308 received spectacles. In early February 2018, during the third month of the trial, 40 students were purposively identified and invited to participate in the FGD. A total of 34 students were interviewed in four groups across four schools. Additionally, a fifth group of selected adults was interviewed in a hall. The interviews took place in mid-February 2018 and each session lasted between 45 and 85 min . The findings reveal a mix of sociocultural misconceptions, stigma, environmental factors and self-perception issues influence children's decision to wear spectacles. According to the Health Belief Model, low perceived risk, high barriers to use, and limited cues to action hinder consistent wear. While improved vision and academic performance motivate some children, these benefits are outweighed by peer pressure and a lack of support. Enhancing self-efficacy through child-centred approaches, such as frame choice and improving frame aesthetics, promoting peer acceptance through targeted. School and community-based eye health initiatives should improve compliance.