Enhancing vaccination uptake through community engagement: evidence from China.

With growing recognition of the importance of community engagement in addressing public health challenges, its role in promoting healthy behaviors and preventing infectious diseases has gained attention. However, vaccination coverage remains a significant concern in many developing countries. While previous studies have linked community engagement to positive health outcomes, there is a gap in understanding its influence on individual vaccination choices, particularly in the context of developing countries. Utilizing data from the 2021 Chinese General Social Survey (CGSS), this study examines the impact of community engagement on COVID-19 and flu vaccination uptake among 7281 individuals. Community engagement, measured by community vaccination notifications, serves as the key independent variable. The study employs Ordinary Least Squares (OLS) regression and Propensity Score Matching (PSM) methods to analyze the relationship between community engagement and vaccination behavior. The analysis reveals a positive association between community engagement and vaccination rates. Specifically, individuals receiving notifications were more likely to get the COVID-19 vaccine compared to non-recipients (vaccination rates: 100% vs. 53.3%), and flu vaccination rates were also significantly higher among those notified (2.7% vs. 1.9%). Mechanism analysis suggests that individuals receiving community notifications are more aware of the benefits of vaccination, leading to higher vaccination rates among this group. This study underscores the effectiveness of community engagement strategies in promoting positive vaccination behavior among individuals in China. By enhancing awareness and trust in immunization, community engagement initiatives play a crucial role in shaping health behaviors and improving vaccination uptake. These findings emphasize the importance of integrating community engagement approaches into public health interventions to address vaccination challenges.

Relationship between visual impairment and school entrance age in rural China.

CLINICAL RELEVANCE: Children with uncorrected visual impairment have lower scores on various motor and cognitive tests. Exploring the association between visual impairment and school entrance age among school children in rural China may assist in enhancing the visual health of early-entry school students. BACKGROUND: Educational pressures may play a role in the visual health of students. School entrance age is associated with educational pressures. This study explored whether school entrance age can contribute to visual impairment among younger generations. METHODS: A cross-sectional study was conducted with 17,510 students from 252 primary schools in two prefectures in western China. Information on the sampled students was collected through questionnaires and vision examinations. The relationship between visual impairment and school entrance age was further analysed by multiple regression. The school entrance age was classified as early-entry and late-entry, early-entry was defined as students entering school at the age 6 years. RESULTS: The results showed that the myopia rate of early-entry students (26.92%) was higher than late-entry students (23.86%). Multiple regression showed that visual impairment increased with the earlier age of school entry (P = 0.044). The prevalence of myopia was also significantly higher in higher grades for children of the same age. The prevalence of myopia in 10-year-old and 11-year-old fourth- and fifth-grade students was 20.6% to 30.5%, 21.7% to 27.4% (P < 0.001). The near work with eyes was significantly different among children of the same age in different grades during this study (P < 0.001). CONCLUSION: Myopia is related to the school entrance age of children. Children who start school earlier are more likely to suffer from myopia. Educational pressures and digital screens may play a role in the association. Changes in the current education mode by reducing the study burden in the early years of learning may be significant.

To investigate the individual and household-level factors influencing the willingness to pay for cataract surgery among patients aged 50 years and older in rural China: a cross-sectional study.

OBJECTIVES: To investigate the factors influencing the willingness to pay (WTP) for cataract surgery among patients aged 50 years and older in rural China at both individual and household levels. DESIGN: A cross-sectional study. SETTING: The study was conducted in Gansu, China. PARTICIPANTS: Patients aged ≥50 years who were diagnosed with cataracts indicated for surgery and lived rural in Gansu from October to December 2020 were included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: The main study outcome was the patients' WTP for cataract surgery. The association of individual characteristics, knowledge about cataracts, health status and household characteristics with patients' WTP was also evaluated based on the collected data using structured questionnaires. RESULTS: A total of 324 (85.94%) patients in the study reported that they were willing to pay for their cataract surgery. However, only 179 (47.48%) patients were willing to pay over ¥1000 to cover the cost of cataract surgery under the New Rural Cooperative Medical System (NRCMS). Patients aged 75 years and older were significantly less likely to pay for cataract surgery (p=0.037). Better visual status (p=0.032), self-reported severe poor visual status (p=0.001), higher annual household income (p=0.052) and a higher level of children's education (p=0.076) were significantly more likely to pay for cataract surgery. CONCLUSIONS: The WTP for cataract surgery in rural China is still insufficient. More than half of patients' WTP for surgery do not cover the cost of cataract surgery after reimbursement by the NRCMS. Both individual and household characteristics contribute to the low WTP for cataract surgery.

Association between visual impairment and body mass index in students from rural China.

Introduction: Visual impairment and obesity remain the major public health issues among school-age students in rural areas of China. Obesity is an underlying risk of vision problems. This study aimed to assess the association between visual impairment and body mass index (BMI) among school-age students in rural northwest China. Methods: This study included 39,385 students from the 4th to 9th grade in rural northwest China. From 2018 to 2020, students underwent an assessment of visual acuity (VA) and completed a questionnaire on family demographics, and height and weight measurements. Multiple logistic regression analyses were used to analyse the data. Results: The association between visual impairment and BMI groups was significant in the study population (P = 0.002) and in different groups (at the different educational, provincial and national levels) (P < 0.001, separately). Multiple logistic regression analyses revealed a positive relationship between visual impairment and obesity in the study population, including those attending primary school, Han students and the residents of Ningxia autonomous region. Conclusion: The association between visual impairment and obesity was significant among school-age students in rural northwest China. There should be implementation of policies to address the problem about visual impairment and obesity among school-age students in rural areas.

Gender differences in vision health-seeking behavior and vision health outcomes among rural Chinese schoolchildren by birth order and family size.

BACKGROUND: The gender gap remains a major impediment in the path toward equality, and it is especially wide in low-income countries. Gender differences in health-seeking behaviors may be a factor. Family size and childbirth order are two critical factors affecting family resource allocation. This study examines gender differences in healthcare-seeking behaviors among children with visual impairment in rural China across different family structures (birth order and family size). METHODS: We draw on a dataset containing 19,934 observations constructed by combining data from 252 different school-level surveys spanning two provinces. The surveys were all conducted in 2012 using uniform survey instruments and data collection protocols in randomly selected schools across western provinces in rural China. The sample children range in grades from 4 to 5. Our analysis compares rural girls with rural boys regarding vision health outcome and behavior (vision examination and correction). RESULTS: The findings revealed that girls have worse vision than boys. Regarding vision health behaviors, girls have a lower overall vision examination rate than boys. There is no gender difference when the sample student is the only child or the youngest child in the family, but there is still a gender difference when the sample student is the oldest child in the family or the middle child in the birth order. When it comes to vision correction behavior, boys are more likely to own eyeglasses than girls are for groups of students with mild visual impairment, even when the sample student is the only child in the family. However, when the sample student has another brother or sister (the sample student is the youngest, the oldest child in the family, or the middle child in the birth order), the gender difference disappears. CONCLUSIONS: Gender differences in vision health outcomes are correlated with gender differences in vision health-seeking behaviors among rural children. Depending on the birth order and family size, gender disparities in visual health practices vary. In the future, consideration should be given to providing medical subsidies to reduce the cost of vision health behaviors and to provide information interventions to change gender inequality in households and promote equality in children's vision health behaviors. TRIAL REGISTRATION: The trial was approved by the Stanford University Institutional Review Board (Protocol No. ISRCTN03252665). Permission was received from local Boards of Education in each region and the principals of all schools. The principles of the Declaration of Helsinki were followed throughout. Written informed consent was obtained from at least one parent for all child participants.

The prevalence and county-level socioeconomic correlates of visual impairment and glasses ownership among rural students in Western China.

Objectives: Vision health has been a major issue in public health care. The vision problems of children in rural China are of particular concern. Effective policies for children's vision health should consider the heterogeneity of individual health levels and regional differences in healthcare services. This study systematically explored the relationship of student visual impairment and glasses ownership with county-level socioeconomic status (namely, county-level per capita GDP, population density and industrial structure) in rural China. Methods: The study sample included 99,670 students in grades 4-9 from 445 schools in 13 counties in Shaanxi Province. From 2014 to 2020, students took school-based vision screening tests and completed sociodemographic questionnaires. Multivariate regressions were used for empirical analysis. Results: The prevalence of visual impairment was 30.4% in the total sample, and the rate of visual impairment in girls (34.3%) was higher than that in boys (27.0%). Among visually impaired students, the rate of glasses ownership was only 39.7%, with girls (40.6%) higher than boys (38.8%). The study also found that the visual impairment was significantly correlated with county-level average income, population density and industrial structure, and the glasses ownership was significantly correlated with population density and industrial structure (all p < 0.001). Conclusions: The study found that the county-level socioeconomic status was positively and significantly correlated with visual impairment and glasses ownership, respectively. The vision health management services for students should be jointly carried out by the education, medical and public health departments, and additional investment is needed to increase the accessibility and affordability of vision care services, with special focus on poor regions and disadvantaged groups, so as to narrow the gap in vision health services.

Knowledge of cataracts and eye care utilization among adults aged 50 and above in rural Western China.

Background: Cataracts are highly prevalent in rural China, but patient utilization of eye care services is low. Cataract knowledge is regarded as an important factor in eye care utilization. Few studies, however, have been conducted to measure the level of cataract knowledge and its relationship with eye care utilization among older adults in rural China. Hence, we described cataract knowledge and investigated the relationships between cataract knowledge and eye care utilization among adults (≥50 years) in rural Western China. Methods: A large community-based cross-sectional study was conducted from October to December 2020 among adults aged 50 years and older in 73 rural villages in Qingcheng County, Western China. The participants underwent an eye examination at their village clinic to determine whether they had cataracts. Participants also answered a questionnaire about cataracts, eye care utilization status, and sociodemographic characteristics. The collected data underwent descriptive and multiple logistic regression analyses. Results: The eye examinations revealed that 45.15% (675/1,495) of participants had cataracts in at least one eye, yet 90.67% (612/675) were left untreated. The average score achieved by participants about cataract knowledge was 4.91 points (total score was eight points). Correct knowledge about cataracts was positively associated with cataract screening and cataract surgery. Elders with better cataract knowledge were 2.21 times more likely to undergo cataract screening (OR, 2.21; 95% CI, 1.54-3.16) and 5.61 times more likely to undergo cataract surgery (OR, 5.61; 95% CI, 2.87-10.98). More than half had three fundamental misconceptions about how cataracts should be treated, how much they should cost, and when they should be treated. Participants who did not have these misconceptions were more likely to receive cataract screening by 1.21-2.02 times and cataract surgery by 1.76-3.48 times. Conclusion: There are misunderstandings about cataract treatment methods, treatment costs and timing in the sample areas. A better understanding of cataracts was significantly positively associated with cataract screening and cataract surgery. Health education on cataracts and regular eye examinations are needed to improve eye care utilization in rural China.

The Role of Village Doctors in Residents' Uptake of Eye Screening: Evidence from Ageing Residents in Rural China.

The lack of formal eye screening is the main reason for insufficient eye care utilization in rural China. Cataract, in particular, is increasingly prevalent with the aging population, but the treatment rate is relatively low. Village doctors are the most accessible health care resource for rural residents, receiving few empirical investigations into their role in eye care. This study aims to assess the role of village doctors in residents' uptake of eye screening (vision and cataract screening), the first step of cataract treatment. Data come from a community-based, cross-sectional survey conducted in 35 villages of a county of the Gansu Province, Northwestern China, in 2020. Among 1010 residents aged ≥ 50 and 35 village doctors, the multivariate logistic regression shows that village doctors' age, time spent on public health service, and service population were positively associated with residents' uptake of vision and cataract screening. Village doctors were capable of playing an active role in primary eye health services due to their richer knowledge about cataracts than residents (accuracy rate 86.75% vs. 63.50%, p < 0.001), but less than half of them were willing to undertake eye screening. This study highlights the positive role of village doctors in aging residents' eye screening and the potential role in improving the uptake of eye screening by offering health education.

Factors influencing post-screening visits of students to local vision centres in rural northwest China.

CLINICAL RELEVANCE: Children with uncorrected visual impairment have lower scores on a variety of motor and cognitive tests. Exploring the influencing factors of low-income groups seeking vision care services is helpful for identifying relevant barriers and necessary measures to improve the utilization rate of vision care services. BACKGROUND: The community-based vision center (VC) is a popular model for solving vision problem of students in rural China. Compliance is the key factor to the success of the VC model. Factors determining compliance with visitations to VC among primary school students after screening were explored. METHODS: A cross-sectional study was conducted with 15,763 students from 228 primary schools. Information was collected through questionnaires and vision examinations. The determinants that affect visits of students to the VC were analyzed using logistic regression. RESULTS: Among the 15,763 sample, 5,361 (34%) students had a visual impairment. At baseline, only 962 (18%) of students with visual impairment sought vision care services. After a local VC was established, among the 5,163 students who needed to be referred, only 2,237 (43.33%) students visited the VC. Multivariate logistic regression models for predicting students visit the VC revealed that the following characteristics were significant predictors: poor uncorrected visual acuity (P < 0.001), a higher grade level (P = 0.008; P = 0.010), 'left-behind' children (P < 0.001), short living distance between home and the VC (P < 0.001), and the fact that these students lived in Gansu province (P < 0.001). CONCLUSIONS: Establishing a VC that provides students with vision screening and free vision care services can increase the rate of seeking vision health services for students in rural areas, but the compliance rate still needs to be improved. The influencing factors for student compliance have been identified.

Factors influencing cataract awareness and treatment attitudes among the middle-aged and older in western China's rural areas.

Purpose: This study was conducted to determine the level of knowledge about cataracts and the associated factors among adults aged 50 and above in rural areas of Qingcheng county in Gansu Province of Western China, 2020. Methods: A large community-based cross-sectional study was conducted among the randomly selected 1,503 adults aged 50 and above from October to December 2020. Data were collected by conducting eye examinations and face-to-face interviews. Multivariate binary logistic regression and multivariate linear regression were used to identify associated factors of knowledge about cataracts. Odds Ratio (OR), Coefficient (C), and 95% Confidence Interval (CI) were reported to declare the statistical associations between knowledge about cataracts and the independent variables. Results: Of the 1,503 study participants, 1,078 (71.7%) had good knowledge about cataracts. The primary school completed [OR = 1.43 (95% CI 1.08-1.90), P = 0.012], Secondary school & above [OR = 2.69 (95% CI 1.86-3.89), P <0.001], Examine for cataract [OR = 1.82 (95%CI 1.27-2.62), P = 0.001] were positively significantly associated with knowledge about cataracts. Whereas eye examinations [OR = 0.73(95% CI 0.55-0.96), P = 0.022] were negatively associated with knowledge about cataracts. Multivariate linear regression analyses showed a significant negative correlation between age and knowledge of cataract treatment options. Living with at least one child was positively correlated with knowledge of the therapeutic effects of cataracts. And monthly household income was significantly positively correlated with knowledge of the therapeutic effects of cataracts, treatment options, and the surgical reimbursement ratio for cataracts. Conclusions: More than one-third of the participants still had poor knowledge about cataracts. The respondents with at least primary education and above, with previous examinations, and with examination for cataracts had significant associations with good knowledge about cataracts. So, it is recommended that stakeholders in different hierarchies organize health education by considering the education level of the community, focusing on cataract treatment knowledge and the surgical reimbursement ratio to improve cataract surgery rates.