Parents with at least one child aged 16 years or younger who attended The Kidz Academy (TKA) exhibition in Singapore (29 June to 1 July 2018) were invited to complete a tablet-based questionnaire, which was administered face-to-face by trained interviewers. Eligible participants provided written informed consent before administration of the questionnaire. Principles of the Declaration of Helsinki were observed.
An interviewer-administered online questionnaire (Google form) was developed by the research team (Additional file 1). The questionnaire consisted of 13 items that were separated into two domains. The first domain captured the participants’ socio-demographic information (5 items) and evaluated basic awareness of myopia and eye care management strategies (4 items). The second domain recorded their children’s demographics and past ocular history (4 items).
Participant socio-demographic information included age, gender, race, highest educational qualification and number of children (5 items). The questionnaire also recorded the age of the participants’ children and the children’s last eye examination period. The first 2 items enquired about the age and last eye examination period of the first child, while the remaining 2 items enquired about the other child/children’s age and last eye examination period.
Myopia knowledge and awareness items
The questionnaire contained 4 items on the participants’ myopia awareness, consisting of 3 four-option multiple choice items with 1 correct answer and 1 four-option item with more than 1 correct answer:
i. The participants were asked to state what they believed the prevalence of myopia was in secondary school-going Singaporean children by selecting one of the following percentages: 30%, 50%, 75% or 90%. The correct answer of 75% was based on data from the Singapore Health Promotion Board (HPB) in 2011 .
ii. The next item required the participants to state what they believed was the average amount of time 12-year old children in Singapore spend on devices daily by selecting one of the following options: 2 hours, 4.5 hours, 6.5 hours or 8 hours. The correct answer was 6.5 hours based on a report from the DQ Institute .
iii. The participants were then asked on their awareness of the minimum safe distance of device screens from the eyes, by requiring them to select one of the following options: 10cm, 20cm, 30cm or 40cm. The correct answer was 30 cm based on studies investigating the average working distance when using phones, and that closer working distances were associated with adverse ocular symptoms [18, 19].
iv. The last item which had multiple correct answers was related to participant awareness of strategies to prevent the onset and slow the progression of myopia, with the correct answer being all four of the proposed strategies, including outdoor activity and natural light exposure, looking far into the distance, taking regular breaks and undergoing annual eye check-ups.
De-identified data were downloaded from the Google form server and imported into SPSS statistics software version 25.0 (IBM Corporation, United States). A P-value of .05 was used for significance testing. Descriptive statistics were used to summarise the demographic characteristics of the survey population and logistic regression tests were utilised to compare the questionnaire responses. Multinomial logistic regression was used to assess the relationship between the demographic variables and participants’ awareness of the prevalence of myopia, recommended eye-to-screen distance and average daily time spent on devices. Binomial logistic regression was utilised to investigate the association between the demographic variables and knowledge of the effective strategies to prevent the onset and slow the progression of myopia. Odds ratios (OR) and 95% confidence intervals (CI) were also calculated for risk factors that were significantly and independently associated with the participants’ myopia awareness.