Understanding parental engagement in children and adolescents' myopia prevention and control: a push-pull-mooring framework approach.

OBJECTIVE

Successful endeavors in myopia prevention and control require parental participation. This study applied the Push-Pull-Mooring (PPM) framework to explore how push, pull, and mooring factors foster parents' willingness to engage in myopia prevention and control, and to examine the moderating role of information provision on the relationship between parental willingness and actual engagement.

METHODS

A cross-sectional study was conducted among parents of children and adolescents in the Yangtze River Delta region of China. A total of 996 participants completed a web-based self-administered questionnaire. Structural equation modeling and hierarchical regression were employed to investigate the determinants of parental willingness and actual engagement in myopia prevention and control.

RESULTS

Push factors, including perceived risk of myopia (β = 0.119, p < 0.001) and knowledge of myopia (β = 0.221, p < 0.001), was significantly associated with parental willingness to engage. Pull factors, including recognition of policies and campaigns (β = 0.268, p < 0.001) and peer influence (β = 0.288, p < 0.001), are also positively associated with willingness. Among mooring factors, cost of myopia prevention and control (β = -0.082, p < 0.01) was negatively associated with parental willingness, and also weakened the positive association with push and pull factors on willingness. Parental willingness (β = 0.531, p < 0.001) is positively associated with actual engagement; however, information provision did not significantly moderate the relationship between willingness and actual engagement.

CONCLUSION

The PPM framework effectively explained the psychosocial determinants of parental engagement in myopia prevention and control. Peer influence and recognition of myopia prevention policies and campaigns were the strongest predictors of parental willingness, while prevention costs served as a key barrier. Parental willingness, in turn, was a strong predictor of actual engagement behavior. These findings suggest that policymakers should strengthen parental willingness through targeted campaigns that leverage peer influence, improve policy awareness, and reduce prevention-related costs through resource provision at the family level.