Knowledge, Attitude, and Practice of Chinese Parents Regarding Myopia in Children and Adolescents: A Cross-Sectional Study with Structural Equation Modeling.

BACKGROUND

The high and increasing prevalence of myopia among Chinese children and adolescents is a major public health concern. Parents play a pivotal role in myopia control, yet large-scale studies investigating the mechanisms linking their Knowledge, Attitude, and Practice, KAP are limited.

OBJECTIVE

To assess the KAP levels of Chinese parents concerning childhood myopia, identify influencing factors, and, crucially, employ Structural Equation Modeling, SEM to explore the mediating pathway from knowledge to practice via attitude.

METHODS

A cross-sectional online survey was conducted among parents of children aged 0-19 years. The questionnaire captured demographics and KAP dimensions. Analyses included descriptive statistics, univariate analysis (rank-sum tests, t-tests, ANOVA), and SEM with bootstrap resampling to test the mediating effect of attitude.

RESULTS

Among 193 valid responses, the mean total KAP score was 69.83 ± 7.48, with attainment (≥60% of total score) and excellence (≥85% of total score) rates of 98.96% and 41.45%, respectively. Attitude scores were highest (excellence: 75.65%), while practice scores were lowest (excellence: 27.98%). Residence, parental education, parental myopia, and child's age at myopia onset significantly influenced KAP (all p < 0.05). Notably, 46.11% of children engaged in >8 hours of daily online learning. SEM demonstrated a good model fit (CFI=0.972, TLI=0.969, RMSEA=0.070). Critically, the direct effect of knowledge on practice was non-significant (β = -0.012, p = 0.892), whereas the indirect effect via attitude was significant (β = 0.232, p = 0.003), indicating full mediation.

CONCLUSION

Chinese parents possess favorable KAP levels, yet a significant knowledge-practice gap persists, fully mediated by attitude. This empirically validates the KAP theory's core tenet: knowledge alone is insufficient; it must catalyze a positive attitude to translate into action. Future interventions should strategically shift from pure knowledge dissemination to targeted attitude shaping to bridge this gap and enhance effective myopia prevention practices.