Psychological causes of non-compliance with electronically monitored occlusion therapy for amblyopia
- S E Loudon1,
- J Passchier2,
- L Chaker1,
- S de Vos1,
- M Fronius3,
- R A Harrad4,
- C W N Looman5,
- B Simonsz1,5,
- H J Simonsz1
- 1Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- 2Department of Medical Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- 3Department of Ophthalmology, JW Goethe University, Frankfurt am Main, Germany
- 4Bristol Eye Hospital, Bristol, UK
- 5Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Correspondence to Dr S E Loudon, Department of Ophthalmology, Room Ee 1607, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands;
- Accepted 25 May 2009
- Published Online First 5 August 2009
Aim: To analyse psychological causes for low compliance with occlusion therapy for amblyopia.
Method: In a randomised trial, the effect of an educational programme on electronically measured compliance had been assessed. 149 families who participated in this trial completed a questionnaire based on the Protection Motivation Theory after 8 months of treatment. Families with compliance less than 20% of prescribed occlusion hours were interviewed to better understand their cause for non-compliance.
Results: Poor compliance was most strongly associated with a high degree of distress (p<0.001), followed by low perception of vulnerability (p = 0.014), increased stigma (p = 0.017) and logistical problems with treatment (p = 0.044). Of 44 families with electronically measured compliance less than 20%, 28 could be interviewed. The interviews confirmed that lack of knowledge, distress and logistical problems resulted in non-compliance.
Conclusion: Poor parental knowledge, distress and difficulties implementing treatment seemed to be associated with non-compliance. For the same domains, the scores were more favourable for families who had received the educational programme than for those who had not.
Funding Health Research and Development Council of The Netherlands; MF: Albert von Metzler Foundation, Augenstern Association, Research Award of the German Society of Ophthalmology (DOG), Germany.
Competing interests None.
Provenance and Peer review Not commissioned; externally peer reviewed.
Ethics approval Ethics approval was provided by Erasmus MC University Medical Center Rotterdam.
Patient consent Obtained.
▸ A supplemental file is published online only at http://bjo.bmj.com/content/vol93/issue11