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Psychological causes of noncompliance with electronically monitored occlusion therapy for amblyopia
  1. Sjoukje Loudon1,
  2. Jan Passchier1,
  3. Layal Chaker1,
  4. Sander de Vos1,
  5. Maria Fronius2,
  6. Richard Harrad3,
  7. Caspar Looman1,
  8. Brigitte Simonsz-Toth1,
  9. Huibert Simonsz1
  1. 1 ErasmusMC University Medical Center Rotterdam, Netherlands;
  2. 2 J.W. Goethe Institute, Frankfurt am Main, Netherlands;
  3. 3 Bristol Eye Hospital, Netherlands
  1. * Corresponding author; email: sjoukje.loudon{at}


Aim: To analyze psychological causes for low compliance with occlusion therapy for amblyopia.

Method: In a randomized 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 noncompliance.

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 noncompliance.

Conclusion: Poor parental knowledge, distress and difficulties implementing treatment seemed to be associated with noncompliance. For the same domains, the scores were more favourable for families who had received the educational programme than for those who had not.

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