Evaluating the Effectiveness and Scalability of the WHO MyopiaEd Digital Intervention: A Mixed-Methods Study (Preprint)

BACKGROUND The rapid rise of myopia worldwide, particularly in East and Southeast Asia, has implied environmental influences beyond genetics. Lifestyle factors, such as near-work activities and outdoor time, were identified to play a role. To address this growing public health concern, the World Health Organization (WHO) and International Telecommunication Union (ITU) launched the MyopiaEd program, which aims to promote knowledge and healthy behaviors regarding eye health to delay myopia onset and slow progression. South Korea, with its high rates of myopia and smartphone use, presented a suitable context for evaluating the effectiveness of the MyopiaEd program. OBJECTIVE This is the first study to date to evaluate the effectiveness and scalability of the MyopiaEd program in promoting eye health behavior change among parents of children in South Korea. METHODS A mixed-methods approach was employed utilizing both quantitative and qualitative data collection methods. Pre- and post-intervention surveys were used to assess changes in parental knowledge and behavior regarding myopia prevention. Semi-structured interviews was conducted to explore participants' experiences in-depth and receive feedback on program design. Prior to the intervention, the MyopiaEd program design and message libraries were adapted for the Korean context following WHO and ITU guidelines. Parents of children aged 7-8 years old participated, receiving 42 MyopiaEd messages over six months. RESULTS A total of 133 parents, consisting of 60 with myopic children and 73 with non-myopic children were included in the study. Both groups reported high engagement and satisfaction with the program. The program significantly increased knowledge about myopia in both groups (p < .001). While time spent on near-work activities did not change significantly, parents of children with myopia reported increased outdoor time (p = 0.048) and more frequent use of eyeglasses (p < .001) after the intervention. The qualitative analysis uncovered that parent had a shift in their perspectives toward outdoor activities, with an enhanced understanding of the advantages associated with such activities leading to positive changes in their behavior. However, challenges to reduce near-work activities were due to children's preference for smartphone use and indoor pursuits during leisure periods. The credibility of the institution delivering the program influenced parents' engagement and children's adoption of healthy behaviors. Messages that addressed common eye health misconceptions and specific behavioral guidance were perceived as the impactful elements of the program. CONCLUSIONS This study demonstrates the MyopiaEd program's potential as a scalable and innovative digital intervention for mitigating myopia risk in children. The program's effectiveness supports wider program adoption and can inform future myopia prevention policies.