Sociocultural and psychological determinants in migrants for noncompliance with occlusion therapy for amblyopiaReport as inadecuate

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Graefe-s Archive for Clinical and Experimental Ophthalmology

, Volume 249, Issue 12, pp 1893–1899

First Online: 12 March 2011Received: 26 May 2010Revised: 17 January 2011Accepted: 11 February 2011


BackgroundCompliance with occlusion therapy for amblyopia in children is low when their parents have a low level of education, speak Dutch poorly, or originate from another country. We determined how sociocultural and psychological determinants affect compliance.

MethodsIncluded were amblyopic children between the ages of 3 and 6, living in low socio-economic status SES areas. Compliance with occlusion therapy was measured electronically. Their parents completed an oral questionnaire, based on the -Social Position and Use of Social Services by Migrants and Natives- questionnaire that included demographics and questions on issues like education, employment, religion and social contacts. Parental fluency in Dutch was rated on a five-point scale. Regression analysis was used to describe the relationship between the level of compliance and sociocultural and psychological determinants.

ResultsData from 45 children and their parents were analyzed. Mean electronically measured compliance was 56 ± 44 percent. Children whose parents had close contact with their neighbors or who were highly dependent on their family demonstrated low levels of compliance. Children of parents who were members of a club and who had positive conceptualizations of Dutch society showed high levels of compliance. Poor compliance was also associated with low income, depression, and when patching interfered with the child’s outdoor activity. Religion was not associated with compliance.

ConclusionsPoor compliance with occlusion therapy seems correlated with indicators of social cohesion. High social cohesion at micro level, i.e., family, neighbors and friends, and low social cohesion on macro level, i.e., Dutch society, are associated with noncompliance. However, such parents tend to speak Dutch poorly, so it is difficult to determine its actual cause.

KeywordsAmblyopia Ethnic groups Patient compliance Social cohesion Social class Ms. H. Akcan and Ms. F. Ziylan contributed equally to this work.

This work was supported by: ZonMw — the Netherlands Organization for Health Research and Development grant number: #6320.0008.

Clinical trials registration reference number: ISRCTN22835481 - NTR713

A part of this study was the graduate thesis of Ms. H. Akcan and Ms. F. Ziylan of the HU University of Applied Sciences Utrecht Hogeschool Utrecht the Netherlands, Department of Orthoptics in October 2008.

The authors have full control of all primary data, and they agree to follow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data upon request.

Electronic supplementary materialThe online version of this article doi:10.1007-s00417-011-1637-5 contains supplementary material, which is available to authorized users.

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Author: Angela M. Tjiam - Hilal Akcan - Fatma Ziylan - Elizabet Vukovic - Sjoukje E. Loudon - Caspar W. N. Looman - Jan Passchi


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