SWISH (See Well to Stay In ScHool: Randomised trial of spectacle distribution to decrease secondary school dropout rates in rural communities)

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What we want to know: Will giving free glasses to short-sighted Chinese children in poor rural areas, and working with teachers to encourage them to use the glasses in class, result in more children going on to high school?Type of study: Called a "trial," this kind of study chooses at random (like flipping a coin) the study group that all children in a particular school will be in.Why the study is needed: Chinese children are some of the most short-sighted in the world, but only one in five children in poor areas who needs glasses has them. Our team has already showed in other trials that giving children free glasses leads to better grades, and that free glasses have a bigger impact on grades than factors like parents' education level and the amount of money a family has. The effect on grades from glasses is greater than from other health services in school, like giving vitamins. Only about one in three children in rural western China goes on to a regular, non-vocational high school. We would like to show the Chinese government strong evidence of what glasses can do to help children continue their education, in order to help convince the government to carry out national programs to provide free glasses for children who need them.Study Plan: We will choose 130 middle schools at random in Ningxia, western China, and all children in Years 1 and 2 (one class each) at each school will go at random into one of two groups: either a group getting free glasses, with support from teachers to push them to wear the glasses ("Intervention") or a group getting just glasses prescriptions ("Control.") The study will mainly look at the rate of children going on to high school, and is large enough to find out whether we produced at least a 10% rise in this number. We'll also look at the children's test scores, whether they wear their glasses at school, and how often they use blackboards (harder for short-sighted kids to see) or textbooks to learn from. These other things will help us to better understand whether the idea that making the vision better with glasses leads to better grades and then to higher rates of going on to high school really makes logical sense. We'll also study how much it costs to give the glasses and the teacher support to wear them, compared to how much benefit it brings to children. We will also study the thinking of students, teachers and parents about wearing glasses and staying in school, to make sure our approaches are suitable in this area.Study Team: Dr Congdon, the head of the study, is an eye doctor and public health expert who speaks fluent Chinese. He works at both the UK (Queen's) and Chinese (Zhongshan) universities seeking this grant. Also at Queen's there are specialists in this type of study (trials), an expert data analyst who speaks Chinese, an expert to carry out the part of the study looking at costs and benefits, and also a cultural expert to help us understand local attitudes about wearing glasses and staying in school. Working with us in China are staff at Zhongshan, the top eye hospital in China and a center for doing trials such as this one, and Shaanxi Normal (teacher training) University, which has very close connections to the bureau running the schools in Ningxia where we plan to work. Another partner is an American group, REAP, at Stanford University. They are experts in doing studies to prove what changes help rural Chinese schools to improve. Our team has worked together on many trials on glasses like this one in Chinese schools.