Improving preventive health compliance among rural children through behavioral nudges
| ISRCTN | ISRCTN12582665 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN12582665 |
| Sponsor | Shaanxi Normal University |
| Funder | Investigator initiated and funded |
- Submission date
- 08/05/2026
- Registration date
- 11/05/2026
- Last edited
- 11/05/2026
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Eye Diseases
Plain English summary of protocol
Background and study aims
Poor vision and uncorrected refractive errors remain common among children in rural China. Although many children receive initial vision screening and eyeglasses, follow-up compliance after eyeglass provision is often low. Delayed or missed follow-up visits reduce the long-term effectiveness of vision care interventions.
Behavioral economics research suggests that non-compliance may result from factors such as forgetfulness, present bias, and delayed decision-making rather than lack of access alone. Simple behavioral nudges, including reminders and small incentives, may help families prioritize preventive health behaviors.
This study aims to evaluate whether reminder phone calls and reminder-plus-subsidy interventions can improve children’s follow-up compliance for vision care services in rural China.
Who can participate?
Children aged between 8 and 15 years old from rural northwestern China who previously attended participating vision centers and whose caregivers can be contacted by phone.
What does the study involve?
Participants are randomly assigned to one of three groups.
Children in the control group receive a routine phone call asking about current eyeglass use, without reminders or incentives.
Children in the reminder group receive a phone reminder encouraging caregivers to schedule a follow-up examination.
Children in the reminder plus subsidy group receive the same reminder, together with information that replacement eyeglasses will be subsidized if new glasses are clinically required.
Researchers then track whether children return for follow-up care within two weeks and within two months after the intervention.
What are the possible benefits and risks of participating?
Potential benefits include increased awareness of children’s vision health needs and improved access to timely follow-up vision care.
The intervention itself involves only phone communication and information provision. Risks are minimal and primarily related to the handling of personal information. All data are anonymized and securely stored to protect participant privacy.
Where is the study run from?
The study is conducted in rural counties in northwestern China in collaboration with local vision care centers and coordinated by Shaanxi Normal University.
When is the study starting and how long is it expected to run for?
The study runs from October 2023 to March 2024.
Who is funding the study?
The study is independently initiated by the research team and is not supported by commercial funding.
Who is the main contact?
Prof Hongyu Guan, guanhongyu_ceee@snnu.edu.cn
Contact information
Principal investigator, Public, Scientific
No. 620 West Chang’an Street, Chang’an District
Xi’an, Shaanxi Province
710119
China
 ORCID ID |
0000-0002-0659-3527 |
|---|---|
| Phone | +86-029-81530873 |
| guanhongyu_ceee@snnu.edu.cn |
Study information
| Primary study design | Interventional |
|---|---|
| Allocation | Randomized controlled trial |
| Masking | Blinded (masking used) |
| Control | Active |
| Assignment | Parallel |
| Purpose | Treatment |
| Scientific title | Improving preventive health compliance through behavioral nudges: evidence from a vision care intervention in rural China |
| Study acronym | VISION-NUDGE Trial |
| Study objectives | The primary objective of this study is to evaluate whether behavioral nudges can improve follow-up compliance with preventive vision care among rural children in China. Specifically, the study examines the effectiveness of two intervention strategies — reminder phone calls and reminder phone calls combined with eyeglass subsidies — in increasing the likelihood that children return for recommended follow-up vision examinations after an initial clinic visit. The study further aims to compare the timing and magnitude of intervention effects across different follow-up periods, including short-term compliance (within two weeks) and longer-term compliance (within two months). In addition, the study explores whether intervention effectiveness differs across subgroups defined by gender, baseline vision severity, prior eyeglass ownership, educational stage, and geographic accessibility to health services. More broadly, the study seeks to contribute to the literature on preventive health behavior and behavioral economics by examining how low-cost behavioral interventions may reduce non-compliance in resource-constrained rural settings. |
| Ethics approval(s) |
Approved 14/03/2025, Shaanxi Normal University Academic Committee (No. 620 West Chang’an Street, Chang’an District, Xi'an, Shaanxi Province, 710119, China; +86-029-85308047; jyxb@snnu.edu.cn), ref: GZK2025-142 |
| Health condition(s) or problem(s) studied | Vision care compliance |
| Intervention | This study is an individually randomized controlled trial (RCT) designed to evaluate whether behavioral nudges can improve follow-up compliance in preventive vision care among rural children. Randomization was conducted at the individual level using Stata’s random number generator based on the Vision Center’s administrative records. Eligible students were randomly assigned in approximately equal proportions (1:1:1) to the reminder group, reminder-plus-subsidy group, or control group. The allocation sequence was generated centrally by the research team prior to intervention delivery. Intervention assignments were then implemented by trained project staff during caregiver phone calls. No sealed-envelope procedure was used. Eligible participants are randomly assigned to one of three groups: 1. Control group Caregivers receive a phone call asking about children’s current eyeglass use and vision status. No reminder or financial incentive is provided. 2. Reminder group Caregivers receive a behavioral reminder informing them that their child is approaching the recommended follow-up vision examination period and are encouraged to schedule a clinic visit. 3. Reminder plus subsidy group Caregivers receive the same reminder as Group 2. In addition, they are informed that if the child requires replacement eyeglasses after examination, the cost of replacement glasses will be subsidized. |
| Intervention type | Behavioural |
| Primary outcome measure(s) |
|
| Key secondary outcome measure(s) |
|
| Completion date | 30/04/2026 |
Eligibility
| Participant type(s) | Carer, Patient |
|---|---|
| Age group | Child |
| Lower age limit | 8 Years |
| Upper age limit | 15 Years |
| Sex | All |
| Target sample size at registration | 274 |
| Total final enrolment | 274 |
| Key inclusion criteria | 1. Rural primary or junior secondary school students who previously received vision care services at participating vision centers 2. Students whose previous clinic visit occurred approximately six months before intervention 3. Children with valid caregiver contact information 4. Students residing in rural counties in northwestern China |
| Key exclusion criteria | 1. Participants whose caregivers could not be reached by telephone after repeated attempts. 2. Participants lacking sufficient clinic record information for follow-up tracking. |
| Date of first enrolment | 01/10/2025 |
| Date of final enrolment | 30/04/2026 |
Locations
Countries of recruitment
- China
Study participating centre
Xi’an
710119
China
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|---|
| IPD sharing plan |
Editorial Notes
08/05/2026: Study’s existence confirmed by the Shaanxi Normal University Academic Committee, China.
