Attachment in Schizophrenia: Its Associations with Theory of Mind, Childhood Trauma and Psychosocial Functioning.

The foundation of health promotion rests on expert-driven health education, which seeks not only to influence positive eyecare behaviours but also to enhance the utilisation of healthcare (eyecare) services [–]. Health literacy, fostered through health promotion, plays a pivotal role in shaping health-related behaviour, which encompasses attitudes, beliefs, motivations, and values [, ]. For such behaviours to be sustained, particularly values, they must be coherent within broader societal norms, thereby enabling individuals to exercise greater control over their health [, ]. School-based health promotion has demonstrated particular value, especially in settings with a high burden of disease and limited uptake of health services, such as developing countries, including South Africa [–]. In these contexts, such initiatives not only enhance learners’ health literacy but also positively influence their academic performance []. Conversely, within the school environment, eyecare health promotion (EHP) is notably limited, with vision screening often constituting “only eye health-related activity” []. A lack of eyecare health promotion, especially in schools, comes as eye health is classified as imperative for quality of life []. This neglect arises in part because most schools' health promotion efforts have historically prioritised health aspects such as smoking cessation, physical activity, and sexual health [, , ]. School-based health promotion is most effective when addressing both the individual and the environmental determinants of health []. The individual component includes knowledge, behaviour, and skills, whereas the environmental dimension encompasses the social and physical environment, ranging from the family to the community []. A dual focus yields more sustainable behaviour change []. Similarly, eyecare health promotions coupled with the provision of free spectacles enhanced both knowledge of eye health and spectacle wear compliance [–]. The effectiveness of health promotion is further enhanced when interventions account for social and cultural concepts []. Participants' health, beliefs, perceived susceptibility and severity, as well as perceived benefits and barriers form part of these concepts []. In South Africa, the national guidelines for the prevention of blindness explicitly recognise health education as a primary prevention strategy integrated within primary healthcare []. Nevertheless, a review of EHP in South Africa highlighted several deficiencies: its implementation has been fragmented, largely curative rather than preventative, insufficiently prioritised, and poorly documented [, ]. The study determined that eyecare health promotion activities are not included in primary healthcare due to the lack of a dedicated directorate, like other disciplines []. These shortcomings have been attributed to weak intergovernmental collaboration and limited political will to integrate eyecare services within primary healthcare [, ], despite optometry being classified as a primary healthcare service []. This gap is particularly concerning given the centrality of vision in learning, and the profound academic, psychological, social, and economic consequences of unaddressed vision problems for children [, , –]. Given the significance of EHP for global health outcomes, schools, as established institutions for learning and community engagement, are well-positioned to bridge deficits in health literacy, including eye health [, ]. Since school communities are also susceptible to ill-health (eye problems), the provision of health services, including the promotion of health literacy, can yield good results []. Furthermore, teachers whose role as health educators is well recognised can play an essential role in mitigating the negative effects of vision impairment, particularly in under-resourced contexts [, ]. Health promotion interventions are most effective when they are culturally, socially, and behaviourally contextualised, rather than generic or misaligned with the needs of the population [, ]. Notwithstanding the unaffordability and inaccessibility of eyecare services for those in rural areas, the dearth of eyecare health promotion in South Africa has been attributed to poor uptake of eyecare []. The impetus for this study arose from observed barriers to spectacle uptake in local communities, including low levels of eye health knowledge, inaccessibility, and unavailability, factors which have been consistently reported in previous studies [, , ]. Given that several EHP interventions have demonstrated improvements in health behaviour [, , , , , ], It was deemed important to implement and assess the effectiveness of the intervention. This study aimed to implement an eyecare health promotion among learners, parents, and teachers and to assess its effectiveness.