Parent perceived barriers and determinants for vision and eye screening of preschool children in Saudi Arabia- A survey

INTRODUCTION

Childhood blindness is one of the priority components of Universal Eye Care and VISION 2020.1, 2 Given its impact on disability-adjusted life years in the era of long-term support for children with visual disabilities, early detection of blinding eye diseases and their management is of paramount importance. In preverbal ages, children cannot complain, and noting signs by parents is often too late for successful intervention. Therefore, universal or opportunistic vision and eye screening of preschool children is essential. Such initiatives include eye screening at birth, vaccination visits, pediatrician visits for other health ailments, and kindergarten or primary school entry. 3, 4, 5 Limited information on the magnitude of childhood blindness and the usefulness of preschool vision screening exists in the Middle East over the last five years. Global and regional child eye care initiatives have recommended proactive steps for early detection and timely management of eye problems, including amblyopia.^{6, 7}

The Kingdom of Saudi Arabia, with 23.9% of the population below 15 years of age, had 2.6 million children under <5 years and 5.5 million school-going children.⁸ Primary education is mandatory and free of cost. The health services at government hospitals are also free of cost to the Saudi population. Secondary and tertiary child health services, including eye care, are available in each region of the Kingdom. The vision and eye screening of 444,259 school children reported a 10.9% prevalence of visual impairment in the 2018-19 academic year.⁹ Few regions noted the need for kindergarten vision screening, but to our knowledge, no national policy for vision and eye screening of <5 has been implemented so far.^{10, 11}

Parents are essential stakeholders in the success of a child's health initiatives, including vision and eye screening. Their awareness and identification of perceived bottlenecks in eye care for children will help prevent blindness and improve child healthcare within the public health sector, particularly when planning/revisiting VISION 2030 in the Kingdom. In developed countries, preschool vision screening is recommended but optional. In developing countries, it is recommended but not feasible. Saudi Arabia, with a per capita GDP of US$32,530 in 2023, allocated 11% of its budget for health.⁸ Therefore, this country's barriers to eye and vision care could be unique and applicable to Gulf countries with similar religious beliefs and infrastructure status while planning kindergarten vision screening programs.

Female gender, lack of knowledge, negative beliefs, fear, lack of access to pediatric eye care, referencing protocols and policies, and high cost are a few known barriers that were hurdles for implementing vision and eye screening of children <5 years of age.^12,13-15 Parents' perceived barriers could enable decision-makers to make screening initiatives parent-friendly. The Knowledge, attitudes, and practices of parents, teachers, and primary health staff have been studied in the kingdom, but parents' perceived barriers to implementing such screening have not been reviewed.^{16, 17, 18}

We present the perceived barriers and determinants of eye and vision screening for preschool children among parents in Saudi Arabia in 2024.

METHODS

The Institution Research Board approved the research project. (HAPO-01-R-011) Randomly selected parents of kindergarten-aged children were invited to participate in this survey. Written informed consent was obtained to participate in the survey. Those agreeing were included. Those who did not agree to participate were excluded. The tenets of the Helsinki Declaration were strictly abided by in all stages of the research.

This was a cross-sectional survey. We assumed that among 2 million Saudi parents with kindergarten children, the lack of awareness among preschool children was low, as reported by Al-Atawi et al.¹⁵ To achieve a 95% confidence interval and 3% acceptable error margin with a study design factor of 1.5, we need at least 1,456 participants in the survey. We used the OpenEpi software statistical calculator by Rollins School of Public Health, USA, to estimate the survey sample.¹⁹

The study team carefully organized and oversaw the recruitment process to ensure comprehensive coverage across the five main regions of Saudi Arabia, thereby obtaining a representative sample. The sample was conveniently collected but was stratified in proportion to the regional population distribution of parents with kindergarten-aged children. Specifically, the targeted sample included 400 participants from the Central region, 200 from the Eastern region, 50 from the Northern region, 400 from the Western region, and 150 from the Southern region. The survey was distributed electronically using a pretested Google Form to facilitate data collection. Additionally, the study team provided participants with a clear explanation of the research purpose, promptly addressed their inquiries, and obtained informed consent before participation. Team members were also available to assist participants who faced confusion or technical difficulties during the survey. Finally, all responses were treated with the utmost confidentiality, and ethical guidelines were rigorously followed to safeguard participant privacy. The demographic information included age group, gender, relationship with the child in KG, area of residence, nationality, education, employment, number of children, children in KG, children wearing spectacles, and parents wearing spectacles. The questionnaire related to the barriers included 26 questions. They included a negative attitude of parents (6), being busy (2), distance (1), affordability (1), fear (2), primary eye care provider-related (6), pediatric ophthalmology service-related (7), and a bad experience in the past (1). The participants used five graded Likert scales to respond to the questions related to barriers to vision and eye screening of preschoolers that they perceived. The fully disagree response was allotted 1 point, while fully agreeing was allotted 5 points. The total barrier score for 26 questions and eight subgroups of barriers was calculated and graded using 25% grouped as a very severe barrier (<25%), severe barrier (26% to 50%), moderate barrier (51% to 75%), and mild barrier (>75%). Of the total maximum barrier score of 130, we estimated the barrier score of each participant.

To maintain the quality of the survey, we undertook a few steps. They included a pilot of 20 participants who were not included in the study. We carried out a reverse translation from English to Arabic. We used reliability testing and found that the responses of all participants had a Cronbach alpha of 0.842. The Likert scale analysis was performed in line with the internationally recommended method for health studies.²⁰

The data was collected on a pretested Google form. The Microsoft XL spreadsheet was created to generate responses and test their consistency. Then, it was transferred into the Statistical Package for Social Studies (SPSS 25) (IBM-NY, USA) spreadsheet. The numerical variables were studied for distribution. If found normal, the mean and standard deviation were presented. If not distributed normally, we presented the median and its interquartile range. The categorical variables were presented as numbers and percentages. To compare the outcome (barrier score) among subgroups, we used the student's t-test and estimated chi-square and two-sided P values. The independent variables significantly associated with the barrier score in univariate analysis were included in the linear regression analysis model to study the interaction of the variables and identify the predictors of the barrier score. A p-value of <0.05 was considered statistically significant.

RESULTS

We interviewed 1,404 parents of Saudi children. Their profiles are given in Table 1. More mothers participated than fathers. Regional participation varied, with the highest in the central region and the lowest in the northern, southern, and eastern areas. More than one-third of participants had a child in KG. Participants' higher education level and fathers' higher employment rates are worth noting.

Table 1 Profile of Saudi parents expressing perceived barriers to preschool vision and eye screening.
Variables	Number	Percentage
Relationship with child	FatherMother	469935	33.466.6
Age group	20 to 3031 to 40>40 years	360455589	25.632.442.0
Area of Saudi Arabia	CentralEasternNorthernWesternSouthern	430200145402227	30.614.210.328.616.2
Nationality father	SaudiNon-Saudi	1,37331	97.82.2
Nationality mother	SaudiNon-Saudi	1,35549	96.53.5
Fathers Employment	StudentEmployedUnemployedRetiredOther	219902827392	1.570.52.019.46.6
Mothers Employment	StudentEmployedUnemployed/housewifeRetiredOther	366236207649	2.644.444.25.43.5
Fathers Education	Presecondary schoolHigh schoolDiplomaBachelorMastersDoctorate	12328215666712452	8.820.111.147.58.83.7
Mothers Education	Presecondary schoolHigh schoolDiplomaBachelorMastersDoctorate	1222321487807646	8.716.510.555.65.43.3
Number of children	1 -23-4More than 4	429521454	30.637.132.3
Children in kindergarten	NoYes boyYes GirlMissing	80524430055	57.317.421.43.9
Children wearing spectacles	NoYes	802602	75.142.9
Parents using spectacles	NoFatherMotherBothMissing	550293223193145	39.220.915.913.710.3

Figure 1 presents the grades of barriers for preschool vision screening based on the responses to questions related to barriers as perceived by the parents of children in this study. Two-thirds of parents perceived an intermediate grade of barriers to preschool vision and eye screening. The responses to each question by parents are displayed in Table 2. Several parents provided a neutral opinion about cost as a barrier.

Figure 2 displays the percentage of participants perceiving the barrier grade for each of the eight subgroups. Negative attitudes (56.2%) and eye care delivery-related barriers (46.3%) were the main hurdles for preschool vision and eye screening as perceived by the parents.

Table 3 gives the risk factors for a high score of parents' perceived barriers to vision and eye screening of preschool children in Saudi Arabia. All demographic and refractive status-related risks were significantly associated with a high score of barriers.

The factors significantly associated with the outcome were included in the regression model to identify the predictors. Table 4 shows that Parents with more children living in a region other than the central region and not having spectacles in children were predictors of higher perceived barriers for preschool vision and eye screening in Saudi Arabia.

	Grades of perceived barrier
Very high (N = 176)	High (N = 929)	Low (N = 299)	Validation
Number	Percentage	Number	Percentage	Number	Percentage
Gender	FatherMother	7898	44.355.7	301628	32.467.6	90209	30.169.9	Χ2 = 11.3P = 0.004
Age-group	20 to 3031 to 40>40 years	545171	30.729.040.3	224329376	24.135.440.5	8275142	27.425.147.5	Χ2 = 13.2P = 0.008
Area of residence	CentralEasternNorthernWesternSouthern	4116235046	23.39.113.128.426.1	294135102251147	31.614.511.027.015.8	95492010134	31.816.46.733.811.4	Χ2 = 32P <0.001
Education	Presecondary schoolHigh schoolDiplomaBachelorMastersDoctorate	27361685102	15.320.59.148.35.71.1	601211095347530	6.513.011.757.58.13.2	1950351611816	6.416.711.753.86.05.4	Χ2 = 26.1P =0.003
Employment	StudentEmployedUnemployed/housewifeRetiredOther	79343249	4.052.824.413.65.1	175152749726	1.855.429.510.42.8	6170842712	2.056.928.19.04.0	Χ2 = 20.6P =0.001
Number of children	1-23-4>4	614867	34.727.338.1	289345295	31.137.131.8	7912892	26.442.830.8	Χ2 = 12.4P =0.02
Kid with spectacles	YesNo	8987	50.649.4	405524	43.656.4	108191	36.163.9	Χ2 = 10.0P =0.007
Parents with spectacles	YesNoMissing	103629	58.535.216.3	466358105	50.238.512.3	14013022	46.843.510.7	Χ2 = 12.4P =0.02

Table 4: Predictors of Parents' Perceived Barriers to Preschool Vision and Eye Screening in Saudi Arabia.

DISCUSSION

The results of this cross-sectional survey show the essential perceived barriers that parents in Saudi Arabia face regarding vision and eye screening for preschool children. The discussion section puts the findings into international and global literature databases and reviews these issues to inform how to enhance Pediatric eye care initiatives.

Parents’ knowledge of vision screening and its barriers was demonstrated in the following manner: According to our study on intermediate barriers, two-thirds of parents perceived these barriers. The two most familiar barriers mentioned were negative attitude (56.2%) and barriers to pediatric eye care services (46.3%). The conclusion reached is comparable to global concerns that suggest that parents’ attitudes and system constraints are influential determinants of low utilization of vision screening services.^4,5 For instance, misconceptions like no signs/symptoms imply no need for examination and cultural beliefs that eye check-ups are irrelevant for a female child are common barriers recognized in emerging nations, resonating with the investigations.¹⁴

There are few studies on barriers to eye and vision screening of 3 to 5-year-old children in the literature. There are several real and perceived barriers.²¹ In a study in the USA, Su et al noted a child’s gender, parents' education, employment status, household income, and access to transportation as barriers to preschool vision screening.²² In South India, Ravindran et al reported low levels of education among parents, low income, type of occupation, and distance of eye care from residence as barriers to referrals for further assessment after vision screening of preschoolers.²³ Parental misconceptions about the need for spectacles for young children were the main barrier to better outcomes of preschool vision screening in the UK.²⁴ A review of barriers among 5 to 12-year-old children reported that the cost and quality of the services and the myth that spectacles harm the eyes of children were the main barriers.²⁵ Only half of the participating parents agreed to send their wards for further assessment after preschool vision screening, as reported in a study by Gordon-Shaag et al.²⁶

Also, it was found that maternal involvement, increased age, geographic differences, and educational levels affected the observed perceptions of barriers substantially. There was also a significant difference in mothers reporting barriers, where mothers, especially those with higher education attainment, were likely to identify and report barriers. This is similar to other studies that show maternal health literacy predicts healthcare-seeking behavior in a pediatric setting.⁶ However, families living outside the central region were more likely to experience more incredible access difficulty, which has been seen in other places where healthcare facility distribution is irregular.¹⁶ The interaction between past refractive error history, either with parents or children experiencing or having a record of glasses wearing, and lower perceived barriers shows that personal experience enhances awareness and minimizes hesitancy.¹² Since health services for children for Saudi citizens, including screening, are provided free of cost, the parents' response to the cost for screening as a perceived barrier should be looked at with caution. Neutral responses could be wrongly understood as a medium level of barrier.

The excuses for not excluding minorities from service were also economic considerations, but these were raised less often. The issues with the unaffordability of services and perceived costs were similar to those found in other middle-income countries, where healthcare insurance remains insufficient to eliminate the financial barrier to exclusive pediatric services.³ However, for poor families, the cost of the spectacles and other subsequent treatments is high, despite the Kingdom of Saudi Arabia offering free health services.⁸

Our study also identified several pertinent system-level barriers, including the scarcity of pediatric ophthalmologists and the culturally specific need for female physicians. Such findings are also refined in other GCC nations; therefore, concrete steps may improve service uptake, including expanding the workforce of trained female pediatric ophthalmologists.

These findings have several implications for strategies for public health. Efficient strategies for correcting misconceptions, especially those spreading through word of mouth, regarding vision screening for children who appear asymptomatic yet suffer from undeveloped vision difficulties, are an essential facet that must be addressed through effective education-oriented approaches. Furthermore, extending vision screening programs by introducing them to other child health intervention contacts, such as during vaccination or entry into school, could enhance uptake.⁷ The government should also ensure standards are set for preschool vision screening because most developed countries with effective screening programs have established guidelines for screening the vision of preschool-going children.⁵

However, it is necessary to point out certain limitations of this study and consider directions for further research. The self-administered data raises the possibility of a socially desirable response bias, and the cross-sectional data do not allow the development of causal relationships. Future studies should, therefore, employ longitudinal designs and include quantitative indices of service use as outcomes. However, it is also possible to discuss the results from the viewpoints of healthcare providers and educators to better consider the systemic issues. The targeted sample size of 1,456 could not be achieved by 52 (3.6%). This could have resulted in a marginally wider confidence interval of the primary outcome.

Our study has highlighted the complex issues surrounding preschool vision screening in Saudi Arabia. These challenges require public health interventions, including educational programs, policy changes, and improvements in the delivery of services to remote, rural areas. All these endeavors are of paramount importance not only in the realization of VISION 2030 but also in similar contexts worldwide.

CONCLUSIONS

This study highlights the key challenges influencing preschool vision screening in Saudi Arabia, including parental misconceptions, cultural beliefs, and limited access to pediatric ophthalmologists. At the same time, financial barriers were not a primary issue; logistical obstacles and the need for female physicians in certain areas affected service utilization. Addressing these gaps requires targeted awareness campaigns, integration of vision screening into routine child health services, and policies that improve accessibility. Future research should explore long-term service utilization patterns and incorporate insights from both parents and healthcare providers. Strengthening these efforts will ensure more children receive timely eye care, ultimately supporting national health initiatives and improving early childhood vision outcomes.

REFERENCES:

1. Abdulhussein D, Abdul Hussein M. WHO Vision 2020: Have We Done It? Ophthalmic Epidemiol. 2023;30:331-339. doi: 10.1080/09286586.2022.2127784.

1. World Health Organization. Vision and eye screening of preschool children In ‘Vision and eye screening implementation handbook’. 2023: 25-35. Vision and eye screening implementation handbook accessed on 06/09/2025.

1. Asare AO, Wong AMF, Maurer D, Kulandaivelu Y, Saunders N, Ungar WJ. Economic evaluations of vision screening to detect amblyopia and refractive errors in children: a systematic review. Can J Public Health. 2022;113:297-311. doi: 10.17269/s41997-021-00572-x.

1. Malik AN, Evans JR, Gupta S, Mariotti S, Gordon I, Bowman R, et al. Universal newborn eye screening: a systematic review of the literature and review of international guidelines. J Glob Health. 2022;12:12003. doi: 10.7189/jogh.12.12003.

1. Jonas DE, Amick HR, Wallace IF, Feltner C, Vander Schaaf EB, Brown CL, et al. Vision screening in children aged 6 months to 5 years: evidence report and systematic review for the US preventive services task force. JAMA. 2017;318:845–858. doi: 10.1001/jama.2017.9900.

1. Gibson DM. Vision Screening Prevalence and Disparities Among U.S. School-Aged Children Prior to and During the COVID-19 Pandemic. Ophthalmic Epidemiol. 2025 Jun 5:1-7. doi: 10.1080/09286586.2025.2512324.

1. IAPB School Eye Health Work Group. IAPB School Eye Health Guidelines. 2024. IAPB School Eye Health Guidelines - English (2024 edition).pdf accessed on 17/12/2024.

1. Ministry of Health, Saudi Arabia. Health Indicators in the Statistical Yearbook. 2023. pp 2-4. Statistical-Yearbook-2023.pdf accessed on 16/12/2024.

1. Al Daajani MM, Al-Habib DM, Ibrahim MH, Al Shewear NA, Fagihi YM, Alzaher AA, et al. Prevalence of health problems targeted by the national school-based screening program among primary school students in Saudi Arabia, Healthcare (Basel) 2021; 9: 1310. doi: 10.3390/healthcare9101310.

1. AlHarkan DH. Amblyogenic risk factors and validity of vision screening using spot-screener among kindergarten children in Qassim region, Saudi Arabia. Saudi J Ophthalmol. 2024;38:268-274. doi: 10.4103/sjopt.sjopt_246_23.

1. Ali Q, Heldal I, Helgesen CG, Krumina G, Costescu C, Kovari A, et al. Current challenges supporting school-aged children with vision problems: A rapid review. Applied Sciences. 2021;11:9673. doi:10.3390/app11209673.

1. Vongsachang H, Friedman DS, Inns A, Kretz AM, Mukherjee MR, Callan J, et al. Parent and teacher perspectives on factors decreasing participation in school-based vision programs. Ophthalmic Epidemiology. 2020;27:226-36. doi: 10.1080/09286586.2020.1730910.

1. Akuffo KO, Abdul-Kabir M, Agyei-Manu E, Tsiquaye JH, Darko CK, Addo EK. Assessment of availability, awareness, and perception of stakeholders regarding preschool vision screening in Kumasi, Ghana: An exploratory study. Plos one. 2020;15:e0230117. doi: 10.1371/journal.pone.0230117.

1. Alrasheed SH. A systemic review of barriers to accessing paediatric eye care services in African countries. African Health Sciences. 2021;21:1887-97. doi: 10.4314/ahs.v21i4.47.

1. Alatawi A, Alali N, Alamrani A, Hashem F, Alhemaidi S, Alreshidi S, et al. Amblyopia and routine eye exam in children: Parent’s perspective. Children. 2021;8:935. doi: 10.3390/children8100935.

1. AlHarkan DH. Knowledge, attitude, and practice of parents of 3- to 5-year-olds regarding preschool vision and eye screening of kindergarten children in Al-Qassim Province, Saudi Arabia-a survey. Digit J Ophthalmol. 2025;31(1):1-8. doi: 10.5693/djo.01.2024.06.003.

1. AlHarkan DH, AlRubaysh NS, Aldekhail MI, Alayidi SA, Alashgar MS, Almishali FF. Knowledge, Attitude, and Practice Regarding Vision and Eye Screening of Preschool Children Among Primary Health Center Staff in the Qassim Region, Saudi Arabia. Cureus. 2024;16. doi: 10.7759/cureus.52743.

1. AlHarkan DH. Knowledge, attitude, and practice among kindergarten teachers regarding vision and eye screening of preschool children. Oman Journal of Ophthalmology. 2024;17:366-70. doi: 10.4103/ojo.ojo_260_23.

1. Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version. www.OpenEpi.com, updated 2013/04/06, accessed 2023/12/18.

1. Harpe SE. How to analyze Likert and other rating scale data. Currents in pharmacy teaching and learning. 2015;7:836-50. Doi:10.1016/j.cptl.2015.08.001.

1. Alley CL. Preschool vision screening: update on guidelines and techniques. Curr Opin Ophthalmol. 2013;24(5):415-20. doi: 10.1097/ICU.0b013e3283641c56.

1. Su Z, Marvin EK, Wang BQ, van Zyl T, Elia MD, Garza EN, et al. Identifying barriers to follow-up eye care for children after failed vision screening in a primary care setting. J AAPOS. 2013;17(4):385-90. doi: 10.1016/j.jaapos.2013.05.008.

1. Ravindran M, Pawar N, Renagappa R, Ravilla T, Khadse R. Identifying barriers to referrals in preschool-age ocular screening in Southern India. Indian J Ophthalmol. 2020;68(10):2179-2184. doi: 10.4103/ijo.IJO_1603_19.

1. Donaldson L, Subramanian A, Conway ML. Eye care in young children: a parent survey exploring access and barriers. Clin Exp Optom. 2018;101(4):521-526. doi: 10.1111/cxo.12683.

1. Sharma A, Congdon N, Patel M, Gilbert C. School-based approaches to the correction of refractive error in children. Surv Ophthalmol. 2012;57(3):272-83. doi: 10.1016/j.survophthal.2011.11.002.

1. Gordon-Shaag A, Ben-Eli H, Sztrigler Cohen O, Toledano M, Benyamin A, et al. Adherence to referrals from preschool vision screening and identification of barriers for non-adherence in Israel. Clin Exp Optom. 2023;106(2):202-210. doi: 10.1080/08164622.2022.2107891.

FIGURES:

Figure: 1 Grades of barriers for eye and vision screening of preschool children as perceived by Saudi parents.

Figure 2. The parents' perceived barrier subgroups to vision and eye screening of preschool children in Saudi Arabia.

The X-axis shows the percentage of participants suggesting a barrier score for the subgroup.

The axis depicts the type of barriers to preschool vision and eye screening.

The green bar shows the lowest grade of perceived barrier

The yellow color bar depicts the lower grade of the perceived barrier

The grey color shows a neutral perception of the barrier

The orange color bar shows a high grade of perceived barrier

The red color bar indicates a very high level of perceived barrier.

TABLES:

Table: 2 Parents' responses to the questions about the barriers to vision and eye screening of preschool children
	Question	I strongly disagree	I disagree	Neutral	I agree	I strongly agree
1	I do not see the need for eye and vision examinations for children.	349	149	109	368	429
2	I think that a child who does not have symptoms does not need to be tested.	267	257	213	438	229
3	I think the child is too young to examine and use spectacles.	189	166	216	509	324
4	I think that if the child is a girl, there is no need for an eye examination and spectacles.	151	103	116	544	490
5	Because we are busy at work, we cannot take our children for examination and further eye care.	291	426	220	255	212
6	Because we are busy with other children, we cannot make time for eye examinations.	354	470	198	201	181
7	The nearest eye center is far from where I live, so I cannot take children for examinations.	276	470	234	216	208
8	The eye doctor at the optical store is not qualified to provide child eye care.	139	139	139	139	139
9	Ophthalmologists do not have sufficient experience to care for children’s eyes.	274	458	286	195	191
10	A nearby eye doctor cannot provide the eye care needed for a child with an eye problem.	212	472	315	216	189
11	I often need an ophthalmologist (female) to treat my child’s eyes.	277	485	244	189	209
12	I prefer only Saudi doctors to take care of my children’s eyes.	131	299	322	280	372
13	I prefer an ophthalmologist in a private hospital rather than an ophthalmologist in a government hospital.	217	408	327	209	243
14	The cost of glasses and treatment is high for me, so I avoid examining the child’s eyes.	246	246	246	246	246
15	I find it difficult to communicate with the eye doctor due to the difference in language.	299	490	273	176	166
16	I am afraid that the child will have surgery if I am advised to do so	177	370	308	280	269
17	I had a bad and long experience treating my children’s eyes.	277	466	296	186	179
18	Awareness about pediatric eye examinations is low among health center doctors and pediatricians.	107	107	107	107	107
19	Awareness about children’s eye examinations is low among kindergarten teachers.	73	246	340	390	355
20	There is no policy for eye and vision examinations for children aged 3 to 5 years in the Kingdom of Saudi Arabia.	141	279	370	288	326
21	There is no pediatric ophthalmologist available in my city.	289	455	266	195	199
22	It is not easy to make an appointment with an ophthalmologist.	179	407	275	271	272
23	[I do not know how to reach an ophthalmologist in a government hospital.	187	384	266	274	293
24	I fear the eye doctor will tell me something disturbing about my child.	218	406	292	259	229
25	I believe that children’s eye problems will disappear as they grow.	169	164	306	471	294
26	I find that medical advice on social media is unreliable.	105	282	414	265	338

Table: 3 Factors associated to the parent perceived barriers to preschool vision and eye screening in Saudi Arabia
Variables	Odds Ratio	Adjusted Odds ratio	95% confidence interval	Two-sided P value
Residence	CentralEasternNorthernWesternSouthern	0.510.640.060.67	0.600.531.060.511	0.39 - 0.930.32 - 0.860.58 - 1.930.33 - 0.79-	0.020.010.850.000.004
Number of children	1-23-4More than 4	0.17-0.3	1.180.761	0.84 - 1.670.56 - 1.03-	0.340.080.02
Children with spectacles	YesNo	-0.4	0.671	0.51 - 0.87-	0.003-
Constant		2.1	7.87	-	<0.001

Omnibus Model coefficient chi square= 30.9, degree of freedom = 7, P<0.001