Knowledge, Attitudes, and Practices (KAP) Survey Study in Chinese Children’s and Adolescents’ Guardians on the Three Methods of Myopia Intervention

Objective To investigate the knowledge, attitudes, and practices (KAP) of the guardians of children and adolescents aged 6–12 years in eight cities across China regarding three myopia control interventions (0.01% atropine eye drops, spectacles, and contact lenses) and analyze the influencing factors. Methods A KAP questionnaire on basic knowledge, attitudes, and practices regarding myopia was developed through a literature review and expert consultation. An online survey was administered to guardians of children aged 6–12 years across eight selected cities, and the data were analyzed using SPSS 27.0. Results Among the 1,509 valid questionnaires collected, 48.1% were from the guardians of myopic children; this group exhibited a significant difference from the guardians of non-myopic children on basic myopia questions (U = 301754.0, W = 564929.0, P  < 0.05), with the former (40 (35, 47)) scoring slightly higher than the latter (39 (34, 46)). Knowledge of spectacles and contact lenses was linked to positive attitudes and compliant behaviors ( P  < 0.001), with favorable attitudes predicting higher compliance ( P  < 0.05). Regarding 0.01% atropine eye drops, knowledge was positively correlated with attitude (r = 0.475, P  < 0.001), but neither was significantly correlated with behavior ( P  > 0.05). Common pitfalls in the usage of 0.01% atropine eye drops included discontinuing medication and transferring it to others. KAP scores were influenced by the demographics of the guardians, with higher education, urban residence, and an age range of 35–49 years being associated with higher KAP scores. Significant intercity disparities were observed, with Beijing demonstrating the highest adherence to atropine and Changsha exhibiting the poorest spectacle use among the surveyed cities. While clinical consultations remained the predominant information channel, the high valuation of digital media underscores their potential as a scalable complementary strategy to bridge existing knowledge gaps. Conclusion The use of spectacles and contact lenses exhibited robust KAP alignment, whereas the use of 0.01% atropine manifested a critical knowledge-behavior disconnect characterized by prevalent self-discontinuation. Higher education, urban residence, and middle age predicted better KAP scores, whereas significant intercity disparities reflected a "prevalence–awareness paradox" favoring cities whose medical centers were early adopters of 0.01% atropine for myopia control. These findings underscore the necessity of stratified educational interventions—particularly digital health education delivered by ophthalmologists and medical students—to bridge the information gaps and ensure equitable myopia guidance across diverse populations. Trial Registration Not applicable.