基于COM-B模型分析我国眼视光从业者视觉训练推荐意愿向推荐行为转化的影响因素

doi:10.3969/j.issn.1006-5725.2026.18.014

Abstract

Abstract:

Objective Based on the COM-B model， this study analyzed the factors influencing vision therapy recommendation intention and recommendation behavior among optometric practitioners in China， and to explore the potential mechanisms underlying the translation of intention into behavior. Methods A national cross-sectional questionnaire survey was conducted from June to October 2024， and enrolled a total of 1 750 optometric practitioners. According to the COM-B （Capability，Opportunity，Motivation-behaviour） model， the capability dimension included knowledge assessment scores and professional qualifications； the opportunity dimension included institution type and vision therapy implementation barriers； the motivation dimension referred to recommendation intention； and the behavior dimension was measured by cumulative clinical recommendation volume levels. Reflective motivation was constructed （including perceived familiarity， perceived clinical effectiveness， and perceived effectiveness of external promotion）， and its influence on recommendation intention was analyzed. Quantile regression was used to examine factors affecting recommendation intention. Ordered logistic regression models were employed to analyze recommendation behavior. These models also assessed the changes in model fit following the incorporation of the intention variable. Results Optometric practitioners demonstrated high intention to recommend vision therapy 9.0（8.0， 10.0）. However， 49.8% of practitioners were classified in the lowest recommendation volume category （< 500 cases）. Reflective motivation was significantly positively associated with recommendation intention （full sample β = 0.857， optometric physician subgroup β = 0.769， both P < 0.001）. Capability factors showed no significant effect on intention. In the ordered logistic regression models， after adding recommendation intention， the Nagelkerke R² increased by 0.120 in the full population and by 0.058 in the physician subgroup. Every 1-point increase in recommendation intention was associated with higher odds of being in higher recommendation volume levels （full sample： OR = 1.50， 95%CI： 1.42 - 1.59， P < 0.001； optometric physician subgroup： OR = 1.42， 95%CI： 1.24 - 1.63， P < 0.001）. Years of work experience in the capability dimension positively influenced behavior in both groups. The main barriers were lack of unified clinical guidelines （76.9%）， irregular market order （75.9%）， and insufficient medical insurance coverage （70.7%）. Conclusions Reflective motivation is the core factor influencing vision therapy recommendation intention. The translation of high intention into behavior is structurally constrained by the opportunity dimension. Strengthening expert consensus guidelines， optimizing insurance reimbursement policies， and regulating market practices may facilitate the conversion of recommendation intention into clinical implementation.

Key words: vision therapy, COM-B model, recommendation intention, optometric practitioners

CLC Number:

Tao Liu, Qinglin Xu, Yao Tang, Zhao Chen, Xiaoyun Xi, Wei Pan, Zhikuan Yang, Weizhong Lan. Vision therapy recommendation intention and recommendation behavior based on the COM-B model[J]. The Journal of Practical Medicine, 2026, 42(18): 3356-3363.

Figures/Tables 5

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References 42

[1]	American Optometric Association. Vision therapy： American Optometric Association Vision Therapy Task Force ［EB/OL］. St. Louis： American Optometric Association.［2026-07-23］
[2]	Birch E E， Kelly K R. Amblyopia and the whole child ［J］. Prog Retin Eye Res， 2023， 93：101168. doi： 10.1016/j.preteyeres. 2023.101168．
[3]	Chen Jing， Xu Jin， Jia Huili， et al. The effects of binocular visual function training after concomitant exotropia surgery［J］. Curr Eye Res， 2023， 48（7）： 662-668. doi：10.1080/02713683.2023.2188574 .
[4]	Ma M M， Kang Ying， Chen Chao， et al. Vision therapy for intermittent exotropia： A case series［J］. J Optom， 2021， 14（3）： 247-253. doi：10.1016/j.optom.2020.05.006 .
[5]	Ma M M， Kang Ying， Scheiman M， et al. Effect of office-based vergence and anti-suppression therapy on binocular vision and accommodation in small-to-moderate angle intermittent exotropia： A randomised clinical trial［J］. Ophthalmic Physiol Opt， 2025， 45（1）： 50-66. doi：10.1111/opo.13415 .
[6]	Cruz O A， Repka M X， Hercinovic A， et al. Amblyopia Preferred Practice Pattern ［J］. Ophthalmology， 2023， 130（3）：136-178. doi： 10.1016/j.ophtha.2022.11.003．
[7]	Jackson M L， Virgili G， Shepherd J D， et al. Vision rehabilitation preferred practice pattern®［J］. Ophthalmology， 2023， 130（3）： 271-335. doi：10.1016/j.ophtha.2022.10.033 .
[8]	中华医学会儿科学分会康复学组，中华医学会儿科学分会眼科学组. 儿童脑源性视觉障碍诊断与治疗专家共识［J］. 中华儿科杂志， 2024， 62（5）：402-411. doi： 10.3760/cma.j.cn112140-20240112-00043．
[9]	Park A S Y， Wong G H T， Tan K W S， et al. Efficacy of perceptual learning in low vision： A systematic review and meta-analysis ［J］. Optom Vis Sci， 2024， 101（6）：305-320. doi： 10.1097/opx.0000000000002157．
[10]	Wang Bo， Kuwera E. Vision therapy： A primer and caution for pediatricians ［J］. Children， 2022， 9（12）：1873. doi： 10.3390/children9121873．
[11]	Pan Wei， Saw S M， Wong T Y， et al. Prevalence and temporal trends in myopia and high myopia children in China： A systematic review and meta-analysis with projections from 2020 to 2050［J］. Lancet Reg Heal West Pac， 2025， 55： 101484. doi：10. 1016/j.lanwpc.2025.101484 .
[12]	Ma M M， Yeo A C H， Scheiman M， et al. Vergence and accommodative dysfunctions in emmetropic and myopic Chinese young adults ［J］. J Ophthalmol， 2019， 2019：5904903. doi： 10.1155/2019/5904903．
[13]	Chen Danni， Li Rui， Li Xiaoxiao， et al. Prevalence， incidence and risk factors of strabismus in a Chinese population-based cohort of preschool children： The Nanjing Eye Study［J］. Br J Ophthalmol， 2021， 105（9）： 1203-1210. doi：10.1136/bjophthalmol-2020-316807 .
[14]	Huang Dan， Chen Xuejuan， Zhu Hui， et al. Prevalence of amblyopia and its association with refraction in Chinese preschool children aged 36-48 months［J］. Br J Ophthalmol， 2018， 102（6）： 767-771. doi：10.1136/bjophthalmol-2016-310083 .
[15]	Li Yunping， Zhou Mengwen， Forster S H， et al. Prevalence of amblyopia among preschool children in central South China［J］. Int J Ophthalmol， 2019， 12（5）： 820-825. doi：10.18240/ijo. 2019.05.19 .
[16]	Keyworth C， Epton T， Goldthorpe J， et al. Acceptability， reliability， and validity of a brief measure of capabilities， opportunities， and motivations （"COM-B"）［J］. Br J Health Psychol， 2020， 25（3）：474-501. doi： 10.1111/bjhp.12417．
[17]	Michie S， Van Stralen M M， West R. The behaviour change wheel： A new method for characterising and designing behaviour change interventions ［J］. Implement Sci， 2011， 6：42. doi： 10.1186/1748-5908-6-42．
[18]	Woo G C， Lin Zhi. Development of optometry in the people′s republic of China［J］. Clin Exp Optom， 2021， 104（2）： 139-142. doi：10.1111/cxo.13115 .
[19]	Gunn P J， Creer R C， Bowen M， et al. Scope of practice of optometrists working in the UK hospital eye service： Second national survey［J］. Ophthalmic Physiol Opt， 2022， 42（3）：428-439. doi： 10.1111/opo.12952．
[20]	Boynton P M， Greenhalgh T. Selecting， designing， and developing your questionnaire［J］. BMJ， 2004， 328（7451）：1312-1315. doi： 10.1136/bmj.328.7451.1312．
[21]	Boateng G O， Neilands T B， Frongillo E A， et al. Best practices for developing and validating scales for health， social， and behavioral research： A primer ［J］. Front Public Health， 2018， 6：149. doi： 10.3389/fpubh.2018.00149．
[22]	Piñero D P， Bataille L， Martínez-Plaza E， et al. Professional perspective and practice patterns of vision therapy in Spain［J］. Clin Exp Optom， 2024， 107（3）： 341-348. doi：10.1080/08164622. 2023.2215383 .
[23]	Garin O. Ceiling effect ［M］∥Michalos A C. Encyclopedia of quality of life and well-being research. Dordrecht： Springer Netherlands， 2014：631-633． doi:10.1007/978-94-007-0753-5_296
[24]	Sheeran P， Webb T L. The intention-behavior gap ［J］. Soc Personal Psychol Compass， 2016， 10（9）：503-518. doi： 10.1111/spc3.12265．
[25]	Duan Lisi， Wang Ting， Guo Yinning， et al. Barriers and facilitators to shared decision-making for patients with cancer and health care providers based on the COM-B model： A systematic review［J］. BMC Med Inform Decis Mak， 2025， 25（1）： 369. doi：10. 1186/s12911-025-03194-2 .
[26]	Atkins L， Francis J， Islam R， et al. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems ［J］. Implement Sci， 2017， 12（1）：77. doi： 10.1186/s13012-017-0605-9．
[27]	Dillard J P， Weber K M， Vail R G. The relationship between the perceived and actual effectiveness of persuasive messages： A meta-analysis with implications for formative campaign research ［J］. J Commun， 2007， 57（4）：613-631. doi： 10.1111/j.1460-2466.2007.00360.x．
[28]	Cappella J N. Perceived message effectiveness meets the requirements of a reliable， valid， and efficient measure of persuasiveness ［J］. J Commun， 2018， 68（5）：994-997. doi： 10.1093/joc/jqy044．
[29]	Barker F， Atkins L， De Lusignan S. Applying the COM-B behaviour model and behaviour change wheel to develop an intervention to improve hearing-aid use in adult auditory rehabilitation ［J］. Int J Audiol， 2016， 55 ：S90-S98. doi： 10.3109/14992027. 2015.1120894．
[30]	Blebil A Q， Saw P S， Dujaili J A， et al. Using COM-B model in identifying facilitators， barriers and needs of community pharmacists in implementing weight management services in Malaysia： A qualitative study ［J］. BMC Health Serv Res， 2022， 22（1）：929. doi： 10.1186/s12913-022-08297-4．
[31]	Terwee C B， Bot S D， De Boer M R， et al. Quality criteria were proposed for measurement properties of health status questionnaires ［J］. J Clin Epidemiol， 2007， 60（1）：34-42. doi： 10.1016/j.jclinepi.2006.03.012．
[32]	Ahmed N， Barlow S， Reynolds L， et al. Mental health professionals' perceived barriers and enablers to shared decision-making in risk assessment and risk management： A qualitative systematic review ［J］. BMC Psychiatry， 2021， 21（1）：594. doi： 10.1186/s12888-021-03304-0．
[33]	Alasmari A， Larson H J， Karafillakis E. A mixed methods study of health care professionals' attitudes towards vaccination in 15 countries ［J］. Vaccine X， 2022， 12：100219. doi： 10.1016/j.jvacx.2022.100219．
[34]	Girard H， Bosshard W， Krief H， et al. Effectiveness of information sessions about COVID-19 vaccines in healthcare professionals working in geriatrics ［J］. Gerontol Geriatr Med， 2022， 8：23337214221115235. doi： 10.1177/23337214221115235．
[35]	Modderkolk L， Schoon Y， Touw H， et al. Factors impacting the delivery of contextualized care in serious illness： A focus group study with healthcare professionals ［J］. BMC Med， 2026， 24（1）：117. doi： 10.1186/s12916-026-04662-w．
[36]	Cao Yulong， Gao Yan， Yang Ruiqi， et al. Delirium-care barriers among intensive care nurses based on the Capability， Opportunity， Motivation-Behaviour （COM-B） model： A cross-sectional study［J］. Intensive Crit Care Nurs， 2026， 96： 104440. doi：10.1016/j.iccn.2026.104440 .
[37]	杨媛，胡鹏，黄艳. 社区医护人员高尿酸血症健康管理知信行现状分析［J］. 实用医学杂志， 2024， 40（14）：2015-2020. doi： 10.3969/j.issn.1006-5725.2024.14.019．
[38]	Sharma U， Majumder R， Biswas V， et al. Awareness， knowledge， and barriers to vision therapy services among eye care practitioners ［J］. Int J Community Med Public Health， 2025， 12（3）：1379-1384. doi： 10.18203/2394-6040.ijcmph20250625．
[39]	韩超，祝学梅，王莹，等. 日间医疗的规范化发展思考［J］. 实用医学杂志， 2024， 40（8）：1038-1041. doi： 10.3969/j.issn.1006-5725.2024.08.002．
[40]	Tilden V P， Tilden S， Benner P. From novice to expert， excellence and power in clinical nursing practice ［J］. Res Nurs Health， 1985， 8（1）：95-97. doi： 10.1002/nur.4770080119．
[41]	Carraccio C L， Benson B J， Nixon L J， et al. From the educational bench to the clinical bedside： Translating the Dreyfus developmental model to the learning of clinical skills ［J］. Acad Med， 2008， 83（8）：761-767. doi： 10.1097/ACM.0b013e31817eb632．
[42]	Rethans J J， Norcini J J， Barón-Maldonado M， et al. The relationship between competence and performance： Implications for assessing practice performance ［J］. Med Educ， 2002， 36（10）：901-909. doi： 10.1046/j.1365-2923.2002.01316．

特征	例数（n = 1 750）
年龄
< 30岁	846（48.3）
30 ~ 39岁	586（33.5）
40 ~ 49岁	255（14.6）
50 ~ 59岁	52（3.0）
≥ 60岁	11（0.6）
职业角色
医生	395（22.6）
视光师	1 355（77.4）
眼视光科工作年限
< 1年	63（3.6）
1 ~ 5年	932（53.3）
6 ~ 10年	417（23.8）
> 10年	338（19.3）
机构类型
私立眼科医院	1 382（79.0）
私立眼科诊所	248（14.2）
公立眼科医院	64（3.7）
公立眼科诊所	56（3.2）

变量	全样本(n = 1 750)		眼科医生亚组
变量	β	P值	β	P值
反思性动机	0.857	< 0.001	0.769	< 0.001
专业知识得分	< 0.001	1.000	-0.062	0.334
眼视光科工作年限（≤ 10年vs. > 10年）	-0.143	0.115	-0.308	0.115
职业角色（眼科医生vs. 验光师）	0.143	0.096	-	-
职称	-	-	0.154	0.135
手术权限	-	-	0.154	0.368
机构类型	0.429	0.002	0.487	0.221

变量	基础模型	全模型	P 值	OR（95% CI）
专业知识得分	0.144 ± 0.032	0.144 ± 0.032	< 0.001	1.15（1.08 ~ 1.23）
眼视光科工作年限（≤ 10年vs. > 10年）	- 0.996 ± 0.116	- 1.024 ± 0.118	< 0.001	0.36（0.29 ~ 0.45）
职业角色（验光师 vs. 医生）	- 0.142 ± 0.110	- 0.011 ± 0.113	0.924	0.99（0.79 ~ 1.23）
医院性质（公立 vs. 私立）	0.098 ± 0.184	0.307 ± 0.189	0.104	1.36（0.94 ~ 1.97）
推荐意愿	-	0.408 ± 0.030	< 0.001	1.50（1.42 ~ 1.59）
模型评价
Nagelkerke R²	0.069	0.189	-	-
模型χ²（P值）	107.997（P < 0.001）	314.696（P < 0.001）	-	-
平行线检验P值	0.206	0.078	-	-

变量	基础模型	全模型	P值	OR（95%CI）
专业知识得分	0.078 ± 0.083	0.104 ± 0.083	0.215	1.11（0.94 ~ 1.31）
眼视光科工作年限（≤ 10年vs. > 10年）	-1.657 ± 0.247	-1.727 ± 0.251	< 0.001	0.18（0.11 ~ 0.29）
职称（参照：主任医师）
医师	-1.342 ± 0.447	-1.094 ± 0.458	0.017	0.33（0.14 ~ 0.82）
主治医师	-0.613 ± 0.409	-0.389 ± 0.420	0.354	0.68（0.30 ~ 1.54）
副主任医师	-0.104 ± 0.413	0.067 ± 0.423	0.874	1.07（0.47 ~ 2.45）
是否手术（是 vs. 否）	0.335 ± 0.211	0.416 ± 0.215	0.054	1.52（0.99 ~ 2.31）
医院性质（公立 vs. 私立）	-0.904 ± 0.517	-0.698 ± 0.509	0.170	0.50（0.18 ~ 1.35）
推荐意愿	-	0.354 ± 0.070	< 0.001	1.42（1.24 ~ 1.63）
模型评价
Nagelkerke R²	0.276	0.334	-	-
模型χ²（P值）	110.356（P < 0.001）	137.970（P < 0.001）	-	-
平行线检验P值	0.197	0.027	-	-

Vision therapy recommendation intention and recommendation behavior based on the COM-B model

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