The Interplay Between Self-Determination and Cognitive Bias: Nonlinear Associations Between Myopia Control Knowledge Reserve and Parental Communication Preparedness.

OBJECTIVE: Parents bear statutory proxy responsibilities during adolescent myopia diagnosis and treatment. This study aimed to reveal the relationship between myopia control knowledge reserve (KR) and parental communication preparedness (CP), explore the moderating role of the Dunning-Kruger effect within the self-determination theory (SDT) framework, thereby providing theoretical foundations for optimizing myopia control strategies. METHODS: This study achieved standardized health knowledge exposure through science popularization videos, and conducted cross-sectional questionnaire surveys among parents of adolescents in representative major cities across China to collect research data. This study divided different groups based on parental KR levels, and conducted comparative analyses of variable characteristic differences in KR, participation in decision-making (PD), perceived a community with shared future for doctor-patient (PCSF), and CP across each group. Meanwhile, this study employed structural equation modeling to thoroughly explore the nonlinear association between KR and CP, and examined the mediating mechanisms of PD and PCSF between the two. RESULTS: In the low KR group, KR was significantly negatively correlated with CP. In the high KR group, KR was significantly positively correlated with PD. In the high KR group, PD and PCSF demonstrated mediating effects between KR and CP. However, this mediating pathway was not established in the low KR group. Furthermore, PCSF exerted partial mediating effects between PD and CP across both groups, with a stronger mediating contribution observed in the low KR group. CONCLUSION: This study, for the first time, integrated the Dunning-Kruger effect within the SDT framework. Parents with low health literacy should be prioritized for consolidating fundamental control knowledge and correcting cognitive biases. Parents with high health literacy should be emphasized for strengthening training in collaborative medical decision-making capabilities. Furthermore, establishing a shared decision-making platform between doctors and patients can provide practical references for precision science popularization and collaborative control management of adolescent myopia.