Background <p>Childhood myopia has emerged as a growing public health concern, adversely affecting both visual function and vision-related quality of life (VR-QoL). This study examined the relationships among parent engagement, primary school children’s eye care behaviors, and vision-related quality of life based on the Health Belief Model (HBM).</p> Methods <p>In 2022, a total of 2,139 parent–child dyads were recruited from six primary schools in Hangzhou City, China, using stratified cluster sampling. Both children and their parents completed validated, self-administered questionnaires assessing eye care behaviors, engagement efficacy, and HBM variables. Multiple regression analyses were conducted to examine the associations among parent and child health beliefs, parent engagement practices, children’s eye care behaviors, and VR-QoL.</p> Results <p>The participated children were aged from 9.24 to 10.19 years old. After adjusting for sociodemographic factors, parents with greater eye care knowledge, fewer perceived barriers, and stronger engagement efficacy were more likely to support their children’s eye care behaviors. Among children, higher levels of eye care knowledge, perceived severity of myopia, and perceived benefits of protective practices were significantly associated with more frequent engagement in eye care behaviors. Children with stronger perceptions of severity and benefits, lower susceptibility, fewer barriers, and better eye care behavior reported higher VR-QoL.</p> Conclusions <p>Health belief variables were significantly associated with parent engagement, children’s eye care behaviors, and VR-QoL. These findings highlight the importance of considering both parent- and child-level cognitive and behavioral factors when examining childhood eye health. Theory-informed assessments can inform the development of contextually appropriate vision health promotion strategies.</p>