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Sustainable Development Goal Target 4.2.1 is monitored by determining the proportion of children aged 24 to 59 months who are developmentally on track in the domains of health, learning, and psychosocial well-being. UNICEF has developed a caregiver report measure, the Early Childhood Development Index 2030 (ECDI2030), to measure progress towards this target. This paper examines whether a newly developed tool, the Early Childhood Development Assessment Scale--Direct Assessment (ECDAS-DA) can add value to the measurement of Target Indicator 4.2.1 by complementing UNICEF's ECDI2030, and explores the psychometric properties of the ECDAS-DA. A total of 956 children (476 girls) aged 3 to 5 years from Bangladesh, China, India and Myanmar were administered the ECDAS-DA in individual sessions. Caregivers provided responses to a survey based on UNICEF's ECDI2030. Confirmatory Factor Analyses indicated that learning, health, and psychosocial well-being domains of the ECDAS-DA were three component parts of one underlying construct of early child development. Significant correlations between the ECDAS-DA and the caregiver-reported ECDI2030 survey were found in the learning and health domains but findings were mixed for the psychosocial well-being domain. Multiple measures of early development could be important in measuring SDG Target 4.2.1 and the ECDAS-DA has the potential to complement UNICEF's ECDI2030.

As the ageing population in China continues to grow, more people will be living with long-term health conditions and require support from family care-givers. This scoping review therefore aims to explore sources of stress and coping mechanisms adopted by care-givers of older relatives living with long-term conditions in mainland China. Literature searches were conducted in English (CINAHL, EMBASE, MEDLINE, PsycINFO and SCOPUS) and Chinese (CNKI, WANFANG DATA, CQVIP and CBM) databases between October and November 2019. The searches focused on the stressors and coping mechanisms utilised by family care-givers residing in the community. Narrative synthesis was used to identify themes within the data. Forty-six papers were included: 20 papers from English and 26 from Chinese databases. Six themes captured stressors: care-giving time (N = 22), financial resources (N = 17), role and personal strains (N = 42), preparedness (N = 4), social roles (N = 10) and lack of adequate formal support (N = 22); and one theme captured coping (N = 14). Unmet needs of care-givers of older relatives in mainland China were found to be extensive. Only a few studies had attempted to explore the causal link between stressors, coping and the influence of culture. Findings underscore the significance of adequately capturing intricacies around care-givers' unmet needs, rather than generalising on the basis of culture. Qualitative studies are critical to providing a better understanding of the relationship between stressors, coping and resources afforded to care-givers by their cultural environment. Having such understanding is crucial to inform the development of competent care, which promotes self-efficacy and self-actualisation in care-givers in mainland China. [ABSTRACT FROM AUTHOR]

Caregivers, i.e., parents, grandparents, and anyone caring for children, make up the majority of users in many urban centers around the world, including in China. Yet urban design and planning rarely consider specific needs of caregivers. This can result in a negative perception among people that cities are unfriendly places to raise children. Such negative perception is among the major contributors to the aging population problem, as parents and parents-to-be feel reluctant to give birth and raise more than one or even any children. Using an interdisciplinary approach, i.e., cognitive science, psychology, behavioral economics, and urban studies, this paper examines a new city model of "parent-friendly city," where urban design serves the needs of caregivers, effectively creating a perception that cities are friendly places for raising children. First, we identify that caregivers' needs are characterized by two major factors: (1) provision: parents want to provide for their children, such as providing places for play and learning, and (2) restoration: parents want to restore things that they lack due to childcare responsibilities, such as lack of rest and interaction with other adults. Second, we offer cognitive-based design principles that can work powerfully and effectively to fill both needs. Third, using real case studies from cities in China and around the world, we illustrate how these design principles work, even reversing caregivers' perception from negative to positive. Ultimately, thoughtful urban design can support parents in raising children, making cities into partners in parenthood. [ABSTRACT FROM AUTHOR]

This paper represents the first research study conducted to date on the use of Dance/Movement Therapy (DMT) to treat children with Autism Spectrum Disorder (ASD) in Mainland China. This study gives detailed clinical examples of how to use DMT in the treatment of this population, and demonstrates the linguistic, nonverbal, and relational changes that took place after 7 months of individual sessions. Data from interviews with caregivers yielded four themes regarding the impact of DMT: (1) Improvement of ability to use language and to communicate, (2) Expansion of nonverbal communication and understanding of bodily language, (3) Emergence of new behaviors: game playing, imagination, and bodily movement, and (4) Appearance of positive emotional expression. In addition, the VB-MAPP assessment was used to evaluate the children's language levels before and after DMT. Findings indicate that it is necessary, appropriate, and effective to use DMT in the treatment of children with ASD, and that this evidence-based treatment should receive further development in China. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Physical restraint is widely used in the elderly at home, and cognitive impairment is an important risk factor. Family caregivers of people with dementia are the main decision makers and implementers of physical restraint at home.Most people with dementia in China receive home care, and family caregivers face enormous care and moral pressures influenced by Confucian culture.Current research on physical restraints focuses on quantitative analysis of its prevalence and reasons within the institutions. There is little research on how family caregivers perceive physical restraints in home care context, especially under Chinese culture. What the paper adds to existing knowledge?: Many family caregivers face approach – avoidance conflict and moral dilemmas when making decisions to restrain, and they make difficult choices in these dilemmas.In China, family caregivers are influenced by many unique factors, including traditional Confucian culture, family affection, and rural home environment.Inadequate laws and policies provide the ground for abuse of physical restraints, and family caregivers rarely consider legal and policy restrictions when using physical restraints. What are the implications for practice?: With limited medical resources, nurse‐led dementia management is the hope to reduce physical restraints in home.Mental health nurses need to assess for the appropriateness of physical restraints associated with psychiatric symptoms in people with dementia.At both organizational and community levels, improving effective communication and relationships between professionals and family caregivers are important to address. Improvements in this context require education and time for staff to develop skills and experience which is necessary to provide family caregivers with ongoing information and psychological support within their communities.Considering Confucian culture will be of value for mental health nurses working in other countries where there are Chinese communities to better understand perceptions of family caregivers. Introduction: The use of physical restraints is a common practice in home care. Family caregivers face care‐related and moral pressures due to the influence of Confucian culture in China. The use of physical restraints in the Chinese cultural environment may differ from the use of such restraints in other cultures. Scientific Rationale: Current research on physical restraints focuses on quantitative analysis of its prevalence and reasons within the institutions. However, there is little research on how family caregivers perceive physical restraints in home care context, especially under Chinese culture. Aim: To explore the perceptions of family caregivers on physical restraints in people diagnosed with dementia receiving home care. Method: A descriptive, qualitative study of Chinese family caregivers of people diagnosed with dementia in home care. Framework method analysis was adopted using the multilevel socio‐ecological model. Results: Beliefs about benefit lead to a dilemma for family caregivers. Cherishing family's affection encourages caregivers to reduce physical restraints, but lack of help from family members, professionals and the community forces them to restrain their loved ones. Discussion: Future research should explore the complex issue of culturally specific physical restraints decisions. Implications for Practice: Mental health nurses must receive education regarding the negative outcomes of the use of physical restraints for family members of people diagnosed with dementia. A more liberal approach to mental health and relevant legislation, which is an emerging global phenomenon that is currently in an early phase of development in China, grants human rights to people diagnosed with dementia. Effective communication and relationships between professionals and family caregivers can contribute to the establishment of a dementia‐friendly community in China. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to describe levels of social support and explore the factors predictive of social support for Chinese family caregivers of patients with dementia. Background: Social support levels and their predictive factors in Chinese dementia caregivers have not been well documented, which need to be further clarified to provide a basis for creating effective social support strategies. Methods: This was a cross‐sectional study with 91 participants who completed a demographic questionnaire and the Social Support Rating Scale from 2015 to 2016. Results: Chinese family caregivers of patients with dementia received moderate social support. Caregivers' subjective support domain scores and support utilization domain scores were significantly lower than those of the normal Chinese population, whereas caregivers' total social support scores were higher than those of the normal Chinese population. Family caregivers' monthly household income, educational level and place of residence were predictors of their own social support. Conclusion: Social support in Chinese caregivers of patients with dementia needs to be improved, especially the subjective support and support utilization. Healthcare professionals should pay special attention to caregivers with a lower monthly household income and educational level and caregivers who lived in the suburban area. Summary statement: What is already known about this topic? Social support is important for family caregivers of patients with dementia.Social support levels and their predictive factors in Chinese dementia caregivers have not been well documented. What this paper adds? Caregivers' subjective support and support utilization were significantly lower than the normal Chinese population; caregivers' total social support was significantly higher than the normal Chinese population.The best predictors of caregivers' social support were the monthly household income, educational level and place of residence of the caregivers. The implications of this paper: Healthcare professionals should pay special attention to caregivers with a lower monthly household income and educational level and caregivers who lived in the suburban area.Future research is needed to create effective nursing regimes, paying attention to caregivers with a lower educational level and caregivers who lived in the suburban area. [ABSTRACT FROM AUTHOR]

Background and aims: Dementia is recognized globally as a massive burden on public health and wider society. It is a major cause of disability and mortality amongst older people. China has the largest population of people with dementia worldwide, accounting for approximately 25% of the entire global population of people with dementia. The study investigated the perceived experiences of care giving and care receiving in China, with one area identified in the data concerning the extent to which the participants discussed death. The research also explored the meaning of living with dementia in modern China, where the economy, demography and culture are rapidly changing. Method: The qualitative approach of interpretative phenomenological analysis was used for this study. Semi-structured interviews were used for data collection. Finding: The paper reports on one specific finding concerning death as a way out of the situation that participants found themselves in. Conclusion: The study described and interpreted one of the specific issues, 'death', in the participants' narratives. This finding reflects how psychological and social factors, such as stress, social support, healthcare cost, caring burden and medical practice have created the participants' thoughts of 'wishing to die' and the reasons why they believe 'death is a way to reduce burden'. It calls for an understanding, supportive social environment and a reconsideration of a culturally and economically appropriate family-based care system. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore the experiences of family caregivers interacting with people with dementia. Background: A majority of people with mild‐to‐moderate dementia live at home with family caregivers. This interaction creates positive experiences and challenges for these caregivers. Design Descriptive phenomenological qualitative inquiry guided this study. Methods: This qualitative study involved semi‐structured interviews with the caregivers of people with mild‐to‐moderate dementia (n = 10). Data were collected from June to September 2018, and then data were thematically analysed. Results: Six categories of themes were identified from the interviews: (1) unexpected things often happen; (2) positive coping strategies; (3) sense of accomplishment because people with dementia actively participate in activities; (4) sense of frustration because of the reluctance of people with dementia to participate in activities; (5) hope for the happiness of people with dementia; and (6) want to have their own life. Conclusions: This study reveals that caregivers could positively interact with people with dementia through creating opportunities and arranging meaningful activities. Future research should focus on family management and training on how to help caregivers interact effectively with people with dementia. SUMMARY STATEMENT: What is already known about this topic? A majority of people with mild‐to‐moderate dementia live at home with family caregivers.Many caregivers suffer from depression, anxiety, fatigue, insomnia, family conflicts and low levels of life satisfaction.How caregivers interact with people with dementia at home remains unclear. What this paper adds? Caregivers experience various feelings, such as a sense of accomplishment and occasionally frustration, when interacting with people with dementia.Caregivers stated that they wanted people with dementia to be happy and live their life. Thus, the caregivers changed their attitude, accepted the situation and organized meaningful activities for people with dementia.Caregivers employed various strategies for handling situations involving people with dementia and shared how they interacted with such individuals. The implications of this paper: Care organizations that can offer certain services for people with dementia should be developed to lessen caregivers' burden.Community nurses should develop caregivers' strengths and enhance their abilities to improve interaction with people with dementia.Future research should focus on family management and training on how to help caregivers interact effectively with people with dementia. [ABSTRACT FROM AUTHOR]

Introduction: Cancer patients and caregivers have myriad unmet needs which can have detrimental consequences on their psychosocial wellbeing. This systematic review aims to identify the unmet supportive care needs of immigrant and native Chinese cancer patients and caregivers. Methods: We systematically searched various electronic databases (e.g. Scopus, CINAHL, PsycInfo, etc.) from the earliest date available until January 2018. Additional studies were identified through reference lists and citation tracking. Eligibility criteria included: (a) qualitative, quantitative and/or mixed methods studies published in English; (b) immigrant and native Chinese cancer patients and/or caregivers (age ≥18 years); (c) unmet needs and/or their correlates. Studies were assessed for their risk of bias, and a narrative synthesis of findings was performed. Results: Forty‐seven papers from 45 studies met eligibility criteria. The most prevalent area of unmet needs was health system and information. Patients most commonly desired one member of the hospital to talk to about all aspects of their care. Caregivers preferred information about the patient's prognosis and likely outcome. Anxiety was most commonly associated with higher levels of health system and information needs. Conclusion: Chinese patients and caregivers experience a range of unmet health system and information needs, which differ depending on their stage along the cancer trajectory. [ABSTRACT FROM AUTHOR]

Background: The prevalence of pediatric asthma in China is approximately 3%, and asthma remains poorly controlled in many of these patients. This study assessed the rate of adherence to home nebulizer treatment in paediatric patients in China. Methods: The CARE study was a 12-week, multicentre, prospective, observational study across 12 tertiary hospitals in China. Patients were aged 0–14 years, clinically diagnosed with asthma and prescribed home nebulizer inhaled corticosteroid (ICS) therapy for ⩾3 months. The primary endpoint was electronically monitored treatment adherence. Patients attended onsite visits at 0, 4, 8 and 12 weeks to assess asthma control, severity and treatment adherence (recorded by electronic monitoring devices and caregivers). Results: The full analysis set included 510 patients. Median treatment adherence reported by electronic monitoring devices was 69.9%, and median caregiver-reported adherence was 77.9%. The proportion of patients with well-controlled asthma increased from 12.0% at baseline to 77.5% at visit 4. Increased time between asthma diagnosis and study enrolment was a significant predictor for better adherence [coefficient: 0.01, p = 0.0138; 95% confidence interval (CI): 0.00, 0.01] and asthma control (odds ratio = 1.001, p = 0.0498; 95% CI: 1.000, 1.002). Negative attitude to treatment by the caregiver was associated with poorer asthma control. Conclusions: Adherence to home nebulization, a widely used treatment for asthma, was high among Chinese pediatric patients. Asthma control improved with increasing treatment duration. These results suggest that home nebulization of ICS is an effective and recommendable long-term treatment for paediatric patients with asthma. Trial registration ClinicalTrials.gov identifier: NCT03156998 The reviews of this paper are available via the supplemental material section. [ABSTRACT FROM AUTHOR]

Introduction: A culturally adaptive and easy‐to‐administer 12‐item Caregiving Rewarding Feelings (CRF) scale has been developed in China yet never published in English and validated in another population. Aim: The current study aimed to validate the CRF among a community sample of Chinese caregivers of those diagnosed with schizophrenia. Method: A sample of 449 family caregivers was recruited for scale validation that included factorial validity, construct validity, measurement invariance, item analysis, internal consistency reliability, test–retest reliability, known‐group validity, convergent validity and divergent validity. Results: Confirmatory factor analysis supported the a priori three‐factor structure. Construct validity was supported by high standard regression weight (SRW) and average variance extracted (AVE), measurement invariance across age and gender groups. The CRF showed good internal consistency and test–retest reliability. Known‐group validity was confirmed by the higher CRF scores among caregivers with certain socio‐demographics. The convergent validity of the CRF was supported by its positive correlations with social support, active coping and family functioning. The divergent validity of the CRF was supported by its negative associations with stigma, stress and depressive symptoms. Conclusions: This study confirmed the reliability and validity of the CRF specifically designed for caregivers in Chinese culture. Implications for Practice: The CRF may be further applied and validated in other populations and other countries. [ABSTRACT FROM AUTHOR]

Taking care of people with dementia is stressful for informal caregivers. Respite care can provide a break for them. But it is often underused, and its acceptability can be low in China. One reason is that it fails to meet their needs. This study aimed to explore the preference of caregivers of people with dementia for respite care services. A discrete choice experiment was used. Attributes and levels of respite care were informed by a literature review and expert consultations. A fractional factorial design was used to reduce the number of choice sets. A questionnaire survey was conducted in Tianjin, China. A mixed logit model was used to compute coefficients for attributes and levels. Respite care packages differed in five attributes, which were content, provider, duration, frequency, and cost. 322 caregivers completed valid discrete choice experiment questionnaires. All five attributes were statistically significant. Two most preferred attributes were "providers" (coefficient 1.297, p < 0.001) and "frequency" (coefficient 1.169, p < 0.001). Caregivers prefer highly qualified service providers and frequent respite care. The desirable respite care for caregivers would be assistance with personal care for people with dementia which was provided by an experienced worker with attitudes of understanding and respect towards people with dementia more than 3 times per week regularly and more than 4 h every time with a lower cost. This study offered new information on Chinese dementia caregivers' preferences for respite care. Policymakers should pay attention to the frequency and quality of providers when designing respite care to improve service uptake and ultimately lighten the burden on caregivers of people with dementia. [ABSTRACT FROM AUTHOR]

Objective: To explore the care experiences of spouses as long-term and primary caregivers for disabled older adults in China. Methods: A descriptive phenomenological method was used in this study, as well as purposive and convenient sampling. Semi-structured interviews were conducted with 15 spousal caregivers in Guangdong, China, from March to December 2021. Interview audio-recordings were transcribed verbatim and data were analyzed using Colaizzi's phenomenological analysis method. Results: We identified four themes from the data: spousal care motivation; sacrifices in caregiving; obstacles in caregiving; spousal caregivers' positive experiences. Conclusions: Spouses took responsibility for providing care for their disabled partners regardless of their willingness. They had positive experiences while providing care, but negative experiences were dominant, especially for spouses of severely disabled older adults. Spouses are always perfect in caregiving roles, although they may also need medical assistance. To prevent a decline in spousal caregivers' quality of life and relieve their care burdens, health care providers should support them as soon as possible or offer formal care for disabled older adults. It is necessary to intervene considering disabled older adults and their spousal caregivers as a unit to empower their confidence in coping with life together. [ABSTRACT FROM AUTHOR]

Aim: To examine the multidimensional properties of caregiver burden among family caregivers of patients with advanced cancer in a palliative context. Design: A sequential, explanatory, mixed‐method study was performed. Methods: Family caregivers of patients diagnosed with advanced cancer were recruited from a palliative care department of a third‐level hospital in Sichuan Province, China. The Caregiver Burden Inventory, Social Support Rating Scale and Connor–Davidson Resilience Scale were used to collect quantitative data, and a total of 150 caregivers were recruited from January 2022 to September 2022. Qualitative data were collected through semi‐structured interviews, and a total of 22 caregivers were interviewed from October 2022 to November 2022. Survey data were analysed using descriptive statistics, and the factors of caregiver burden were identified using the Mann–Whitney U test, Kruskal–Wallis H test and Spearman correlations. Interpretative phenomenological analysis was performed to analyse the interview data to initially explore the multidimensions of caregiver burden. The following‐a‐thread method and convergence coding matrix were used for triangulation to examine the multidimensional properties of caregiver burden. Results: The participants experienced a moderate level of caregiver burden (32.97 ± 13.09). Through triangulation, six meta‐themes and nine meta‐subthemes were identified as multidimensional properties of caregiver burden, including physical (too many caring tasks and poor health condition), emotional (strong negative emotions resulting from patients' suffering and insufficient and ineffective family communication), social (less social interaction and social role conflict) and economic burdens, factors that aggravate burden (prevention and control of COVID‐19 and spousal relationship with patients) and factors that mitigate burden (social support). Conclusion: Multiple dimensions of caregiver burden were experienced by family caregivers of patients with advanced cancer in the palliative context. Family‐centred palliative care must be further developed. Implications for the profession: It is important to develop family‐centred palliative care. Therefore, the focus must be on developing a rational understanding of palliative care in public and a culture‐oriented death education in palliative units. Impact: This study adopted a mixed‐method approach to comprehensively understand the phenomenon of and factors in caregiver burden in the Chinese palliative oncology context.Our findings suggest that family caregivers in palliative oncology experience a moderate level of caregiver burden, with dimensions including physical, emotional, social and economic burdens, among which emotional burden is the most prominent.The findings of this study provide policy makers and nurse practitioners with targets to be addressed in family‐centred care in Chinese palliative units. Reporting Method: The results of this study are reported based on the guidelines of the Mixed‐Methods Article Reporting Standards. Patient or Public Contribution: Eligible caregivers were invited to participate in the study and semi‐structured interviews. Nurse managers of the palliative unit helped us access the patient‐management system. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to capture and explore family caregivers' lived experience of caring for hospitalised patients with cancer during the lockdown. Background: The unprecedented lockdown episodes due to COVID‐19 have brought significant changes in the hospital visiting policies and caregiving practices. As part of the precautionary measures for hospital visits, the bedside companion was restricted to one caregiver for patients with cancer in Shanghai hospitals. Design: This study adopted a descriptive phenomenological approach. Methods: Data were collected among 20 family caregivers recruited from the Oncology department of a tertiary hospital in Shanghai in May 2022, using purposive sampling method and followed by unstructured, open‐ended interviews. Colaizzi's seven‐step data analysis method was used to analyse the data to reveal the emergent themes and subthemes of the phenomenon. Results: Four themes were generated on family caregivers' lived experience of caring for hospitalised patients with cancer during the lockdown, including (1) Feeling scared for the patient; (2) Living a life feeling trapped under COVID‐19 surveillance; (3) Feeling neglected and unseen; (4) Growing resilience and appreciation. Conclusions: The lockdown exacerbated the burden of family caregivers when they cared for the hospitalised patients with cancer during the lockdown period. However, positive reframing of the lived experience facilitated their coping with the challenging situation. Relevance to Clinical Practice: Findings from this study highlighted the potential proactive roles the healthcare providers could play in improving family caregivers' health and supporting them during and beyond the COVID‐19 pandemic. Reporting Method: The study adhered to relevant EQUATOR guidelines; the study was reported according to the COREQ checklist. Patient or Public Contribution: Family caregivers of patients with cancer were involved in data collection and member‐checking of the transcripts and interpretations of their experiences. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the perspectives of stroke survivors, caregivers and nurse coaches on a health coaching program during hospital‐to‐home transitional care. Background: Stroke is a major public health problem that seriously affects the health and safety of people in China. Nurse‐led health coaching is a promising support option in enabling smooth hospital‐to‐home transition for stroke survivors and family caregivers. A qualitative study is valuable for gaining insight into their perspectives on using this program. Design: An exploratory, descriptive qualitative process evaluation was conducted parallel with a former randomised controlled trial. Data were obtained from 26 stroke survivors, 33 caregivers and four nurse coaches with semi‐structured interviews. The inductive reflexive thematic analysis approach was used for data analysis. The COREQ checklist was followed in reporting this study. Results: Seven themes were generated from the data: (1) the applicability of individualised health coaching sessions, (2) driving self‐efficacy to establish self‐care skills, (3) the key role of nurse coaches, (4) coordination among healthcare teams during the transition, (5) adequate community and social support, (6) insufficient rehabilitative services after discharge and (7) perceived extra workload for nurse coaches. Conclusions: The study captured perspectives on a nurse‐led health coaching program towards hospital‐to‐home transition care from stroke survivors, caregivers and nurse coaches. Individualised health coaching sessions and driving self‐efficacy were perceived as facilitators for empowering the self‐care skills of stroke survivors and caregivers. The key role of nurse coaches in coordinating healthcare teams and adequate community and social support were detected as the power frame of the program's implementation. However, health system obstacles, such as insufficient rehabilitative services and the high workload of nurses, still need to be addressed to ensure the sustainability of health coaching intervention in transitional care. Relevance to Clinical Practice: The study suggested the feasibility of implementing nurse‐led health coaching to smooth post‐stroke hospital‐to‐home transitional care. The findings also highlighted the importance of qualitative process evaluation when implementing evidence‐based interventions in health care. Trial Registration: The trial was registered with the Australia New Zealand Clinical Trials Registry (ID: ACTRN12619000321145). [ABSTRACT FROM AUTHOR]

Background: Although stigma and caregiving burden are important in relation to mental health recovery, few studies have been conducted on affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia (FCPWS) in rural China. Aims: This study aimed to examine the severity level of affiliate stigma and caregiving burden, and identify the correlates among FCPWS in rural China. Methods: A mental health survey was conducted (N = 253 FCPWS) in Xinjin county, Sichuan province, China. Affiliate Self-Stigma Scale and Zarit Burden Interview Short Form were used. The regression analysis was performed to explore the correlates of stigma and burden. Results: Most FCPWS reported experiencing high and severe level of affiliate stigma (78.66%) and caregiving burden (95.26%). Family caregivers who were middle aged, unemployed, with high caregiving burden and low quality of life (QoL), showed more severe affiliate stigma. Family caregivers who were female, older, with low income, high affiliate stigma and low QoL, experienced greater caregiving burden. Conclusions: The large majority of FCPWS in rural China experienced severe affiliate stigma, caregiving burden and poor QoL. It is crucial to develop culture-specific anti-stigma interventions to reduce caregivers' stigma and caregiving burden, and improve QoL. Specific risk factors of family caregivers' affiliate stigma and caregiving burden should be considered for development of health policy and community-based mental health services. [ABSTRACT FROM AUTHOR]

This study investigated the trajectory patterns of activities of daily living (ADLs) and cognitive function among older urban Chinese adults with disabilities and their influence on their family caregivers' (i.e., spouse and adult children) positive caregiving experiences. Data were derived from the three-wave longitudinal panel study titled "Longitudinal Study on Family Caregivers for Frail Older Adults Aged 75 or Above in Shanghai." A total of 251 older adults and their spouse/adult child caregivers participated in the 2010, 2013, and 2016 waves and were included in the final analytic sample. Growth curve modeling was applied to examine the proposed model. The findings suggest that ADLs and cognitive function trajectories declined over six years. Changes were predicted based on the older adults' age and education levels. In 2016, the change rate of cognitive function trajectory was associated with self-affirmation and life enrichment. Neither the initial status (intercept) nor the change rates (slope) of the ADLs' trajectory were associated with the two dimensions of positive caregiving experiences. This study extended the stress process model by demonstrating the trajectory patterns of stressors and their influence on positive caregiving experiences. Change rates in older adults' cognitive function were key risk factors for positive caregiving experiences. This finding has important implications for family-based care systems in China. [ABSTRACT FROM AUTHOR]

The impact of grandparenting on the grandparents' health has been relatively under-studied. This study examined country differences in the effects of grandchild care provision on the grandparents' depression in Italy, Spain, China, Denmark and Sweden using the longitudinal Harmonised CHARLS and SHARE data collected between 2010–2015. Controlling for the grandparents' depression in 2011, grandmothers providing non-intensive grandparental care in Sweden in 2013 reported lower depression score in 2015 compared to those who did not provide any care in 2013. Chinese grandfathers, Italian and Swedish grandmothers who provided intensive grandchild care reported lower depression score compared to their counterparts who did not provide any grandchild care. This study indicates that the Structural Ambivalence Theory can only partially explain the findings, suggesting further theoretical development in this area. Future research can focus on identifying the causal pathways between grandparenting and wellbeing, and the implications of such pathways for older persons' wellbeing worldwide. [ABSTRACT FROM AUTHOR]

This scoping review explored the occupations of terminally ill Chinese adults and their caregivers. Seven databases were searched for peer-reviewed journal articles published in English or Chinese before June 2020. Of the 16 studies that met the selection criteria, only one directly used the term "occupations" while the other 15 studies contained descriptions of occupations. Eight themes were extracted and compared with existing literature. The top two reported themes were occupations surrounding life roles and tasks and those surrounding food and eating. More study is required about the occupational engagement of this client group. [ABSTRACT FROM AUTHOR]

Grandparental caregiving is common in China, which can directly impact grandchild development. In addition, grandparents may have an indirect impact on children through their relationship with and support of the parents. However, associations between grandparenting, parenting, and child outcomes are rarely investigated. The current study is a pilot study which includes 42 mothers, fathers, and co-residing grandparents in China, and examines whether grandparental sensitivity relates to parental sensitivity (biological child of the grandparent), and whether grandparental sensitivity and maternal and paternal sensitivity each uniquely contribute to 14-month-old children's Executive Function (EF). Results did not show a significant relation between parental and grandparental sensitivity or a unique contribution of sensitivity from mothers, fathers, or grandparents to infant EF. Our findings from exploratory analyses showed differences in sensitivity of grandparents and parents towards the third generation but did not confirm a combined effect of multiple caregivers on infant EF development in China. Highlights: This pilot study is the first to observe caregiving in mothers, fathers and co-residential grandparents in China. The study investigated the relation between grandparenting and parenting, and the association of multiple caregiving with infant EF development. Sensitivity levels of grandparents towards the third generation were lower than those of parents. There was no significant combined effect of multiple caregivers (mother, father and grandparent sensitivity) on infant EF development. [ABSTRACT FROM AUTHOR]

Qualitative meta‐synthesis is a coherent approach to answering an overarching research question by synthesising past qualitative studies so as to create new meanings from their results. We conducted a qualitative meta‐synthesis to systematically evaluate and integrate the caregiving experiences of adult children providing care for an elderly parent with cancer. The search was conducted in the databases Web of Science, PubMed, Embase, MEDLINE, Cochrane Library, Grew Literature in the Health Sciences, CNKI, WanFang Data, VIP, SINOMED and China Academic Journals as well as Chinese grey literature databases (China Academic Conference Literature Database/中国学术会议文献数据库, National Science and Technology Library) from inception to June 9, 2021. Thirteen studies were included in the final synthesis. The caregiver experiences they describe are synthesised into three primary themes: care needs, care burden and care gains, with numerous secondary themes. Besides our findings that seem to align with those from studies focused on other cultures, we have highlighted three main discoveries from the synthesis that stand out in the Chinese context: (1) many sub‐themes related to specific caregiving skills; (2) a strong expectation for health professionals to improve their communication skills with family caregivers; (3) the negative and positive influences of filial piety in caregiving experiences. Our findings can help multidisciplinary healthcare teams in China support adult children as caregivers in their emphasis on improving caregiver education and training, ways of making the most of potential care gains, and ways of easing care burdens. [ABSTRACT FROM AUTHOR]

Despite a rapid increase in people with Parkinson's disease (PD) in China, studies focusing on caregiver burden remain scarce. Challenges faced by caregivers in other Asian societies are also underexplored in the PD‐related research field. To addresses this gap, this study drew on the theory of resilience and examined the caregiving experiences of Chinese family caregivers for older people with PD. We conducted participant observation and semi‐structured interviews with 15 family caregivers of older people with PD in Shanghai in 2018. We used thematic analysis to identify key patterns of stressors and factors affecting the capacity of caregivers to address burdens. Our analysis shows that stressors faced by Chinese PD caregivers included physical limitations, psychological and emotional problems, reduction in social connections, financial burden and lack of information and knowledge. Three levels of factors—personal, social and structural—played different roles in resilience among Chinese PD caregivers. However, resilience was unevenly developed among PD caregivers across gender, kinship, residential status and generation. Our study provides novel empirical evidence about the burden on Chinese PD caregivers. It can inform policymakers and social workers as they develop a holistic understanding of promoting resilience building in this rapidly growing group. Our study also enriches cross‐cultural knowledge about factors contributing to caregivers' resilience building in Asian societies. [ABSTRACT FROM AUTHOR]

The Chinese population is ageing and the burden of caregiving for elderly on society is getting heavier. With formal long-term care system underdeveloped, informal care provided by family members remains the predominant form of care provision in China. Urban and rural caregivers may face different situations in their informal caring roles due to China's strict household registration system (hukou). There are few studies focusing on rural–urban disparities in elderly care from the perspective of female caregivers. We used hukou status rather than living location to distinguish urban and rural, and the informal care was divided into low-intensity and high-intensity in our study. We used repeated cross-sectional data from the China Health and Nutrition Survey (CHNS). Multinomial logistic regressions and Oaxaca–Blinder decomposition techniques were used to explore the urban–rural disparities. We found that respondents with urban hukou were around 30% more likely to provide informal care than those with rural hukou, and the relative risk ratios value for both low (RRR = 1.29) and high (RRR = 1.30) intensity care were significantly at 5% level. The results of the Oaxaca–Blinder decomposition showed that the mean difference of informal care time between urban and rural was 3.11. Among them, education attainment can explain 25.10% of the total difference between urban and rural and was the largest contributor to the overall gap. Long-term care system in China should be established and improved, and policies should focus more on the most vulnerable groups such as rural hukou holders and the less-educated. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore the stressors along with coping strategies in Chinese family caregivers whose relative with dementia had been placed into a long-term care facility. Methods: A qualitative descriptive study was conducted with 17 Chinese family caregivers of institutionalised older adults with dementia, recruited via purposeful sampling. Information regarding stressors along with coping strategies was collected through face-to-face semi-structured individual interviews. The interviews were audio-recorded, transcribed, anonymised and imported into MAXQDA 2018.2. Data were analysed with qualitative content analysis. Findings: Three categories of stressors emerged: socioeconomic pressure, hassles arising from continuing caregiving and suboptimal care provided by the facility. In particular, the family caregivers' experienced tremendous pressure of negative comments from people around since long-term care placement was traditionally viewed as unfilial in Chinese societies. Various coping strategies were adopted by Chinese family caregivers to deal with the stressors; however, they were not always adaptive. Implications: Health care authorities and professionals should recognise family caregivers' stressors after long-term care placement of a relative with dementia with the consideration of the unique socio-cultural needs. Appropriate and effective interventions should be developed and implemented to facilitate family caregivers to cope with stressful situations after long-term care placement and further to safeguard their psychosocial well-being. [ABSTRACT FROM AUTHOR]

Aims: To examine patient-caregiver concordances about psychological distress among Chinese patients with breast cancer undergoing chemotherapy and identify factors related to concordance among patients and family caregivers. Design: Cross-sectional study. Methods: From October 2019 to June 2020, 137 patient-caregiver dyads were enrolled. Sociodemographic information, the distress thermometer (including the problem list), the Distress Disclosure Index and the Family Adaptability and Cohesion Evaluation Scale were used to collect data. Data were analysed using intraclass correlation coefficients (ICC), kappa statistics, two related samples test, chi-square tests and/or Fisher's exact tests and binary logistic regression. Results: Overall, fair agreement was identified between patients' and caregivers' reports (intraclass correlation coefficients [ICC] = .528). Patients reported significantly higher psychological distress scores than paired caregiver reports. Lower psychological distress concordance was found among patients with comorbidities (odds ratio [OR], 0.352; 95% confidence interval [CI], 0.155-0.798) and lower levels of self-disclosure (OR, 0.402; 95% CI, 0.186-0.868). Conclusion: There was relatively low concordance between patients' reports and caregivers' perceptions of psychological distress. Family caregivers tended to underestimate patients' psychological distress. A comorbid condition and lower levels of self-disclosure contributed to this bias. Impact: Having an awareness of the incongruence between patient and caregiver may help healthcare providers better interpret caregiver assessments. Healthcare providers should reinforce patient-caregiver dyadic psychosocial education to improve concordance. More psychological care and substantial emotional support should be provided for Chinese breast cancer patients undergoing chemotherapy by family caregivers and healthcare providers. [ABSTRACT FROM AUTHOR]

Background: Medication adherence is a common issue influenced by various factors among patients with severe mental disorders worldwide. However, most literature to date has been primarily quantitative and has focused on medication adherence issue from the perspective of patients or their caregivers. Moreover, research focused on medication adherence issue in China is scarce. Present study aims to explore the influential factors of medication adherence among patients with severe mental disorders form the perspective of mental health professionals in Hunan Province, China. Methods: A qualitative study was performed in Hunan Province, China with 31 mental health professionals recruited from October to November 2017. And semi-structured interviews or focus group interviews were conducted along with audio recordings of all interviews. Interview transcripts were then coded and analyzed in Nvivo software with standard qualitative approaches. Results: Three major themes influencing medication adherence among patients with severe mental disorders were identified as: (1) attitudes towards mental disorder/treatment; (2) inadequate aftercare; (3) resource shortages. Conclusions: This qualitative study identified the factors influencing medication adherence among patients with severe mental disorders in China. As a locally driven research study, it provides practical advice on medication adherence promotion for mental health workers and suggests culturally tailored models that improve the management of patients with severe mental disorders in order to reduce economic burden on individual and societal level. [ABSTRACT FROM AUTHOR]

Background: Caregivers' parenting knowledge is of importance to child development and to achieve positive child outcomes. Even though some caregiver education programs have demonstrated positive effects, most of them are carried out in developed countries and among western samples. As a developing country with the second‐largest child population worldwide, China has initiated caregiver education programs to promote parenting knowledge among caregivers since 2016. This study examines the effect of an innovative caregiver education program on caregivers' perceived increase of parenting knowledge. Methods: A total of 310 caregivers with a child aged between 0 and 3 from Z city, China, were randomly selected to complete a survey. Caregivers' perceived increase of parenting knowledge was assessed by five specified knowledge dimensions, namely, child growth, feeding behaviours, daily care, disease prevention and safety. The independent variable was program participation, measured by respondents' use of program services. OLS regression was employed to assess the association between caregivers' program participation and their perceived increase of knowledge, controlling basic demographic and socio‐economic factors. Results: In general, program participation had statistically significant associations with caregivers' perceived increase of parenting knowledge. The associations varied by service type. Particularly, online development evaluations and in‐home sessions showed relatively consistent and positive effects on caregivers' perceived increase of parenting knowledge. Conclusions: This caregiver education program had a positive effect on caregivers' perceived increase of parenting knowledge, particularly through the use of the online development evaluations and in‐home sessions. As one of the earliest initiatives of this kind in China, the findings reveal the promise of an innovative program to advance caregivers and children. [ABSTRACT FROM AUTHOR]

Background: Nurses' palliative and hospice care-specific education is associated with the quality of palliative and hospice care that influences health outcomes of patients with life-limiting illnesses and their caregivers. However, China lacks measures available to assess nurses' educational needs in palliative and hospice care. The End-of-Life Professional Caregiver Survey (EPCS) is a psychometrically reliable self-reporting scale to measure multidisciplinary professionals' palliative and hospice care educational needs. This study was performed to explore the psychometric properties of the Chinese version of the EPCS (EPCS-C) among Chinese nurses. Methods: We translated and culturally adapted the EPCS into Chinese based on Beaton and colleagues' instrument adaptation process. A cross-sectional study design was used. We recruited 312 nurses from 1482 nurses in a tertiary hospital in central China using convenience sampling to complete the study. Participants completed the EPCS-C and a demographic questionnaire. Exploratory and confirmatory factor analysis was carried out to test and verify the construct validity of the nurse-specific EPCS-C. Cronbach's alpha coefficient was used to appraise the reliability of the nurse-specific EPCS-C. Results: A three-factor structure of EPCS-C was determined, including cultural, ethical, and national values; patient- and family-centered communication; and effective care delivery. The exploratory factor analysis explained 70.82% of the total variances. The 3-factor solution of the nurse-specific EPCS-C had a satisfactory model fit: χ2 = 537.96, χ2/df = 2.96, CFI = 0.94, RMSEA = 0.079, IFI = 0.94, and GFI = 0.86. Cronbach's alpha coefficient of the overall questionnaire was 0.96. Conclusions: The nurse-specific EPCS-C showed satisfactory reliability and validity to assess nurses' palliative and hospice care educational need. Further research is required to verify the reliability and validity of the EPCS-C in a larger sample, especially the criterion-related validity. [ABSTRACT FROM AUTHOR]

Ageing in place is a key principle of older care services in many countries, especially in China where the social convention, cultural expectation and legal obligation emphasise that looking after parents is the children's responsibility. As a result, the majority of older, frail Chinese have been cared for at home by their families. Previous studies have argued that being cared for at home contributes positively to the well-being and quality of life of older people and to economic cost. However, due to the sociocultural, economic and demographic changes in China, older people and their family caregivers are facing many challenges as they 'age in place' at home. This study aims to explore the meaning of family supported home care in China from the perspectives of people with dementia and family caregivers. The study is based on qualitative data collected from 24 people with dementia and family caregivers recruited from one mental health centre in Shandong province, China. Three main themes and nine subthemes were found: home care may create a sense of social isolation; home care is a burden; home care versus institutional care. The study suggests that while home care may bring social and psychological benefits, it also can be a barrier to building social connection, receiving social support, and other related services in China. [ABSTRACT FROM AUTHOR]

Objectives: Caregivers of children with Autism Spectrum Disorder (ASD) may experience varying degrees of both psychopathological symptoms and enriched personal growth. The mechanisms underlying these associations are not well understood. The aim of the current study was to explore the relationships between post-traumatic growth (PTG) and psychological distress, namely depression, anxiety and stress among caregivers of autistic children in China, with self-compassion as a potential relating factor. Methods: One hundred and twenty-one caregivers of children with ASD, ranged in age from 26 to 53, completed the questionnaires. The instruments utilized include a socio demographic questionnaire, Posttraumatic Growth Inventory (PTGI), the Chinese version of the Short Form Depression Anxiety Stress Scales (DASS-21) and the Chinese version of the Short Form Self-Compassion Scale (SCS-SF). Results: The results showed that there was no significant linear or curvilinear relationship between PTG and psychological distress. PTG indirectly correlated with psychological distress through self-compassion. The positive and negative components of self-compassion uniquely correlated with PTG and psychological distress respectively. Conclusions: The findings of this study suggested that PTG may play a protective role of mental health among Chinese caregivers of children with ASD through enhancing self-compassion. More importantly, the current study suggested that self-compassion should be better conceptualized in order to move the relevant research forward. [ABSTRACT FROM AUTHOR]

Background: The high prevalence of early childhood caries (ECC) is widespread around the world, and oral health education (OHE) plays a vital role in preventing ECC. Numerous studies on ECC risk factor assessment have assisted us in enriching the content of OHE. The objective of this study was to further assess independent risk factors for ECC at different ages to provide evidence and insights for OHE. Methods: Children aged 3–5 years old (N = 1301) in Shandong Province were enrolled in this cross-sectional study. Data about oral health status and caregivers' oral health knowledge, attitude, and practice (KAP) were extracted from the 4th National Oral Health Survey of China. The associations between ECC prevalence and various KAP variables were tested with chi-square tests, bivariate analysis and multivariable logistic regression analyses. Results: The ECC prevalence in Shandong Province was 64.6%, and the dmft mean was 3.15. The independent variables with an increased risk for ECC were age, feeding method within 6 months of birth, bedtime sugar frequency, experience of toothache over the past year and dental visits (P < 0.05, chi-square tests). Complete breastfeeding within 6 months of birth primarily contributed to the high ECC risk of the 3-year-old group (OR: 3.39, 95% CI: 1.41–8.17), while high frequency bedtime sweet consumption mainly contributed to that of the 5-year-old group (OR: 3.22, 95% CI: 1.03–10.06; logistic regression analysis). Tooth brushing was not associated with ECC in this study, and some positive knowledge and attitude variables were positively correlated with a high risk of ECC. Conclusion: These data provide evidence to suggest that the ECC-related risk factors at different ages are inconsistent, which provides some insights for OHE. We should highlight the effects of feeding methods in the early stages of deciduous dentition and sugar habits in the late stages of deciduous dentition on ECC, as well as encourage preventive dental visit and supplemental training for oral health practices. [ABSTRACT FROM AUTHOR]

Purpose: To explore the experience of caregivers of family members with schizophrenia. Design and methods: A qualitative approach was adopted to examine the experience of caregivers of people with schizophrenia. The researcher conducted semi‐structured interviews with 16 participants recruited through purposive sampling. Findings: The change findings encompassed five major themes: (a) loss of personal life, (b) mixed emotions, (c) changes in family relationships, (d) the need for professional support and help, and (e) coping strategies. Practice implications: Clinicians, including nurses, must be aware of the cultural importance of mental illness, particularly the widespread cultural beliefs and patterns of help‐seeking behaviors, to provide culturally sensitive health care and develop empirical strategies for helping both these caregivers and their dependents. [ABSTRACT FROM AUTHOR]

Objectives: With over one-fifth of the world's older population, shrinking family size and increasing number of women in the workforce, elder care is a growing challenge for families in mainland China. This study explored the moderating effect of working status and gender on caregiving time and depressive symptoms among adult children caregivers in mainland China. Method: Participants were 660 adult children caregivers from a nationally representative sample of individuals aged 45 + (N = 13,204) who participated in the China Health and Retirement Longitudinal Study (CHARLS) Wave 2 (2013). Multiple linear regression was used to analyze the direct effect of caregiving time and the moderating effects of working status and gender on symptoms of depression among caregivers. Results: Significant main effect between caregiving time and depressive symptoms was found controlling for demographic covariates. The three-way interaction between working status, gender and caregiving time was also significant. Working status and gender moderate the effect of caregiving time on depressive symptoms: among employed men and women caregivers, spending more hours providing care predicted fewer depression symptoms. Unemployed men caregivers who spent more hours providing care showed highest level of depressive symptoms. Conclusion: The relationship between caregiving time and depressive symptoms was moderated by working status and gender. Future research is needed to explore factors that influence changes in caregivers' health and well-being over time. [ABSTRACT FROM AUTHOR]

Background: Bipolar disorder (BD) is a chronic mental disorder, and family members play a key role in taking care of the affected individuals. The recovery movement has gradually transformed mental health services, for example, through the introduction of peer support services (sharing of expert-by-experience knowledge), and it has challenged the prevailing view that people with mental illness cannot recover. Aims: Through this study, the researchers explored how family caregivers in a Chinese context conceptualise recovery, how caregivers interact with peer support workers (PSWs) and how they perceive peer support services. Methods: Fourteen family caregivers from community settings participated in individual semi-structured interviews. The data were analysed through thematic analysis. Results: Family caregivers had multifaceted definitions of recovery and had various degrees of contact with PSWs. The views and experiences shared by PSWs were hope-instilling for caregivers and changed their perception of BD and their loved ones. Some limitations of PSWs were also identified. Conclusion: Social connectedness and functional outcomes were important indicators of recovery among Chinese family caregivers. Caregivers began to understand the benefits of PSWs after experiencing their services. Peer-led services could be a helpful support for both service users and family caregivers. [ABSTRACT FROM AUTHOR]

Background: Assertive Community Treatment (ACT) is an evidence-based treatment program for people with severe mental illness developed in high-income countries. We report the first randomized controlled trial of ACT in mainland China. Methods: Sixty outpatients with schizophrenia with severe functional impairments or frequent hospitalizations were randomly assigned to ACT (n = 30) or standard community treatment (n = 30). The severity of symptoms and level of social functioning were assessed at baseline and every 3 months during the 1-year study. The primary outcome was the duration of hospital readmission. Secondary outcomes included a pre-post change in symptom severity, the rates of symptom relapse and gainful employment, social and occupational functioning, and quality of life of family caregivers. Results: Based on a modified intention-to-treat analysis, the outcomes for ACT were significantly better than those of standard community treatment. ACT patients were less likely to be readmitted [3.3% (1/30) v. 25.0% (7/28), Fisher's exact test p = 0.023], had a shorter mean readmission time [2.4 (13.3) v. 30.7 (66.9) days], were less likely to relapse [6.7% (2/30) v. 28.6% (8/28), Fisher's exact test p = 0.038], and had shorter mean time in relapse [3.5 (14.6) v. 34.4 (70.6) days]. The ACT group also had significantly longer times re-employed and greater symptomatic improvement and their caregivers experienced a greater improvement in their quality of life. Conclusion: Our results show that culturally adapted ACT is both feasible and effective for individuals with severe schizophrenia in urban China. Replication studies with larger samples and longer duration of follow up are warranted. [ABSTRACT FROM AUTHOR]

Objective: This study examined the differences in 14-year outcomes of persons with schizophrenia with and without family caregiver(s) in a rural community in China.Methods: All participants with schizophrenia (n = 510) aged 15 years and older were identified in a 1994 epidemiological investigation of 123,572 people and followed up in 2004 and 2008 in Xinjin County, Chengdu, China.Results: Individuals without family caregiver in 1994 had significantly higher rate of homelessness (23.8 %) and lower rate of survival (47.5 %) in 2008 than those with family caregivers (5.1 and 70.9 %). Compared with individuals with family caregivers, those without family caregivers were more likely to be male, live alone, have fewer family members, lower family economic status, lower rates of marriage and complete remission, higher mean scores on PANSS and lower mean score on GAF in 2008. The predictors of participants without family caregiver in 2008 included having a small number of family members at baseline and being male.Conclusions: The absence of a family caregiver is a predictive factor of poorer long-term outcome of persons with schizophrenia in the rural community. The critical role of family caregiving should be incorporated in the planning and delivering of mental health policies and community-based mental health services. [ABSTRACT FROM AUTHOR]

Background: Most schizophrenia patients are supported by main informal caregivers at home in China. This study aims to investigate the further needs of social supports for main informal caregivers of schizophrenia patients and to analyze influencing factors on the awareness and utilization of social supports in Beijing. The results of this study could potentially act as reference for health professionals to implement appropriate and effective support programs. Methods: A mixed-methods approach was used in this study. Awareness, utilization and influencing factors of social supports for main informal caregivers were investigated using questionnaires in 6 urban districts in Beijing. Meanwhile, individual in-depth interviews with 10 main informal caregivers from the urban districts of Beijing were conducted to identify the caregivers' perspective on social supports and their further needs. Results: Quantitative results showed that although the government provided multi-channel resources for schizophrenia patients and their families, awareness and utilization of the resources such as rehabilitation and relevant subsidies were less than 10.0 and 5.0% respectively. Most caregivers in in-depth interviews expressed that they had negative experiences with respect to obtaining social supports, and they emphasized that more support would be needed in terms of financial support, respect, and rehabilitation institutions. Conclusions: The awareness and utilization of social supports are low for main informal caregivers of schizophrenia patients. More services and improved public attitudes are needed for schizophrenia patients and their caregivers. [ABSTRACT FROM AUTHOR]

Background: The aim of the current study was to explore the factors influencing dental caries among 3–5-year-old children in Sichuan Province and the interrelationship between these factors using structural equation modelling (SEM). Methods: A cross-sectional study was conducted among 2746 3–5-year-old children in Sichuan Province. Examination of caries was conducted on all children and a questionnaire was answered by the children's caregiver. SEM alternative models were constructed to interpret the intricate relationships between socio-economic status (SES), caregiver's oral health knowledge, attitudes, children's oral health behaviours and children's dental caries. Result: The results showed that dental caries were significantly associated with dietary behaviours (β = 0.11, SE = 0.03, P = 0.001, BC 95% CI =0.05/0.18) and SES (β = − 0.17, SE = 0.03, P<0.001, BC 95% CI = -0.23/− 0.10) directly, While the indirect effect of SES on dmft is in an opposite direction (β = 0.08, SE = 0.02, BC 95% CI = 0.04/0.12). Conclusion: We found that unhealthy dietary behaviours increased the prevalence of dental caries. However, oral health knowledge and attitude failed to affect dietary behaviour in this model. This result warns that oral health education should strengthen feeding-related knowledge. Meanwhile, it also reminds that it is easier known than done. Future oral health education should focus on exploring a more effective way for the public to turn knowledge into action. [ABSTRACT FROM AUTHOR]