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BACKGROUND Because of their cancer and treatment adverse effects, most pediatric oncology patients will experience 1 or more symptoms at one time that can seriously affect their quality of life. Because these children are attached to parents, their symptom burden directly influences the parental stress level and parental interpretations of their children's quality of life. OBJECTIVE The aim of this study was to examine the association between child-reported symptom burden and the pediatric quality of life reported by children with cancer and their parents, and whether parental perceived stress mediates these relationships. METHODS In a cross-sectional design, convenience sampling was used to recruit 80 parent-child dyads. Advanced statistical methods were adopted to analyze the mediating effects of parental stress between children's symptom burden and their quality of life. RESULTS The results revealed that parental stress was the mediator in the relationship between child-reported symptom burden and children's quality of life reported by parents. The results also showed that parental stress was not a mediator in the relationship between child-reported symptom burden and their quality of life. This underscored the differences in interpretations of quality of life reported by children and their parents. CONCLUSION Children's symptom burden is an important factor in predicting parental stress level and the quality of life reported by the children. Children's voice should be incorporated whenever possible. IMPLICATIONS FOR PRACTICE The knowledge gained from this study will facilitate intervention development to enhance parents' abilities in stress management and symptom management for their children with the support of the nursing profession.

Background and Purpose:Fear of cancer recurrence (FCR) is a frequent psychological adverse effect among cancer survivors. This study aimed to test the psychometric properties of the Traditional Chinese version of the 12-item Fear of Progression Questionnaire-Short Form (FoP-Q-SF).Methods:An online survey was conducted with 311 cancer survivors in Hong Kong. The factor structure, known-group validity, and internal consistency reliability were examined.Results:The values measuring validity is good, with acceptable goodness-of-fit indexes (RMSEA = 0.073, SRMR = 0.042, CFI = 0.954), moderate to large correlations with unmet needs (0.339–0.816), being female, younger, had completed treatment ≤ 2 years, and had undergone chemotherapy/radiotherapy scored significantly higher on the FoP-Q-SF. The Cronbach’s alpha of the scale was .922.Conclusion:High validity and reliability indicate the scale’s value in assessing FCR in Hong Kong cancer survivors.

Introduction Cancer burden continues to rise globally and locally. Due to the shift of the cancer care from the hospital to the community, many cancer patients requiring needs in palliative care from their informal caregivers. Many caregivers often taking up the important roles and responsibilities but their own needs are largely neglected, and hence may induce caregiving burden. This study aims to explore the relationships of caregiving burden with unmet support needs in both cancer patients and their caregivers. Method A convenience sample of 280 patient-caregiver dyads was recruited from the oncology outpatient clinic of two hospitals in Hong Kong between April and June 2018. Among them, 258 (92.1%) patient-caregiver dyads provided complete information on unmet supportive care needs (Patient: the 34-item SCNS-SF34-C, Caregivers: the 26-item SPUNS-SF), and caregiving burden (Caregiver Strain Index). Results Among the patients, their mean age was 60.8 (SD = 13.6) and 66% were female. Among the caregivers, their mean age was 49.3 (SD = 14.6), 67.2% were female, and 38.2% were children of the patient. Mean level caregiving burden in caregivers was 4.87 (SD = 3.75) out of a range 0–13. Regression analysis showed that higher caregiving burden was associated significantly with higher caregiver’s unmet support in personal and emotional needs (βstd = 0.348) and future concerns (βstd = 0.204), and patient’s unmet support in physical and daily living needs (βstd = 0.201), but lower caregiver’s unmet support in information needs (βstd = −0.233) after controlling for age, gender, and education level of both patients and caregivers. Conclusions The findings shed lights in designing interventions aim at reducing caregiving burden by targeting caregiver’s unmet support in personal and emotional need and those caregivers are taking care of cancer patients with unmet support in physical and daily living needs. However, the finding on caregiver’s unmet support in information needs was a protective factor of caregiving burden warrants further exploration.

Introduction Better communications among the patient, their family, and healthcare providers can enable a shared understanding on patient’s end-of-life (EOL) care preferences. Discussion about death-related issue however has been thought to be taboo among Chinese people. This study aims to explore perceived quality of EOL communication provided by healthcare professionals (HCPs) among frail older Chinese patients. Method Frail older patients were recruited from a medical ward of a public hospital for a randomized controlled trial of the effectiveness of a nurse-led advance care planning. Participants completed a baseline questionnaire including the 7-item Quality of Communication (QOC) Questionnaire which measures perceived quality of EOL communication provided by HCPs (0 “The worst or none happened” to 10 “The best”). Bivariate analyses examined associated factors of QOC. Results Between December 2018 and January 2020, 105 participants were recruited and have completed the QOC. Their mean age was 80 years old (SD = 7.1), and 74% (n = 78) reported had received some formal education. A total of 95 participants (91%) responded “0” to all the 7 items in QOC (poor QOC group). For individual QOC item, all participants scored “0” in 4 items, 99 scored “0” in Item 1 “Talking about details if you got sicker”, 104 scored “0” in Item 2 “Talking about how long you might have to live”, and 101 scored “0” in Item 7 “Respecting your spiritual or religious beliefs”. Participants with “0” score in QOC reported a significant lower mean level in certainty regarding decision-making in EOL preferences (1.2 ± 1.6 vs. 2.3 ± 1.8, p = 0.039). Conclusion Occurrence of talking about EOL care with frail older Chinese patients by HCPs was rare, and the quality of EOL communication associated with decision-making certainty regarding EOL preferences. Training of initiation of EOL discussions and improve communication skills for HCPs is essential. Funding: RGC, HKSAR, China (PolyU14162617H).

Background: The aim of this study was to investigate the association between children’s reported symptom burden and their parents’ quality of life, and whether parents’ perceived stress mediates this relationship. Method: this was a cross-sectional quantitative research study. Convenience sampling was used to recruit 80 pairs of parents and their children with cancer. Advanced statistical methods were used to analyse the mediating effects of parental stress between children’s symptom burden and parents’ quality of life. Results: The results showed that parental stress was the mediator in the relationship between children’s reported symptom burden and their parents’ quality of life. Conclusions: Symptom burden was prevalent in Chinese children with cancer living in the community. Children’s symptom burden is an important factor in predicting parental stress level, which simultaneously and directly lower parents’ quality of life. The evidence in this study enlarges the knowledge base about the mediating effect of parental stress on the association between the symptom burden of children with cancer and their parents’ quality of life. This evidence is crucial in paving the way for the development of interventions that improve the parental quality of life through stress-reduction programs.

The Brief Experiential Avoidance Questionnaire (BEAQ) has been widely used to measure experiential avoidance (EA). However, the BEAQ is not available in Chinese. The current study aimed to translate the BEAQ into Chinese and validate it on a sample consisting of college students in China. A convenience sample of 698 students completed two surveys in June 2019 (T1) and July 2019 (T2) in a longitudinal study. Both surveys were included in the analyses. Using the T1 data, confirmatory factor analysis (CFA) showed that the original one-factor model of the BEAQ did not fit the data adequately. Moreover, exploratory factor analysis revealed that a 2-factor structure in this Chinese version of the BEAQ (labelled as cognitive avoidance and behavioural avoidance) and a subsequent CFA of the BEAQ using T2 data replicated the two-factor structure. The two BEAQ subscales demonstrated good internal consistency in T1 and T2 (Cronbach's alpha values of >0.78) and acceptable test–retest reliability over a two-month interval (ICC > 0.45). T1 cognitive avoidance scores were associated significantly with another measure of experiential avoidance and negative measures of negative affect and anxiety and depression. They also significantly predicted increased negative affect in T2. T1 behavioural avoidance scores were associated significantly with positive outcomes of positive affect, life satisfaction and resilience, and significantly reduced predicted negative affect and increased positive affect and life satisfaction in T2 but the associations were small in magnitude. Results highlight the importance of interpreting experiential avoidance through cultural lens. The Chinese version of the BEAQ could be used to measure experiential avoidance in Chinese college students and hence support further research in developing knowledge regarding the mechanisms of diverse strategies.

Background eHealth educational programs have proven to be an effective means for health promotion, yet limited studies have been conducted for coronary heart disease (CHD) patients to improve their total physical exercise, self-efficacy for exercise, and cardiovascular risk factor profile. Method A prospective randomized controlled trial (RCT) was conducted in two cardiac clinics in Hong Kong. Four hundred thirty-eight eligible CHD clients were randomly assigned to either the control or the intervention group. All of the participants received standard care, which consisted of regular medical and nursing care in the cardiac clinic. The intervention group received an additional web-based educational support intervention (eHES), which consisted of a 20-minute individual educational session on the use of the eHES web link. The eHES web link contains a health information platform related to CHD care and an individual member area with records of health measures and physical exercise data for six months. Data were collected at baseline, at three-month and six-month intervals at the cardiac clinic. The primary outcome was the total amount of physical exercise, measured by the Godin-Shephard Leisure-Time Physical Activity Questionnaire. The secondary outcomes were self-efficacy for exercise and cardiovascular disease (CVD) risk markers (body weight, blood pressure, lipid profile). The data were analyzed using a generalized estimating equations model. Results The intervention group reported a statistically higher amount of physical exercise and a higher HDL-C at 3 and 6 months, respectively. There were no statistical differences between the groups in self-efficacy for exercise and other CVD risk markers. Linking evidence to action The study demonstrated the effectiveness of the eHES in meeting the challenge of boosting the amount of physical exercise and increase HDL-C among CHD patients who engaged for over three months. The results provide insight for eHealth development to support and promote exercise among CHD patients in the community.

The article proposes the 4-Es (namely Exposure, Explanation, Experience, and Evaluation) pedagogical model in empathy building that can facilitate moral development in students. This research reveals that the 4-Es pedagogy, which has been adopted in a university’s service-learning course to study the living conditions of disadvantaged residents in urban Hong Kong, is largely effective as most students have expressed positive comments from their reflective journals and the pre- and post-program evaluation. Yet the actual efficacy is mediated by a number of factors which include the past experience of the students and the learning motivation.

Background: Frailty is a natural consequence of the aging process. With the increasing aging population in Mainland China, the quality of life and end-of-life care for frail older people need to be taken into consideration. Advance Care Planning has also been used worldwide in long-term facilities, hospitals and communities to improve the quality of end-of-life care, increase patient and family satisfaction, and reduce healthcare costs and hospital admissions in Western countries. However, it has not been practiced in China. Research objective: This study aimed to evaluate the effectiveness of a modified Advance Care Planning intervention in certainty of end-of-life care, preferences for end-of-life care, quality of life concerns, and healthcare utilization among frail older people. Research design: This study used a quasi-experimental design, with a single-blind, control group, pretest and repeated posttest approach. Participants and research context: A convenience sample of 74 participates met the eligibility criteria in each nursing home. A total of 148 frail older people were recruited in two nursing homes in Zhejiang Province, China. Ethical considerations: The study received ethical approval from the Clinical Research Ethics Committee, the Faculty of Medicine, and The Chinese University of Hong Kong, CREC Ref. No: 2016.059. Findings: The results indicated the Advance Care Planning programme was effective at increasing autonomy in decision making on end-of-life care issues, decreasing decision-making conflicts over end-of-life care issues, and increasing their expression about end-of-life care. Discussion: This study promoted the participants’ autonomy and broke through the inherent custom of avoiding talking about death in China. Conclusion: The modified Advance Care Planning intervention is effective and recommended to support the frail older people in their end-of-life care decision in Chinese society.

Advance care planning (ACP) facilitates individuals to proactively make decisions on their end-of-life care when they are mentally competent. It is highly relevant to older adults with frailty because they are more vulnerable to cognitive impairment, disabilities, and death. Despite devoting effort to promoting ACP among them, ACP and advance directive completion rates remain low. This study aims to explore the experiences among frail older adults who did not complete an advance directive after an ACP conversation. We conducted a thematic analysis of audiotaped nurse-facilitated ACP conversations with frail older adults and their family members. We purposively selected ACP conversations from 22 frail older adults in the intervention group from a randomized controlled trial in Hong Kong who had ACP conversation with a nurse, but did not complete an advance directive upon completing the intervention. Three themes were identified: “Refraining from discussing end-of-life care”, “Remaining in the here and now”, and “Relinquishing responsibility over end-of-life care decision-making”. Participation in ACP conversations among frail older adults and their family members might improve if current care plans are integrated so as to increase patients’ motivation and support are provided to family members in their role as surrogate decision-makers.

The population in the Western Pacific region is aging rapidly. Nutritional deficiency is prevalent in older adults; however, information regarding nutritional deficiency in this population is scarce. Using the 2019 Global Burden of Disease (GBD) results, the age-standardized disability-adjusted life years (DALYs) and years of healthy life lost due to disability (YLDs) from nutritional deficiency were estimated between 1990 and 2019 for this population. Average annual percentage change (AAPC) was used to assess temporal trends, and linear mixed-effects models were used to examine socioeconomic and sex inequalities. From 1990 to 2019, the age-standardized DALYs of nutritional deficiency in this population decreased from 697.95 to 290.95 per 100,000, and their age-standardized YLDs decreased from 459.03 to 195.65 per 100,000, with the greatest declines seen in South Korea (AAPCs < −5.0). Tonga had the least decline in DALYs (AAPC = −0.8), whereas Fiji experienced an increase in YLDs (AAPC = 0.1). Being female and having a lower sociodemographic index score was significantly associated with higher age-standardized DALYs and YLDs. The magnitude and temporal trends of the nutritional deficiency burden among older adults varied across countries and sex in the region, indicating that health policies on nutritional deficiency among older adults must be crafted to local conditions.

To compare the effect of a lifestyle intervention programme using mobile application versus booklet for adults with metabolic syndrome (MetS) living in the community.A multisite randomized controlled trial with three parallel arms, namely metabolic syndrome app group, booklet group, and control group.The research study has been supported by the Health and Medical Research fund in Hong Kong in 2019. The protocol was approved by the study university and the selected community centres. Three hundred and sixty subjects will be recruited from community centres and randomized into either one arm. Inclusion criteria are those adult with MetS, able to use a smart phone. All participants received a 30-min health educational session. App group participants will receive a mobile application while booklet group participants will receive a specific booklet of MetS care and the control group receive a placebo booklet only. The primary outcomes comprises of body weight. The secondary outcomes include total physical exercise, cardiometablolic risk factors, cardiovascular endurance, self-efficacy for exercise, and stress level. Data will be collected at baseline, weeks 4, 12, and 24. SPSS and generalized estimating equations model will be employed for data analysis.Metabolic syndrome is a common health problem associated with the heightened risk of cardiovascular disease and the risks are potentially amenable to lifestyle intervention. The results will compare the relative effectiveness of a lifestyle intervention using an app versus a booklet on physical and psychological outcomes for adults with MetS.What problem will the study address? The results will inform the healthcare professional and nurses about the effective way for health promotion, to enhance patient's lifestyle modification and exercise sustainability that will be beneficial to the clients' health.目的: 比较对生活在社区中患有代谢综合征(MetS)的成年人采取手机应用程序干预方案与手册进行干预的效果。 设计: 采用代谢综合征手机应用程序组、手册组以及对照组三组平行进行多组随机对照试验。 方法: 本研究已于2019年获得香港卫生与医学研究基金的资助。该方案已被研究大学和选定社区中心批准。将从社区中心招募360名试验对象并随机分为两组。入选标准是那些患有代谢综合征、能够使用智能手机的成年人。所有参与试验的人都接受了30分钟的健康教育。手机应用程序组受试者将接收到一款手机应用程序,而手册组受试者将收到一份关于代谢综合征护理的详细手册,对照组则只会收到一份安慰手册。主要试验结果包括体重。次要结果则包括所有体育锻炼、心脏代谢的种种风险因素、心血管耐力、锻炼自我效能以及压力水平。将在基线、第4周、第12周以及第24周收集数据。将采用SPSS和广义估计方程模型进行数据分析。 讨论: 代谢综合征是一种与心血管疾病的高风险相关的常见健康问题,这些风险可能适合生活方式干预。该结果将比较使用手机应用程序的生活方式干预与手册干预对患有代谢综合征的成年人身心影响的相对有效性。 影响: 该研究将会解决什么问题?该结果将有助于医护人员及护士了解促进健康的有效方法,从而改善病人的生活方式以及加强能促进病人健康的运动的可持续性。.

Objective: The uptake of cervical cancer screening among South Asian ethnic minorities is low, rendering them at higher risk of developing cervical cancer. Interventions should, therefore, be developed to enhance their knowledge of this disease and its prevention. We developed and implemented a Health-Belief-Model-based and culturally sensitive multimedia intervention for South Asian women in Hong Kong, and evaluated its feasibility, acceptability and effectiveness using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework.Design: At post-intervention, a short survey was conducted to assess the participants' perceptions of the acceptability and effectiveness of the intervention. Focus group and/or telephone interviews with persons-in-charge of community organizations were conducted to collect feedback on the intervention's effectiveness and long-term sustainability.Results: The intervention was implemented successfully in partnership with 54 community organizations, of which 51 expressed a willingness to continue doing so at their centers. 1061 South Asian women received the intervention through attendance at the 51 health talks held. Over 90% of them agreed that the intervention was acceptable and effective.Conclusions: The intervention appeared to be feasible, and is potentially effective in enhancing participants' knowledge of cervical cancer and self-efficacy in undergoing screening.

Background Global societal changes, such as increasing longevity and a shortage of family caregivers, have given rise to a popular worldwide trend of employing live-in migrant care workers (MCWs) to provide homecare for older people. However, the emotional labor and morality inherent in their interactions with older people are largely unknown. The aim of the present study is to understand the corporeal experiences of live-in migrant care workers in the delivery of emotional labor as seen in their interactions with older people by: (1) describing the ways by which they manage emotional displays with older people; and (2) exploring their morality as enacted through emotional labor. Methods We performed a secondary analysis drawing on feminist phenomenology to thematically analyze data from interviews with 11 female MCWs. Follow-up interviews were conducted with 10 participants. The participants had two to 15 years of experience in caring for older people in their homes in Hong Kong. Results Performing emotional labor by suppressing and inducing emotions is morally demanding for live-in MCWs, who experience socio-culturally oppressive relationships. However, developing genuine emotions in their relationships with older people prompted the MCWs to protect the interests of older people. Through demonstrating both fake and genuine emotions, emotional labor was a tactic that live-in MCWs demonstrated to interact morally with older people. Conclusions Emotional labor allowed live-in MCWs to avoid conflict with older people, and to further protect their own welfare and that of others. This study highlights the significance of empowering live-in MCWs by training them in ways that will help them to adapt to working conditions where they will encounter diverse customs and older people who will develop an increasing dependence on them. Thus, there is a need to develop culturally appropriate interventions to empower live-in MCWs to deliver emotional labor in a moral manner.

Resilience is a key health protective factor for those with adverse childhood experiences (ACEs), but little research has explored how it manifests in early adulthood or across cultures. The purpose of this study was to generate a fuller understanding of resilience and its contribution to the relationships between mental health problems and ACEs among Chinese young adults in Hong Kong. Using a sequential explanatory mixed-methods design, 433 Chinese young adults aged 18 to 24 years were surveyed online to examine the relationships between ACEs, resilience, and mental health problems (depression, anxiety, maladjustment, and posttraumatic stress symptoms). Among them, 34 participants with ACEs were purposively selected and interviewed to explore cultural factors that influenced their resilience. Quantitative data were analyzed using multiple hierarchical regression analyses; qualitative data were analyzed using a qualitative descriptive approach. Higher cumulative ACE exposure was associated with higher severity of adjustment disorder and odds for screening positive for posttraumatic stress disorders, but not for symptoms of depression or anxiety. Resilience significantly contributed to explaining variances across all mental health outcomes over and beyond ACEs and in a protective fashion. Four themes emerged from qualitative interviews: (a) Privacy, emotional restraint, and “saving face”; (b) Conforming to preserve harmony; (c) A will to excel; and (d) Viewing adversity as a matter of luck. These findings suggest Chinese young adults’ resilience was influenced by cultural norms of restraint, conformity, competition, and superstition. The present study provides a model for future studies using a mixed-methods design to deeply examine resilience among younger people exposed to early adversities within sociocultural, historical, or geographical contexts.

Background In Hong Kong, the use of alcohol, tobacco, and other drugs (ATOD) is associated with strong peer influences; frequently absent parents; academic pressures; and a lack of interpersonal skills to cope with stress and conflict. It is posited that this social context alters the nature of the adolescent risk of using ATOD. The study aimed to explore how social interactions in their local context shape experiences of adolescents who smoke or use alcohol with their parents and other significant people (e.g., teachers, peers) in their lives. Results The participants consistently indicated that the communication of risk was fundamentally influenced by the attachment between the primary parent(s) and the child. In secure attachments, parents could positively discourage ATOD use by instilling fear or expressing regret or disappointment over its use. However, some parents expressed an overly permissive attitude about ATOD use, or stated that they had a limited ability to influence their child, or that the harm arising from their child’s use of ATOD would be minimal. Under these conditions, the authors posited that the potential influence of peers to disrupt parental attachments was stronger. Conclusions Descriptive phenomenology was adopted in this study and Colaizzi’s method was used to analyse the collected data. Focus group interviews were conducted with 45 adolescents, 11 parents, and 22 school teachers and social workers in two districts in Hong Kong. A secure attachment between a parent and a child enhances the child’s sense of self-efficacy in avoiding addictive behaviours such as ATOD use. In contrast, insecure parent-child attachments may trigger children to resist social norms, and disrupt their parental attachments. In these instances, parents may inadvertently convey the message that their children do not need protection from the risks of using ATOD. The key findings suggest that reinforcing secure parental attachments, as well as emphasizing how messages of vulnerability to ATOD are conveyed, may counter balance pressures (including peer influence) to use these substances. Further research is needed to uncover mechanisms of communication that add to the vulnerability of adolescents to using ATOD, and to the negative long-term consequences from ATOD use.

As higher education has made the transition from elite to mass enrolments, the student body has become more diverse and online and blended learning have become more common. This study aimed to examine the impacts on attrition of admitting a more diverse student body with the shift towards online and blended learning. A hypothesised path model of attrition was tested with structural equation modelling. The model contained four presage variables related to the changed demographic of the student body and alternative modes of study; attendance mode, admission basis, remoteness and socio-economics status. There were two intervening variables; age and year of study. The two outcome variables were dropout and GPA value. The model was tested against a large sample of data from a student record system of a regional Australian university. The model showed a good fit to the data predicting that the expansion of higher education, along with the increasing use of online and blended learning, will impact on attrition.

Background: The original 46-item diabetes quality of life (DQOL) scale has been translated into different languages, and the translated DQOL has shown good reliability and validity after deleting some items. The aim of this study was to translate the diabetes quality of life (DQOL) scale into Afaan Oromoo and to culturally adapt and evaluate the psychometric properties of the DQOL-Afaan Oromoo (DQOL-AO) among people living with T2D in Ethiopia. Methods: A cross-sectional study with a convenience sampling technique was conducted in 2020. The DQOL was translated and adapted to Afaan Oromoo. Item–total correlations and exploratory factor analysis (EFA) assessed factor structure, the Cronbach’s alpha assessed internal consistency and relationships with gender, educational status, marital status, age, and employment status, and status of diabetes-related disease assessed the construct validity of the DQOL-AO. Results: 417 participants responded to all items of the DQOL. Item–total correlation analysis and EFA produced a 34-item DQOL-AO with four subscales, which demonstrated that the internal consistency of the overall DQOL-AO was 0.867, and scores were 0.827, 0.846, 0.654, and 0.727 for the impact, satisfaction, social/vocational worry, and diabetes-related worry subscales, respectively. Statistically significant differences between QOL were obtained in educational status (F = 7.164, p &lt, 0.001) and employment status (F = 4.21, p = 0.002). Individuals who attended college and above and government employees had better QOL. Conclusion: The 34-item DQOL-AO provided preliminary evidence as a reliable and valid tool to measure diabetic-related QOL before it can be widely used among adults living with T2D who speak Afaan Oromoo.

Background Among the few existing needs assessment tools for family carers, the 14-item Carer Support Needs Assessment Tool (CSNAT) is the only brief and holistic needs screening tool designed for everyday use in palliative care practices. The aim of this study was to evaluate the reliability, validity, and acceptability of the traditional Chinese version of the CSNAT in palliative care settings in Hong Kong. Methods This adopted a cross-sectional and correlation design with repeated measures. The participants were 125 family carers of palliative cancer patients and 10 healthcare providers (HCPs) that were recruited from two local hospitals. The evaluation of psychometric properties included the following: (1) content validity through HCPs including frontline physicians, nurses, social workers, and clinical psychologists; (2) construct validity between the CSNAT items and those of the validated tools that measured caregiver burden, social support, and caregiving self-efficacy; and (3) one-week test-retest reliability in a sub-sample of 81 caregivers. The acceptability of the tool was assessed by the carers using several closed-ended questions. Results The content validity index of the CSNAT at the scale level was 0.98. Each item of the CSNAT was significantly and moderately correlated with caregiver burden (Spearman’s r = 0.24 to 0.50) and caregiving self-efficacy (r = − 0.21 to − 0.52), but not for social support. All CSNAT items had fair to moderate test-retest reliability (weighted kappa = 0.21 to 0.48), with the exception of two items “managing your relatives’ symptoms, including giving medicines” and “having time for yourself in the day”. Regarding the acceptability of the CSNAT, almost all HCPs were willing to use the CSNAT for carer assessment and support. 89.6% of the carers demonstrated a comprehensibility of the CSNAT tool and 92.9% felt comfortable answering the questions. Around 90% of the carers agreed to use the tool for screening, discussing needs, and making referrals. Conclusion The traditional Chinese version of the CSNAT is a tool with high validity and acceptability and adequate reliability that measures family carers’ support needs, which should be considered for wide application in local palliative care practices.

Aim To develop and examine the preliminary effects of a nurse-led, community-based diabetes self-management education and support program on clinical outcomes, self-care behaviours, quality of life, and family support through a pilot randomized controlled trial among adults living with type 2 diabetes in Western Ethiopia. Methods A two-arm parallel-group pilot randomized controlled trial involving patient-caregiver dyads will be conducted. A total of 76 dyads will be recruited, with 38 dyads randomly allocated to the intervention arm receiving six sessions of the diabetes self-management education and support program supported by an educational handbook, flier, and video on top of the usual care; the control arm will continue to receive the usual care. The intervention will be guided by social cognitive theory and related international guidelines for diabetes management, addressing misconceptions, using culturally tailored foods, and involving family members in the intervention. Subjects will be recruited at Nekemte Specialized Hospital over two months. Nurses will deliver the intervention in the community in Nekemte, western Ethiopia. Diabetes self-care behaviour, quality of life, family support, glycosylated haemoglobin, body mass index, blood pressure, and lipid profiles will be assessed. Descriptive statistics will summarize the sociodemographic variables of the dyads; people living with diabetes' clinical outcomes, self-care behaviours, quality of life and the level of family support; and family caregivers' behaviours; and the acceptability level. Cohen's d will be computed to estimate the effect size. Trial registration The Chinese Clinical Trial Registry prospectively registered the trial, and the registration number was ChiCTR2000040292.

Eliza Mi Ling Wong 1Doris YP Leung 1Hon Lon Tam 1Qun Wang 2Kai Wang Yeung 1Angela YM Leung 1 1School of Nursing, The Hong KongPolytechnic University, Hong Kong, SAR,People’s Republic of China; 2School ofNursing, Shenzhen University, Shenzhen,Guangdong, People’s Republic of China Correspondence: Eliza Mi Ling WongSchool of Nursing, GH 521, School ofNursing, The Hong Kong PolytechnicUniversity, Hung Hom, Kowloon,Hong Kong, SAR, People’s Republic ofChinaTel +86 852- 27666544Fax +86 852-2364 9663Email eliza.wong@polyu.edu.hk Purpose: This study aimed to examine the preliminary effect, feasibility, and acceptabilityof a lifestyle intervention program using a mobile application (app) versus the effect ofa program using a booklet for adults with metabolic syndrome (MetS).Patients and Methods: This trial was conducted in two community centers of Hong Kong.Participants were included if they were adults with MetS, aged over 50, and able to usea smartphone. Eligible subjects were randomly assigned to either the app group or bookletgroup. Those in the booklet group received a health talk and a booklet, whereas those in theapp group received a health talk and a MetS app to support their exercise maintenance andhealth records for 3 months. Both groups received similar educational content related tohealthcare for MetS clients. Data were collected at baseline (T1) and at 1- (T2) and 3-month(T3) intervals. Outcomes were body weight (primary outcome), total amount of exercise,blood pressure, and lipid concentrations. Data were analyzed using the generalized estimatingequation models. Feasibility and acceptability were assessed in process evaluation.Results: Ninety-eight individuals were screened for eligibility and 77 were randomized intothe app group (n = 38) or booklet group (n = 39). The attrition rate at T3 was 11.690%. Theapp group showed a significant reduction in body weight (β = − 1.069, p = 0.012) and bodymass index (β = − 0.371, p = 0.026), a greater amount of exercise (β = 8.454, p = 0.032), andimproved exercise self-efficacy (β = 10.62, p = 0.001) within 3 months. There were nosignificant differences between groups for other outcomes. The participants appreciated theproposed intervention of the programme.Conclusion: The MetS app may be incorporated in the health promotion programme tosupport exercise maintenance and a healthy lifestyle in the community.Keywords: exercise, body weight, metabolic syndrome, intervention, programme, mobileapplication

Summary Pneumoconiosis is a common occupational lung disease among construction workers. Educational interventions targeting specific ethnic groups of construction workers are of benefit for pneumoconiosis prevention. The aim of this study was to develop a multimedia educational intervention for pneumoconiosis prevention for South Asian construction workers, and to evaluate its feasibility, acceptability and effectiveness in increasing knowledge of pneumoconiosis, modifying beliefs about pneumoconiosis, and enhancing intention to implement measures for its prevention among the workers. This evaluation was performed using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. A one-group design was adopted and intervention mapping was used to guide the process of intervention development, while the Health Belief Model guided the development of intervention content. The intervention was delivered at construction sites, ethnic minority associations and South Asian community centres. Data were collected via surveys completed at pre-intervention, post-intervention and 3 months after the intervention. A total of 1002 South Asian construction workers participated in the intervention. The participants reported a moderate-to-large increase in knowledge, perceived susceptibility, perceived severity, perceived benefits, cues to action and self-efficacy (Cohen’s d: 0.37–0.89), a small reduction in perceived barriers (Cohen’s d = 0.12) and a moderate improvement in attitudes and intention to practice (Cohen’s d: 0.45, 0.51) at post-intervention. A follow-up survey of 121 participants found that the implementation of preventive measures appeared to increase. Overall, the findings demonstrate that the implementation of a culturally adapted multimedia educational intervention could be an effective approach to improving knowledge, self-efficacy and intention regarding pneumoconiosis prevention among South Asian construction workers.

Aim To examine the effects of diabetes self-management interventions on physiological outcomes among people living with diabetes in Africa compared with patients receiving usual care. Methods Relevant databases including PubMed, CINAHL Complete, Scopus, the Cochrane Library and Google Scholar were searched from inception to 28 September 2019, for randomised controlled trials (RCTs) involving adults living with diabetes in Africa. Nine RCTs were included in the review, and the quality of the studies was assessed using Cochrane's collaboration risk of bias tools. Results A meta-analysis of the outcomes showed the significant effects of diabetes self-management interventions on blood pressure, total cholesterol and body mass index, whereas non-significant and inconclusive results were obtained for waist circumference and glycosylated haemoglobin, respectively. Conclusions The diabetes self-management interventions (DSM) effectively improved many physiological outcomes, but their effectiveness in HbA1c was inconclusive, suggesting a need for modifications in DSM interventions for African people living with diabetes.

There is currently growing recognition of the complex care needs of patients with life-limiting conditions and their family members, prompting the need to revisit the goals of medicine. This Special Issue reflects a broad research agenda in the field of palliative and end-of-life care. A total of 16 papers of empirical studies and systematic review are included spanning five domains, namely, patient, caregiver, healthcare provider, policy, and methodology. The results generally suggest the merits of palliative care and reveal room for further improvement in palliative care education, manpower, infrastructure, and legal and policy frameworks.

Objective To examine components of the Health Belief Model (HBM) as mediators and socio-demographic characteristics as moderators of the effects of an educational intervention on intention to practise pneumoconiosis prevention among South Asian construction workers. Methods The study used a one-group pretest and posttest design. Analytic data was from 1001 South Asian construction workers in Hong Kong. Results Changes in the perceived susceptibility, perceived severity, perceived benefits, cues to action, and self-efficacy mediated the intervention's efficacy in improving intention to practise pneumoconiosis prevention. The intervention was more effective in reducing perceived barriers in younger workers, enhancing self-efficacy in older workers and relatively new employees, and improving the intention in unmarried workers. Conclusions It provided preliminary support for the efficacy of the intervention based on the HBM in improving intention to practise pneumoconiosis prevention among South Asian construction workers.

Background Despite healthcare scholars valuing diversity, current cultural awareness training does not address mechanisms that drive societal patterns, that generates cultural insensitivity and reinforces stereotypes of minority groups. The influence of culture on thinking is an important issue because of potential ethnocentric biases on the design, data collection, analysis, and dissemination of research. Objectives Using internationalization-at-home activities to explore the mechanisms that enhance the development of cultural awareness in postgraduate health and social science research students. Design and methods A pragmatic critical realist study, qualitatively dominant, using mixed-methods to integrate and analyze qualitative and quantitative data. Data were collected pre- and post-internationalization-at-home activities. Qualitative data were collected from online discussion forums and focus groups, and quantitative data were collected from a pre-test and post-test measure of cultural awareness. Setting and participants Eighteen research students in postgraduate health and social science programs from three universities (Australia, Hong Kong, and Sweden) participated in five formal internationalization-at-home webinars and informal international group activities. Results Participants reported four mechanisms counteracting structures (i.e., ethnocentric biases) toward the emergence of cultural awareness: 1. awareness of cultural issues motivating people toward achieving a common goal; 2. reflexivity within psychological safety; 3. deliberations that challenge the veracity of individual assumptions; 4. courage coupled with curiosity. When some or all the mechanisms occurred, properties of enhanced cultural awareness emerged, as confirmed by the quantitative data. Conclusions Cultural awareness training should emphasize social relations to allow cultural safety to develop for postgraduate health and social science research students. Without skills revealing unconsciously held ethical values, this study argues that postgraduate health and social science students may inadvertently reconstitute and reinforce in their research the discrimination of underserved groups.

Few studies have explored the inter-relationships of sources of social support and caregiving self-efficacy with caregiver burden and patient&rsquo, s quality of life among patients with palliative care needs and their caregivers. This study tested the associations of two sources of social support (family and friends) and the mediating role of caregiving self-efficacy on caregiver burden and patient&rsquo, s quality of life. A convenience sample of 225 patient&ndash, caregiver dyads recruited between September 2016 and May 2017 from three hospitals in Hong Kong was included in the current analysis. Results showed that the final model provided a satisfactory fit (SRMR = 0.070, R-RMSEA = 0.055 and R-CFI = 0.926) with the data, as good as the hypothesized model did (p = 0.326). Significant associations were detected. Family support had a significant negative indirect effect on caregiver burden and a significant positive indirect effect on patient&rsquo, s quality of life through caregiving self-efficacy, whereas friend support had a significant positive direct effect on caregiver burden but a minimal effect, if any, on patient&rsquo, s quality of life. These findings emphasized (1) the importance of caregiving self-efficacy in improving caregiver burden and patient&rsquo, s quality of life and that (2) sources of social support may be an important dimension moderating the associations of caregiving self-efficacy with caregiver burden and patient&rsquo, s quality of life.

An outbreak in Wuhan, China in late 2019 of a highly infectious new coronary pneumonia (COVID-19) led to the imposition of countrywide confinement measures from January to March 2020. This is a longitudinal study on changes in the mental health status of a college population before and after their COVID-19 confinement for the first two weeks, focusing on states of psychological distress, depression, anxiety and affectivity. The influence of possible stressors on their mental health were investigated, including inadequate supplies and fears of infection. Five hundred and fifty-five undergraduate students were recruited from Hebei Agricultural University in Baoding, China. The participants completed two online surveys&mdash, on anxiety and depression, and on positive and negative affect. One survey was conducted before the confinement and the other was conducted 15&ndash, 17 days after the start of the confinement. Increases in negative affect and symptoms of anxiety and depression (p-values &lt, 0.001) were observed after 2 weeks of confinement. Inadequate supplies of hand sanitizers, a higher year of study, and higher scores on anxiety and depression were common predictors of increased negative affect, anxiety, and depression across the confinement period. The results suggest that healthcare policymakers should carefully consider the appropriate confinement duration, and ensure adequate supplies of basic infection-control materials.

Background: The aim of this cross-sectional study was to assess the dementia literacy of community-dwelling adults in four cities (Hong Kong, Guangzhou, Macau, and Zhuhai) of the Greater Bay Area of China, and to determine their mass media preferences for receiving dementia information. Methods: The survey was completed by 787 community-dwelling adults. Dementia literacy was indirectly measured using two validated scales—the 30-item Alzheimer’s Disease Knowledge Scale and the 20-item Dementia Attitude Scale (DAS). Participants were also asked to indicate whether they wanted to receive dementia information via digital or traditional media. Chi-square tests, logistic regressions, and MANOVA analyses were conducted. Results: Unemployed or retired people had poor attitudes towards dementia and lower levels of knowledge about dementia. Single, cohabiting, or divorced people in Hong Kong and Macau had lower DAS scores than married people. Young people and those with a secondary education preferred to get their dementia information from social media. People with a tertiary education and employed people enjoyed searching government or hospital websites for information. Middle-aged, unemployed, or retired people tended to learn about dementia from television or radio. Conclusion: It is worth educating the public about dementia and developing strategies consistent with their preferences for types of mass media.

Background Type 1 diabetes (T1D) is one of the most common chronic diseases in childhood. Daily diabetes management poses a major challenge for parents. Intensive insulin therapy using continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) are recommended for patients with T1D, but evidence for their effectiveness on parental quality of life (QOL) and glycemic control among children with T1D is inconclusive. Objectives A systematic review was conducted to determine the best available evidence regarding the effectiveness of CSII compared to MDI on parental QOL and glycemic control among children with T1D. Methods Studies in English and Chinese from 1978 to March 2015 were identified by searching electronic databases, published references, and unpublished studies. Randomized controlled trials (RCTs) comparing CSII with MDI related to parental QOL and glycemic control (HbA1c) among patients aged 18 years or below with T1D were included. Secondary outcomes were episodes of severe hypoglycemia (SH) and diabetic ketoacidosis (DKA). Results Seven RCTs were identified. Parental QOL was reported in two studies, with one study reporting no significant improvement in the CSII group and one reporting a significant reduction in diabetes-related worry in the CSII group but increased frequency of stress relating to child medical care in the MDI group. Meta-analysis of seven RCTs involving 220 patients demonstrated that CSII was associated with significant decrease in HbA1c level (MD = -0.24%, 95% CI = -0.41 to -0.07, p = .006) compared to MDI. There were no significant differences in episodes of SH and DKA between the CSII and MDI groups. Linking evidence to action CSII slightly reduced HbA1c by .24% compared to MDI. Based on two RCTs with small sample sizes, there is insufficient evidence to draw any conclusions on the beneficial effects of CSII compared with MDI on parental QOL among children with T1D. More RCTs with larger samples are needed.