Examining the Intervening Roles of Patient-Centered Care and Patient Activation in the Health Impacts of Offline Healthcare Obstacles and Online Health Consultations Among Deaf and Hard-of-Hearing Patients.

Deaf and hard-of-hearing (DHH) patients often encounter difficulties in effective communication with healthcare professionals and are less likely to receive quality medical care. However, DHH populations are understudied in health communication research. This study examined how offline healthcare obstacles and online health consultation impact DHH patients' health, and the mediating roles of patient-centered care (PCC) and patient activation. Data from 323 DHH patients were analyzed using structural equation modeling to test the hypothesized mediation pathway model. Results indicate that offline healthcare obstacles negatively affect DHH patients' perception of patient-centeredness, which reduces their ability and confidence in self-care (conceptualized as patient activation in this study). This reduced patient activation may jeopardize DHH patients' physical and psychological health. Meanwhile, online health consultation is positively associated with PCC, and higher levels of PCC can increase patient activation, contributing to better physical and psychological health. Testing the same model with hearing-abled participants (n = 3542) revealed significant differences in these intervening relationships. Overall, this study provides valuable insights into the relationship between DHH patients' healthcare experience and their health outcomes. The findings support interventions that focus on enhancing PCC and patient activation to improve the physical and psychological health outcomes of DHH patients.

Reconciling intimacy and safety: a qualitative systematic review of HIV pre-exposure prophylaxis implementation among gay and bisexual men.

This review synthesises qualitative research on pre-exposure prophylaxis (PrEP) uptake by sexual minority men to provide an overarching conceptualisation of the implementation processes involved. Twenty-four studies-comprising 734 participants from USA, UK, France, Canada, and Taiwan-were synthesised using thematic synthesis. The synthesis elucidates the dual significance of PrEP uptake: (1) risk management: reinforcing relational circumstances, and rebalancing safety and risk; and (2) sexual empowerment: reclaiming health and sexuality and refocusing on sexual fulfillment and intimacy. Overall, the findings show how gay and bisexual men use PrEP to reconcile their antagonistic desires for intimacy and safety by recalibrating protection and reimagining intimacy. This review conceptualises the essence of users' experiences of PrEP implementation as reconciliation work-the labour and agency in making and remaking practices to manage discontinuities and incongruities-about the new HIV prevention modality. The concept of reconciliation work illustrates how using PrEP influences users' practices, which in turn, shape the meanings of PrEP use within the community. This work engenders contingent transformations and outcomes beyond HIV protection, encompassing the broader aspects of health and sexuality. Findings support the adoption of more holistic and empowering approaches to sexual health promotion and intervention.

How Online Patient-Provider Communication Impacts Quality of Life: Examining the Role of Patient-Centered Care and Health Competence.

The question of how patient-provider communication affects health outcomes has been a longstanding concern for health communication scholarship and practice. As patient-provider communication becomes increasingly mediated by digital technologies, much research has sought to compare online patient-provider communication (OPPC) with that conducted in-person, weighing its relative merits against its costs and barriers. This line of inquiry has mostly focused on the comparative benefits of OPPC for service delivery with little attempt to link these benefits to the wider health implications of OPPC. Consequently, the mechanisms that explain the impacts of OPPC on patients' overall wellbeing have been underexamined. Through a survey of 681 participants in China, this study examined the direct and indirect pathways between OPPC and quality of life (i.e., sleep, exercise, social activities, and psychological wellbeing). Our results demonstrate statistically significant direct relationships between OPPC and the four quality-of-life constructs examined as well as the mediation effects of patient-centered care and health competence in these relationships. The findings call for greater attention to the longer-term contributions of OPPC in empowering patients, especially those who are underserved by the healthcare system.

Breast health, risk factors, and cancer screening among lesbian, bisexual, and queer/questioning women in China.

In this study, we examine the health disparities of sexual minority women by surveying 310 lesbian, bisexual, and queer/questioning women (LBQW) in China about their breast health and cancer screening practices. We found that Chinese LBQW, particularly those identified with a masculine gender role and practice chest binding, are vulnerable to breast cancer given their high rates of behavioral risk factors (e.g., cigarette smoking) and symptoms (e.g., breast lumps) but low rates of self and clinical breast examinations. Salient barrier (stigma) and facilitators (social support availability, self-efficacy, and breast cancer information exposure) of breast cancer screening were also identified.

"Do You Know How Much I Suffer?": How Young People Negotiate the Tellability of Their Mental Health Disruption in Anonymous Distress Narratives on Social Media.

The emergence of mental distress presents significant difficulties and dilemmas for adolescents and early adults about being open with their troubles and emotions. To better understand the communication practices and challenges that reflect the lived realities of marginalized youth struggling with mental health disruption, this study examines 136 anonymous personal stories disclosing self-harm behaviors or suicidal thoughts on a Facebook "secrets" page for Hong Kong students. The narrative analysis unveils young people's anecdotal accounts of hidden grievances and struggles around their mental distress, hitherto untold not because they are too difficult to tell but because they are too negative to be heard. Extending the concept of tellability, this study illustrates how anonymous distress storytelling on social media enables silenced and isolated distressed youth to resist the denial - invisibility, discredit, and mischaracterization - of their suffering by turning their disruptive experiences into stories worth telling through disclosure, clarification, and testimony. This study further clarifies the salient interpretive frameworks that shape young people's experience and communication of mental distress: the tyranny of happiness depicted to engender distress and languages of suffering used to resist culpability and plead for social respite. It highlights the disconnection in interpretations regarding the transitory nature of distress and its controllability as a major source of communication gap and interpersonal communication breakdowns. The findings call on health communication practices around mental health promotion to refrain from highlighting individual deficiencies or messages of positivity and speak out on the structural inconsistencies and communication denial that perpetuate and silence youth distress.

Beyond Homonegativity: Understanding Hong Kong People's Attitudes About Social Acceptance of Gay/Lesbian People, Sexual Orientation Discrimination Protection, and Same-Sex Marriage.

This study examined attitudes about social acceptance, discrimination protection, and marriage equality for gay/lesbian people with a representative sample of 1,008 Hong Kong Chinese adults via a telephone survey. Despite majority endorsement of homosexuality (52.29% positive vs. 34.12% negative) and discrimination protection (50.72% favorable vs. 14.64% opposed), attitudes toward same-sex marriage diverged (32.79% favorable vs. 39.41% opposed). There was a sharp distinction in accepting gay/lesbian people as co-workers (83.57%) and friends (76.92%) versus relatives (40.19%). Having more homosexual/bisexual friends or co-workers contributed to greater endorsement of social acceptance and discrimination protection but not same-sex marriage. Age, religion, political orientation, and homonegativity consistently predicted attitudes toward social acceptance, discrimination protection, and same-sex marriage, whereas gender-role beliefs, conformity to norms, and cultural orientations had varying impacts. This article informs theory and advocacy by disentangling homonegativity from attitudes about gay/lesbian issues and highlighting the centrality of family-kinship and relative-outsider delineation in Chinese societies.

Sharing "Sex Secrets" on Facebook: A Content Analysis of Youth Peer Communication and Advice Exchange on Social Media about Sexual Health and Intimate Relations.

Social media present opportunities and challenges for sexual health communication among young people. This study is one of the first to examine the actual use of Facebook for peer communication of sexual health and intimate relations. Content analysis of 2186 anonymous posts in a "sex secrets" Facebook page unofficially affiliated with a Hong Kong University shows gender balance among posters, inclusiveness of sexual minorities, and frequent sharing of personal experiences in storytelling or advice seeking. The findings illuminate young people's health concerns regarding condom use, avoiding pain, birth control, sexually transmitted infections, and body appearance. Relational concerns found entailed sexual practices, expectations, and needs-predominantly within dating relationships and include not wanting to have sex. Supportive communication among users was prevalent. A majority of posts involved advice solicitation in the form of request for opinion or information (30.38%), request for advice (13.68%), situation comparison (5.40%), or problem disclosure (9.97%). Comments to the advice-seeking posts were mostly supportive (69.49%); nonsupportive responses (unsolicited messages and gratuitous humor) were concentrated with ambiguous advice solicitations. These findings hold implications for understanding self-disclosure of intimate concerns within social networks, and attuning sexual health intervention on social media to young people's actual needs and advice preferences.

Social-cultural factors of HIV-related stigma among the Chinese general population in Hong Kong.

HIV-related stigma in the wider community compounds the suffering of people living with HIV (PLWH) and hampers effective HIV prevention and care. This study examines the level of public stigma toward PLWH in Hong Kong and associated social-cultural factors. A telephone survey was conducted in June-July 2016 with 1080 Chinese adults aged 18-94 randomly selected from the general population. The results indicate substantial degree of public stigma toward PLWH. Overall, 58.1% of the participants endorsed at least one statement indicating negative social judgment of PLWH. Over 40% attributed HIV infections to irresponsible behaviors and nearly 30% perceived most PLWH as promiscuous. About 20% considered HIV to be a punishment for bad behavior and believed that PLWH should feel ashamed of themselves. These statistics indicate that HIV-related stigma among the general Hong Kong population had no noticeable reduction in a decade but is lower than that among rural and urban populations in China. Our findings suggest that the lower stigma in Hong Kong may be linked to higher education levels rather than Hongkongers' more Westernized outlook. The results of a multiple regression analysis showed that education level (ß = -.19), homophobia (ß = .30), and conformity to norms (ß = .14) were independent predictors of HIV-related stigma but not age, income, or cultural orientations. By differentiating between associated social-cultural factors, this study provides a more nuanced understanding of the layered nature of HIV-related stigma: not broadly grounded in religion or Chinese culture but stemming from more specific social-cultural beliefs - perceptions of norm violation and negative attitudes toward homosexuality, which were not mutually exclusive. These findings have implications for HIV-related stigma reduction by providing evidence for the importance of addressing homophobia. Existing HIV publicity activities should be re-examined for inadvertent contribution to the stigmatization process - particularly press conferences and prevention campaigns that reinforce negative stereotypes of gay/bisexual men and PLWH.

Sexual risk behaviors among apps-using young men who have sex with men in Hong Kong.

This study is among the first to examine the sexual risk behaviors and attendant factors of young men who have sex with men (YMSM) in Hong Kong using location-aware gay social networking mobile applications ("gay apps"). Among the 213 YMSM (Mage = 21.52, SD = 2.29 years, range 17-25) who reported their recent (past six months) sexual history with male partners and gay apps use, inconsistent condom use (ICU) during anal sex was fairly common (60.2% regular partners, 45.8% non-regular partners). One-fifth of the sample reported condomless internal ejaculation (CIE) during anal sex (19.3% insertive, 19.8% receptive). Frequent "Grindr" and "Jack'd" users were less likely to report anal sex, and hence ICU, with regular [adjusted odds ratio (AOR) = 0.72] and non-regular (AOR = 0.62) partners, respectively. Sexual partnering via apps doubled the odds of ICU with both regular (AOR = 1.99) and non-regular (AOR = 2.17) partners. The odds of ICU with regular partners also increased with relationship status (AOR = 2.86 exclusive, AOR = 3.23 non-exclusive) but reduced for those who never had STI/HIV testing (AOR = 0.27). With non-regular partners, YMSM's likelihood of ICU increased with more recent partners (AOR = 3.25) and drug use (AOR = 3.79), but reduced with group sex (AOR = 0.15). The odds of receptive CIE increased with alcohol consumption (AOR = 4.04), non-exclusive relationship (AOR = 4.10), and more recent partners (AOR = 2.47), but reduced with group sex (AOR = 0.15) and older age (AOR = 0.84). For insertive CIE, the odds increased with bisexual YMSM (AOR = 2.89), exclusive relationship (AOR = 3.97), and longtime apps-use (AOR = 1.81). The findings identify meaningful differences among YMSM app-users that inform sexual health intervention and suggest attention on alcohol or drug use during sex and condomless sex with non-exclusive regular partners.

Between '0' and '1': safer sex and condom use among young gay men in Hong Kong.

Young men who have sex with men are becoming the most at-risk subgroup for HIV incidence in Hong Kong. To understand how young gay men in Hong Kong interpret and implement safer sex and condom use, focus-group discussions and individual in-depth interviews were held. The 74 participants were nearly all ethnic Chinese gay men aged between 18 and 25 years. Findings indicate that the challenge for health intervention lies in young gay men's inconsistent condom use despite their high level of HIV-related knowledge. Participants described using condoms, testing for HIV and abstaining from anal sex as measures undertaken to prevent HIV infection. However, sociocultural norms and expectations pertaining to '0' (docile, bottom) and '1' (assertive, top) roles and trust between partners complicate the consistent implementation of risk-reduction measures. Influenced by heteronormative and romantic beliefs, sexual behaviours such as condomless anal sex and internal ejaculation hold symbolic meanings - exclusivity, commitment, intimacy, possession - for young gay men in Hong Kong, which override health concerns. These findings support more empowerment-driven HIV programming for young gay men.