Validation of the Revised Illness Perception Questionnaire of Obstructive Sleep Apnea among Elderly Chinese in the General Population.

PURPOSE: The prevalence of under-diagnosis among individuals with obstructive sleep apnea (OSA) is alarming, and may be associated with perceptions regarding OSA. To facilitate future studies on OSA, this study validated the revised version of the Illness Perception Questionnaire (IPQ-R) for OSA in a general population. METHODS: A random anonymous population-based telephone survey interviewed 580 adults aged ≥ 50 years in Hong Kong, who self-reported not having been told by doctors as having OSA, from February 5 to March 19, 2021. RESULTS: The confirmatory factor analysis identified a modified 7-factor model (i.e., timeline chronic, consequence, personal control, treatment control, illness coherence, timeline cyclical, and emotional representation) that showed satisfactory model fit index and internal consistency. Nine items were removed from the original version because of low factor loadings. No floor and ceiling effects were observed. Convergent validity was supported by the positive associations between the consequence subscale with perceived negative outcomes of OSA and between the illness coherence subscale and perceived understanding of OSA symptoms. The participants tended to endorse the items of timeline chronic, treatment control, and illness coherence but not with those of emotional representations. The mean scores of the IPQ-R subscales differed by age and education level. CONCLUSION: The modified IPQ-R of OSA showed acceptable psychometric properties. It is applicable to assessing illness perceptions of OSA in the Chinese general population aged ≥ 50 years not having received OSA diagnosis. The validated tool would support future studies and health practices related to OSA.

Development and validation of the conservation of resources scale for COVID-19 in the Chinese adult general population.

Globally, the coronavirus disease 2019 (COVID-19) pandemic has caused severe and multi-dimensional resource losses among individuals. The Conservation of Resource (COR) theory postulates that resource loss generates related stress responses. It can suitably be applied to understand the pandemic's encompassing adverse consequences. Yet, no assessment tool exists. This study hence developed and validated the COR Scale for COVID-19 (CORS-COVID-19) to facilitate relevant research. The five hypothesized domains included losses in financial resource, family resource, future control, fun, and social resource. A population-based random telephone survey interviewed 300 Chinese adults in the general population in Hong Kong, China during April 3-10, 2020. The levels of different types of resource losses were high (especially for loss in fun). The 5-factor structure identified by factor analysis matches with the five hypothesized dimensions. Its psychometric properties are acceptable, including good internal consistency, content validity (the correlations between the items and their respective subscales were stronger than that between the items and the other four subscales), concurrent validity (significant correlations between the scale/subscale scores and both emotional distress due to COVID-19 and satisfaction with living in Hong Kong), and convergent validity (significant correlations between specific subscales and corresponding external variables). Relatively high floor effects were detected in some subscales. The scale, which is the first of the types to assess resource losses during a pandemic, can provide theory-based understandings/assessment about the negative impacts of COVID-19. It also facilitates warranted comparisons across countries and time periods in future studies. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-021-01933-y.

Working from home and positive/negative experiences due to social distancing as interacting factors of depressive symptoms during the COVID-19 pandemic in a Chinese general population.

PURPOSE: This study investigated the associations between some factors related to working from home status (WFHS) and positive/negative experiences due to social distancing and their interactions effects on depressive symptoms during the COVID-19 pandemic. METHODS: A random population-based telephone survey interviewed income-earning adults in the Hong Kong general population during April 21-28, 2020 (n = 200). RESULTS: Mild to severe depression (according to PHQ-9) was reported by 12% of the participants. The prevalence of WFHS categories was 14% for 3-7 days and 13% for ≥ 8 days (past 2 weeks). The multivariable regression analysis showed that, social isolation (ß = 0.36; p < 0.001), relaxation feeling in daily life (ß = - 0.22; p = 0.002), and WFHS ≥ 8 days (ß = 0.15; p = 0.027), but not perceived huge inconvenience and improved family relationship, were associated with depressive symptoms. Statistically significant interaction effects were found. Some positive experiences buffered the potential harms of some negative experiences of social distancing on depressive symptoms; WFHS ≥ 8 days significantly moderated the risk/protective effects of social isolation, improved family relationship, and relaxation feeling on depressive symptoms. CONCLUSIONS: Social distancing is double-edged. Positive experiences should be maximized while negative experiences be minimized, as both were directly and interactively associated with depression. Intensive but not mild to moderate (< 80%) WFHS may impact depressive symptoms negatively via its direct association with depression; it also moderated the associations between positive/negative experiences due to social distancing and depression. Further research is required to discern the inter-relationships among WFHS, positive/negative experiences of social distancing, and depression to better cope with the stressful pandemic.

Potential joint effects of perceptions related to COVID-19 and future social development on depressive symptoms: a Chinese population-based study.

BACKGROUND: The COVID-19 pandemic has caused significant negative socio-political, economic, and psychological consequences. AIMS: To investigate the impact of individual-level (illness representations of COVID-19) and structurally derived (anticipated social-political development in the economy, security, and social harmony in the next year) factors, and their potential moderation effects on depressive symptoms. METHODS: An anonymous population-based telephone survey was conducted among the general public of Hong Kong, China during 3-10 April 2020 (n = 300, response rate 56%). Depressive symptoms were assessed by the validated Chinese version of the Patient Health Questionnaire-9. RESULTS: Of the participants, 8.7% showed probable moderate-to-severe depression. Hierarchical linear regression models showed that illness representations of personal/treatment control and emotional responses and anticipated deterioration in social harmony were independently and significantly associated with depressive symptoms. Anticipated deterioration in security significantly moderated the associations between perceived consequence/treatment control of COVID-19 and depressive symptoms, such that the associations were stronger among people who anticipated a strong deterioration in security. CONCLUSIONS: The findings suggested that perceptions of COVID-19 and future social-political development jointly and interactively contributed to depressive symptoms during the COVID-19 pandemic. Mental health professionals and promotions should take the multiple-level mental health determinants into account.

Psychometric properties and normative data of the 10-item Connor-Davidson Resilience Scale among Chinese adolescent students in Hong Kong.

This study aimed to assess the psychometric properties of the 10-item Connor-Davidson Resilience Scale (CD-RISC10) and generate normative data for Chinese adolescents. A total of 24,499 participants (male 52.1%, mean age 13.3 years) were enrolled in the school-based survey among 132 secondary schools in Hong Kong during 2017. The CD-RISC10 showed high reliability and confirmatory factor analysis supported a unidimensional structure. Metric invariance across the gender, age, and grade subgroups was demonstrated. CD-RISC10 scores were positively correlated with psychological well-being and negatively correlated with mental distress. Male and younger students had higher resilience scores. There were significant interaction effects of gender and age/grade, with CD-RISC10 scores decreasing with age/grade in females while similar trends were not observed in males. Overall, the findings suggest that CD-RISC10 is appropriate for use in Chinese adolescents. The availability of normative data will facilitate the interpretation and comparison of research results in future studies.

Trend and Factors Associated with Condom Use Among Male Clients of Female Sex Workers in Hong Kong: Findings of 13 Serial Behavioural Surveillance Surveys.

This study investigated the trend and associated factors of condom use among male clients of female sex workers (CFSW) in Hong Kong. A total of 25,443 males of the general population were screened to identify 2,330 CFSW via 13 rounds of population-based serial cross-sectional telephone surveys during 1998 through 2015. Over time, there were no significant changes in condom use with various types of female sex partners (p ranged 0. 219-0.837) and prevalence of self-reported STI (p = 0.975) in the past 6 months. Decrease in the prevalence of non-regular sex partners (p < 0.001) and increase in perceived efficacy of condom use for HIV prevention (p = 0.028) were observed. Perceived efficacy of condom use for HIV prevention and self-reported STI experience were significantly associated with condom use with various types of female sex partners in the past 6 months. No evident improvement for condom use was found. Tailored intervention programs are warranted.

Prevalence and factors of self-corrective intention among Hong Kong secondary school students who are self-assessed Internet addiction cases.

BACKGROUND: Adolescent Internet addiction (IA) is prevalent. No study, however, has applied the health belief model (HBM) to investigate issues on IA nor investigated factors associated with intention to correct one's perceived IA problem (self-corrective intention). Such information facilitates design of related interventions, which are warranted. METHODS: This cross-sectional study surveyed 9,618 Chinese secondary school students in Hong Kong; 4,111 (42.7%) self-assessed that they had IA (self-assessed IA cases); 1,145 of these self-assessed IA cases (27.9%) were also classified as IA cases (concordant IA cases), as their Chen Internet Addiction Scale score exceeded 63. RESULTS: The prevalence of self-corrective intention among these two subsamples was only 28.2% and 34.1%, respectively. In the self-assessed IA subsample, the HBM constructs including perceived susceptibility to IA [adjusted odds ratio (ORa) = 1.24, 95% CI = 1.16, 1.34], perceived severity of IA (ORa = 2.28, 95% CI = 2.09, 2.48), perceived benefits for reducing Internet use (ORa = 1.21, 95% CI = 1.18, 1.24), self-efficacy to reduce Internet use (ORa = 1.07, 95% CI = 1.03, 1.11), and cues to action to reduce Internet use (ORa = 1.15, 95% CI = 1.11, 1.20) were positively, while perceived barriers for reducing Internet use (ORa = 0.95, 95% CI = 0.94, 0.97) were negatively, associated with self-corrective intention. Similar factors were identified in the concordant IA subsample. CONCLUSIONS: A large proportion of the students perceived that they had IA but only about one-third intended to correct the problem. Future interventions may consider altering students' HBM constructs, and focus on the segment of concordant IA with self-corrective intention, as they show readiness for changes.

Incidence and predictive factors of Internet addiction among Chinese secondary school students in Hong Kong: a longitudinal study.

PURPOSE: Internet use has global influences on all aspects of life and has become a growing concern. Cross-sectional studies on Internet addiction (IA) have been reported but causality is often unclear. More longitudinal studies are warranted. METHODS: We investigated incidence and predictors of IA conversion among secondary school students. A 12-month longitudinal study was conducted among Hong Kong Chinese Secondary 1-4 students (N = 8286). Using the 26-item Chen Internet Addiction Scale (CIAS; cut-off >63), non-IA cases were identified at baseline. Conversion to IA during the follow-up period was detected, with incidence and predictors derived using multi-level models. RESULTS: Prevalence of IA was 16.0% at baseline and incidence of IA was 11.81 per 100 person-years (13.74 for males and 9.78 for females). Risk background factors were male sex, higher school forms, and living with only one parent, while protective background factors were having a mother/father with university education. Adjusted for all background factors, higher baseline CIAS score (ORa = 1.07), longer hours spent online for entertainment and social communication (ORa = 1.92 and 1.63 respectively), and Health Belief Model (HBM) constructs (except perceived severity of IA and perceived self-efficacy to reduce use) were significant predictors of conversion to IA (ORa = 1.07-1.45). CONCLUSIONS: Prevalence and incidence of IA conversion were high and need attention. Interventions should take into account risk predictors identified, such as those of the HBM, and time management skills should be enhanced. Screening is warranted to identify those at high risk (e.g. high CIAS score) and provide them with primary and secondary interventions.

Potential impact of internet addiction and protective psychosocial factors onto depression among Hong Kong Chinese adolescents - direct, mediation and moderation effects.

BACKGROUND: Internet addiction (IA) is a risk factor while some psychosocial factors can be protective against depression among adolescents. Mechanisms of IA onto depression in terms of mediations and moderations involving protective factors are unknown and were investigated in this study. METHODS: A representative cross-sectional study was conducted among Hong Kong Chinese secondary school students (n=9518). RESULTS: Among males and females, prevalence of depression at moderate or severe level (CES-D≥21) was 38.36% and 46.13%, and that of IA (CIAS>63) was 17.64% and 14.01%, respectively. Adjusted for socio-demographics, depression was positively associated with IA [males: adjusted odds ratio (AOR)=4.22, 95% CI=3.61-4.94; females: AOR=4.79, 95% CI=3.91-5.87] and negatively associated with psychosocial factors including self-esteem, positive affect, family support, and self-efficacy (males: AOR=0.76-0.94; females: AOR=0.72-0.92, p<.05). The positive association between IA and depression was partially mediated by the protective psychosocial factors (mainly self-esteem) across sexes. Through significant moderations, IA also reduced magnitude of protective effects of self-efficacy and family support among males and that of positive affect among both sexes against depression. CONCLUSIONS: The high IA prevalence contributes to increased risk of prevalent depression through its direct effect, mediation (reduced level of protective factors) and moderation (reduced magnitude of protective effects) effects. Understanding to mechanisms between IA and depression through protective factors is enhanced. Screening and interventions for IA and depression are warranted, and should cultivate protective factors, and unlink negative impact of IA onto levels and effects of protective factors.

The intention to get COVID-19 booster vaccination and its association with cognitive and emotional factors: A survey of Chinese COVID-19 infected people in Hong Kong.

BACKGROUND: Although the pandemic has ended officially, COVID-19 remains impactful. Booster COVID-19 vaccination is still needed to protect individuals against COVID-19 and the disease's harmful consequences. This study investigated the prevalence of the intention to get booster COVID-19 vaccination after receiving the COVID-19 diagnosis and its associated factors among people reporting prior COVID-19. METHODS: A population-based anonymous telephone survey was conducted in Hong Kong, China from June to August 2022 among Chinese people reporting prior COVID-1 between February and August 2022 and having taken up ≥2 doses of COVID-19 vaccines prior to COVID-19 diagnosis. RESULTS: The prevalence of the intention to get booster vaccination was 59.2 %. Older age (>60 years), being currently married, not employed full-time, and having chronic diseases were positively associated with the intention to get booster vaccination. Adjusted for the background factors, higher levels of the cognitive factors of perceived susceptibility to COVID-19, perceived acquired moderate-to-strong immunity against COVID-19, and perceived adequate knowledge of COVID-19 were positively associated with the intention to get booster vaccination; stronger perceived severity of prior infection despite vaccination was negatively associated with the intention outcome. In contrast, stronger mental distress due to COVID-19, illness concern, and emotional representation were positively associated with the intention. Self-perceived long COVID status was not a significant factor. DISCUSSION: The prevalence of the intention to get booster COVID-19 vaccination was limited, especially among younger people reporting prior COVID-19. Health promotion is still required among people reporting prior COVID-19 and may emphasize the significant cognitive factors positively associated with the intention. Future studies are needed to confirm the findings, clarify the role of emotional factors on booster vaccination, and explore other factors of the intention to get booster vaccination among people reporting prior COVID-19.

Level and factors of support for the Living with the Virus policy in a Chinese adult general population: a mediation analysis via positive and negative attitudes toward the policy.

Background: This study investigated the public's support for the Living with the Virus (LWV) policy, its associated factors, and related mediations at a time when more countries were considering adopting the LWV policy amid the COVID-19 pandemic. Methods: A random, population-based telephone survey was conducted among 500 Chinese adults in Hong Kong during March/April 2022. Results: 39.6% of the participants were supportive/strongly supportive of the LWV policy. Perceived efficacy of the control measures was negatively associated with the support and was partially mediated via the perception that the policy would greatly improve the economy/daily life of the policy. Perceived physical harms of the Omicron variant was negatively associated with the support and was fully mediated via perceived negative impacts of the policy. 26.2%/54.6% believed that the policy would improve the economy/daily life greatly; about 40% perceived negative impacts on deaths and the medical system due to the policy. COVID-19 ever infection did not significantly moderate the studied associations. Conclusion: The public was split regarding the support for the LWV policy and whether it would cause better economy/daily life, unnecessary deaths, and the collapse of the medical system. Health communication is needed in shifting toward the LWV policy.

A pilot clustered randomized control trial evaluating the efficacy of a network-based HIV peer-education intervention targeting men who have sex with men in Hong Kong, China.

HIV is a serious health threat among men who have sex with men (MSM). A 2-month pilot network-based peer intervention was conducted among Chinese MSM in Hong Kong. Eight MSM peer educators were randomized into the Intervention or the Control Groups and recruited 36 and 33 peers to join the program, respectively. The educators of the Intervention Group delivered standardized and theory-based preventive messages to their peers via daily social interactions. The Control Group received education materials. Baseline between-group differences were non-significant. At post-intervention, intervened participants were more likely than controlled participants to intend to use condoms consistently during anal sex with men in the next 6 months [94.4% versus 60.6%; Relative Risk (RR): 1.56 (95% Confidence Interval (CI): 1.17, 2.08)] and to perceive behavioral control over taking up voluntary HIV testing and counseling [97.2% versus 72.7%; RR: 1.34 (95% CI: 1.08, 1.66)]. Large scale randomized trials are warranted.

Reduction in COVID-19 related resource loss and decline in prevalence of probable depression in Chinese adults: an application of the Conservation of Resource Theory.

BACKGROUND: The levels of resource losses due to coronavirus disease 2019 (COVID-19) and mental distress may change during the pandemic period. Based on the Conservation of Resource (COR) Theory, this study investigated such changes and the mediation between survey time (Round 2 versus Round 1) and depression via resource losses. METHODS: Two serial random population-based telephone surveys interviewed 209 and 458 Hong Kong Chinese adults in April 2020 and May 2021, respectively. Probable depression was defined as 9-item Patient Health Questionnaire (PHQ-9) score ≥ 10. The validated Conservation of Resources Scale for COVID-19 (CORS-COVID-19) scale was used to assess resource losses due to COVID-19. Multivariable logistic regression analysis, hierarchical logistic regression analysis, and structural equation modeling (SEM) was conducted to test the association, interaction, and mediation hypotheses, respectively. RESULTS: The prevalence of probable depression declined from 8.6% to 1.0% over time, together with reductions in losses of financial resource (Cohen's d = 0.88), future control (Cohen's d = 0.39), social resource (Cohen's d = 0.60), and family resource (Cohen's d = 0.36) due to COVID-19. All the overall scale/subscales of the CORS-COVID-19 were positively and associated with probable depression [adjusted odds ratio (aOR) ranged from 2.72 to 42.30]. In SEM, the survey time was negatively associated with the latent variable of resource loss (ß = - 0.46), which in turn was positively associated with probable depression (ß = 0.73). In addition, the direct effect of survey time on probable depression was statistically non-significant (ß = - 0.08), indicating a full mediation effect of resource losses. CONCLUSIONS: The lessening of the resource losses might have fully accounted for the significant decline in probable depression from Month 3 to 15 since the first COVID-19 outbreak in Hong Kong, China. The level of depression might have increased during the first phase of the pandemic, but might decline in the later phases if resources losses could be lessened. All stakeholders should hence work together to minimize individuals' COVID-19-related resource losses to prevent depression in the general population, as COVID-19 might be lasting.

Illness representation of COVID-19 affected public's support and anticipated panic regarding the living with the virus policy: a cross-sectional study in a Chinese general population.

Background: There is a global trend for countries to adopt the Living with the Virus (LWV) policy regarding COVID-19. Little is known about the public's supportiveness and emotional responses (e.g., anticipated panic) related to this policy. Such responses may be associated with illness representations of COVID-19 (i.e., how people think and feel about COVID-19). This novel topic was investigated in this study to facilitate policy-making and health communication. Methods: A random, population-based telephone survey interviewed 500 adults aged ≥18 of the Hong Kong general adult population from March to April 2022. Results: The prevalence of the public's support and anticipated panic regarding the LWV policy, which were negatively correlated with each other, was 39.6 and 24.2%, respectively. The illness representation constructs of consequences, timeline, identity, illness concern, and emotional representations were negatively associated with supportiveness and positively associated with anticipated panic regarding the LWV policy. Illness coherence was significantly associated with policy support but not with anticipated panic. The associations between personal control/treatment control and supportiveness/anticipated panic were statistically non-significant. Moderation analyses showed that the above significant associations were invariant between those with and without previous COVID-19 infection. Conclusion: Policymakers need to be sensitized about the public's supportive/unsupportive attitude and potential worry (panic) when adopting the LWV policy. Such attitudes/emotional responses may be affected by people's illness representations of COVID-19. In general, those who found COVID-19 involving a milder nature and less negative emotions would be more supportive and anticipated less panic under the LWV policy.

Time to Lift up COVID-19 Restrictions? Public Support towards Living with the Virus Policy and Associated Factors among Hong Kong General Public.

The fifth wave of the COVID-19 pandemic has caused an unprecedented toll on Hong Kong. As more countries are starting to lift COVID-19 restrictions, it would be important to understand the public attitudes towards lifting COVID-19 restrictions and to identify its associated factors. The present study examined the level of support towards the living with the virus (LWV) policy for COVID-19 among the public in Hong Kong and to identify the associations between resilient coping, self-efficacy and emotional distress with support towards the LWV policy. A random population-based telephone survey was conducted among 500 Hong Kong Chinese adults from 7 March to 19 April 2022, i.e., during the fifth wave of COVID-19 outbreak. Of the respondents, 39.6% showed a supportive attitude towards the LWV policy. Results from the structural equational modeling showed a positive correlation between resilient coping and self-efficacy. Resilient coping was associated with support towards the LWV policy directly and indirectly through a lower level of emotional distress. Self-efficacy had a direct association with support towards the LWV policy but its indirect association through emotional distress was not significant. Interventions that foster resilient coping and self-efficacy would be effective in reducing public emotional distress and promoting their positive view towards the LWV policy.

Levels and Determinants of COVID-19 Vaccination at a Later Phase among Chinese Older People Aged 60 Years or Older: A Population-Based Survey.

The early attainment of high COVID-19 vaccination rates can minimize avoidable hospitalizations/deaths. The fifth wave COVID-19 outbreak in Hong Kong caused >9000 deaths, and most of them were unvaccinated older people. This study hence investigated determinants of taking the first dose vaccination at a later phase (Phase 3: during the fifth wave outbreak, i.e., February-July 2022) versus two earlier phases (Phase 1: first six months since vaccine rollout, i.e., February-July 2021; Phase 2: six months prior to the outbreak, i.e., August 2021-January 2022) via a random telephone survey among 386 ever-vaccinated Hong Kong older people aged ≥60 (June/July 2022). A total of 27.7%, 51.1%, and 21.3% took the first dose at Phase 1, Phase 2, and Phase 3, respectively. Unfavorable perceptions related to COVID-19/vaccination, exposure to conflicting/counter-information about the suitability of older people's vaccination from various sources, unsupportive family influences prior to the outbreak, and depressive symptoms were significantly associated with taking the first dose at Phase 3 instead of Phase 1 and Phase 2. To speed up COVID-19 vaccination and avoid unnecessary deaths, the government and health professionals should rectify misinformation, provide clear/consistent information for older people and their family members, and focus on those having depressive symptoms at an earlier stage of the pandemic.

Application of the protection motivation theory to understand determinants of compliance with the measure of banning gathering size >4 in all public areas for controlling COVID-19 in a Hong Kong Chinese adult general population.

BACKGROUND: Restriction of gathering size in all public areas is a newly and commonly exercised governmental social distancing policy during the COVID-19 pandemic. Its effectiveness depends on the general public's compliance. This study applied the Protection Motivation Theory (PMT) to investigate determinants (i.e., perceived severity, perceived susceptibility, perceived response efficacy, and perceived self-efficacy) of compliance with the social distancing policy of banning gathering of >4 people in all public areas (BG4PA) in the Hong Kong general adult population. METHODS: 300 participants were interviewed through a population-based telephone survey during April 21-28, 2020. RESULTS: The compliance rate of BG4PA was high (78%). Adjusted for the background factors, multiple linear regression analysis found that perceived response efficacy and perceived self-efficacy were significantly and positively associated with compliance with BG4PA (p<0.05), while the associations between perceived severity/perceived susceptibility and compliance were of marginal significance (0.05

How Motives Related to Benefits for Oneself and Others Would Affect COVID-19 Vaccination in a Hong Kong Chinese General Adult Population?

Outcome expectancies involving self-directed and others-directed domains are potential determinants of completed or scheduled first-dose COVID-19 vaccination (CSFCV). This study investigated factors of CSFCV, including (a) self-directed motives [personal positive outcome expectancies (POE) and personal negative outcome expectancy (NOE)], and (b) others-directed motives (societal POE and the personality trait of prosociality). It also investigated the mediations of personal POE between societal POE and CSFCV, and moderations of prosociality between personal POE/personal NOE/societal POE and CSFCV. A cross-sectional population-based telephone survey interviewed 500 people aged 18-75 in Hong Kong in May 2021. The prevalence of CSFCV was 21.0%. Significant factors of CSFCV included personal POE (i.e., physical/practical/emotional/interpersonal benefit), personal NOE, and societal POE. The association between societal POE and CSFCV was fully mediated by the overall scale and some domains of personal POE. Furthermore, the association between physical benefit and CSFCV was stronger at lower levels of prosociality; prosociality showed a stronger effect on CSFCV at lower levels of physical benefit. The results suggest that self-directed motives might be more important than others-directed motives in affecting CSFCV. The findings require confirmations from longitudinal studies and cross-country comparisons.

Multi-dimensional factors related to participation in a population-wide mass COVID-19 testing program among Hong Kong adults: A population-based randomized survey.

RATIONALE: Mass testing is considered as an important policy response to the COVID-19 pandemic, and high population coverage is pivotal to its effectiveness. A range of factors derived from health behaviour theories were hypothesized to be associated with public uptake of mass testing, including illness representations of COVID-19, perceived susceptibility to COVID-19, perceived efficacy of the testing program, and general trust toward governmental measures for controlling COVID-19. OBJECTIVE: This study aimed to investigate the multi-dimensional factors associated with participation in a free and voluntary population-wide mass COVID-19 testing program. METHODS: A cross-sectional study was conducted in Hong Kong within two weeks after the Universal Community Testing Program for COVID-19 concluded on September 14, 2020. A random population-based telephone survey interviewed 443 Hong Kong general adults who were aged ≥18 and had not joined other COVID-19 testing programs. The dependent variable was participation in the Universal Community Testing Program. Logistic regression analysis was conducted to test the associations of participation in the program with the proposed factors. RESULTS: The standardized participation rate of the testing program was estimated to be about 37.2% among the general adults (33.0% among males; 40.8% among females) in Hong Kong. The participation rates were significantly lower among males and younger adults. Adjusted for socio-demographics, significant factors included four dimensions of illness representations of COVID-19 (treatment control: adjusted odds ratio [AOR] = 1.41; illness identity: AOR = 1.10; concern: AOR = 1.14; emotions: AOR = 1.10), perceived susceptibility to COVID-19 (AOR = 1.40), perceived efficacy of the testing program (AOR = 2.73), and trust toward governmental control measures (AOR = 4.30). CONCLUSIONS: The participation rate of the population-wide mass testing program was not high among general adults in Hong Kong, evidence-based health promotion is necessary. The study informs some critical factors to be addressed to effectively boost public support for the mass testing policy in response to emerging infectious diseases.

Would Illness Representations of COVID-19 and COVID-19 Fears During Clinic Visits Promote or Reduce Behavioral Intention to Seek Medical Consultations for Flu Symptoms? A Random Telephone Survey in Hong Kong, China.

Background: The study investigated the level of behavioral intention to consult doctors for flu symptoms (BICDFS) during the Coronavirus Disease 2019 (COVID-19) pandemic and examined its associations with illness representations of COVID-19 and fear of COVID-19 during clinic visits in a general Chinese adult population. Methods: A random telephone survey was conducted among 300 residents in Hong Kong, China in April 2020 when the second wave of COVID-19 was just ended in the region. The participants were asked about their intention to consult doctors if they had mild or severe flu symptoms in the next week (from 1 = definitely no to 5 = definitely yes). Illness representations of COVID-19 were measured by the Chinese version of the Brief Illness Perception Questionnaire (BIPQ). The fear of COVID-19 during clinic visits were assessed by two single items. Linear regression adjusted for background variables and hierarchical strategies were employed. Results: Of the participants, 52.3 and 92.0% showed an intention to consult doctors for mild and severe flu symptoms, respectively. Adjusted for background factors, COVID-19-related cognitive representations (consequences: standardized b = 0.15, p = 0.010; understanding: standardized b = 0.21, p = 0.001) and emotional representations (concern: standardized b = 0.17, p = 0.001; negative emotions: standardized b = 0.19, p = 0.001) were positively associated with BICDFS. In the hierarchical model, independent significant factors of BICDFS included understanding (standardized b = 0.16, p = 0.013) and negative emotions (standardized b = 0.17, p = 0.008). The fear-related variables showed non-significant associations with the BICDFS. Conclusions: Promotion of care-seeking behaviors for flu symptoms during the COVID-19 pandemic should consider improving people's understanding of COVID-19 and providing advice on related coping strategies for emotional responses to COVID-19.