Understanding the Experience of Cancer Survivorship Among Pediatric and Adolescent Cancer Survivors and Their Parents Through Camera Lenses: A Photovoice Study.

OBJECTIVE: Although the relative survival rate of childhood cancer has increased substantially in recent years, the pursuit of successful outcomes is often accompanied by negative impacts on pediatric and adolescent cancer survivors and their parents' physical and psychological well-being. However, little is known about their experiences during the period of cancer survivorship. This study aimed to gain an understanding of the experience of cancer survivorship among pediatric and adolescent cancer survivors and their parents. METHODS: This study utilized a descriptive qualitative study employing the photovoice design. From September 2022 to March 2023, 17 pediatric and adolescent cancer survivors (9-18 years), who had completed active treatment at least 6 months before recruitment, participated in this study. A total of 217 photographs submitted by survivors and their parents and the interview data, were thematically analyzed to identify themes and subthemes. RESULTS: The analysis revealed five prominent themes: indelible marks, struggling with late effects, striving to return to normalcy, the strength of support, and living in the moment and hope for the future. CONCLUSION: The findings shed light on the experiences of pediatric and adolescent cancer survivors and their parents throughout the cancer journey, elucidating the influence on both negative and positive aspects. Additionally, the study highlighted that photovoice facilitated self-reflection, the discovery of values, and the recognition of strengths and can be a therapeutic strategy for pediatric and adolescent cancer survivors and their parents in further research.

Immersive and Nonimmersive Virtual Reality-Assisted Active Training in Chronic Musculoskeletal Pain: Systematic Review and Meta-Analysis.

BACKGROUND: Virtual reality (VR) in different immersive conditions has been increasingly used as a nonpharmacological method for managing chronic musculoskeletal pain. OBJECTIVE: We aimed to assess the effectiveness of VR-assisted active training versus conventional exercise or physiotherapy in chronic musculoskeletal pain and to analyze the effects of immersive versus nonimmersive VR on pain outcomes. METHODS: This systematic review of randomized control trials (RCTs) searched PubMed, Scopus, and Web of Science databases from inception to June 9, 2024. RCTs comparing adults with chronic musculoskeletal pain receiving VR-assisted training were included. The primary outcome was pain intensity; secondary outcomes included functional disability and kinesiophobia. Available data were pooled in a meta-analysis. Studies were graded using the Cochrane Risk-of-Bias Tool version 2. RESULTS: In total, 28 RCTs including 1114 participants with some concerns for a high risk of bias were identified, and 25 RCTs were included in the meta-analysis. In low back pain, short-term outcomes measured post intervention showed that nonimmersive VR is effective in reducing pain (standardized mean difference [SMD] -1.79, 95% CI -2.72 to -0.87; P<.001), improving disability (SMD -0.44, 95% CI -0.72 to -0.16; P=.002), and kinesiophobia (SMD -2.94, 95% CI -5.20 to -0.68; P=.01). Intermediate-term outcomes measured at 6 months also showed that nonimmersive VR is effective in reducing pain (SMD -8.15, 95% CI -15.29 to -1.01; P=.03), and kinesiophobia (SMD -4.28, 95% CI -8.12 to -0.44; P=.03) compared to conventional active training. For neck pain, immersive VR reduced pain intensity (SMD -0.55, 95% CI -1.02 to -0.08; P=.02) but not disability and kinesiophobia in the short term. No statistical significances were detected for knee pain or other pain regions at all time points. In addition, 2 (8%) studies had a high risk of bias. CONCLUSIONS: Both nonimmersive and immersive VR-assisted active training is effective in reducing back and neck pain symptoms. Our study findings suggest that VR is effective in alleviating chronic musculoskeletal pain. TRIAL REGISTRATION: PROSPERO CRD42022302912; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302912.

'I cannot accept it' distressing experiences in parents of children diagnosed with cancer: A qualitative study.

AIMS: To explore the distressing experiences of Chinese parents of children with cancer from the perspective of psychological inflexibility. DESIGN: A qualitative study using a descriptive qualitative approach based on the model of psychological inflexibility was adopted. METHODS: Individual semi-structured interviews through synchronized online video were conducted with 21 Chinese parents of children with cancer from October 2020 to May 2021. Data were analysed using content analysis. RESULTS: Four themes and 11 subthemes were identified: (i) immersion in struggling and suffering, (ii) avoidance and suppression, (iii) blaming and complaint and (iv) helplessness and worthlessness. Parents were unwilling to accept the diagnosis and witness their children's suffering, trapped in uncontrollable negative emotions and thoughts. Avoiding emotions and socializing, blaming themselves or complaining of injustice were common. They felt helpless towards life and valueless without the child. CONCLUSION: The research findings provide additional perspectives in understanding the distressing experiences in parents of children with cancer. Overall, the emotional and coping styles indicated the lack of psychological flexibility of parents when facing childhood cancer, which is profoundly influenced by Chinese culture. IMPLICATIONS FOR THE PROFESSION: Healthcare professionals are recommended to provide culturally sensitive strategies or interventions for building psychological flexibility in addressing parental psychological distress. IMPACT: The study provides insights into exploring distressing experiences and reveals the inflexible psychological and behavioural patterns in parents of children with cancer, which could benefit healthcare providers in managing parental psychological distress and helping these parents build flexible coping strategies. REPORTING METHOD: The COREQ guideline was followed. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement.

Symptom Clusters in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Systematic Review.

BACKGROUND: Breast cancer patients experience various adverse symptoms during adjuvant chemotherapy. These adverse symptoms often form symptom clusters and have a negative impact on patients. AIMS: To summarise common symptom clusters in different dimensions and their longitudinal changes among breast cancer patients receiving adjuvant chemotherapy. DESIGN: A systematic review. DATA SOURCES: Ten electronic databases were searched from 2001 to January 2024, and the search was last updated on 16 August 2024. METHODS: Two reviewers independently assessed the eligibility of each study and extracted data. The Standard Quality Assessment Criteria for Evaluating Primary Research Papers was used to evaluate the quality of included studies. The findings were synthesised narratively. This systematic review has been registered (CRD42022370210). RESULTS: Nine studies with a total of 1454 participants were included. The common symptom clusters in breast cancer patients receiving adjuvant chemotherapy were the gastrointestinal symptom cluster (nausea-lack of appetite), the fatigue-pain-sleep disturbance symptom cluster and the psychological symptom cluster (worry-sadness-nervousness-distress-feeling irritable-difficult concentrating). The severity dimension was the most frequently utilised in identifying symptom clusters, with the number and concurrence of symptom clusters showing variation over time. CONCLUSIONS: This study summarised common symptom clusters in breast cancer patients receiving adjuvant chemotherapy and revealed their changes from symptom dimensions and the chemotherapy process. These findings support further exploration of symptom cluster changes and underlying mechanisms, facilitating the design of targeted management strategies, including appropriate interventions and measurement dimensions in clinical nursing, to ultimately reduce patients' symptom burden. IMPACT: Common symptom clusters have been identified in breast cancer patients receiving adjuvant chemotherapy. Clinical nursing in oncology can prioritise these symptom clusters and provide patients with targeted management strategies. REPORTING METHODS: PRISMA guidelines and SWiM guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Examining Eye Tracking Metrics and Cognitive Function in Post-Stroke Individuals: A Comparison of Visual Searching Tasks Between Those with and without Cognitive Impairment.

INTRODUCTION: After a stroke, individuals commonly experience visual problems and impaired cognitive function, which can significantly impact their daily life. In addition to visual neglect and hemianopia, stroke survivors often have difficulties with visual search tasks. Researchers are increasingly interested in using eye tracking technology to study cognitive processing and determine whether eye tracking metrics can be used to screen and assess cognitive impairment in patients with neurological disorders. As such, assessing these areas and understanding their relationship is crucial for effective stroke rehabilitation. METHODS: We enrolled 60 stroke patients in this study and evaluated their eye tracking performance and cognitive function through a series of tests. Subsequently, we divided the subjects into two groups based on their scores on the HK-MoCA test, with scores below 21 out of 30 indicating cognitive impairment. We then compared the eye tracking metrics between the two groups and identified any significant differences that existed. Spearman correlation analysis was conducted to explore the relationship between clinical test scores and eye tracking metrics. Moreover, we employed a Mann-Whitney U test to compare eye tracking metrics between groups with and without cognitive impairment. RESULTS: Our results revealed significant correlations between various eye tracking metrics and cognitive tests (p=<.001-.041). Furthermore, the group without cognitive impairment demonstrated higher saccade velocity, gaze path velocity, and shorter time to target than the group with cognitive impairment (p=<.001-.040). ROC curve analyses were performed, and the optimal cut-off values for gaze path velocity and saccade velocity were 329.665 (px/s) (sensitivity= 0.80, specificity = 0.533) and 2.150 (px/s) (sensitivity= 0.733, specificity= 0.633), respectively. CONCLUSIONS: Our findings indicate a significant correlation between eye tracking metrics and cognitive test scores. Furthermore, the group with cognitive impairment exhibited a significant difference in these metrics, and a cut-off value was identified to predict whether a client was experiencing cognitive impairment.

'Life became slow down': A descriptive qualitative study of the experiences of cancer-related fatigue amongst people with advanced lung cancer.

BACKGROUND: Cancer-related fatigue is a complex multidimensional concept. However, little is known about the experience of cancer-related fatigue in people with advanced lung cancer. How they emotionally react to and cope with the experience of cancer-related fatigue according to cultural influences has not been extensively explored. AIM: To explore the experience of cancer-related fatigue, its impacts and emotional reactions to and coping strategies for cancer-related fatigue amongst people with advanced lung cancer in China. DESIGN: This was a cross-sectional, descriptive qualitative study with face-to-face semi-structured interviews. Data were analysed using content analysis. SETTING/PARTICIPANTS: Twenty-one people with advanced lung cancer who experienced cancer-related fatigue were recruited in a hospital setting. RESULTS: Four themes were identified: multifaceted experiences of cancer-related fatigue, impacts of cancer-related fatigue, negative perceptions of cancer-related fatigue and avoiding cancer-related fatigue. The multifaceted experience of cancer-related fatigue had physical, psychological and social impacts along the cancer trajectory. Informants regarded it as a sign of a 'bad ending', searched for root causes and had negative attitudes towards role changes. Avoiding coping strategies included not discussing cancer-related fatigue, refusing encouragement and support, hiding feelings, withdrawing from social life and attempting to control cancer-related fatigue. CONCLUSION: The findings provide insights into the lack of flexibility of people with advanced lung cancer to adapt to the multidimensional experience of cancer-related fatigue. The reactions and coping towards cancer-related fatigue are profoundly influenced by Chinese culture. Developing psychological interventions based on the cultural background are highly recommended to cultivate the ability to cope flexibly with stressful events and live a meaningful cancer life.

Use of a Linguistically Appropriate Decision Aid for Cervical Cancer Screening of South Asian Ethnic Minority Women in Hong Kong: A Pilot Randomised Controlled Trial.

BACKGROUND: Decision aids have been shown to be effective in assisting the decision-making process in healthcare settings. This study aimed to examine the feasibility and acceptability of a linguistically appropriate printed decision aid for cervical cancer screening in South Asian women and to preliminarily estimate its effects on decisional conflicts, clarity of values, risk perception, the screening decision and screening uptake. METHODS: This was a pilot randomised controlled trial. Forty-eight South Asian women aged 25 to 64 years were recruited and allocated to either the intervention group or control group. The participants in the intervention group read a linguistically appropriate printed decision aid. RESULTS: All of the participants in the intervention group agreed that the decision aid was useful in aiding their decision-making. These participants showed significantly greater improvement in decisional conflicts, clarity of values and risk perceptions than those in the control group (all p < 0.05). The screening uptake rate was significantly higher in the intervention group than in the control group (p < 0.001). CONCLUSIONS: The decision aid was feasible and acceptable among South Asian women, and it resulted in reduced decisional conflict and increased screening uptake compared with usual care. To improve the convenience of using decision aids, they could be developed in various forms, such as printed and mobile application forms, to meet individual requirements. TRIAL REGISTRATION: The trial was registered at the Chinese Clinical Trial Registry on 23 October 2021 (ChiCTR2100052225).

Nurses' and Families' perceptions and practices and factors influencing the implementation of family-centred care for hospitalised children and their families.

AIMS AND OBJECTIVES: To explore the perceptions of family-centred care among nurses and the family members of hospitalised children and investigate the facilitators of and barriers to the implementation of family-centred care in Malawi. BACKGROUND: In Malawi, approximately 34% of children have long-term illnesses that require hospitalisation. Family-centred care ensures that the delivery of healthcare is grounded in partnerships between healthcare providers, patients and their families, which can improve the psychological well-being of families. However, there is lack a good understanding of how families and nurses perceive this concept, its facilitators and the barriers. DESIGN: This was an exploratory qualitative study. Data were analysed deductively and inductively using the five-step qualitative content analysis method. METHODS: Twenty-nine nurses and 31 families were recruited. Data were collected through in-depth, semi-structured and face-to-face individual interviews. The study was reported using the COREQ checklist. RESULTS: Both nurses and families of hospitalised children recognised the importance of nurse-family partnerships in family-centred care. Four themes emerged as follows: Perceptions of family-centred care, elements of family-centred care, facilitators of family-centred care and barriers to family-centred care. Specific information to families and the religious beliefs of families were identified as important facilitator and barrier to family-centred care, respectively. CONCLUSION: The implementation of family-centred care is promising in Malawi, as it is positively perceived by nurses and families, and its implementation is consistent with the Institute for Patient and Family-Centred Care Framework. RELEVANCE TO CLINICAL PRACTICE: Our findings present the best practices, gaps and challenges in the context of a low-income country regrading implementation of family-centred care. Education programmes on family-centred care are crucial for sustaining the current gains.

The moderating effects of nurses' background characteristics on the relationship between family-centred care perception and practice for hospitalized children and their families in Malawi.

PURPOSE: Globally, limited information is available on the relationship between the perception and practice of family-centered care (FCC), and the moderating effects of nurses' background characteristics on this relationship. This study investigated the relationship between FCC perception and FCC practice and the moderating effects of the nurses' background characteristics on this relationship. DESIGN AND METHODS: A cross-sectional study was conducted using a two-stage stratified sampling method. Data were collected from 444 nurses using the Family Centered Care Questionnaire-Revised and analyzed using IBM SPSS Version 25. The Hayes PROCESS macro model, version 3, was integrated into SPSS to examine the moderating effects at a significance level of 0.05. RESULTS: The response rate was 98%, and a statistically significant positive association was found between FCC perception and FCC practice (r = 0.353, p < .001). Gender of a nurse (ΔR2 = 0.0206, p < .002), having children (ΔR2 = 0.0231, p < .001), experience (ΔR2 = 0.0107, p = .028), and working in a medical-surgical ward (ΔR2 = 0.0208, p = .008) had a statistically significant moderating effect on the relationship between FCC perception and FCC practice. CONCLUSION: These findings provide minimal evidence of the existence of non-modifiable moderators of FCC. Future studies with modifiable moderators are therefore needed. PRACTICE IMPLICATIONS: Understanding the moderating effects of nurses' background characteristics on the relationship between FCC perception and FCC practice may facilitate the development of FCC interventions that favor these background characteristics and facilitate the integration of FCC into routine policies and practices.

The effect of virtual reality on cognitive, affective, and psychomotor outcomes in nursing staffs: systematic review and meta-analysis.

BACKGROUND: In the healthcare systems of the world, reinforcing the competence and professionalism of nurses has become a concern. Gaining clinical nursing competence in the healthcare system requires more effort, and additional training is required. Medical education and training have begun using digital technologies, such as virtual reality (VR). The purpose of this research was to examine the efficacy of VR in terms of cognitive, emotional, and psychomotor outcomes and learning satisfaction in nurses. METHOD: The study searched eight databases (Cochrane library, EBSCOHost, Embase, OVID MEDLINE, ProQuest, PubMed, Scopus, and Web of Science) for articles that met these criteria: (i) nursing staff, (ii) any virtual reality technology intervention for education, all levels of immersion, [1] randomized control trial and quasi-experiment study, and (iv) published articles and unpublished theses. The standardized mean difference was measured. The random effect model was applied to measure the main outcome of the study with a significance level of p < .05. The I2 statistic assessment was applied to identify the level of heterogeneity of the study. RESULTS: A total of 6740 studies were identified, of which 12 studies with 1470 participants met the criteria for inclusion. The meta-analysis showed a significant improvement in the cognitive aspect (standardized mean difference [SMD] = 1.48; 95% CI = 0.33-2.63; p = .011, I2 = 94.88%), the affective aspect (SMD = 0.59; 95% CI = 0.34-0.86; p < .001, I2 = 34.33%), the psychomotor aspect (SMD = 0.901; 95% CI = 0.49-1.31; p < .001, I2 = 80.33%), and learning satisfaction (SMD = 0.47; 95% CI = 0.17-0.77; p = .002, I2 = 0%) aspects of the groups that received the VR intervention compared to the control groups. Subgroup analysis found that dependent variables (e.g., level of immersion) did not improve study outcomes. The quality of evidence was low which is affected by major methodological issues. CONCLUSIONS: VR may favorable as alternative method to increase nurse competencies. Randomized controlled trials (RCTs) on larger samples are needed to strengthen the evidence for the effect of VR in various clinical nurse settings. ROSPERO registration number: CRD42022301260.

Discrepancies between nurses' current and perceived necessary practices of family-centred care for hospitalised children and their families: A cross-sectional study.

PURPOSE: This study investigated (1) the discrepancies between the nurses' current and perceived necessary practices of family-centred care (FCC), and (2) the nurses' demographic characteristics associated with current and perceived necessary practices of FCC for hospitalised children and their families in Malawi. DESIGN AND METHODS: A cross-sectional study involving 444 nurses was conducted. The Family-Centred Care Questionnaire-Revised was used to examine the discrepancies between the nurses' current and perceived necessary practices of FCC. Univariate and multivariate statistical analyses were performed to identify the nurses' demographic characteristics associated with current and perceived necessary practices of FCC. RESULTS: The total mean score of the nurses' current practices of FCC (M = 34.78, SD = 7.06) was significantly lower than that of the nurses' practices of FCC that were perceived as necessary (M = 38.63, SD = 5.60, p < 0.001). The nurses who were over 40 years of age (regression coefficient, ß = 9.162, p = 0.014), had a postgraduate qualification (ß = 23.314, p < 0.001), were separated or widowed (ß = 9.661, p = 0.029), had a Tumbuka cultural background (ß = 12.984, p < 0.001), were Seventh-day Adventist members (ß = 8.863, p = 0.026), and worked in mission hospitals (ß = 16.401, p = 0.021) were more likely to implement current practices of FCC. Conversely, the nurses who were members of the Moslem, Buddhist, or Hindi religious denomination (ß = 6.587, p = 0.040), had a Tonga or Ngonde cultural background (ß = 6.625, p = 0.046), and were nurse midwife technicians (ß = -23.528, p = 0.012) were more likely to implement practices of FCC that they perceived as necessary. CONCLUSION: Significant differences between the nurses' current and perceived necessary practices of FCC suggested that there were barriers to implementing necessary practices of FCC. The nurses' cultural and religious backgrounds were predictors of current practices of FCC, and this finding could direct the future development and testing of FCC interventions in Malawi. PRACTICE IMPLICATIONS: Continued educational activities and research on the factors that contributed to the discrepancies between the nurses' current and perceived necessary practices of FCC and their impact on FCC in Malawi are critical.

Association of early-life gut microbiome and lifestyle factors in the development of eczema in Hong Kong infants.

Childhood eczema is common but its prevalence is variable in different regions of the world. In this study, we explore the associations of various risk factors such as the microbiome, environment, lifestyle, diet and maternal stress with the development of eczema among infants in Hong Kong. Upon enrolment in the study, the infants' parents provided demographic data by self-reporting. At enrolment and 1 year after birth, the infants' allergic conditions, lifestyles and dietary factors and the degree of maternal stress were assessed using various questionnaires. The infants' gut microbiomes were analysed by 16S RNA sequencing, and the longitudinal changes in various bacterial strains were compared between control and eczema-affected groups. Multivariate analyses (after adjustment for other significant factors) revealed that the changes in the abundance of Hungatella hathewayi in the gut were significantly associated with the development of eczema (p = 0.005). In conclusion, the increased abundance of Hungatella hathewayi was associated with an increased risk of developing eczema by 1 year of age. This study thus explored the potential risk factors for the development of eczema in Hong Kong infants, and sheds light on the possible association between early-life gut microbiome and other environmental factors.

Identifying a cut-off score for the COST measure to indicate high financial toxicity and low quality of life among cancer patients.

PURPOSE: To identify a cut-off score for the COmprehensive Score for financial Toxicity (COST) to predict a clinical implication of a high level of financial toxicity (FT). METHODS: A total of 640 cancer patients were recruited from three regional hospitals in Hong Kong. They completed a questionnaire comprising the COST measure and the Functional Assessment of Cancer Therapy - General (FACT-G) instrument. The cut-off score for the COST that predicts the lowest quartile of the FACT-G total score was identified by receiver operating characteristic (ROC) analysis. The sample was then stratified by this cut-off score, and characteristics were compared using Fisher's exact, chi-squared or independent sample t-test. RESULTS: The mean scores were 20.1 ± 8.8 for the COST and 71.6 ± 15.5 for the FACT-G. The ROC analysis suggested that the cut-off of 17.5 yielded an acceptable sensitivity and specificity. Characteristics of patients with a higher level of FT included being younger, having a monthly household income of < 10,000 HKD (approximately 1290 USD), being more likely not employed, having stage IV cancer and receiving targeted and/or immunotherapy. In terms of financial support, a higher proportion of these patients had discussed financial issues with health care professionals and had received financial assistance. In addition, fewer of them were covered by private health insurance. CONCLUSION: Our findings suggest a cut-off for the COST that can be used to screen for FT in clinical settings. In addition, while a considerable proportion of high-FT patients received targeted therapy, they often received financial assistance. There is a gap between financial hardship and assistance that warrants attention.

A Mixed Methods Study of Symptom Experience in Patients With End-Stage Renal Disease.

BACKGROUND: Patients with end-stage renal disease receiving dialysis experience a significant symptom burden. Identifying factors associated with this burden may improve symptom management. However, specific evidence about patients' experiences is lacking. OBJECTIVES: The aim of this study was to explore factors that are associated with patients' symptom experiences. METHODS: The convergent parallel mixed methods design was used. In the quantitative component, the Dialysis Symptom Index was used to assess the symptom burden of 271 participants to examine its associations with patient characteristics using correlation coefficients and multivariate regression analyses. In the qualitative component, associated factors reported by 10 participants were identified through semistructured interviews using content analysis. Assessments were conducted at enrollment, 6 months, and 12 months. After separate data analyses, findings were integrated using side-by-side comparison and joint display. RESULTS: Several significant associations were identified between patient characteristics and symptom burden, and the participants described four categories of factors (i.e., treatment related, pathophysiological, situational, dietary) associated with a higher symptom burden during their interviews. Across both components of this study, three factors were consistent (i.e., employment, hyperphosphatemia, anemia). Participants described several factors not reported previously. DISCUSSION: This study explored subjective and objective factors influencing the symptom experiences of patients with end-stage renal disease using a mixed methods design. These risk factors can be used to identify high-risk patients. Our findings suggest that participants relied on laboratory results and treatments to explain their symptom experiences. These findings suggest that assessment of both subjective and objective factors is needed to explore patients' symptom experiences.

Development of a multimedia intervention to improve pneumoconiosis prevention in construction workers using RE-AIM framework.

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.

Acceptance and Commitment Therapy for psychological and behavioural changes among parents of children with chronic health conditions: A systematic review.

AIMS: To systematically identify the application of Acceptance and Commitment Therapy among parents of children with chronic health conditions and determine its effectiveness in parental psychological flexibility, psychological distress and parenting behaviour. DESIGN: Systematic review. DATA SOURCES: Nine databases (i.e. MEDLINE, PubMed, Embase, Cochrane Library, CINAHL, PsychINFO, Web of Science, China National Knowledge Infrastructure and WanFang Data) were systematically searched from inception to October 2019. REVIEW METHODS: Quality of studies was appraised by using the Joanna Briggs Institute critical appraisal checklist. Findings were synthesized narratively. This work was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. RESULTS: Eight studies involving 485 parents were included. Results indicated that Acceptance and Commitment Therapy significantly improved parental psychological flexibility and reduced psychological distress compared with usual care and waitlist, but was not significantly different from active treatments. Limited studies have provided very preliminary evidence that Acceptance and Commitment Therapy can significantly improve dysfunctional parenting behaviour than usual care and waitlist. High attrition rate at follow-up made the overall confidence of maintained effect relatively low. CONCLUSION: This review provides preliminary evidence that Acceptance and Commitment Therapy is beneficial for improving psychological flexibility, psychological distress and parenting behaviour among parents of children with chronic health conditions. Future studies with rigorous designs and large sample sizes are warranted to verify the evidence and explore its long-term efficacy. IMPACT: Acceptance and Commitment Therapy has been increasingly applied to parents of children with chronic health conditions. This review provides positive evidence of its effects on psychological and behavioural outcomes among these parents. This work will help healthcare professionals and researchers with their practice and further research.

Challenges encountered by patients with end-stage kidney disease in accessing symptom management services: A narrative inquiry.

AIM: To understand the storied experiences of accessing symptom management services of patients with end-stage kidney disease (ESKD) who are receiving maintenance dialysis. DESIGN: Narrative inquiry. METHODS: Ten patients with ESKD who were receiving dialysis were recruited at two regional hospitals in Hong Kong and interviewed three times each between July 2017-July 2018 to capture their narratives. The data were analysed using the narrative inquiry approach from the perspective of Levesque's framework of access to care. RESULTS: Five themes emerged from the participants' narratives. The first theme illustrated access to care as a process by which symptom management needs were met. However, clinicians occasionally identified patients based on their diseases instead of their needs and this process was affected differently by interpersonal and system factors. The themes 'building trust' and 'facilitating communication' described interpersonal factors that were essential to maintaining a constructive patient-clinician partnership. The themes 'balancing efficiency' and 'navigating fragmented system' described system-related factors. CONCLUSIONS: This study identified the factors that influenced the delivery and/or reception of symptom management services for patients with ESKD who were receiving dialysis. The results suggest that healthcare services should be streamlined based on patients' needs and that this process should address the important elements of trust and communication. IMPACT: The study's results suggest potential improvements to symptom management services that would enable patients' needs to be addressed in a timely and humanistic manner.

Mobile Health to Improve Hypertension and Diabetes Health Literacy Among Asian Indian Migrants to Hong Kong.

The use of mobile technologies to improve health outcomes or mobile health is rapidly evolving, and culturally relevant resources are needed to address health disparities among vulnerable populations. Noncommunicable disease health disparities among Asian Indian migrants to Hong Kong are prevalent. A mobile health application designed to improve hypertension and type 2 diabetes mellitus health literacy was tested using a mixed-methods design to determine its impact on improving health literacy among this subpopulation. Quantitative findings indicated the mobile health application was effective in improving health literacy. Qualitative findings revealed participant perceptions about the application explored its informative nature, usability and likability of application components, and its ability to initiate intentionality for a healthier lifestyle among users. This feedback was valuable to ensure future modifications that will promote the application's scalability and sustainability.

Enhancing generic capabilities and metacognitive awareness of first-year nursing students using active learning strategy.

BACKGROUND: Developing students' generic capabilities is a major goal of university education as it can help to equip students with life-long learning skills and promote holistic personal development. However, traditional didactic teaching has not been very successful in achieving this aim. Kember and Leung's Teaching and Learning Model suggests an interactive learning environment has a strong impact on developing students' generic capabilities. Metacognitive awareness is also known to be related to generic capability development. This study aimed to assess changes on the development of generic capabilities and metacognitive awareness after the introduction of active learning strategy among nursing students. METHODS: This study adopted a quasi-experimental single group, matched pre- and posttest design. It was conducted in a school of nursing at a university in Hong Kong. Active learning approaches included the flipped classroom (an emphasis on pre-reading) and enhanced lectures (the breaking down of a long lecture into several mini-lectures and supplemented by interactive learning activities) were introduced in a foundational nursing course. The Capabilities Subscale of the Student Engagement Questionnaire and the Metacognitive Awareness Inventory were administered to two hundred students at the start (T0) and at the end of the course (T1). A paired t-test was performed to examine the changes in general capabilities and metacognitive awareness between T0 and T1. RESULTS: A total of 139 paired pre- and post-study responses (69.5 %) were received. Significant improvements were observed in the critical thinking (p < 0.001), creative thinking (p = 0.03), problem-solving (p < 0.001) and communication skills (p = 0.04) with the implementation of active learning. Significant changes were also observed in knowledge of cognition (p < 0.001) and regulation of cognition (p < 0.001) in the metacognitive awareness scales. CONCLUSIONS: Active learning is a novel and effective teaching approach that can be applied in the nursing education field. It has great potential to enhance students' development of generic capabilities and metacognitive awareness.

Burden of living with multiple concurrent symptoms in patients with end-stage renal disease.

AIMS AND OBJECTIVES: To explore the experience of multiple concurrent symptoms over time and their impact on daily living in patients with end-stage renal disease undergoing dialysis. BACKGROUND: Patients undergoing dialysis experienced multiple concurrent symptoms because of the disease and treatment. Evidence suggests that these symptoms cluster around and have a significant impact on quality of life. However, the experience of this impact remained not clear. DESIGN: A longitudinal descriptive qualitative study. METHODS: Ten patients were purposely selected from the cohort of a longitudinal quantitative study in Hong Kong. A total of 28 face-to-face semi-structured interviews were conducted between July 2017 and July 2018. Interviews were audiotaped, transcribed and analysed using a thematic analysis approach. Findings were reported following the COREQ checklist. RESULTS: Four themes emerged from the data. The first theme "complex symptom experience" described a dynamic pattern of symptoms among patients. Although patients were unaware of the relationships among symptoms, a cluster of tiredness, breathlessness, dizziness and sleep disturbance was identified in the narratives of individual symptoms. The report of symptom experience and its change revealed a unique pattern of symptom perception. The three other themes illustrated the impact of multiple concurrent symptoms on daily living, namely "decreased physical functioning," "changes in social functioning" and "diet and fluid restrictions." CONCLUSIONS: Patients perceived dynamic and complex symptom experiences. This perception appears to be modulated by a number of factors. In addition, these experiences had negative and positive effects on patients' daily living. RELEVANCE TO CLINICAL PRACTICE: Patients perceived unique impact of symptoms on daily living. Therefore, a nurse-led person-centred approach of care is warranted. In addition to routine symptom assessment, nurses need to capture the specific impact of symptoms on day-to-day life. Based on this assessment, symptom management interventions (e.g. health education, referral) can be tailor-made and prioritised.