Process research: compare and contrast the recovery-orientated strengths model of case management and usual community mental health care.

BACKGROUND: The strengths model of case management (SMCM), which was developed by Rapp and Goscha through collaborative efforts at the University of Kansas, assists individuals with mental illness in their recovery by mobilizing individual and environmental resources. Increasing evidence has shown that the utilization of the SMCM improves outcomes, including increased employment/educational attainment, reduced hospitalization rates, higher self-efficacy, and hope. However, little is known about the processes through which the SMCM improves outcomes for mental health service users. This study explores the views of case workers and service users on their experience of providing or receiving the SMCM intervention. METHODS: A qualitative design was employed using individual interviews with service users and case workers drawn from two study conditions: the SMCM group and the control group (treatment as usual). For both study conditions, service users were recruited by either centres-in-charge or case workers from integrated community centres for mental wellness (ICCMWs) operated by three non-governmental organizations (NGOs) in different districts of Hong Kong. Through purposeful sampling, 24 service users and 14 case workers from the SMCM and control groups joined the study. We used an inductive approach to analyse the qualitative data. RESULTS: We identified two overarching themes: service users' and case workers' (1) perceptions of the impacts of the interventions (SMCM and control group) and (2) experiences of the interventions, such as features of the interventions and the factors that facilitated the outcomes. The results showed that there were improvements in the functional recovery of the SMCM group in areas such as employment and family relationships, how self-identified goals were achieved, and how service users gained a better understanding of their own strengths and weaknesses. Regarding their experience of the interventions, participants in both the SMCM group and the control group reported that a good relationship between service users and case workers was vital. However, some concerns were raised about the use of SMCM tools, including the strengths assessment and the personal recovery plan (PRP) and the risk of case workers being subjective in the presentation of cases in group supervision sessions. CONCLUSION: The results were promising in terms of supporting the use of the SMCM, with some refinements, in mental health services for Chinese clients. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617001435370 , registered on 10/10/2017.

The evaluation of a palliative care programme for people suffering from life-limiting diseases.

AIMS AND OBJECTIVES: To report on the effectiveness of an eight-week palliative care programme in Hong Kong. BACKGROUND: A recent survey reported that the quality of palliative care services in Hong Kong ranked the 20th among 40 countries and it is far behind other Asian countries. There are disagreement and inadequate communication in clinical decision-making among patients, families and healthcare professionals, and that the nurses lack sufficient knowledge and skills in providing palliative care and advance care planning. DESIGN: A pretest post-test design and semi-structured interviews were adopted. METHODS: A total of 108 home care patients with life-limiting disease and their family caregivers in Hong Kong were recruited to complete a set of questionnaire including The McGill Quality of Life Questionnaire for Hong Kong Chinese and the Family Satisfaction Scale before and after they attended an eight-week programme. The programme comprised the elements of symptom management, intensive communication on advance care planning and psychosocial intervention. RESULTS: Pearson's chi-square tests and Wilcoxon matched paired tests show a general trend that the patients' quality of life was improved after the programme. Their understanding and active participation in advance care planning was also improved. The hospital readmission rate and the days of hospital stays were significantly reduced. In qualitative interview, four major themes were identified that are as follows: improvement in the communication of treatment plans and after-death arrangements, symptom management, emotional support and suggested areas of improvement. CONCLUSION: The study supports the benefit of implementing a palliative care programme to patients with life-limiting disease. Patients demonstrated improved understanding and changed behaviour as regards the preparation for death and dying after the eight-week programme. RELEVANCE TO CLINICAL PRACTICE: The programme could be replicated in other hospitals and infirmaries that offer home care services.

Implementation of the Project P.A.T.H.S. in a school with a religious background: a case study.

This paper reports the findings of a case study that attempted to identify school-related factors influencing the quality of implementation of the Tier 1 Program of the Project P.A.T.H.S. in Hong Kong. The case study method was utilized to investigate perceptions of the program implementers of program effectiveness, and to identify the crucial factors for program success in a school with a religious background that admits students with high academic achievement. Findings demonstrated that incorporation of the program into the formal curriculum, good administrative support, efficient management from school, and presence of dedicated teachers contributed to program success. The present findings provide insight for the implementation of the Project P.A.T.H.S. in schools with a religious background.

Implementation of the Project P.A.T.H.S. in Hong Kong: observations based on the Co-Walker Scheme.

The implementation quality of the Tier 1 Program (Secondary 1 Program) of the Project P.A.T.H.S. in the third year of the Full Implementation Phase was examined in this study, with classroom observations of 233 units in 157 schools. Results demonstrated that the overall level of program adherence was generally high with an average of 72.96%. A total of 13 aspects regarding program delivery were significantly correlated. Multiple regression analyses indicated that overall implementation quality was significantly predicted by student participation and involvement, classroom control, use of positive and supportive feedback, degree of achievement of the objectives, and time management. Student participation and involvement, classroom control, degree of achievement of the objectives, and time management were significant predictors of success of implementation.

Evaluation of a school-based dissemination of the movement guidelines for young children in Hong Kong: Study protocol.

BACKGROUND: Healthy movement behaviors in early childhood are believed to track to adulthood, potentially imparting protective benefits against non-communicable diseases. Highlighting the collaborative and complementary roles of parents and educators in promoting health of young children, this study aims to enable parents and teachers to successfully promote healthy movement behaviors in young children. Guidelines for physical activity, sedentary screen time, and sleep of children aged 2 to 6 years will be systematically disseminated to parents and teachers of children enrolled in early childhood education centers (ECECs) in Hong Kong. An evaluation will be conducted to assess the implementation process and the outcomes of the dissemination of said guidelines. METHODS: The evaluation will include formative and summative components to examine the implementation (i.e., process evaluation) and the outcomes (i.e., outcome evaluation). Participants include teachers, parents, and children from ECECs in Hong Kong. The process evaluation will be guided by the RE-AIM framework (i.e., reach, efficacy, adaptation, implementation, maintenance). Data gathering and analysis will take a mixed-methods triangulation design - convergence model. The outcome evaluation consists of a non-randomized observational study, using quantitative data from questionnaires and accelerometers. The primary outcome to be measured is the extent to which children meet the guidelines for physical activity, sedentary screen time, and sleep; the secondary outcome is teachers' and parents' knowledge and awareness of the guidelines. DISCUSSION: Young children who engage in healthy movement behaviors are likely to become adults who will have the disposition to engage in behaviors that have protective effects against non-communicable diseases. The findings of this evaluation are expected to contribute to improving the strategies of systems and government agencies that aspire to promote healthy movement behaviors of young children.

Prevalence and associated factors of alexithymia among Chinese adolescents in Hong Kong.

Alexithymia ("no words for feelings") is a personality construct characterized by an inability to identify, describe, and verbalize one's feelings, constricted imagination, and an externally oriented way of thinking. Alexithymia is commonly measured with self-report instruments. Data, in particular from Asian countries, regarding the epidemiology of alexithymia in adolescents are relatively limited. The objectives of this study were to examine the prevalence and explore the relationship between alexithymia, family emotional expressiveness, parental acceptance-rejection, and depression. A total of 1606 Chinese adolescents aged between 10 and 17 years old were recruited from 11 schools across the three major geographical regions of Hong Kong. A self-report questionnaire was administered. About 36% of adolescents were classified as alexithymic in the whole sample (males: 34.3%, females: 40.0%) and no gender differences were found. Adolescents with lower family emotional expressiveness and depression were more likely to report alexithymia. The alexithymia rate among Chinese adolescents was higher than in most of the existing studies. The association of alexithymia with diminished family emotional expressiveness underscores the relevance of targeting adolescents with low family emotional expressiveness, and depressive symptoms to increase their capacity to identify and communicate emotions in order to improve their psychological well-being.

Subjective outcome evaluation of the project P.A.T.H.S. (Secondary 2 program): views of the program participants.

A total of 196 secondary schools participated in the Secondary 2 Program of the Full Implementation Phase of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes). After completion of the Tier 1 Program, 30,731 students responded to the Subjective Outcome Evaluation Form (Form A) to assess their perceptions of the program, instructors, and perceived effectiveness of the program. Based on the consolidated reports submitted by the schools to the funding body, the research team aggregated the consolidated data to form a "reconstructed" overall profile on the perceptions of the program participants. Findings demonstrated that high proportions of the respondents had positive perceptions of the program and the instructors, and roughly four-fifths of the respondents regarded the program as beneficial to them. Correlation analyses showed that perceived program and instructor characteristics were positively associated with perceived benefits of the program.

Qualitative evaluation of the project P.A.T.H.S.: findings based on focus groups with student participants.

This paper reports a qualitative evaluation study conducted to explore the perceptions of students who joined the Tier 1 Program of the Project P.A.T.H.S. A total of 92 students were randomly selected to participate in 10 focus groups, which provided qualitative data for the study. With specific focus on how the informants described the program, the descriptors used were primarily positive; the metaphors named by the informants that could stand for the program were basically positive. Program participants also perceived the program to be beneficial in different psychosocial domains. The present study lends further support to the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. in promoting holistic development in Chinese adolescents.

Secondary 1 program of project P.A.T.H.S.: process evaluation based on the co-walker scheme.

This study examined the implementation quality of the Tier 1 Program (Secondary 1 Curriculum) delivered in the second year of the Full Implementation Phase of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes). Under the "Co-Walker Scheme", systematic observation of curriculum units was conducted in 138 schools. Results indicated that the overall level of program adherence was high, with an average of 82.9%. The mean ratings of the program implementation quality were also high. Despite limitations, the findings of this study suggest that the implementation of the Secondary 1 Program (Tier 1 Program) of the Full Implementation Phase was of very high quality. The present findings also provide strong evidence to account for the successful and encouraging outcomes of a major positive youth development program in Hong Kong.

Low coverage of influenza vaccination among Chinese children aged 12-23 months: Prevalence and associated factors.

This study aimed to investigate prevalence and associated factors of influenza vaccination (IV) among children aged 12-23 months. Our cross-sectional survey interviewed 489 parents of children aged 12-23 months anonymously at twelve maternal and child health centers in Hong Kong. Results showed that only 11.5% of the children had ever received IV (64.3% being subsidized). Adjusted for the child's age, significant factors of the children's IV included parental knowledge about governmental policy/recommendation (Adjusted odds ratio [AOR] = 2.64, 95%CI = 1.09,6.40), knowledge about annual IV requirement (AOR = 2.30, 95%CI = 1.21,4.38), perceived safety-related barrier (AOR≥0.14, 95%CI = 0.06,0.33), cue to action (AOR = 7.79, 95%CI = 3.45,17.58), and subjective norm (AOR = 4.59, 95%CI = 2.34,9.00). IV prevalence of children aged 12-23 months remained low despite a subsidization scheme. The higher IV prevalence of older children reported by other studies suggested that parents postponed action. Promotion campaigns should shift emphases from cost reduction and mass media approaches to dissemination of knowledge about IV policy and safety, enhancement of health professionals' advice, and creation of supportive subjective norm.

Community-based positive youth development program in Hong Kong: views of the program implementers.

Based on the data collected from the Tier 1 Program of a community-based positive youth development program (Project P.A.T.H.S.) in 2013, the current study explored the perspectives of 634 program implementers who implemented the Tier 1 Program in Hong Kong. Upon the completion of the program, the program implementers responded to a validated client satisfaction scale (Form B). The results showed that the program implementers perceived the program, implementers and benefits of the program in a positive manner. However, there were no differences among perceived program content, implementers and effectiveness across the three grades. Consistent with previous studies, perceived program predicted effectiveness of the program. Nevertheless, program implementers did not predict program effectiveness. Once again, the present findings indicated that the Tier 1 Program was well received by the program implementers.

Positive youth development programs for adolescents with greater psychosocial needs: evaluation based on program implementers.

As program implementers' views are seldom included in program evaluation and there are few related studies in different Chinese communities, this study examined the perceptions of the program implementers who implemented the Tier 2 Program of the P.A.T.H.S. Program in Hong Kong. The Tier 2 Program was designed to promote the development of adolescents with greater psychosocial needs. In the community-based P.A.T.H.S. Project, 400 program implementers completed a subjective outcome evaluation form (Form D) for program implementers. Consistent with the previous findings, program implementers generally held positive views towards the program, implementers, and program effectiveness and their views towards these three domains did not differ across grades. In line with the hypotheses, perceived program quality and perceived implementer quality predicted program effectiveness. The present findings provided an alternative perspective showing that the Tier 2 Program was well received by the program implementers and they regarded the program to be beneficial to the program participants.

Qualitative evaluation of general university requirements in a new 4-year university curriculum: findings based on experiences of students.

Following the North American model, the length of undergraduate program in Hong Kong has been extended from 3 to 4 years since 2012. To maximize the impact of the additional year, The Hong Kong Polytechnic University (PolyU) has implemented a new general education framework entitled "General University Requirements (GUR)" aiming to cultivate students in a holistic manner. This study explored students' impressions of the GUR subjects using a survey collecting primarily qualitative data. Results from 163 students of eight faculties showed that students perceived the GUR subjects favorably. Having opportunities to make new friends from other departments and the teaching and learning methods, particularly experiential learning stimulated students' interest and enriched their learning experiences which were reportedly are unforgettable. Some of the obstacles encountered by students in several subjects were identified. The beneficial effects of the GUR subjects in different domains were voiced by the students.