Influence of Nurses' Perceptions of Government Policies and COVID-19 Risks on Their Mental Health Status: A Web-Based Cross-Sectional Study.

This study aimed to understand nurses' perceptions of COVID-19-related policies and risks during the outbreak of COVID-19 in Hong Kong and to determine how their perceptions influenced their mental health status. A web-based online survey among Hong Kong nurses was conducted. The questionnaire included a self-designed 5-point Likert scale with 17 items to assess the nurses' perceptions of COVID-19-related policies and risks, as well as the Davidson Trauma Scale (DTS), the Perceived Stress Scale (PSS), the Patient Health Questionnaire-2 (PHQ-2) and the Generalised Anxiety Disorder scale (GAD) for measurement of posttraumatic stress disorder (PTSD), stress, depression and anxiety, respectively. Of 592 nurses enrolled, 30.6% had PTSD (DTS total score ≥40), and 80.4%, 19.9% and 16.4% had moderate-to-high levels of stress (PSS-10 score ≥14), depression (PHQ-2 score ≥3) and anxiety (GAD score ≥3), respectively. The top three concerned aspects were 'worried about themselves and friends to suffer this disease' (84.5%), 'insufficient number of isolation wards' (81.8%) and 'insufficient number of personal protective equipment' (74.3%). Logistic regression analyses showed that more negative perception on 'personal protective equipment in the healthcare institutions', 'the confidence in HK's control of COVID-19', 'worried about themselves and friends to suffer this disease' and 'self-perceived risk of infection' indicated higher severity of the four mental health problems (all p < 0.01). The perception on 'public gathering ban', 'the number of isolation wards' and 'expected time to control COVID-19' were significantly associated with PTSD and stress (all p < 0.05). Nurses' perception on government policies and COVID-19 risks played an important role in predicting their mental health status. Policy makers should be aware of nurses' psychological responses and provide timely and targeted emotional support to nurses amid and after the COVID-19 pandemic.

Combined Influence of Eight Lifestyle Factors on Metabolic Syndrome Incidence: A Prospective Cohort Study from the MECH-HK Study.

Although previous studies have shown significant associations between individual lifestyles and metabolic syndrome, limited studies have explored the combined effect of lifestyles. The purpose of this study was to investigate whether a combined lifestyle score was associated with metabolic syndrome incidence in Hong Kong Chinese women. This prospective cohort study included 1634 women (55.9 ± 8.6 years) without baseline metabolic syndrome, diabetes, myocardial infarction, or stroke. Eight lifestyle factors (smoking, physical activity, sedentary time, sleep, stress, fatigue, diet, and alcohol) were included by assigning 0 (unhealthy) or 1 point (healthy). The overall score was the sum of these points, ranging from 0 (the least healthy) to 8 points (the healthiest). Metabolic syndrome was diagnosed by the joint interim statement. During a 1.16-year follow-up, 179 (11.0%) new metabolic syndrome cases were identified. The incidences for the 0-3-point, 4-point, 5-point, and 6-8-point groups were 12.8% (79/618), 11.5% (42/366), 9.4% (29/309), and 8.5% (29/341), respectively. Compared to the lowest combined lifestyle score group, the highest group had a 47% reduced metabolic syndrome incidence, with an adjusted odds ratio and 95% confidence interval of 0.53 (0.33-0.86) (p = 0.010). These findings indicate that a higher combined lifestyle score was associated with a lower metabolic syndrome incidence in this population.

Associations of combined lifestyle index with migraine prevalence and headache frequency: a cross-sectional study from the MECH-HK study.

BACKGROUND: Prior research has shown that individual lifestyles were associated with migraine. Yet, few studies focused on combined lifestyles, particularly in Chinese populations. This cross-sectional study aimed to investigate the relationships of a combined lifestyle index with migraine in Hong Kong Chinese women. METHODS: Baseline data from a cohort study named Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women (MECH-HK) were used for analysis. In total 3510 women aged 55.2 ± 9.1 years were included. The combined lifestyle index comprised eight lifestyle factors: smoking, physical activity, sleep, stress, fatigue, diet, body mass index, and alcohol. Each component was attributed a point of 0 (unhealthy) or 1 (healthy). The overall index was the sum of these points, ranging from 0 (the least healthy) to 8 points (the healthiest). Migraine was diagnosed by the International Classification of Headache Disorders 3rd edition. Additionally, for women with migraine, the data on migraine attack frequency (attacks/month) was collected. RESULTS: A total of 357 women with migraine (10.2%) were identified. The prevalence of migraine for the 0-3-point, 4-point, 5-point, 6-point, and 7-8-point groups were 18.0% (162/899), 10.9% (86/788), 6.6% (51/776), 6.0% (38/636), and 4.9% (20/411), respectively. In the most-adjusted model, compared to the 0-3-point group, the odds ratios and 95% confidence intervals for the 4-point, 5-point, 6-point, and 7-8-point groups were 0.57 (0.43-0.75), 0.33 (0.24-0.46), 0.30 (0.21-0.44), and 0.25 (0.15-0.41), respectively (all p < 0.001). For each component, migraine was significantly associated with sleep, stress, fatigue, and diet; but was unrelated to smoking, physical activity, body mass index, and alcohol. Among women with migraine, per point increase in the combined lifestyle index was associated with a reduced migraine attack frequency (ß = - 0.55; 95% confidence interval = - 0.82, - 0.28; p < 0.001). CONCLUSIONS: A combined lifestyle index was inversely associated with migraine and migraine attack frequency in Hong Kong Chinese women. Adhering to a healthy lifestyle pattern might be beneficial to the prevention of migraine attacks. Conversely, it is also plausible that women with migraine might have a less healthy lifestyle pattern compared to those without headaches.

A Machine Learning-Based Preclinical Osteoporosis Screening Tool (POST): Model Development and Validation Study.

Background: Identifying persons with a high risk of developing osteoporosis and preventing the occurrence of the first fracture is a health care priority. Most existing osteoporosis screening tools have high sensitivity but relatively low specificity. Objective: We aimed to develop an easily accessible and high-performance preclinical risk screening tool for osteoporosis using a machine learning-based method among the Hong Kong Chinese population. Methods: Participants aged 45 years or older were enrolled from 6 clinics in the 3 major districts of Hong Kong. The potential risk factors for osteoporosis were collected through a validated, self-administered questionnaire and then filtered using a machine learning-based method. Bone mineral density was measured with dual-energy x-ray absorptiometry at the clinics; osteoporosis was defined as a t score of -2.5 or lower. We constructed machine learning models, including gradient boosting machines, support vector machines, and naive Bayes, as well as the commonly used logistic regression models, for the prediction of osteoporosis. The best-performing model was chosen as the final tool, named the Preclinical Osteoporosis Screening Tool (POST). Model performance was evaluated by the area under the receiver operating characteristic curve (AUC) and other metrics. Results: Among the 800 participants enrolled in this study, the prevalence of osteoporosis was 10.6% (n=85). The machine learning-based Boruta algorithm identified 15 significantly important predictors from the 113 potential risk factors. Seven variables were further selected based on their accessibility and convenience for daily self-assessment and health care practice, including age, gender, education level, decreased body height, BMI, number of teeth lost, and the intake of vitamin D supplements, to construct the POST. The AUC of the POST was 0.86 and the sensitivity, specificity, and accuracy were all 0.83. The positive predictive value, negative predictive value, and F1-score were 0.41, 0.98, and 0.56, respectively. Conclusions: The machine learning-based POST was conveniently accessible and exhibited accurate discriminative capabilities for the prediction of osteoporosis; it might be useful to guide population-based preclinical screening of osteoporosis and clinical decision-making.

Psychosocial Factors and Parent-Infant Bonding.

BACKGROUND: Parent-infant bonding plays a significant role in promoting the psychosocial well-being of the child. This study aimed to examine the relationships between family sense of coherence, marital satisfaction, depressive symptoms, and parent-infant bonding among Chinese parents at 6 weeks postpartum. METHODS: A secondary data analysis was conducted of an intervention study for postnatal depression. The participants were Chinese parents recruited from public hospitals. Family sense of coherence, marital satisfaction, depressive symptoms, and parent-infant bonding were measured using the Family Sense of Coherence Scale, the Dyadic Adjustment Scale, the Edinburgh Postnatal Depression Scale, and the Postpartum Bonding Questionnaire, respectively. Path analysis was performed on data collected from the control group (n = 211) at 6 weeks postpartum. RESULTS: Less impairment of mother-infant bonding at 6 weeks postpartum was found among mothers who had a stronger family sense of coherence and lower levels of depressive symptoms. Less impairment of father-infant bonding at 6 weeks postpartum was found among fathers who had greater marital satisfaction and family sense of coherence and fewer depressive symptoms. The mothers' levels of family sense of coherence, marital satisfaction, and parent-infant bonding were closely related to those of their partners. CONCLUSION: The study highlights the importance of developing culturally appropriate interventions that focus on strengthening family sense of coherence, enhancing marital satisfaction, and reducing depressive symptoms in both parents to promote the quality of parent-infant bonding at early postpartum.

Sleep and depression in couples during the transition to parenthood.

OBJECTIVES: The objectives were to: (1) investigate the prevalence, differences and changes in sleep quality over time among Chinese couples during pregnancy and at 6 weeks and 6 months postpartum and (2) examine the association between sleep quality and depressive symptoms. METHOD: This study was part of an intervention study for postnatal depression. Childbearing couples were recruited from antenatal clinics. Data on sleep and depression during pregnancy and at 6 weeks and 6 months postpartum were collected using the Pittsburgh Sleep Quality Index (PSQI) and Edinburgh Postnatal Depression Scale, respectively. RESULTS: The prevalence of sleep disturbance (PSQI score > 5) during pregnancy and at 6 weeks and 6 months postpartum was 45.0%, 62.8% and 36.8%, respectively, among women and 26.4%, 36.4% and 27.3%, respectively, among men. Sleep quality declined significantly in both partners from pregnancy to 6 weeks postpartum, followed by a significant improvement by 6 months postpartum. The results revealed significant correlations between partners' scores on sleep quality across the perinatal period, with women experiencing poorer sleep quality than men. Poor sleep was associated with depressive symptoms across the perinatal period for both partners. CONCLUSIONS: This study highlights the importance of screening couples for sleep disturbances throughout pregnancy and the postnatal period and assisting them to develop strategies to improve sleep quality during the transition to parenthood.

The Multimorbidity and Lifestyle Correlates in Chinese Population Residing in Macau: Findings from a Community-Based Needs Assessment Study.

Multimorbidity has become one of the most pressing public health concerns worldwide. The objectives of this study were to understand the prevalence of multimorbidity and its relationship with lifestyle factors among Chinese adults in Macau, and to investigate the combined contribution of common lifestyle factors in predicting multimorbidity. Data were collected through face-to-face interviews using a self-reported questionnaire on common chronic diseases, lifestyle factors and sociodemographics. BMI, physical activity, drinking status, smoking status and sleep quality were assessed, and a composite lifestyle score (0 to 9 points) was calculated, and the higher the score, the healthier the lifestyle. A total of 1443 participants were included in the analysis, of whom 55.2% were female, 51.8% were middle aged or elderly and 30.5% completed tertiary education or higher. The prevalence of multimorbidity was 10.3%. The combination of hypertension and hyperlipidaemia was the most common (22.2%) multimorbidity among the participants with multimorbidity. After the adjustment of the covariates, it was found that the participants who were overweight (OR: 1.95, 95% CI: 1.18-3.20, p = 0.009) or obese (OR: 3.76, 95% CI: 2.38-5.96, p < 0.001), former drinkers (OR: 2.43, 95% CI: 1.26-4.69, p = 0.008), and those who reported poor sleep quality (OR: 2.25, 95% CI: 1.49-3.40, p < 0.001) had a high risk of developing multimorbidity. A one-unit increase in the lifestyle score was associated with a 0.33-times reduction in the risk of developing multimorbidity (OR: 0.67; 95% CI: 0.59-0.77, p < 0.001). A combination of lifestyle factors can influence a variety of multimorbidity among the Chinese adults in Macau. Thus, comprehensively assessing the combined contribution of several lifestyle factors in predicting multimorbidity is important.

Couple-based interpersonal psychotherapy for first-time parents: A process evaluation.

PURPOSE: First-time parents have an increased risk of depression during the transition to parenthood, which has long-term adverse effect on the infant development. Interpersonal psychotherapy (IPT) has been shown to effectively reduce postnatal depression. The objectives of this study were to explore first-time parents' perceptions of a couple-based IPT program and to identify positive and negative influences on the effectiveness of the intervention through a process evaluation. DESIGN AND METHODS: A process evaluation was conducted as part of a randomized controlled trial of a couple-based IPT program. A program satisfaction questionnaire was used to assess the participants' satisfaction with the structure, process and outcome of the program. Semi-structured telephone interviews were conducted with a purposive sample of 44 first-time parents who had received the couple-based IPT. The interview data were analyzed by thematic analysis. RESULTS: The qualitative findings showed that the parents perceived couple-based IPT as useful for enhancing their interpersonal relationship, emotional control and competence in child care. The successful implementation of the couple-based IPT program was influenced by its delivery by midwives, the interactive lessons used to engage the participants, the close fit of the teaching contents to the needs of first-time parents and the flexible program schedule and delivery mode. CONCLUSIONS: The process evaluation indicates that couple-based IPT is an acceptable and feasible intervention for first-time parents to facilitate a healthy transition to parenthood. PRACTICE IMPLICATIONS: The couple-based IPT can be used as an adjunct to standard care to promote perinatal health.

The effects of mHealth interventions on improving institutional delivery and uptake of postnatal care services in low-and lower-middle-income countries: a systematic review and meta-analysis.

BACKGROUND: Maternal mortality due to pregnancy, childbirth and postpartum is a global challenge. Particularly, in low-and lower-income countries, the outcomes of these complications are quite substantial. In recent years, studies exploring the effect of mobile health on the improvement of maternal health are increasing. However, the effect of this intervention on the improvement of institutional delivery and postnatal care utilization was not well analyzed systematically, particularly in low and lower-middle-income countries. OBJECTIVE: The main aim of this review was to assess the effect of mobile heath (mHealth) interventions on improving institutional delivery, postnatal care service uptake, knowledge of obstetric danger signs, and exclusive breastfeeding among women of low and lower-middle-income countries. METHODS: Common electronic databases like PubMed, EMBASE, the Web of Science, Medline, CINAHL, Cochrane library, Google scholar, and gray literature search engines like Google were used to search relevant articles. Articles that used interventional study designs and were conducted in low and lower-middle-income countries were included. Sixteen articles were included in the final systematic review and meta-analysis. Cochrane's risk of bias tool was used to assess the quality of included articles. RESULTS: The overall outcome of the systematic review and meta-analysis showed that MHealth intervention has a positive significant effect in improving the institutional delivery (OR = 2.21 (95%CI: 1.69-2.89), postnatal care utilization (OR = 4.13 (95%CI: 1.90-8.97), and exclusive breastfeeding (OR = 2.25, (95%CI: 1.46-3.46). The intervention has also shown a positive effect in increasing the knowledge of obstetric danger signs. The subgroup analysis based on the intervention characteristics showed that there was no significant difference between the intervention and control groups based on the intervention characteristics for institutional delivery (P = 0.18) and postnatal care utilizations (P = 0.73). CONCLUSIONS: The study has found out that mHealth intervention has a significant effect on improving facility delivery, postnatal care utilization, rate of exclusive breastfeeding, and knowledge of danger signs. There were also findings that reported contrary to the overall outcome which necessitates conducting further studies to enhance the generalizability of the effect of mHealth interventions on these outcomes.

Predictors of Parent-Infant Bonding Among Postpartum Chinese Mothers and Fathers.

INTRODUCTION: The emotional bond that parents feel with their child is a crucial determinant of the child's psychosocial well-being and future development. Few studies have evaluated the predictive roles of depressive symptoms, relationship satisfaction, and family sense of coherence in the quality of parent-infant bonding for both parents during the perinatal period. The aim of this study was to determine the predictive effects of depressive symptoms, relationship satisfaction, and family sense of coherence during pregnancy; changes thereof from pregnancy to 6 weeks postpartum; and the partner's bond with the infant on the quality of parent-infant bonding at 6 weeks postpartum in Chinese mothers and fathers. METHODS: This was a secondary analysis of data from an intervention study. A convenience sample of 231 Chinese childbearing couples was recruited from the antenatal clinics of public hospitals in Hong Kong. Parent-infant bonding, depressive symptoms, relationship satisfaction, and family sense of coherence were measured using the Postpartum Bonding Questionnaire, Edinburgh Postnatal Depression Scale, Dyadic Adjustment Scale, and Family Sense of Coherence Scale during pregnancy and at 6 weeks postpartum. RESULTS: The findings indicated that higher depressive symptoms during pregnancy and poor partner bonding with the infant were the major predictors of impaired parent-infant bonding at 6 weeks postpartum for both parents. Prenatal relationship satisfaction was not a significant predictor of parent-infant bonding at 6 weeks postpartum for either parent. Prenatal family sense of coherence was a strong predictor of parent-infant bonding for mothers but not for fathers. DISCUSSION: The findings highlight the significant effects of depressive symptoms, family sense of coherence, and the partner's bond with the infant on parent-infant bonding during the perinatal period. Comprehensive early prenatal programs that promote parental well-being and strengthen family sense of coherence should be integrated into existing perinatal services to promote the quality of parent-infant bonding for both parents.

Effect of couple-based interpersonal psychotherapy on postpartum depressive symptoms: A randomised controlled trial.

OBJECTIVES: Interpersonal psychotherapy (IPT) is one of the most effective interventions for postnatal depression. Few studies have evaluated the effect of IPT on postnatal depression for both mothers and fathers. This aimed to examine the effect of couple-based IPT on postpartum depressive symptoms among Chinese mothers and fathers at 6 weeks and 6 months postpartum. METHODS: A randomised controlled trial was conducted with 455 childbearing couples recruited from two hospitals and randomly allocated to the couple-based IPT (n = 224) and usual care (n = 231) groups. Postpartum depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Both mothers and fathers in the couple-based IPT demonstrated significant and sustained reduction in depressive symptoms at 6 weeks (mean difference in mothers = 1.91, p < .001; mean difference in fathers = 1.14, p = .005) and 6 months postpartum (mean difference in mothers = 0.89, p = .039; mean difference in fathers = 1.29, p = .003), compared to those in usual care. The proportions of mothers and fathers who were at risk of postnatal depression (EPDS > 9) were significantly lower in the IPT group than in the usual care group at 6 weeks postpartum (difference in mothers = 21.9%, p < .001; difference in fathers = 10.7%, p = .005), but no significant differences were found at 6 months postpartum. CONCLUSIONS: The benefits of the couple-based IPT in this study highlights the importance of incorporating IPT into perinatal services to promote perinatal mental health for both partners.

Relationships between infertility-related stress, family sense of coherence and quality of life of couples with infertility.

This is a cross-sectional study with the objective to examine the relationships between infertility-related stress, family sense of coherence and quality of life of Chinese couples with infertility in Hong Kong. A convenience sample of 135 Chinese couples were recruited at the subfertility clinics of the Family Planning Association of Hong Kong. Data were collected using the Fertility Problem Inventory, Family Sense of Coherence Scale and Fertility Quality of Life. Path analysis was used for data analysis. The results showed that infertility-related stress had a negative association with the quality of life of infertile couples and family sense of coherence mediated the effect of infertility-related stress on quality of life for both partners. The infertility-related stress of women had a negative association with their husbands' quality of life. Infertile women had more infertility-related stress and a lower quality of life than their husbands. The findings provide new insights into the importance of family sense of coherence in facilitating couples' adjustment to infertility. Culturally competent heath care interventions should be developed to strengthen family sense of coherence among Chinese couples with infertility and help them reduce their infertility-related stress, thus improving their quality of life.

The effectiveness of psychoeducation interventions on prenatal attachment: A systematic review.

OBJECTIVE: Positive prenatal attachment facilitates parental role adaptation and psychological adjustment during pregnancy, which is a significant predictor of postpartum attachment. The objective of this systematic review was to examine the effect of psychoeducation interventions on prenatal attachment of pregnant women and their partners. DESIGN: Systematic literature searches of randomized controlled trials (RCTs) were conducted from January 2000 to January 2021, using databases: CINAHL, Embase, Medline, PsycInfo, PubMed, Web of Science and Cochrane Central Register of Controlled Trial and through hand-searching. Studies were independently selected by two reviewers, who also assessed the methodological quality of the included studies using the Cochrane Risk of Bias Tool. Narrative synthesis was conducted due to the significant clinical and methodological heterogeneity. SETTING/PARTICIPANTS: Fifteen studies met the eligibility criteria for this review, among which 11 studies focused on pregnant women and four studies on their partners. FINDINGS: The psychoeducation interventions in the included studies showed consistent favorable effects on prenatal attachment. Nine out of the 11 included studies showed statistical significant effects on maternal fetal attachment. Three out of the four studies reported significant effects favoring paternal fetal attachment. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The preliminary evidence suggests that psychoeducation interventions have potential favorable effects on maternal fetal attachment and can enhance paternal fetal attachment. However, more studies are needed for investigating the effects of psychoeducation on paternal fetal attachment and for enhancing the validity of the evidence. Our review recommends that healthcare professionals to include psychoeducation as a part of their prenatal care for promoting prenatal attachment. Common characteristics of the interventions could act as references when designing psychoeducation programs for enhancing prenatal attachment.

Stress, Marital Relationship and Quality of Life of Couples Across the Perinatal Period.

OBJECTIVES: Transition to parenthood is characterized by a high level of stress, which can affect couples' relationship and quality of life. Limited research compares the relationships and trends in stress, marital relationship and quality of life between both couples across the perinatal period. This study examined the associations, changes over time and gender differences in the stress, marital relationship and quality of life of Chinese couples during the perinatal period. METHODS: A convenience sample of 130 couples participated in this longitudinal study. Data on the assessment of stress, marital relationship and quality of life were collected by validated measures during the second or third trimester of pregnancy and at 6 weeks, 6 months and 12 months postpartum. RESULTS: Both couples experienced an increased level of stress at 6 weeks postpartum and a gradual decline in marital relationship from pregnancy to 1 year postpartum. The mental component of women's quality of life declined sharply at 6 weeks postpartum and recovered at 6 months postpartum. The physical component of quality of life showed gradual improvements from pregnancy to 1 year postpartum for the women, but a decline for the men. The women showed more stress and poorer marital relationship and quality of life than their partners, and the women's levels of stress, marital relationship and mental component of quality of life were closely related to those of their partners' across the perinatal period. Stress was related negatively to marital relationship and quality of life, and a positive marital relationship was associated with better quality of life during the perinatal period. CONCLUSION: The study highlights the need to adopt couple-based approaches in clinical practice directed at helping partners develop realistic expectations and manage stress, which are essential to promoting marital relationships and quality of life during the transition to parenthood.

Perception of family sense of coherence among Chinese couples with infertility.

AIMS AND OBJECTIVES: To explore perceptions of family sense of coherence among infertile couples and to provide a theoretical interpretation of the comprehensibility, manageability and meaningfulness of couples' experiences coping with infertility. BACKGROUND: Infertility is a devastating experience for many couples and can have long-lasting psychosocial consequences. Family sense of coherence has the potential to facilitate a couple's adjustment to the life crisis of infertility and may provide a useful conceptual lens to understand experiences of infertility. METHODS: Sixty-four couples with infertility participated in semi-structured interviews at subfertility clinics. Data were analysed using the constant comparative approach of grounded theory. COREQ guidelines were followed in reporting the study. RESULTS: Three major themes related to infertility emerged from the interviews: comprehensibility, manageability and meaningfulness. The couples experienced psychological strain while making cognitive sense of infertility. The significance of children, which is embedded in traditional Chinese culture, created a sense of meaning and purpose in couples' lives and motivated them to mobilise both internal and external resources to cope with the demands of infertility and its treatment. CONCLUSIONS: The findings indicate that the salutogenic model of family sense of coherence can contribute to our understanding of the experiences of infertility among Chinese couples. RELEVANCE TO CLINICAL PRACTICE: The results offer a theoretical framework that healthcare professionals can use to help couples cope with the life crisis of infertility by strengthening their sense of family coherence.

Effect of Baby-Led Self-Attachment Breastfeeding Technique in the Postpartum Period on Breastfeeding Rates: A Randomized Study.

Objective: To evaluate the effects of a baby-led self-attachment breastfeeding support intervention on the prevalence and duration of exclusive breastfeeding and nipple pain at 3 days, 6 weeks, 3 months, and 6 months postpartum among Chinese mothers. Materials and Methods: A randomized study was conducted with 504 mother-infant dyads allocated to the baby-led self-attachment breastfeeding support intervention (n = 251) and standard postpartum care (n = 253). Data on the prevalence and duration of exclusive breastfeeding and nipple pain were collected at 3 days, 6 weeks, 3 months and 6 months postpartum. Results: Mothers in the intervention group were significantly more likely exclusively breastfeeding at 3 days (mean difference = 12.1%, 95% confidence interval [CI]: 3.9-20.2%, p = 0.004) and 6 months postpartum (mean difference = 17.8%, 95% CI: 8.3-27.4%, p < 0.001). They were less likely to stop breastfeeding over the 6-month period, compared with the control group (Hazard ratio = 0.65; 95% CI: 0.49-0.87). They were also less likely to experience nipple pain at 3 days (mean difference = -8.1%, 95% CI: -15.9 to -0.4%, p = 0.04) and 3 months postpartum (mean difference = -4.9%, 95% CI: -8.7 to -1.2%, p = 0.01). Conclusions: The baby-led self-attachment breastfeeding support is clinically effective in increasing the prevalence and duration of exclusive breastfeeding and reducing nipple pain among Chinese mothers.

An Interactive Web-Based Sexual Health Literacy Program for Safe Sex Practice for Female Chinese University Students: Multicenter Randomized Controlled Trial.

BACKGROUND: Sexual health concerns among young adults worldwide help to motivate preventative practices against sexually transmitted infections. To foster better sexual health, sexual health literacy must be enhanced. Little research has been conducted on the impact of gender power dynamics on sexual health, such as sexual coercion, even though the prevalence of sexual coercion remains high in China. OBJECTIVE: This study describes the development and systematic evaluation of a web-based sexual health literacy intervention called "Smart Girlfriend" for female Chinese university students. METHODS: A multicenter randomized controlled trial was conducted with 781 female university students at 5 universities with dormitories in Hong Kong. Inclusion criteria were used to select unmarried, female, Chinese university students who were ≥18 years old and had not received a sexual health intervention in the past 12 months. Participants were randomly assigned to 2 groups: one group received an interactive web-based sexual health literacy intervention and the other group received a single webpage of online information about condom use. The intervention content was based on the Health Belief Model and the Continuum of Conflict and Control theory. The primary outcome was self-reported consistency of condom use with every partner at 3-month and 6-month follow-up assessments, analyzed using zero/one inflated beta (ZOIB) regression. The secondary outcome was an appraisal of the knowledge, attitudes, norms, and self-efficacy of condom use using the 25-item Multidimensional Condom Attitudes Scale (MCAS). The intention to treat was applied in analyses. RESULTS: Of 1503 individuals that were screened, 781 (52%) were randomized into 2 groups. The retention rates at the 3-month and 6-month follow-ups were 92% and 91%, respectively. Most participants were born locally (536/746, 72%), and 18% (134/746) self-reported as a sexual minority. ZOIB results regarding the consistency of condom use were not significant [model 1: odds ratio (OR) 2.25 with a 95% credible interval (CrI) of 0.84-6.36; model 2: OR 8.03 (95% CrI 0.22-330.31); model 3: OR 1.21 (95% CrI 0.78-1.86)]. Consistency in the intervention group was 5% higher (95% CI -1.90 to 11.63) than the control group at the 3-month follow-up, and 1% higher (95% CI -5.81 to 8·02) at the 6-month follow-up. MCAS scores at the 3-month follow-up were significantly higher in the intervention group (mean 122.51, SD 15.97) than the control group (mean 119.86, SD 15.85; P=.02). CONCLUSIONS: An interactive web-based sexual health literacy program did not significantly increase the consistency of condom use compared to a single webpage of condom use information; however, it did temporarily improve knowledge, attitudes, norms, and self-efficacy regarding condom use. Future revisions of this intervention should be personalized and delivered with a proactive approach. TRIAL REGISTRATION: ClinicalTrials.gov NCT03695679; https://clinicaltrials.gov/ct2/show/NCT03695679.

Process evaluation of couple-based psychoeducation program for first-time parents.

RATIONALE: Postpartum depression is a worldwide public health issue that can have long-term impact on the family. It is crucial to evaluate intervention program to help new parents cope with the stress of parenthood to reduce the risk of postpartum depression. The aim of this study was to explore the perceived benefits of the couple-based psychoeducation to first-time Hong Kong Chinese parents, and the crucial factors influencing the effectiveness of this program underpinned by the concept of process evaluation. METHOD: Using an exploratory qualitative design, a purposeful sample of 27 couples who had participated in the program were interviewed at 1-3 months postpartum. Data were collected using semi-structured interviews and analysed by thematic analysis. FINDINGS: The findings showed that the parents perceived the program to be useful in enhancing their parenting skills and emotional control, and increasing their sense of support. The effectiveness of the program was facilitated by (a) the predisposing factors such as couple-based approach to enhance mutual expectation and shared decision making when experiencing and managing challenges, and telephone follow-up calls to sustain the continuity of care from hospital to the community, (b) the enabling factor for instance, the time of intervention arranged in non-working hour, and (c) reinforcing factor namely involvement of midwives during program implementation and telephone follow-up consultation. CONCLUSIONS: The results of this study suggest the potential of the couple-based psychoeducation to support first-time parents in taking care of their children and controlling their emotions in this critical transition. The program could be integrated into maternal and child care services on a regular basis, and thus accessible to all first-time parents.

Perception of family sense of coherence during parental transition: A qualitative study.

This study described the perspectives and interplay of factors affecting the family sense of coherence of Chinese couples during the perinatal period. We adopted a grounded theory approach and conducted semi-structured interviews with 36 Chinese couples during pregnancy and at 2-3 months postpartum. Four major themes emerged involving meaningfulness, comprehensibility, and manageability of new parenthood and factors affecting the family sense of coherence. The strong sense of family unity and harmony embedded in the Confucian philosophy and the collective coping, in particular the strong social support network, seemed to contribute to couple's experience of new parenthood as meaningful, comprehensible, and manageable.

Perceptions of paternal involvement and labour pain management in Chinese couples during childbirth: A qualitative study.

BACKGROUND: Labour pain is an individual experience embedded in a socio-cultural context. In childbirth, the father's involvement provides important support to the mother during labour. However, few published studies have evaluated couples' experiences of paternal involvement and labour pain management in the Chinese context. AIM: This study aimed to understand the experience of labour pain management and the father's involvement in childbirth from the perspectives of women and their partners in Hong Kong. METHODS: An exploratory qualitative design was adopted. A purposive sample of 45 Chinese parents was recruited at the postnatal unit of a regional hospital. Data were collected through semi-structured face-to-face interviews within 1 month after birth. The data were subjected to content analysis. FINDINGS: The findings revealed six major themes: the mothers' experience of labour pain, effectiveness of pain relief measures, mothers' perceptions of support from their partners, mothers' perceptions of support from healthcare professionals, fathers' experience of involvement in childbirth and suggested improvements to maternity services. DISCUSSION: Chinese mothers experienced intense labour pain and used various pain relief measures. Both parents considered the involvement of fathers and support from healthcare professionals to be highly significant during childbirth. CONCLUSIONS: This study highlights the need for a family-centred model of care during childbirth that involves both parents in the decision-making process. Chinese maternity services should implement individualised birth plans that acknowledge both parents' expectations and preferences, thus promoting a positive childbirth experience for the parents.