The Phenomenon and Determinants of Healthcare Service Utilization for Older Adults With Multimorbidity in China: An Explanatory, Mixed-Method Study.

OBJECTIVES: The objective of this study was to explore the phenomenon and determinants of healthcare service utilization in Chinese older adults with multimorbidity. METHODS: We adopted a mixed-methods explanatory design from July 2022 to May 2023. The quantitative research was a social network analysis to explore the phenomenon of healthcare service utilization in target participants. The quantitative results were further interpreted as the participant's propensity for healthcare services and the potential for information sharing between healthcare providers through shared patients. Logistic regression was conducted to identify individual determinants for healthcare service utilization. The quantitative research was followed by qualitative interviews with stakeholders to deeply understand the phenomenon of interest from the individual, healthcare system, and societal perspectives. RESULTS: We recruited 321 participants for the quantitative study. They preferred using medication services from primary healthcare providers, pharmacists at private pharmacies, and hospital specialists, and preferred using other services from hospital specialists. Dense relationships arose from shared patients among healthcare providers across various professions and settings, making it possible to share patient information. Primary healthcare providers were particularly important in the process, as they were closely related to others through patient sharing. Health status was identified through logistic regression and qualitative interviews as an individual determinant for healthcare service utilization. More determinants were explored in qualitative interviews with 30 stakeholders, including trust, resource allocation, healthcare accessibility, medical treatment process, and healthcare awareness. DISCUSSION: Strategies should be proposed to intervene with patients' nonoptimal propensity toward healthcare services and promote information sharing among healthcare providers.

Social Determinants of Intrinsic Capacity: A National Cohort Study.

INTRODUCTION: Intrinsic capacity (IC), a composite of physical and mental capacities, is a marker of healthy aging. Social determinants of health (SDOH), namely the economic and social environments across a lifespan, are the most fundamental factors influencing health outcomes and health disparities. However, there is limited evidence on the influence of the individual and combined burden of the SDOH on IC. METHODS: Data were obtained from the China Health and Retirement Longitudinal Study (2011-2015), and data analysis was conducted in 2023. Linear mixed-effect regression was employed to investigate the association between SDOH and IC in a longitudinal analysis. RESULTS: This study comprised 7,669 participants (mean [SD] age, 68.5 [7.1] years; 49.8% female; mean [SD] IC, 7.2 [1.6]). In the longitudinal analysis, all five SDOH domains were independently and significantly associated with IC. The absence of social association within the social and community context domain exhibited the weakest association with IC (ß: -0.11 [95% CI -0.20, -0.02]), while illiteracy within the education access and quality domain demonstrated the strongest association with IC (ß: -0.51 [95% CI -0.60, -0.42]). Furthermore, the adverse effects of SDOH on IC became more distinguishable with the cumulative number of SDOH variables (coefficient for 2 SDOH, -0.41 [-0.64, -0.19]; 3 SDOH, -0.70 [-0.93, -0.48]; ≥4 SDOH, -1.10 [-1.33, -0.88]) compared with those without any SDOH. CONCLUSIONS: Certain SDOH levels were significantly and negatively associated with IC. Targeted interventions may be needed to improve SDOH in individuals at high risk of poor IC.

Facilitators and Barriers of Integrated Care for Older Adults with Multimorbidity: A Descriptive Qualitative Study.

Purpose: A lack of coordinated care leads to multiple adverse effects for older adults with multimorbidity, including high treatment burdens, adverse health outcomes, reduplicated healthcare service utilization, and catastrophic healthcare expenditure. To foster healthy aging, person-centered integrated care that is responsive to older adults has been proposed by the World Health Organization. The objective of this study was to identify factors that impact the successful implementation of integrated care for older adults with multimorbidity in China. Patients and Methods: From July 2022 to May 2023, 33 healthcare providers and managers involved in the delivery and management of healthcare services for older adults with multimorbidity were recruited from Zhejiang Province, China using purposeful and maximum variation sampling methods. Semi-structured, face-to-face in-depth interviews were conducted by the same interviewer in the participants' native Chinese language until data saturation was reached. Inductive thematic analysis was used to analyze the data, and then, themes were mapped onto six dimensions using the Rainbow Model of Integrated Care to allow for a comprehensive view of the study's findings. Results: Eleven themes were generated as facilitators and barriers to integrated care for older adults with multimorbidity in China. These themes include (1) clinical integration: patient-centered care, (2) professional integration: interdisciplinary teams and training, (3) organizational integration: resources and accessibility, (4) system integration: community and funds, incentives, and health insurance, (5) functional integration: electronic health record systems, workforce, and guidelines, and (6) normative integration: shared mission. Conclusion: Guided by the Rainbow Model of Integrated Care, various factors at both micro, meso, and macro levels that impact the implementation of integrated care for older adults with multimorbidity in the Chinese context have been identified in this study. The strategies for future interventions and policies should focus on promoting facilitators and addressing barriers.

Effects of an Individualized mHealth-Based Intervention on Health Behavior Change and Cardiovascular Risk Among People With Metabolic Syndrome Based on the Behavior Change Wheel: Quasi-Experimental Study.

BACKGROUND: Metabolic syndrome (MetS) is a common public health challenge. Health-promoting behaviors such as diet and physical activity are central to preventing and controlling MetS. However, the adoption of diet and physical activity behaviors has always been challenging. An individualized mobile health (mHealth)-based intervention using the Behavior Change Wheel is promising in promoting health behavior change and reducing atherosclerotic cardiovascular disease (ASCVD) risk. However, the effects of this intervention are not well understood among people with MetS in mainland China. OBJECTIVE: We aimed to evaluate the effects of the individualized mHealth-based intervention using the Behavior Change Wheel on behavior change and ASCVD risk in people with MetS. METHODS: We conducted a quasi-experimental, nonrandomized study. Individuals with MetS were recruited from the health promotion center of a tertiary hospital in Zhejiang province, China. The study involved 138 adults with MetS, comprising a control group of 69 participants and an intervention group of 69 participants. All participants received health education regarding diet and physical activity. The intervention group additionally received a 12-week individualized intervention through a WeChat mini program and a telephone follow-up in the sixth week of the intervention. Primary outcomes included diet, physical activity behaviors, and ASCVD risk. Secondary outcomes included diet self-efficacy, physical activity self-efficacy, knowledge of MetS, quality of life, and the quality and efficiency of health management services. The Mann-Whitney U test and Wilcoxon signed rank test were primarily used for data analysis. Data analysis was conducted based on the intention-to-treat principle using SPSS (version 25.0; IBM Corp). RESULTS: Baseline characteristics did not differ between the 2 groups. Compared with the control group, participants in the intervention group showed statistically significant improvements in diet behavior, physical activity behavior, diet self-efficacy, physical activity self-efficacy, knowledge of MetS, physical health, and mental health after a 12-week intervention (P=.04, P=.001, P=.04, P=.04, P=.001, P=.04, P=.04, and P<.05). The intervention group demonstrated a statistically significant improvement in outcomes from pre- to postintervention evaluations (P<.001, P=.03, P<.001, P=.04, P<.001, P<.001, and P<.001). The intervention also led to enhanced health management services and quality. CONCLUSIONS: The individualized mHealth-based intervention using the Behavior Change Wheel was effective in promoting diet and physical activity behaviors in patients with MetS. Nurses and other health care professionals may incorporate the intervention into their health promotion programs.

Heterogenous subtypes of health literacy among individuals with Metabolic syndrome: a latent class analysis.

Objective To explore the heterogenous subtypes and the associated factors of health literacy among patients with metabolic syndrome.Methods A cross-sectional study was conducted, and 337 patients with metabolic syndrome were recruited from Sir Run Run Shaw Hospital in Zhejiang Province from December 2021 to February 2022. The Social Support Questionnaire, Short version of the Health Literacy Scale European Questionnaire (HLS-EU-Q16), and MacArthur Scale of Subjective Social Status were used for investigation. Latent class analysis (LCA) was performed to explore the heterogenous subtypes of health literacy among Metabolic syndrome patients. Univariate analysis and logistic regression were used to identify the predictors of the latent classes.Results The findings of LCA suggested that three heterogeneous subtypes of health literacy among individuals with metabolic syndrome were identified: high levels of health literacy, moderate levels of health literacy, and low levels of health literacy. The multinomial logistic regression results indicated that compared with low levels of health literacy class, the high levels of health literacy class were predicted by age (OR 0.932, 95%CI[0.900-0.966]), socio-economic status (OR 1.185, 95%CI[1.058-1.328]), and social support (OR 1.065, 95%CI[1.012-1.120]). Compared with low levels of health literacy class, the moderate levels of health literacy class were predicted by age (OR 0.964, 95%CI[0.934-0.995]), socio-economic status (OR 1.118, 95%CI[1.006-1.242]), male (OR 0.229, 95%CI[0.092-0.576]).Conclusion The levels of health literacy among patients with metabolic syndrome can be divided into three heterogenous subtypes. The results can inform policy-makers and care professionals to design targeted interventions for different subgroups among patients with metabolic syndrome who are male, at older age, have less social support, and with disadvantaged socio-economic status to improve health literacy.

Healthcare for Older Adults with Multimorbidity: A Scoping Review of Reviews.

Purpose: To summarize adverse healthcare outcomes experienced by older adults with multimorbidity and barriers perceived by stakeholders regarding the healthcare systems primarily designed to address individual health conditions. Healthcare elements that aim to provide coordinated, continuous, and comprehensive services for this population were also identified. Patients and Methods: We applied the methodology framework developed by Arksey and O'Malley to guide the review. The three-step search strategy was used to identify relevant English reviews that focused on adverse healthcare outcomes and barriers encountered by older adults with multimorbidity and other stakeholders regarding the single-disease-focused healthcare systems, as well as those concentrated on healthcare elements that aim to provide coordinated, continuous, and comprehensive services for older adults with multimorbidity. Five electronic databases, including PubMed/Medline, CINAHL, Web of Science Core Collection, Cochrane Library, and Embase, were systematically searched from database inception to February 2022. A standardized table was used to extract data. Thematic analysis was then conducted under the guidance of the Rainbow Model of Integrated Care and the Chronic Care Model. Results: Twenty reviews were included in this study. Therapeutic competitions, high healthcare service utilization, and high healthcare costs were three adverse healthcare outcomes experienced by patients. Both patients and healthcare professionals faced various barriers. Other stakeholders, including informal caregivers, healthcare managers, and policymakers, also perceived several barriers. Numerous healthcare elements were identified that may contribute to optimized services. The elements most frequently mentioned included the implementation of shared decision-making, comprehensive geriatric assessments, and individual care plans. Conclusion: This study conducted a comprehensive overview of the current knowledge related to healthcare for older adults with multimorbidity. In the future, it is necessary to develop more coordinated, continuous, and comprehensive healthcare service delivery models based on the healthcare needs of older adults with multimorbidity and the specific characteristics of different countries.

Development of an individualized WeChat mini program-based intervention to increase adherence to dietary recommendations applying the behaviour change wheel among individuals with metabolic syndrome.

BACKGROUND: Metabolic Syndrome (MetS) is a serious public health issue. Dietary changes form the core of MetS treatment. The adherence to dietary recommendations is critical for reducing the severity of MetS components and preventing complications. However, the adherence to dietary recommendations was not adequate among adults with MetS. This study utilizes the Behaviour Change Wheel (BCW) to develop an individualized WeChat mini program-based behavioural change intervention aimed at strengthening adherence to dietary recommendations in people with MetS. METHODS: The BCW theory was used to design an individualized WeChat mini program-based behavioural change intervention. A descriptive qualitative study was conducted to identify the determinants of adherence to dietary recommendations in individuals with MetS. The study was conducted at the health promotion centre of a prominent general university hospital in Zhejiang, China. Subsequently, the intervention functions (IFs) and policy categories were selected following the identified determinants. Afterwards, behaviour change techniques (BCTs) were chosen to translate into potential intervention strategies, and the delivery mode was determined. RESULTS: Our study identified fifteen barriers to improve the adherence to dietary recommendations in this population. These were linked with six IFs: education, training, persuasion, enablement, modelling, and environmental restructuring. Then, twelve BCTs were linked with the IFs and fifteen barriers. The delivery mode was a WeChat mini program. After these actions, an individualized WeChat mini program-based behavioural change intervention was developed to enhance adherence to dietary recommendations for individuals with MetS. CONCLUSIONS: The BCW theory helped scientifically and systematically develop an individualized WeChat mini program-based behavioural change intervention for individuals with MetS. In the future, our research team will refine and upgrade the WeChat mini program and then test the usability and effectiveness of the individualized WeChat mini program-based behavioural change intervention program.

This is the first paper to specify the content and active ingredients of an individualized WeChat mini program-based behavioural change intervention using a systematic evidence- and theory-based method for individuals with MetS.The findings can be used to provide guidance to improve dietary adherence, and ultimately improve the lives of people with MetS.This methodology can serve as a reference for other researchers who are developing behavioural change interventions.

Sedentary behavior patterns and the risk of non-communicable diseases and all-cause mortality: A systematic review and meta-analysis.

BACKGROUND: The association between sedentary behavior and health-related outcomes has been well established, whereas it is inconclusive whether a sedentary behavior pattern is an additional risk factor for health-related outcomes independent of total sedentary time and physical activity. OBJECTIVES: To determine sedentary behavior patterns and their association with risks of noncommunicable diseases and all-cause mortality and to assess whether this association is independent of total sedentary time and physical activity. DESIGN: This was a systematic review and meta-analysis. METHODS: Studies were obtained by searching the Web of Science Core Collection, PubMed/Medline, the Cochrane Library, Embase, CINAHL, and SPORTDiscus up to April 2023. All observational studies published in English or Chinese were included if they explored sedentary behavior patterns and their association with risks of abdominal obesity, metabolic syndrome, diabetes, cardiovascular disease, cancer, and all-cause mortality among individuals who had never experienced the outcome event before the baseline assessment. Data extraction using a standardized form and quality appraisal using two authoritative tools were then performed. All these steps were completed by two independent reviewers from December 2022 to May 2023. If data were sufficiently homogenous, meta-analyses were performed; otherwise, narrative syntheses were employed. Harvest plots were also used to visually represent the distribution of evidence. RESULTS: Eighteen studies comprising 11 prospective cohort studies and seven cross-sectional studies were included. The findings suggested that prolonged sedentary time and usual sedentary bout duration were two metrics that reflected the nonlinear dose-response effect of prolonged sedentary behavior patterns. Only extremely high levels of prolonged sedentary behavior patterns significantly increased the risk of adverse health outcomes, independent of physical activity. Whether prolonged sitting was an additional risk factor for adverse health outcomes, independent of total sedentary time, was inconclusive due to an insufficient number of primary studies that included total sedentary time as one of the potential covariates. There was some evidence that supported a sedentary bout that significantly increased the risk of adverse health outcomes was 30-60 min. The threshold of prolonged sedentary time differed with outcomes, and future studies are needed to make this threshold more precise. CONCLUSION: A prolonged sedentary behavior pattern was associated with increased risks of several major noncommunicable diseases and all-cause mortality. People, especially those who do not reach the recommended level of moderate-to-vigorous physical activity, are encouraged to interrupt sedentary bouts every 30 to 60 min and limit prolonged sedentary time per day as much as possible. TWEETABLE ABSTRACT: Breaking up consecutive sedentary bouts >30 to 60 min and substituting them with brief bouts of physical activity.

Development of a Chinese version of the Stress Adaption Scale and the assessment of its reliability and validity among Chinese patients with multimorbidity. / åŽ‹åŠ›é€‚åº”é‡è¡¨çš„æ±‰åŒ–åŠå ¶åœ¨å¤šç— å ±å­˜æ‚£è€ ä¸­çš„ä¿¡æ•ˆåº¦æ£€éªŒ.

OBJECTIVES: To develop a Chinese version of the Stress Adaption Scale (SAS) and to assess its reliability and validity among Chinese patients with multimorbidity. METHODS: The Brislin model was used to translate, synthesize, back-translate, and cross culturally adapt the SAS. A total of 323 multimorbidity patients selected by convenience sampling method from four hospitals in Zhejiang province. The critical ratio method, total question correlation method, and graded response model (item characteristic curve and item discrimination) were used for item analysis. Cronbach's alpha coefficient and split-half reliability were used for the reliability analysis. Content validity analysis, structural validity analysis, and criterion association validity analysis were performed by expert scoring method, confirmatory factor analysis, and Pearson correlation coefficient method, respectively. RESULTS: The Chinese version of the SAS contained 2 dimensions of resilience and thriving, with a total of 10 items. In the item analysis, the critical ratio method showed that the critical ratio of all items was greater than 3.0 (P<0.001); the correlation coefficient method showed that the Pearson correlation coefficients for all items exceeded 0.4 (P<0.01). The graded response model showed that items of the revised scale exhibited distinct item characteristic curves and all items had discrimination parameters exceeding 1.0. In the reliability analysis, Cronbach's alpha coefficient of the revised Chinese version of the SAS scale was 0.849, and the split-half reliability was 0.873. In the validity analysis, the item-level content validity index and scale-level content validity index both exceeded 0.80. In the confirmatory factor analysis, the revised two-factor model showed satisfactory fit indices (χ2/df=3.115, RMSEA=0.081, RMR=0.046, GFI=0.937, AGFI=0.898, CFI=0.936, TLI=0.915). In the criterion-related validity analysis, the Chinese version of the SAS score was negatively correlated with the Perceived Stress Scale and the Treatment Burden Questionnaire, with correlation coefficients of －0.592 and －0.482, respectively (both P<0.01). CONCLUSIONS: The Chinese version of the SAS has good reliability and validity, which can be used to evaluate the stress adaption capacity among multimorbidity patients in China, and provides a reference for developing individualized health management measures.

Development and testing of the reliability and validity of a Chinese version of the Long-Term Conditions Questionnaire. / æ ¢æ€§ç— é•¿æœŸçŠ¶æ€é—®å·çš„æ±‰åŒ–åŠä¿¡æ•ˆåº¦æ£€éªŒ.

OBJECTIVES: To develop a Chinese version of the Long-Term Conditions Questionnaire (LTCQ) and to test its reliability and validity in Chinese patients with chronic diseases. METHODS: With the consent of the original authors, a Chinese version of LTCQ was developed according to the cultural adjustment guidelines. A questionnaire survey was conducted on 319 patients with chronic diseases in Sir Run Run Shaw Hospital, Wuyi County First People's Hospital and Hangzhou Gongchen Bridge Street Health Service Center. The questionnaire was evaluated by item analysis (including frequency analysis, total question correlation method and critical ratio method), reliability analysis (Cronbach's alpha coefficient) and validity analysis [including content validity (expert scoring method) and structural validity (exploratory factor analysis)]. RESULTS: The Chinese version of the LTCQ included 20 entries, with a Cronbach's alpha coefficient of 0.926, a retest reliability of 0.829, a split-half reliability of 0.878, an entry content validity index of 1, and a content validity index at the questionnaire level of 1. Four common factors were extracted by exploratory factor analysis, namely physical state and daily life, psychological state, support and coping, and safe environment, with a cumulative variance contribution rate of 67.244%. Discussion: The Chinese version of the LTCQ developed in this study has good reliability and validity and it may be used to assess the long-term conditions of patients with chronic diseases in China.

Sedentary time and the risk of metabolic syndrome: A systematic review and dose-response meta-analysis.

The dose-response association between sedentary time and the risk of metabolic syndrome is unclear, which indicates an important knowledge gap in public health. The objective of this study was to determine the categorical and continuous dose-response associations between sedentary time and the risk of metabolic syndrome. A systematic literature search of English articles published in PubMed, CINHAL, Embase, and Web of Science Core Collection prior to June 2022 was conducted. All cohort and cross-sectional studies that examined the association between sedentary time and the risk of metabolic syndrome were considered, and duplicate and non-related studies were excluded. Data extraction using a standardized chart and quality assessment using two appraisal tools were also performed. Two independent reviewers were involved in these processes. In categorical meta-analyses, the pooled effect sizes for metabolic syndrome associated with different categories of sedentary time were calculated by comparing the highest and intermediate with the lowest categories. In continuous meta-analyses, the linear and nonlinear dose-response associations were estimated using generalized least squares and restricted cubic spline models, respectively. Data were collected and analyzed from March to June 2022. Four prospective cohort studies and 22 cross-sectional studies with 105,239 participants and 16,185 MetS cases were included in this study. In categorical analyses, both intermediate (median duration: 4.11 h/day; pooled OR: 1.17, 95% CI: 1.08-1.26, P < 0.001) and high levels (median duration: 7.26 h/day; pooled OR: 1.71, 95% CI: 1.43-2.04, P < 0.001) of total sedentary time were significantly associated with an increased risk of metabolic syndrome. Similarly, a significant association between screen time and the risk of metabolic syndrome was also found in intermediate (median duration: 2.22 h/day; pooled OR: 1.20, 95% CI: 1.10-1.32, P < 0.001) and high levels (median duration: 3.40 h/day; pooled OR: 1.63, 95% CI: 1.44-1.86, P < 0.001) of exposure. Of note, these associations were significantly stronger in women. Different patterns of the behavior-disease association were not observed in children, adolescents, and adults. The findings of continuous meta-analyses could not provide solid evidence for the linearity and nonlinearity of the behavior-disease association. This study demonstrated that long-time sedentary behavior was associated with a higher risk of MetS independent of physical activity and the patterns of association varied by gender instead of age. These findings have implications for future guideline recommendations on physical activity, sedentary behavior, and prevention of metabolic syndrome.