Dementia literacy of racially minoritized people in a Chinese society: a qualitative study among South Asian migrants in Hong Kong.

OBJECTIVES: Research on dementia literacy in Chinese societies is still emerging, and this is especially the case among racially minoritized groups. The present study explored the knowledge, causal beliefs, and help-seeking behaviors of South Asian migrants in Hong Kong about dementia. It also investigated existing community barriers related to dementia knowledge and help-seeking. DESIGN: We conducted a qualitative study from a purposive sample of 38 older people and family caregivers from India, Pakistan, and Nepal who lived in Hong Kong. Focus groups and individual in-depth interviews were used to gather information, while thematic analysis was employed to analyze the data. RESULTS: Five main themes were identified: normalization with stigmatization of dementia; spiritual and psychosocial attributions of dementia; familial responsibility despite potential caregiving burden; uncertainties versus openness to professional care; and barriers and opportunities in dementia literacy. Ethnic minorities recognized dementia as a disease of normal aging or a mental disorder. They also perceived spiritual and psychosocial factors as their main causes. While participants recognized the potential burden of dementia caregiving, families were their first point of help-seeking, as many of them expressed contrasting feelings of confidence or doubt toward professional services. Utilization of health education strategies, together with collaboration with community leaders, could address the barriers to dementia literacy. CONCLUSIONS: This is the first study to explore how ethnic minorities in Asia perceive dementia and its related help-seeking behaviors in their communities. South Asian migrants in Hong Kong have a limited understanding of dementia and may experience delays in obtaining relevant community services. While culture influenced their knowledge, health education may address their misperceptions and help-seeking behaviors toward dementia. Culture- and language-specific programs could also improve dementia knowledge and health service access.

The Effects of Immersive Virtual Reality Applications on Enhancing the Learning Outcomes of Undergraduate Health Care Students: Systematic Review With Meta-synthesis.

BACKGROUND: Immersive virtual reality (IVR) applications are gaining popularity in health care education. They provide an uninterrupted, scaled environment capable of simulating the full magnitude of sensory stimuli present in busy health care settings and increase students' competence and confidence by providing them with accessible and repeatable learning opportunities in a fail-safe environment. OBJECTIVE: This systematic review aimed to evaluate the effects of IVR teaching on the learning outcomes and experiences of undergraduate health care students compared with other teaching methods. METHODS: MEDLINE, Embase, PubMed, and Scopus were searched (last search on May 2022) for randomized controlled trials (RCTs) or quasi-experimental studies published in English between January 2000 and March 2022. The inclusion criteria were studies involving undergraduate students majoring in health care, IVR teaching, and evaluations of students' learning outcomes and experiences. The methodological validity of the studies was examined using the Joanna Briggs Institute standard critical appraisal instruments for RCTs or quasi-experimental studies. The findings were synthesized without a meta-analysis using vote counting as the synthesis metric. A binomial test with P<.05 was used to test for statistical significance using SPSS (version 28; IBM Corp). The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation tool. RESULTS: A total of 17 articles from 16 studies totaling 1787 participants conducted between 2007 and 2021 were included. The undergraduate students in the studies majored in medicine, nursing, rehabilitation, pharmacy, biomedicine, radiography, audiology, or stomatology. The IVR teaching domains included procedural training (13/16, 81%), anatomical knowledge (2/16, 12%), and orientation to the operating room setting (1/16, 6%). The quality of the 75% (12/16) of RCT studies was poor, with unclear descriptions of randomization, allocation concealment, and outcome assessor blinding procedures. The overall risk of bias was relatively low in the 25% (4/16) of quasi-experimental studies. A vote count showed that 60% (9/15; 95% CI 16.3%-67.7%; P=.61) of the studies identified similar learning outcomes between IVR teaching and other teaching approaches regardless of teaching domains. The vote count showed that 62% (8/13) of the studies favored using IVR as a teaching medium. The results of the binomial test (95% CI 34.9%-90%; P=.59) did not show a statistically significant difference. Low-level evidence was identified based on the Grading of Recommendations Assessment, Development, and Evaluation tool. CONCLUSIONS: This review found that undergraduate students had positive learning outcomes and experiences after engaging with IVR teaching, although the effects may be similar to those of other forms of virtual reality or conventional teaching methods. Given the identification of risk of bias and low level of the overall evidence, more studies with a larger sample size and robust study design are required to evaluate the effects of IVR teaching. TRIAL REGISTRATION: International prospective register of systematic reviews (PROSPERO) CRD42022313706; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=313706.

Palliative Care for Older Adults Hospitalized for Stroke From the Informal Caregivers' Perspectives: A Qualitative Study.

BACKGROUND: International guidelines have promoted palliative care (PC) for stroke survivors, but definition and implementation have been less than ideal. This practice gap is more prominent in China, where discussion of death remains taboo. AIM: The aim of this study was to explore the perspectives of PC among caregivers of hospitalized patients with stroke. DESIGN AND SETTING: A descriptive qualitative study design was used. Seventeen in-depth interviews with bedside caregivers in a first-rank tertiary hospital (general hospital with bed capacity exceeding 500) in China were analyzed thematically. RESULTS: "Promoting comfort" stands at the core of PC and was operationalized by "meeting physical care needs," "ensuring communication," "providing psychoemotional care," "providing cognitive stimulation," and "avoiding discussion on death and dying." Caregivers who took care of older adults for a long time have described the use of "cognitive stimulation" to promote patients' positive emotional and cognitive reactions. All interviewees avoided mentioning "death" to protect patients' feelings, because they believed discussion of death was hurtful. CONCLUSIONS: The high care demand for patients with stroke is a defining feature of stroke PC and should be recognized in addition to its prognosis estimation to promote this concept. The healthcare system should integrate PC as part of the regular service for patients with severe stroke to shift the focus of care from survival to promotion of comfort. A discussion of the dying process requires sensitivity and should be approached in a discussion of advanced PC planning, which views death as a meaningful transition.

Intrinsic capacity of older people in the community using WHO Integrated Care for Older People (ICOPE) framework: a cross-sectional study.

BACKGROUND: The World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to guide assessing and promoting intrinsic capacity of older adults. This study, adopting the WHO ICOPE framework, assessed the intrinsic capacity impairment and investigated the relationship among intrinsic capacity, social engagement, and self-care capacity on performing activities of daily living. It also assessed the sensitivity of the initial brief screening and the detailed full assessment. METHODS: This is a cross-sectional study conducted in 11 community centers in Hong Kong. Intrinsic capacity was assessed in two steps identical to WHO ICOPE handbook: using WHO ICOPE brief screening tool (step 1) and detailed full assessment (step 2) to assess the intrinsic capacity domains of locomotion, cognition, vitality, psychological well-being, and sensory capacity (hearing and vision). Structural equational modeling analysis was used to examine the relationship among intrinsic capacity, social engagement, and self-care capacity, and the mediating role of intrinsic capacity in the relationships. RESULTS: A total of 304 older adults with a mean age 76.73 (SD = 7.25) years participated in WHO ICOPE Step 1 brief screening, and 221 participants (72.7%) showed intrinsic capacity impairment. After completing Step 2 full assessment, 202 participants (66.4%) had one or more impaired intrinsic capacity domains. The overall sensitivity and specificity of the screening tool were 95% and 57.6% respectively, whereas the sensitivity of each domain ranged from 74.7% to 100%. The percentage of impairment in locomotion (117, 39.8%), cognition (75, 25.5%), psychological well-being (34, 11.6%), vision (75, 24.7%), hearing capacity (82, 27.9%), and vitality (8, 2.7%). People in younger old age (ß = -0.29, p < 0.001), with more education (ß = 0.26, p < 0.001), and absence of hypertension (ß = -0.11, p < 0.05) were more likely to have better intrinsic capacity. Intrinsic capacity was positively associated with self-care capacity in performing activities of daily living (ß = 0.21, p < 0.001) and social engagement (ß = 0.31, p < 0.001). CONCLUSIONS: The ICOPE screening tool is a sensitive instrument to detect intrinsic capacity impairment among community-dwelling older adults and it does not demand substantial workforce; its use is worthy to be supported. The intrinsic capacity impairment in community-dwelling older adults are prevalent, in particular, in locomotor and cognitive capacity. Actions should be taken to slow or prevent the impairment, support self-care and social engagement in old age.

Interventions addressing functional abilities of older people in rural and remote areas: a scoping review of available evidence based on WHO functional ability domains.

BACKGROUND: The World Health Organization (WHO) encourages healthy ageing strategies to help develop and maintain older people's functional abilities in five domains: their ability to meet basic needs; learn, grow, and make decisions; be mobile; build and maintain relationships, and contribute to society. This scoping review reports the available evidence-based interventions that have been undertaken with people ≥ 50 years of age in rural and remote areas and the outcomes of those interventions relevant to enhancing functional ability. METHODS: The scoping review was undertaken following the JBI methodology. A literature search was carried out to identify published intervention studies for enhancing functional ability in older people living in rural and remote settings. The databases searched included CINAHL, Scopus, ProQuest Central, PubMed, EBSCOHost, APA PsycInfo, Carin.info, and the European Network for Rural Development Projects and Practice database. Gray literature sources included government reports, websites, policy papers, online newsletters, and studies from a bibliographic hand search of included studies. RESULTS: Literature published from January 2010 to March 9, 2021 were included for review. A total of 67 studies were identified, including quasi-experimental studies (n = 44), randomized controlled trials (n = 22), and a descriptive study. Five main types of interventions were conducted in rural and remote areas with older people: Community Services, Education and Training, Exercise and Physical Activity, Health Promotion Programmes, and Telehealth. Health Promotion Programmes (n = 28, 41.8%) were the most frequently reported interventions. These focused primarily on improving the ability to meet basic needs. About half (n = 35, 52.2%) of the included studies were linked to the ability to learn, grow, and make decisions, and 40% of studies (n = 27) were relevant to the ability to be mobile. Only a very limited number of intervention studies were geared towards outcomes such as maintaining relationships (n = 6) and contributing to society (n = 3). CONCLUSION: Interventions for enhancing functional ability focused primarily on the ability to meet basic needs. We identified the need for health-related interventions in rural and remote areas to consider all five functional ability domains as outcomes, particularly to strengthen the psychosocial wellbeing of older people and enhance their sense of purpose through their contributions to society.

Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study.

BACKGROUND: Digital communication technologies are playing an important role in the health communication strategies of governments and public health authorities during the COVID-19 pandemic. The internet and social media have become important sources of health-related information on COVID-19 and on protective behaviors. In addition, the COVID-19 infodemic is spreading faster than the coronavirus itself, which interferes with governmental health-related communication efforts. This jeopardizes national public health containment strategies. Therefore, digital health literacy is a key competence to navigate web-based COVID-19-related information and service environments. OBJECTIVE: This study aimed to investigate university students' digital health literacy and web-based information-seeking behaviors during the early stages of the COVID-19 pandemic in Germany. METHODS: A cross-sectional study among 14,916 university students aged ≥18 years from 130 universities across all 16 federal states of Germany was conducted using a web-based survey. Along with sociodemographic characteristics (sex, age, subjective social status), the measures included five subscales from the Digital Health Literacy Instrument (DHLI), which was adapted to the specific context of the COVID-19 pandemic. Web-based information-seeking behavior was investigated by examining the web-based sources used by university students and the topics that the students searched for in connection with COVID-19. Data were analyzed using univariate and bivariate analyses. RESULTS: Across digital health literacy dimensions, the greatest difficulties could be found for assessing the reliability of health-related information (5964/14,103, 42.3%) and the ability to determine whether the information was written with a commercial interest (5489/14,097, 38.9%). Moreover, the respondents indicated that they most frequently have problems finding the information they are looking for (4282/14,098, 30.4%). When stratified according to sociodemographic characteristics, significant differences were found, with female university students reporting a lower DHLI for the dimensions of "information searching" and "evaluating reliability." Search engines, news portals, and websites of public bodies were most often used by the respondents as sources to search for information on COVID-19 and related issues. Female students were found to use social media and health portals more frequently, while male students used Wikipedia and other web-based encyclopedias as well as YouTube more often. The use of social media was associated with a low ability to critically evaluate information, while the opposite was observed for the use of public websites. CONCLUSIONS: Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with certain abilities to evaluate information. There is a need to strengthen the digital health literacy capacities of university students using tailored interventions. Improving the quality of health-related information on the internet is also key.

A nurse-led lifestyle intervention using mobile application versus booklet for adults with metabolic syndrome-Protocol for a randomized controlled trial.

AIMS: To compare the effect of a lifestyle intervention programme using mobile application versus booklet for adults with metabolic syndrome (MetS) living in the community. DESIGN: A multisite randomized controlled trial with three parallel arms, namely metabolic syndrome app group, booklet group, and control group. METHODS: The research study has been supported by the Health and Medical Research fund in Hong Kong in 2019. The protocol was approved by the study university and the selected community centres. Three hundred and sixty subjects will be recruited from community centres and randomized into either one arm. Inclusion criteria are those adult with MetS, able to use a smart phone. All participants received a 30-min health educational session. App group participants will receive a mobile application while booklet group participants will receive a specific booklet of MetS care and the control group receive a placebo booklet only. The primary outcomes comprises of body weight. The secondary outcomes include total physical exercise, cardiometablolic risk factors, cardiovascular endurance, self-efficacy for exercise, and stress level. Data will be collected at baseline, weeks 4, 12, and 24. SPSS and generalized estimating equations model will be employed for data analysis. DISCUSSION: Metabolic syndrome is a common health problem associated with the heightened risk of cardiovascular disease and the risks are potentially amenable to lifestyle intervention. The results will compare the relative effectiveness of a lifestyle intervention using an app versus a booklet on physical and psychological outcomes for adults with MetS. IMPACT: What problem will the study address? The results will inform the healthcare professional and nurses about the effective way for health promotion, to enhance patient's lifestyle modification and exercise sustainability that will be beneficial to the clients' health.

Exploring the Influencing Factors of Health Literacy among Older Adults: A Cross-Sectional Survey.

Background and Objectives: To investigate the health literacy (HL) among older adults in Taiwan, we referenced an existing integrated model of HL to confirm the influencing factors of HL in older adults. We propose this study to examine the personal, situational, and socioenvironmental factors influencing HL among older adults. Materials and Methods: A cross-sectional survey was conducted at a district hospital and affiliated community center in northern Taiwan from August 2016 to May 2017. This study used the Mandarin Chinese version of the European Health Literacy Survey Questionnaire (EU-Q47). We designed three models based on the three domains of HL. Model 1 assesses personal factors. Model 2 incorporates situational factors. Model 3 adds the socioenvironmental factor. Results: We recruited 161 participants aged over 65 years. Most adults in this study had limited overall HL. The final regression model revealed that age >85 years, unknown insurance status, and dominant spoken dialect of Hakka or Taiwanese were significantly associated with higher scores of HL. Conclusions: Our study results may help clinicians with early identification of older adults at high risk for poor HL and help health administrators establish geriatric policies and health education plans.

Seasonal pattern of single falls and recurrent falls amongst community-dwelling older adults first applying for long-term care services in Hong Kong.

BACKGROUND: few studies had investigated seasonal pattern of recurrent falls. OBJECTIVE: to examine seasonal pattern of both single and recurrent falls amongst community-dwelling older adults first applying for long-term care (LTC) services. METHODS: a cohort of 89,100 community-dwelling Hong Kong older adults aged 65 and over first applying for LTC services from 2005 to 2014 was obtained. Logistic regression models were used to examine seasonal pattern in single and recurrent falls, whilst controlling for gender, age and year. RESULTS: amongst 89,100 older adults, about 32% fell in past 90 days. Amongst the fallers, 34% fell recurrently. In 2014, the incidences of all fall, single fall and recurrent fall were 1.95, 0.80 and 1.15 per person-years, respectively. For single falls, the 90-day fall risk was highest during November to February with an odds ratio (OR) of 1.29 (95% confidence interval [CI] 1.19-1.41), compared with the lowest one during July to October. For recurrent falls, the highest OR for 90-day risk was highest during November to February (1.46, 95% CI 1.31-1.64) as well. CONCLUSIONS: single and recurrent falls both peaked during winter months. Interventions, such as implementing educational publicity and sending reminder to older adults in fall season, may be considered.

Overview of dementia care under the three-tier long-term care system of China.

OBJECTIVES: This paper provides an overview of the status of dementia care in Mainland China under the framework of the three-tier long-term care system proposed by the Chinese government, and gives the direction for service development. METHODS: Official documents, annual reports of related associations, and studies conducted in Mainland China from 2006 to 2017, published both in English and Chinese were reviewed. RESULTS: With the establishment of the three-tier long-term care system, the Government has invested a lot in long-term care, and improvements have been made. However, specific areas of dementia care still face challenges. DISCUSSION: Strategies in improving the long-term care services have been achieved. These included training for informal caregivers at home settings, increased investment in community health centers, and increased institutional placements, etc. However, these are not enough to fulfill the needs of people with dementia and their caregivers. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Multiple levels of training and interaction within the framework of the three-tier long-term care system as well as more research are recommended for improving dementia care.

Acupressure for frail older people in community dwellings-a randomised controlled trial.

Background: 'Frailty' is being increasing recognised as a geriatric syndrome of growing importance in the medical field. Acupressure is a non-pharmacological, non-invasive Traditional Chinese Medicine (TCM) treatment, which may serve to improve the quality of life (QOL) or prevent the progressive advancement of frailty in the aged population. Objective: to investigate the effects of a 12-week, TCM-principle guided acupressure intervention on the QOL of the frail older people living in the community. Methods: this is a randomised controlled trial with waitlist control design. Treatment group received 15 min of acupressure treatment, four times a week from both TCM practitioners and trained caregivers for 12 consecutive weeks. The waitlist control group served as a care-as-usual comparison to the treatment group for the 1st 12 weeks and then received the same treatment. Intention-to-treat principle was followed and mixed-effects models were used for data analysis. Results: the mean age of the participants was 76.12 ± 7.08, with a mean Tilburg frailty index score of 7.13 ± 1.76. Significant between-group differences were found in the change of physical domain score of WHOQOL-BREF (P = 0.001); change of Pittsburgh Sleep Quality Index (P < 0.001) and pain intensity (P = 0.006) with the treatment group demonstrating greater improvement. Within-group effect size analysis also indicated that the acupressure protocol has significant impact on these areas. Conclusions: the study's outcomes indicated that the acupressure protocol, when applied continuously for 12 weeks, 3-4 times a week, could improve the general QOL of frail older people living in community dwellings.

Factors associated with chewing problems and oral dryness among older Chinese people in Hong Kong.

OBJECTIVES: This study aims to describe the prevalence of chewing problems and oral dryness when eating and examine their risk factors among Chinese community-dwelling older adults. BACKGROUND: Chewing problems and oral dryness are two common oral health complaints in older people. A number of factors associated with these two oral health problems in older people have been reported, but information regarding Chinese older adults is scarce. MATERIALS AND METHODS: Secondary analysis was conducted on the data collected from 3422 Hong Kong adults aged ≥60 who had completed a screening instrument for long-term care services for the first time. RESULTS: Among the respondents, 15.3% reported having chewing problems and 3.5% reported having oral dryness when eating. More dependence on instrumental activities of daily living (IADL, OR = 1.06, p < 0.001) was associated with a greater likelihood of chewing problems, while more negative mood (OR = 1.19, p < 0.001) was associated with a greater likelihood of oral dryness when eating, after adjusting for the effects of socio-demographic characteristics and medical conditions. Informal care support, poor nutrition status and difficulty in brushing teeth/dentures were positively and significantly associated with these two perceived oral health problems. CONCLUSIONS: The prevalence of both chewing problems and oral dryness was low in Hong Kong older Chinese adults. IADL was related to chewing problems, while negative mood was related to oral dryness independently and significantly, which provide a knowledge base upon which to develop strategic programs of oral health promotion among older Chinese adults.

Intergenerational reciprocity and WHO function ability domains predict loneliness in older Chinese adults.

OBJECTIVES: To examine loneliness in old age and whether intergenerational reciprocity and WHO functional ability predicted loneliness. METHODS: Using the China Health and Retirement Longitudinal Study Wave 4 (2018) database (CHARLS), logistic regression models were adopted to investigate the relationships. RESULTS: The prevalence of loneliness was 28% in older people in China. Corresponding to the five domains of functional abilities, providing financial support to adult children (adj. OR 0.83, 95% CI 0.70-0.99), self-perceived health (adj. OR 1.30, 95% CI 1.19-1.41), having a retirement pension (adj. OR 0.73, 95% CI 0.57-0.93), the ability to decide on taking medications (adj. OR 1.32, 95% CI 1.10-1.58), as well as being able to get up from a chair (adj. OR 1.15, 95% CI 1.02-1.3), and having paid work (adj. OR 0.72, 95% CI 0.54-0.95) were associated with less loneliness. On the contrary, infrequent contact (once a month) with adult children (adj. OR 1.18, 95% CI 1.01-1.38), troubling body pain (adj. OR 1.16, 95% CI 1.10-1.23) and falling since the last interview (adj. OR .23, 95% CI 1.04-1.45) were positively associated with loneliness. CONCLUSIONS: In this study, functional abilities of meeting basic needs, making decisions, being mobile and contributing to the support of adult children and society were protective factors for experiencing loneliness in late life. We need to rethink interventions for addressing loneliness in the context of healthy ageing and specific cultural values, taking into account not only providing services to older adults but also supporting them to gain values by contributing to society.

Trajectories of social engagement and depressive symptoms among long-term care facility residents in Hong Kong.

BACKGROUND: although social engagement and depressive symptoms are important concerns for long-term care facility residents, the dynamic relationship between them has not been adequately studied. OBJECTIVE: this study examines the relationship between social engagement and depressive symptoms and changes in social engagement and depressive symptoms among Chinese residents of long-term care facilities over 6 years. DESIGN AND METHODS: a latent growth model was used to analyse six waves of data collected using the Resident Assessment Instrument Minimum Data Set 2.0 in the Hong Kong Longitudinal Study on Long-Term Care Facility Residents. Ten residential facilities with a total of 1,184 eligible older adults at baseline were included in the study. RESULTS: after controlling for demographic variables at baseline, a higher level of social engagement was associated with fewer depressive symptoms. Trajectories of social engagement were significantly related to trajectories of depressive symptoms. Participants who recorded positive social engagement growth reported reduction in depressive symptoms. CONCLUSION: the findings of our study extend previous research by showing that increased social engagement is associated with decreased depressive symptoms over time. In long-term residential care settings, it is important for services to engage residents in meaningful social activities in order to reduce depressive symptoms.

Residents with Alzheimer's disease in long-term care facilities in Hong Kong: patterns of hospitalization and emergency room use.

OBJECTIVES: This study examined the frequency and predictors of hospitalization and emergency room (ER) use among residents with Alzheimer's disease at admission and after 1 year in a long-term care facility. METHOD: This secondary analysis used data collected with the Chinese version of the Residential Assessment Instrument Minimum Data Set 2.0 during the Hong Kong Longitudinal Study on Long-Term Care Facility Residents. RESULTS: A sample of 169 residents with Alzheimer's disease who were newly admitted between 2005 and 2010 was included in the analysis. Mixed-effects modeling was adopted to assess the associations between risk factors and the frequency of hospitalization and ER use. At admission, 27 (15.98%) respondents had been hospitalized and 19 (11.24%) required ER services during the previous 90 days. At admission, polypharmacy (ß = .081, p < .01) and use of psychotropic drugs (ß = ­.506, p < .05) were significantly associated with frequency of hospitalization. At 1-year follow-up, cognitive impairment (ß = .088, p < .05) and polypharmacy (ß = .058, p < .001) had significant positive associations with frequency of hospitalization, as well as use of ER services (ß = .084, p < .01; ß = .077, p < .001, respectively). Use of psychotropic drugs had a negative association with frequency of ER use at both time points. CONCLUSION: Practitioners should periodically observe cognitive ability, polypharmacy, and use of psychotropic drugs among long-term care residents with Alzheimer's disease.

Development and validation of Chinese Health Literacy Scale for Diabetes.

AIMS AND OBJECTIVES: To develop and to test the psychometric properties of the Chinese Health Literacy Scale for Diabetes. BACKGROUND: Patients with diabetes encounter many challenges when making health decisions in their daily lives, as they have access to many different kinds of health information. Health literacy issues are new topics in Chinese society. Without a valid and reliable instrument in Chinese, it is difficult to measure the level of health literacy and promote the concept of health literacy in Chinese societies. DESIGN: A methodological study with a sample of 137 patients with type 2 diabetes aged 65 years or older. METHOD: Chinese Health Literacy Scale for Diabetes was developed with reference to the revised Bloom's taxonomy model. Psychometric tests (content validity, item analysis, construct validity, discriminative ability and test-retest reliability) were conducted. Correlations between Chinese Health Literacy Scale for Diabetes and four relevant measures were tested. Cronbach's alpha and alpha if item deleted were calculated to assess internal consistency. RESULTS: Cronbach's alpha for Chinese Health Literacy Scale for Diabetes and its four subscales (remembering, understanding, applying and analysing) were 0·884, 0·885, 0·667, 0·654 and 0·717, respectively. The Chinese Health Literacy Scale for Diabetes was significantly correlated with the Diabetic Knowledge Scale (r = 0·398, p < 0·001), the Diabetic Management Self-Efficacy Scale (r = 0·257, p < 0·001), the Preschool and Primary Chinese Literacy Scale (r = 0·822, p < 0·001) and the Chinese Value of Learning Scale (r = 0·303, p < 0·001). It took an average of seven minutes to complete this 34-item instrument. CONCLUSION: The findings of this study support the Chinese Health Literacy Scale for Diabetes as a reliable and valid instrument for measuring the health literacy of Chinese patients with diabetes. RELEVANCE TO CLINICAL PRACTICE: We recommend that clinicians use this tool to assess patients' health literacy before conducting any kind of health promotion.

Are People Willing to Take Regular COVID-19 Vaccines? Prevalence and Determinants of Hesitancy for Regular COVID-19 Vaccination: A Random Population-Based Survey in Hong Kong.

The emergence of new coronavirus variants and evidence of waning immunity offered by COVID-19 vaccines draw attention to the need for regular vaccination. Vaccine hesitancy is one of the top ten threats to global health. There is a dearth of knowledge on people's hesitancy to take regular COVID-19 vaccines. This study aimed to investigate the prevalence and determinants of hesitancy for regular COVID-19 vaccination. A population-based, random telephone survey was performed in Hong Kong in April 2022 (n = 1213). The age-standardized hesitancy rate for regular COVID-19 vaccines among Hong Kong adults was 39.4% (95% CI = 35.3-44.1%), exhibiting a sloping S-shape with age. Regression analyses revealed that females, young adults, self-perceived fair/bad health, low COVID-19 vaccine uptake, and believing there are better ways for prevention of infection were positive determinants of hesitancy for regular vaccination. Vaccine confidence, perceived severity and availability, trust in manufacturers and government, and civic duty inclination were negative determinants. Tailored vaccine promotions are needed for females, young adults, and people perceiving poor health and receiving fewer doses. Information on infection severity, vaccine availability, and trust in suppliers, products, and governments are key attitude-change facilitators to decrease hesitancy for regular COVID-19 vaccination and cope with future pandemics.

Sequential multiple assignment randomised controlled trial protocol for developing an adaptive intervention to improve depressive symptoms among family caregivers of people with dementia.

OBJECTIVES: Family caregivers of people with dementia (FC-of-PWD) suffer from a high level of stress and depressive symptoms, which usually require different interventions at different stages. Although some standalone interventions such as behavioural activation (BA) and mindfulness practice (MP) have been shown to be potentially effective at reducing depressive symptoms, the best sequence and combination of these interventions for caregivers are unknown. This study aims to develop and identify a two-stage adaptive intervention with prespecified rules guiding whether, how or when to offer different interventions initially/over time to reduce depressive symptoms in FG-of-PWD. METHODS: A sequential multiple assignment randomised trial design will be adopted. 272 FG-of-PWD with mild to moderate depressive symptoms will be recruited from the community. Four two-stage, embedded adaptive interventions involving BA and MP of different sequences and dosages (eg, 8 weeks of BA followed by booster sessions for responders and 8 weeks of MP for non-responders) will be assigned to the participants following a set of decision rules. The primary outcomes will be depressive symptoms (measured using the Patient Health Questionnaire-9), assessed after the second stage of the intervention. Other outcomes, such as positive aspects of caregiving (measured using the Positive Aspects of Caregiving Scale), sleep quality (measured using the Pittsburgh Sleep Quality Index) and time points will also be assessed. The analyses will follow the intention-to-treat principle. Several process indicators (eg, engagement in meaningful activities and level of mindfulness) will also be assessed. The findings will have strong implications for the further development of psychosocial adaptive interventions to reduce depressive symptoms among FC-of-PWD. ETHICS AND DISSEMINATION: This study has received ethical approval from the Human Research Ethics Committee at The Hong Kong Polytechnic University (HSEARS20211223001). The findings will be presented at academic conferences and submitted to peer-reviewed journals for publication. TRIAL REGISTRATION NUMBER: NCT05634317.

A psychometric evaluation of a negative mood scale in the MDS-HC using a large sample of community-dwelling Hong Kong Chinese older adults.

BACKGROUND: negative mood is an important construct when assessing the health of older persons. The profile of mood states questionnaire is commonly used to measure mood; however, it might not be suitable for older adults with low education level and those who are not originated North American. OBJECTIVE: to examine a negative mood scale formed by nine items in the Mood Section of the Minimum Data Set-Home Care of the Resident Assessment Instrument. METHODS: a secondary analysis of data from 3,523 older persons aged 60 or over who had first applied for the long-term care services in Hong Kong and completed the screening tool in 2006. Exploratory and confirmatory factor analyses were used to test the factor structure and multiple-group confirmatory factor analysis to test the gender invariance of the Negative Mood Scale in the Minimum Data Set-Home Care. Its reliability using Cronbach's alpha was examined. RESULTS: both a three-factor model at the first level and a one-factor model at the second level provided excellent fits to the overall data, and held equally well for both males and females, and two randomly split samples. Multiple-group confirmatory factor analyses revealed both genders demonstrating an equivalent pattern of factor loadings. Cronbach's alpha value was acceptable for the overall data (0.66). CONCLUSIONS: the Negative Mood Scale is a reliable and valid scale and both genders responded to it using the same framework and metric, suggesting it could be used to measure negative mood in Chinese community-dwelling older adults. Further testing of the instrument is needed.

The Use of an Electronic Painting Platform by Family Caregivers of Persons with Dementia: A Feasibility and Acceptability Study.

Painting is a well-known method for alleviating stress, but it is uncertain whether family caregivers can use an electronic painting platform at home for this purpose. Aim. The aim in this study was to assess the feasibility and acceptability of having family caregivers of persons with dementia (FCPWD) draw electronic paintings using a mobile app, and to assess the preliminary effect of the intervention on their well-being. Methods. This was a two-phase feasibility and acceptability study, with qualitative interviews conducted in Phase 1 and qualitative interviews and a quantitative survey conducted in Phase 2. Caregiving burden, depressive symptoms, self-rated health, and social support were measured before and after the intervention. Participants were asked to draw electronic paintings at any time they liked, and to share the paintings with friends or relatives if they wished. Result. The recruitment rate in Phase 2 was 87.5% (28 out of 32), with 78.6% participants (22 out 28) completing all activities in 8 weeks. The FCPWD regarded the e-painting app as an appropriate channel for expressing their emotions. They found the layout of the app to be easy to use and were satisfied with it. A total of 116 pictures were produced. Log-in frequency was significantly correlated with the sharing of paintings with friends or relatives (r = 0.72, p < 0.001). Conclusion. FCPWD considered the e-painting mobile app to be a feasible and acceptable technology-based psychosocial platform. A further investigation with a larger sample in a full-scale randomized controlled trial is warranted.