Concepts related to Chinese patients' perceptions of health, illness and person: issues of conceptual clarity

The influence of Chinese culture and customs on the beliefs and health-related behaviours of Chinese women with gestational diabetes mellitus: A qualitative study

OBJECTIVE

The study aimed to explore the influence of Chinese culture and customs on the beliefs and health-related behaviours of Chinese women with gestational diabetes mellitus (GDM).

METHODS

This descriptive qualitative study conducted semi-structured interviews with 15 Chinese women between November 2022 and January 2023. The interview data were analysed using thematic analysis.

RESULTS

Three major themes are found: (1) beliefs in health, (2) beliefs in illness and GDM and (3) beliefs in health-related behaviours. They worried about the negative effects of GDM on the infant and family, so they actively sought medical advice to maintain health. However, it is challenging for them to balance adhering to healthcare professionals' advice and avoiding practical difficulties in the impact of the Chinese sociocultural context.

CONCLUSION

This study emphasizes the influence of Chinese culture and customs on the beliefs and health-related behaviours of women with GDM. Healthcare providers should recognize the influence of Chinese culture, customs and beliefs on women with GDM and their families, in order to provide individualized education to help them maintain health-related behaviours.

Body image in patients with prostate cancer undergoing treatment with hormone therapy: Observational study using both a cross-sectional and longitudinal design

This study aims to examine changes in body image (BI) over time and factors related to BI among patients with prostate cancer who receive hormone therapy (HT). A cross-sectional design and longitudinal design were utilized. Patients with prostate cancer who received HT were recruited from the urology outpatient departments in two hospitals in Taiwan between August 2017 and December 2020. Cross-sectional data were collected from 177 patients who had started HT for prostate cancer. Longitudinal data were collected from 34 newly diagnosed patients before receiving HT and at 1, 3, 6, and 12 months after HT. The variables measured included hormonal symptoms and distress, self-efficacy, and BI. The results showed that BI dissatisfaction ranged from 6.1% to 17.2%. Hormonal symptoms and distress (e.g. lack of vitality) were correlated with BI dissatisfaction. Education on the side effects of HT and coping strategies can be provided to patients to prevent BI dissatisfaction.

Stigma and its correlates among patients with Crohn's disease: A cross-sectional study in China

Objectives

Crohn's disease is an incurable disease characterized by unpredictable intestinal symptoms, which unavoidably affect patients' lives and contribute to feelings of stigma. This study aimed to explore the status and its correlates of stigma among patients with Crohn's disease.

Methods

Using a convenience sampling, 146 hospitalized patients with Crohn's disease were recruited in a tertiary hospital in Southern China from October 2020 to March 2021. The participants were assessed by demographic and disease-related questionnaires, the Social Impact Scale (SIS), Inflammatory Bowel Disease-Self-Efficacy Scale (IBD-SES), and Social Support Rating Scale (SSRS). Multivariate linear regression analysis was conducted to explore the influencing factors of stigma among patients with Crohn's disease.

Results

The mean SIS score was 58.14 ± 10.74, representing a moderate effect of stigma, and 85.6% (125/146) of the patients experienced moderate to high levels of stigma. The multiple linear regression analysis showed that perceived public awareness of the disease, family income, age, and self-efficacy were the main influencing factors of stigma, which could explain 52% of the total variation of stigma among patients with Crohn's disease.

Conclusion

Stigma among patients with Crohn's disease is influenced by perceived public awareness of the disease, family income, age, and self-efficacy. Interventions aimed at improving self-efficacy and public awareness should be considered to alleviate the level of stigma, especially for those aged 40 years or older or low-income patients.

Motivational Strategies and Concepts to Increase Participation and Adherence in Cardiac Rehabilitation: AN INTEGRATIVE REVIEW

INTRODUCTION

Low participation and adherence to cardiac rehabilitation (CR) leads to ineffective care and increased risk of cardiac complications. There is a need to identify effective motivational strategies and concepts to increase participation and adherence to CR.

PURPOSE

The aim of this review was to synthesize and integrate the current knowledge about motivational strategies and concepts to increase participation and adherence to CR.

METHODS

A literature search was performed using five electronic databases: CINAHL, Medline via PubMed, Scopus, Embase, and Rehabilitation & Sports Medicine Source. The search was limited to peer-reviewed studies, written in English, and publications from 2010 to 2019. A matrix and narrative synthesis were employed to organize and synthesize the findings, respectively.

RESULTS

Eight of 522 articles met the inclusion criteria. Four articles used motivational interviewing (MotI) and counseling strategy, three articles investigated the autonomy, competence, and relatedness of self-determination theory (SDT) concepts, and one article used a reinforced motivational strategy. Use of MotI led to improving the CR completion rate from 14% to 39%. The number of sessions attended/patient improved from 12 to 20 when the staff was provided attendance feedback and a reward. Autonomy, competence, and relatedness motivated patients to participate in and adhere to CR.

CONCLUSIONS

Motivational interviewing and counseling, motivational and reinforcement strategies, and the autonomy, competence, and relatedness of SDT concepts should be utilized to promote participation and motivation for CR. The effects of these techniques on long-term CR require further research, including combining the identified methods to investigate the efficacy of these techniques on CR adherence.

Dilemma: Disclosure Experience Among Young Female Breast Cancer Survivors in China

Purpose: Culture influences whether cancer patients disclose their disease diagnosis to others. Understanding Chinese young female breast cancer survivors (BCSs)' experiences and perspectives on disclosure could play a vital role in clinical nursing. This study explores the experiences of Chinese young female BCSs with disease disclosure and describes the reasons for their choices. Methods: Using the tenets of phenomenological research and a purpose sampling method, semistructured interviews were conducted with 31 BCSs from February to April 2021. Colaizzi's analysis method was performed with NVivo software to develop common themes from the data. Results: From the analysis of the interviews of the 31 participants, three main themes were identified: (1) disclosure-to whom, including core family members, close friends, roommates, and employers; (2) disclosure to achieve positive outcomes, including: to gain social support, tell others to take precautions, obtain relevant information, and get permission to work flexibly, and (3) nondisclosure to avoid negative outcomes, including fear of discrimination and stigmatization, strengthen the role of the patient, bring excessive burden, and fear of excessive compassion. Conclusions: For young women diagnosed with breast cancer in China, it is a very complicated matter whether they choose to disclose their diagnosis to others. While disclosure can bring many benefits, it is important to look at the reasons why these women are concealing their diagnosis.

Lived experience of dietary change among Chinese colorectal cancer survivors in Hong Kong: A qualitative study

OBJECTIVES

This is a qualitative study which aims to understand the lived experience of dietary changes among Chinese survivors of colorectal cancer who participated in a dietary intervention.

SETTING

The surgical and oncological departments of four public hospitals in Hong Kong.

PARTICIPANTS

Fifty-five Chinese colorectal cancer survivors who were aged 18 years or above and had received potentially curative treatment in the surgical and oncological departments in Hong Kong were examined. Participants' mean age was 64 years, with 29 (53%) males.

INTERVENTION

A 12-month dietary intervention delivered via face-to-face motivational interviews, fortnightly motivational phone calls, monthly electronic pamphlets, quarterly newsletters and quarterly group meeting.

OUTCOME MEASURE

We adopted the qualitative approach to capture participants' perspectives and to apply the understanding pragmatically in everyday life. Content analysis was conducted.

RESULTS

We identified themes of motives to changes of dietary practices including (1) individual commitment to dietary change; (2) adaptive strategies in interpersonal contexts and (3) working with healthcare professionals during the journey.

CONCLUSIONS

The findings demonstrated how Chinese custom and culture posing unique challenges to colorectal cancer survivors and the need of having dietary advice from healthcare professionals. Participants were motivated to change their eating habits by support from family, friends and healthcare professionals. Our findings could help healthcare professionals provide specific dietary advice and guidance to Chinese colorectal cancer survivors.

TRIAL REGISTRATION NUMBER

NCT01708824.

The role of religion in One Health. Lessons from the Hanuman langur (Semnopithecus entellus) and other human-non-human primate interactions

Being revered as deities in some religions of the world, non-human primates (NHPs) often share the same space as humans. Such coexistence and interactions with humans, especially around places of worship, have been known to cause significant changes to the behavior and diet of the NHPs in India. Moreover, the interface may also create an opportunity for zoonotic spillover, similar to the majority of newly emerging or re-emerging infections that are found to originate from animal sources. These include the SARS COV-2 virus responsible for the current COVID-19 pandemic; a catastrophic "One Health" crisis; that has highlighted the interconnections between the health of humans, animals, and the environment. Religious beliefs could potentially influence perceptions, actions, and subsequent One Health outcomes resulting from human-animal interaction, which could impact human and animal welfare. Greater insight in this area could provide a better understanding of the complex relationships between humans and NHPs; that may play an important role in mitigating conflict as well as the spillover of zoonotic disease at the human-NHP interface.

Self-care Experiences of Advanced Prostate Cancer Survivors Who Underwent Androgen Deprivation Therapy

BACKGROUND

Androgen deprivation therapy is the primary treatment for advanced cases of prostate cancer, but its adverse effects may decrease prostate cancer survivors' quality of life.

OBJECTIVE

The aim of this study was to understand the self-care experiences of prostate cancer survivors before and while receiving androgen deprivation therapy.

METHODS

A qualitative study design with inductive content analysis was used. Semistructured interviews were conducted with 13 prostate cancer survivors in Taiwan treated with androgen deprivation therapy. Data collection and analysis proceeded simultaneously until data saturation was reached.

RESULTS

The survivors' self-care experiences were categorized into generic categories: physical impacts, psychosocial impacts, lack of supporting information, changing lifestyle habits, coping with physical symptoms, relieving stress, and acquiring disease-related knowledge. These generic categories were then organized into 2 main categories: impacts and adjustments.

CONCLUSIONS

This article describes the experiences of prostate cancer survivors in terms of the impacts of disease and its treatment and adjustments in self-care before and while receiving treatment. It was found that the information acquired by survivors and the adjustment strategies they used were not entirely appropriate or adequate.

IMPLICATIONS FOR PRACTICE

Healthcare providers should continually assess the self-care experiences of prostate cancer survivors receiving androgen deprivation therapy, provide them with appropriate information, and clarify their understanding. This will improve survivors' disease care-related knowledge, increase the success of their experience of self-care, alleviate their emotional distress, and strengthen their ability to adjust their self-care to cope with the impacts of the disease and its treatment.

Letting nature take its course: A qualitative exploration of the illness and adjustment experiences of Hong Kong Chinese people with Parkinson's disease

Parkinson's disease (PD) is a chronic condition that results in not only physical deterioration but also a spectrum of psychosocial outcomes that demand continuous adjustment and coping. Previous qualitative research into the illness experiences has been conducted mainly in Western populations, yet little is known about Chinese PD patients' adjustment. The aims of this qualitative description study were to (a) understand the illness and adjustment experiences, (b) explore the reasons for psychological distress and (c) discern the adjustment strategies adopted along the course of illness, from the perspective of Hong Kong Chinese PD patients. Individual semi-structured interviews were conducted with 14 patients from January to June, 2016. Data were analysed using thematic analysis. Two themes emerged from the interviews: confronting the changes caused by Parkinson's disease and adjusting to living with Parkinson's disease. Participants reported experiencing turmoil due to progressive loss of functions and abilities, changes in role and identity and unattended emotional needs in the course of their illness. Considering the chronic and fluctuating nature of PD, rehabilitation programs should be applied to address not only the physical symptoms but also the psychological needs of PD patients. Behavioral strategies facilitating active health behaviours and accommodative psychological adjustment are salient to facilitate the holistic well-being of PD patients.

Person-Centered Dementia Care in China: A Bilingual Literature Review

We conducted a bilingual literature review of the existing studies focusing on person-centered dementia care in China. We synthesized key findings from included articles according to three overarching themes: Chinese cultural relevance of person-centered care (PCC), perceived needs for PCC for older adults in China, implementation and measurement of PCC in China, and person-centered dementia care model. We also drew on frameworks, theories, and other contents from the examined articles to develop a person-centered dementia care model with specific relevance to China. The model is a good starting point to help us operationalize globally relevant core principles of PCC in the specific sociocultural context of China. The framework will be informed by more empirical studies and evolve with the ongoing operationalization of PCC. Although PCC is a new concept and has not been vigorously or systematically studied in China, it is attracting increasing attention from Chinese researchers. More empirical studies are needed to link PCC to measurable outcomes, enrich the framework for applying PCC, and construct assessment and evaluation systems to facilitate the provision of PCC across countries and cultures. Global consortia and collaborations with multidisciplinary expertise to develop a PCC common data infrastructure that is internationally relevant for data sharing and comparison are needed.

Effect of Information of Patients' Coping Style on Pregastroscopy Anxiety

Examination of the relationship between patients' coping style, pregastroscopy information, and anxiety associated with gastroscopy in China was the aim of this study. A pretest, post-test, nonrandom assignment study with a two by two design was conducted. One hundred forty-five patients who underwent initial gastroscopy without sedation were classified into 2 groups on the basis of the coping style: information seekers or information avoiders using the Information Subscale of the Krantz Health Opinion Survey (KHOS-I). All participants were given standardized procedural information about gastroscopy as routine care. Half of each group was assigned to receive additional sensory information describing what sensation they would experience and how to cooperate to alleviate the discomfort. State anxiety assessed by the State Anxiety Scale of Spielberg's State-Trait Anxiety Inventory, blood pressure, and pulse were measured at enrollment and before gastroscopy. The information seekers and avoiders who received additional sensory information experienced significantly less state anxiety after the intervention. In contrast, the information seekers and avoiders who received standardized procedural information maintained their preintervention state anxiety level. Most patients reported their preference for sensory information. In conclusion, the provision of sensory information could significantly reduce patients' pregastroscopy anxiety regardless of patients' information coping style.

The Effect of Nursing Interventions Utilizing Music Therapy or Sensory Information on Chinese Patients’ Anxiety Prior to Cardiac Catheterization: A Pilot Study

Background: Unrelieved anxiety can produce an increase in sympathetic nervous system activity leading to an increase in cardiac workload. Nursing interventions using music therapy or sensory information among patients with coronary artery disease has resulted in anxiety reduction, though results in Chinese subjects has not previously been published. Aims: To determine the effects of using nursing interventions of music therapy or sensory information, on reducing anxiety and uncertainty, and improving negative mood among Chinese subjects immediately prior to cardiac catheterization. Methods: An experimental three-group repeated measures design for this pilot study was used. Forty-five hospitalized adults (15/group) undergoing cardiac catheterization were randomly assigned to either (1) a music therapy intervention, (2) a sensory information intervention or (3) treatment as usual (control). Anxiety, uncertainty and mood state were measured using self-reported questionnaires and physiological measures were made at baseline, post-intervention to determine their effect and post-cardiac catheterization to determine whether these interventions had any long-lasting effect. Results: The control group was found to be significantly older ( P=0.001) than the two experimental groups. Older age was associated with lower anxiety scores ( r=−0.31, P=0.04 at baseline; r=−0.30, P=0.04 post-intervention; r=−0.22, P=0.15 post-cardiac catheterization). After controlling for age, the use of music therapy or sensory information did not significantly reduce anxiety, improve mood state, reduce uncertainty, decrease heart or respiratory rate among subjects undergoing cardiac catheterization. Conclusion: The non-significant result may have been affected by the small sample, and the social and cultural expectations regarding the public display of emotions among Chinese populations.

Measurement Properties of Tai Chi Exercise Self-Efficacy among Ethnic Chinese with Coronary Heart Disease Risk Factors: A Pilot Study

BACKGROUND

Improvement in aerobic capacity and reduction in blood pressure after Tai Chi exercise programs in persons with coronary heart disease (CHD) or with CHD risk factors have been reported. Self-efficacy has been shown to be a consistent predictor of behavioral outcomes, now being applied to Tai Chi exercise.

AIM

To assess the utility and appropriateness of existing tools measuring aspects of Tai Chi exercise self-efficacy (TCSE) in a new population, ethnic Chinese with CHD risk factors. Specific objectives were: (1) examine acceptability and feasibility; (2) determine score distributions; (3) assess the reliability and known-groups validity; (4) translate tool into an equivalent Chinese version and determine if there were any differences between ethnic Chinese and non-Chinese.

METHODS

Following a review of the literature, two existing tools used with Caucasians were found and modified; a 9-item exercise self-efficacy tool developed by Resnick and Jenkins [Resnick B, Jenkins LS, Testing the reliability and validity of the Self-Efficacy for Exercise scale. Nurs. Res. 49(3) (2000) 154-159], and a 3-item tool developed by Li et al. [Li F, McAuley E, Harmer P, Duncan TE, Chaumeton NR, Tai Chi enhances self-efficacy and exercise behavior in older adults. J. Aging Phys. Act. 9 (2001) 161-171] to assess gradations of the challenge to perform Tai Chi among elderly populations. The modified TCSE tool was translated into Chinese and back-translated. A pilot study was conducted to pre-test the modified 14-item TCSE tool in ethnic Chinese and non-Chinese.

RESULTS

A total of 18 subjects (mean age = 60 years, S.D. = 18.4) participated. Seven subjects (39%) identified themselves as ethnic Chinese. Ten subjects (56%) had experience performing Tai Chi, ranging from 3 months to 17 years (mean = 5.0 years, S.D.=5.0). Half of the subjects reported having a history of hypertension (n = 9, 50%), while nearly one-third reported having high cholesterol (n = 5, 28%). No significant difference in TCSE mean scores was found between ethnic Chinese and non-Chinese (p > 0.05). Internal consistency estimates were very high (TCSE Barriers, r = 0.95; TCSE Performance, r = 0.97). A statistically significant difference was found in the TCSE mean scores between Tai Chi practitioners and non-practitioners (TCSE Barriers, t = -3.3, p = 0.01; TCSE Performance, t = -2.7, p = 0.03), with Tai Chi practitioners reporting higher self-efficacy; thus providing initial evidence of known-groups validity.

CONCLUSIONS

Measurement of self-efficacy to overcome barriers to Tai Chi exercise (TCSE Barriers) and self-efficacy to perform Tai Chi (TCSE Performance) functioned well in this sample. The acceptability and feasibility of this tool was established and known-groups validity was confirmed. Further research using this tool among ethnic Chinese with CHD or CHD risk factors, including those with less than high school education or low literacy, is recommended as the next step in development of TCSE.

Social support buffers the effect of self-esteem on quality of life of early-stage cervical cancer survivors in Taiwan

PURPOSE

The purpose of this study was to examine the effects of self-esteem and social support on quality of life (QoL) in stage I and II cervical cancer survivors.

METHOD

The sample consisted of 110 participants who had been diagnosed with stage I-II cervical cancer and had completed their treatment 5 years or more before data collection. Each participant completed four structured questionnaires: a demographic-disease survey, the Rosenberg Self-Esteem Scale, Medical Outcomes Study Social Support Survey, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30. Data were analyzed using descriptive statistics, independent sample t-test, one-way ANOVA, and hierarchical multiple linear regression analyses.

RESULTS

The participants' mean age was 60.74 ± 10.69 years. Better QoL was significantly associated with younger age, higher self-esteem, and stronger social support; in addition, social support buffered the effect of self-esteem on global QoL. Together, five variables (age, time since treatment, self-esteem, social support, and the interaction term of self-esteem and social support) explained 36% of the variance in global QoL, with self-esteem being the strongest predictor.

CONCLUSIONS

The results of this study advance current knowledge of QoL in cervical cancer survivors by demonstrating that survivors with low self-esteem and social support tend to have lower QoL than those with low self-esteem but high social support. Health professionals should help survivors seek support and provide appropriate strategies to expand their social networks and enhance their self-esteem to improve their global QoL after cervical cancer.

Construction and validation of a preliminary Chinese version of the Wake Forest Physician Trust Scale

Background

The development, validation, and psychometric properties of the Wake Forest Physician Trust Scale (WFPTS)-equivalent instrument for Chinese patients were investigated.

Material/Methods

We approached 3442 randomly selected outpatients at 3 Shanghai (China) general hospitals, treated ≥2 times per year by the same physician, for participation between November 2008 and December 2008. A Chinese version of the WFPTS (C-WFPTS) was prepared and administered to eligible and consenting patients, and subjected to validity assessment using 5 patient behaviors: (1) recommendation of the physician; (2) occurrence of dispute; (3) seeking a second opinion; (4) treatment adherence; and (5) consideration of switching physicians.

Results

A total of 352 (M: F, 149: 203; mean age, 40.67±17.31 years; age range, 14–94 years) consenting and eligible patients were included in the analysis. The unidimensionality and internal consistency of C-WFPTS was confirmed (Cronbach’s α=0.833). Physician trust correlated significantly with physician satisfaction (r=0.73, P<0.001) and all 5 behaviors (1: r=0.453, 2: r=0.209, 3: r=0.406, 4: r=0.444, 5: r=0.471; P<0.001 for all), indicating validity and predictive validity, respectively. Patient trust increased significantly with increasing age and physician visits (P>0.05), but was not related to gender, birthplace, or insurance type.

Conclusions

C-WFPTS has good psychometric properties, reliability, and validity for the evaluation of patient trust in the patient-physician relationship, and thereby provides an essential tool for the characterization of patient-physician relationships in China, which is necessary for healthcare reform.

Chinese immigrant parents' vaccination decision making for children: a qualitative analysis

Background

While immunization coverage rates for childhood routine vaccines in Hong Kong are almost 100%, the uptake rates of optional vaccines remain suboptimal. Understanding parental decision-making for children’s vaccination is important, particularly among minority groups who are most vulnerable and underserved. This study explored how a subsample of new immigrant mothers from mainland China, a rapidly-growing subpopulation in Hong Kong, made decisions on various childhood and adolescent vaccines for their offspring, and identified key influences affecting their decision making.

Methods

Semi-structured in-depth interviews were conducted with 23 Chinese new immigrant mothers recruited by purposive sampling. All interviews were audio-taped, transcribed and analyzed using a Grounded Theory approach.

Results

Participants’ conversation revealed five underlying themes which influenced parents’ vaccination decision-making: (1) Institutional factors, (2) Insufficient vaccination knowledge and advice, (3) Affective impacts on motivation, (4) Vaccination barriers, and (5) Social influences. The role of social norms appeared overwhelmingly salient influencing parents’ vaccination decision making. Institutional factors shaped parent’s perceptions of vaccination necessity. Fear of vaccine-targeted diseases was a key motivating factor for parents adopting vaccination. Insufficient knowledge about vaccines and targeted diseases, lack of advice from health professionals and, if provided, suspicions regarding the motivations for such advice were common issues. Vaccination cost was a major barrier for many new immigrant parents.

Conclusions

Social norms play a key role influencing parental vaccination decision-making. Insight gained from this study will help inform healthcare providers in vaccination communication and policymakers in future vaccination programme.

Psychometric evaluation of the Perceived Barriers to Health Care-seeking Decision in Chinese patients with acute coronary syndromes

OBJECTIVES

This study aimed to develop the Chinese version of the Perceived Barriers to Health Care-seeking Decision (PBHSD-C) and evaluate its psychometric properties in Chinese patients with acute coronary syndromes (ACS).

BACKGROUND

The assessment of the level of perceived barriers in the care-seeking trajectory of ACS patients is important for the understanding of its impact on pre-hospital delay in seeking care.

METHODS

The psychometric properties of PBHSD-C were evaluated among 114 ACS patients in the cardiac unit of two major hospitals in Hong Kong.

RESULTS

The Content Validity Indexes were ranged from .88 to 1. The Cronbach's alpha of the PBHSD-C was .74. The intraclass correlation coefficients of all items were above .80. The convergent validity of the PBHSD-C was also supported.

CONCLUSION

The PBHSD-C is reliable and valid to be used to assess the level of perceived barriers in the care-seeking of Chinese patients with ACS.

Perspectives of patients, families, and health care professionals on decision-making about dialysis modality--the good, the bad, and the misunderstandings!

OBJECTIVES

This study explored the factors influencing decision-making about dialysis modality, integrating the perspectives of patients, their families, and health care professionals within an Asian population. The study further sought to understand the low penetration rate of peritoneal dialysis (PD) in Singapore. ♢

METHODS

A sample of 59 participants comprising pre-dialysis patients, dialysis patients, caregivers, and health care professionals (HCPs) participated in semi-structured interviews to explore the decision-making process and their views about various dialysis modalities. Data were thematically analyzed using NVivo9 (QSR International, Doncaster, Australia) to explore barriers to and facilitators of various dialysis modalities and decisional support needs. ♢

RESULTS

Fear of infection, daily commitment to PD, and misperceptions of PD emerged as barriers to PD. Side effects, distance to dialysis centers, and fear of needling and pain were barriers to hemodialysis (HD). The experiences of other patients, communicated informally or opportunistically, influenced the preferences and choices of patients and family members for a dialysis modality. Patients and families value input from HCPs and yet express strong needs to discuss subjective experiences of life on dialysis (PD or HD) with other patients before making a decision about dialysis modality. ♢

CONCLUSIONS

Pre-dialysis education should expand its focus on the family as the unit of care and should provide opportunities for interaction with dialysis patients and for peer-led learning. Barriers to PD, especially misperceptions and misunderstandings, can be targeted to improve PD uptake.

Effects of written plus oral information vs. oral information alone on precolonoscopy anxiety

AIMS AND OBJECTIVES

To determine the effect of written plus oral information vs. oral information alone on precolonoscopy anxiety.

BACKGROUND

Information provision has been considered to reduce precolonoscopy anxiety. However, the best means to provide information before colonoscopy has not yet been determined as there is inconsistency in the outcomes of the clinical trials.

DESIGN

A two-group, pretest, post-test, prospective, quasi-experimental design with non-random assignment.

METHODS

Participants were assigned to group 1 or 2 in the study. In the enrolment all the participants completed the questionnaires to collect personal characteristics data and assessed subjects' anxiety level by the Chinese version of the State Scale of State-Trait Anxiety Inventory as baseline data. After that, subjects in group 1 received written plus oral information before colonoscopy, while those in group 2 received oral information before colonoscopy. On the day for colonoscopy all subjects completed the Chinese version of the State Scale of State-Trait Anxiety Inventory again.

RESULTS

There was no difference in state anxiety and personal characteristic between the two groups at enrolment. After the intervention, although the state anxiety scores were dropped, there were no statistical significant differences between two groups or within groups 1 and 2.

CONCLUSIONS

Information provision before colonoscopy did not reduce the anxiety level in patients directly before colonoscopy.

RELEVANCE TO CLINICAL PRACTICE

There was a trend that information had a positive effect on patients' state anxiety. Future information provision studies may need to add more interactive methods appropriately and take patients' gender, educational level and coping style into consideration.

Identifying the informational and psychosocial needs of Chinese immigrant cancer patients: a focus group study

PURPOSE

The Chinese immigrant community faces multiple barriers to quality cancer care and cancer survivorship. Psychosocial interventions can positively impact quality of life, anxiety, and distress in cancer patients. In this study, we explored the informational and psychosocial needs of Chinese cancer patients to inform the development of culturally targeted support and survivorship interventions.

METHODS

We conducted four focus groups with a total of 28 Chinese cancer patients to elucidate their cancer informational and psychosocial needs. The groups were conducted using standard methodology and guided by community-based participatory research principles. Sessions were audio recorded, transcribed, and translated into English. The research team conducted the analysis.

RESULTS

Frequently occurring themes included (1) the need for accurate information on cancer and treatment options, (2) the role of language barriers in accessing cancer care, (3) the role of food in cancer and the need for nutritional information, and (4) the role of Chinese medicine in cancer treatment. Participants expressed significant dissatisfaction with the amount, reliability, and/or comprehensibility of available information.

CONCLUSIONS

Support groups and programs should be developed to address participants' needs for more information on cancer and its treatment. Programs should educate and empower patients on how to find further Chinese language information and resources and effectively communicate their questions and needs to providers in an interpreted encounter. System-level approaches should be implemented to ensure provision of interpretation services. Additionally, programs should incorporate the unique cultural needs of this population related to food/nutrition and Chinese medicine.

Short-term effect of motivational interviewing on clinical and psychological outcomes and health-related quality of life in cardiac rehabilitation patients with poor motivation in Hong Kong: a randomized controlled trial

BACKGROUND

Motivational interviewing (MI) is effective in promoting behavioural changes in patients with substance abuse and smoking. However, its effectiveness on health outcomes in cardiac rehabilitation patients is unclear.

DESIGN

A randomized controlled trial.

METHOD

A total of 146 patients assessed as having poor motivation attended a cardiac rehabilitation programme from February 2008 to June 2010. Patients (n = 73) in the control group received usual care while those in the experimental group (n = 73) received usual care plus four sessions of MI, each lasting 30-45 min. Clinical and psychological outcomes and health-related quality of life were measured at baseline and 3 months after entering the programme. Descriptive statistics, independent t-test, Pearson Chi-squared test, and generalized estimating equations models were used to analyse the data.

RESULTS

There was no significant difference between the two groups on clinical outcomes (all p-values >0.05). Patients in the experimental group had higher increases in health-related quality of life (SF-36) scores in the aspects of general health (4.74, 95% CI 0.04-9.44; p = 0.048) and role limitation due to emotional problems (8.80, 95% CI 1.16-16.43; p = 0.024). However, they reported significantly higher increases in anxiety levels (Hospital Anxiety and Depression Scale) than those in the control group (0.96, 95% CI 0.09-1.83; p = 0.030).

CONCLUSION

The short-term effectiveness of MI on clinical outcomes and health-related quality of life in poorly motivated cardiac rehabilitation patients is limited. MI, however, was shown to increase anxiety levels of patients during the study period (3 months). More evidence is needed to better understand this phenomenon in the future studies.

Gender differences on chest pain perception associated with acute myocardial infarction in Chinese patients: a questionnaire survey

AIMS

To investigate gender differences in chest pain perception among Chinese patients with acute myocardial infarction.

BACKGROUND

Thrombolytic therapy is beneficial to outcomes of acute myocardial infarction if administered within 12 hours from the onset of chest pain. However, cardiac symptom interpretation may impact time of presentation to hospital. Differences in cardiac symptom reports by gender partly explain misdiagnoses and delays in treatment, particularly among women. Whether, such trends apply to Chinese patients with myocardial infarction is unknown.

DESIGN

A descriptive prospective study.

METHODS

Using questionnaires, data on demographic variables, the number of patients reporting chest pain and other chest sensations at the onset of acute myocardial infarction and chest pain intensity, description, location and radiation across the chest were collected.

RESULTS

A total of 128 participants equally divided by gender were recruited. Chest pain was more prevalent among men than women (84.37% vs. 67.19%, p < 0.05). Although no statistical significance was found, Chinese men had higher mean chest pain intensity scores (7.54 SD 2.35 vs. 7.51 SD 2.25) and reported less atypical chest pain (0.00% vs. 9.3%) compared with women. Men had more upper right sided chest pain (40.74% vs. 20.93%, p = 0.038) whereas women experienced increased neck pain and pain to the upper central chest, middle central chest, upper central back, middle central back and middle right back regions.

CONCLUSIONS

Discreet gender differences in chest pain perceptions exist between Chinese men and women, with the latter group, who may be considered as a high-risk group for missed and delayed diagnosis from myocardial infarction, reporting more atypical presentations.

RELEVANCE TO CLINICAL PRACTICE

Irrespective of culture, women with myocardial infarction tend to present with atypical chest pain symptoms and therefore they should be aggressively investigated.

Asia-Pacific nursing scholarship development: qualitative exploration of nurse scholars in Taiwan (Republic of China)

AIM

From the perspective of scholars, to describe a contemporary view of the development, facilitators of and barriers to nursing scholarship in Taiwan, to enhance policy-making about research, education and practise development.

BACKGROUND

Nursing scholarship in the Asia-Pacific region is in different stages of development, depending on in-country resources and socio-economic conditions. Little is known about the facilitators or barriers to nursing scholarship in some of these countries, including Taiwan, where nursing education has changed considerably over the last decade.

DESIGN

A qualitative exploratory design.

METHOD

The study used snowballing to identify scholars who underwent semi-structured in-depth interviews. These were digitally recorded, transcribed verbatim and subjected to content analysis.

RESULTS

Interviews were held with 12 scholars and six major themes arose: 'fulfilling our missions'; 'active research productivity'; 'low levels of collaborative research'; 'increasing demands on time'; 'gender issues' and 'developing effective collaborative networks across Taiwan and Asia'. Participants described Taiwanese scholarship development in terms of fulfilling the missions of universities; trying to balance work and culturally relevant family responsibilities, against a background of decreasing pressures to produce more qualified nurses and being more research productive in rapidly changing and challenging work environments.

CONCLUSIONS

Taiwan's nursing scholarship is in a dynamic early stage of development, with increasing graduate programmes and research productivity, evidenced by rising international publications and the research productivity indexes of academics. However, scholars are facing increasing pressure because of high workloads and balancing family and work responsibilities.

RELEVANCE TO CLINICAL PRACTICE

Understanding scholarship development and its facilitators and barriers in Taiwan helps inform policy makers, the higher education sector and nurses in the country and across the region about what needs to be done to improve nursing practice, raise health outcomes and enhance nursing research productivity and education.

The utility of screening for perinatal depression in the second trimester among Chinese: a three-wave prospective longitudinal study

This paper aims to study the pattern of perinatal depressive symptomatology and determine the predictive power of second trimester perinatal depressive symptoms for future perinatal periods. A population-based sample of 2,178 women completed the Edinburgh Postnatal Depression Scale (EPDS) in the second and third trimesters and at 6 weeks postpartum. Repeated measures ANOVAs were used to determine the EPDS scores across three stages. The predictive power of the second trimester EPDS score in identifying women with an elevated EPDS score in the third trimester and at 6 weeks postpartum were determined. The predictive power of the second trimester EPDS score was further assessed using stepwise logistic regression and receiver operator characteristic curves. EPDS scores differed significantly across three stages. The rates were 9.9%, 7.8%, and 8.7% for an EPDS score of >14 in the second and third trimesters and at 6 weeks postpartum, respectively. Using a cut-off of 14/15, the second trimester EPDS score accurately classified 89.6% of women in the third trimester and 87.2% of those at 6 weeks postpartum with or without perinatal depressive symptomatology. Women with a second trimester EPDS score >14 were 11.78 times more likely in the third trimester and 7.15 times more likely at 6 weeks postpartum to exhibit perinatal depressive symptomatology after adjustment of sociodemographic variables. The area under the curve for perinatal depressive symptomatology was 0.85 in the third trimester and 0.77 at 6 weeks postpartum. To identify women at high risk for postpartum depression, healthcare professionals could consider screening all pregnant women in the second trimester so that secondary preventive intervention may be implemented.

Bipolar disorder and medical adherence: A Chinese perspective

BACKGROUND

The aim of this study was to explore the perspectives of New Zealand Chinese with bipolar disorder in regards to medication adherence.

METHOD

Nine New Zealand Chinese with bipolar disorder (BD) type I or II who had reasonable performance in role functioning were interviewed and data analysis was guided by an inductive approach.

RESULTS

Relationships with doctors had the most impact on the participants' attitudes towards medication. The majority of the participants in this study went to see Chinese psychiatrists and were professionally linked with Chinese social workers. Meetings with health professionals have been described by the participants as forms of interpersonal interactions. With a deep feeling of trust and respect towards their doctors, the participants felt more positive towards using prescribed medication. In contrast, when the participants experienced feelings of neglect by their doctors they felt less satisfaction towards the treatment. However, when the participants saw Western health professionals, their attitudes towards medication were more related to perceived efficacy of treatment.

CONCLUSIONS

There is a strong need for facilitating the connection between health professionals and clients. Furthermore, it would be useful for educating Chinese clients on how medication works, their side effects, and interaction with other drugs.

Chinese health beliefs of older Chinese in Canada

Objectives. This study examines the cultural health beliefs held by older Chinese in Canada. Methods. Chinese surnames are randomly selected from the local Chinese telephone directories. Telephone screening is then conducted to identify eligible Chinese people 55 years of age or older to take part in a face-to-face interview to complete a structured survey questionnaire. Results. The results of exploratory factor analysis indicate that the health beliefs of the older Chinese are loaded onto three factors related to beliefs about traditional health practices, beliefs about traditional Chinese medicine, and beliefs about preventive diet. Education, religion, country of origin, length of residency in Canada, and city of residency are the major correlates of the various Chinese health beliefs scales. Discussion. The findings support the previous prescriptive knowledge about Chinese health beliefs and illustrate the intragroup sociocultural diversity that health practitioners should acknowledge in their practice.

Psychometric evaluation of the Mainland Chinese version of the Edinburgh Postnatal Depression Scale

BACKGROUND

The Edinburgh Postnatal Depression Scale (EPDS) has been validated in many countries, but not in Mainland China.

OBJECTIVES

This study investigated the reliability and validity of the Mainland Chinese version of the EPDS.

DESIGN

A three-stage design was used for this study. Stage I consisted of a multi-stepped process of forward and backward translation, using a panel of six experts to test content validity. Stage II established the psychometric properties of the EPDS by examining the convergent, discriminant and construct validity, internal consistency and stability of the scale. Stage III established its sensitivity, specificity and the optimal cutoff score of the EPDS according the DSM-IV-TR criteria using the Structured Clinical Interview.

SETTING

Three regional public hospitals in Chengdu.

PARTICIPANTS

A convenience sample was composed of 312 and 451 pregnant women at 28-36 weeks' gestation.

METHOD

Translation and back-translation of the original English instrument and content validation by an expert panel. Receiver operating characteristic (ROC) analysis was carried out to evaluate the global functioning of the scale. The Beck Depression Inventory (BDI), Dyadic Adjustment Scale (DAS) and standard SF-12 Health Survey (SF-12) were used to investigate the convergent, discriminant and construct validity. The Cronbach's alpha reliability coefficient, split-half reliability and test-retest reliability were used to examine the internal consistency and stability of the scale.

RESULTS

The translation process was rigorously conducted to ensure that equivalence was established. Content validity was confirmed by a satisfactory level of agreement with a content validity index (CVI) of 0.93. The area under curve (AUC) was 85.6% and the logistic estimate for the threshold score was 9.5 (sensitivity, 80.0%; specificity, 83.03%) for clinical depression. Convergent and construct validity was supported and discriminant validity suggested that the EPDS successfully discriminated among the non-depressed, mildly and clinically depressed groups. The split-half reliability of the EPDS was 0.76, Cronbach's alpha was 0.79 and test-retest reliability was 0.85.

CONCLUSIONS

Based on the results of this psychometric testing, the Mainland Chinese version of the EPDS is considered ready for use in the routine screening of pregnant women. It is hoped that with this type of cross-cultural information, the universality of the constructs of the instrument can be reliably demonstrated.

Taiwanese women's experiences of becoming a mother to a very-low-birth-weight preterm infant: a grounded theory study

BACKGROUND

Significant improvements have occurred in the survival rates of small preterm infants. As more infants survive their preterm birth, the number of parents associated with this experience has also increased. Clearly, the birth of very-low-birth-weight (VLBW) preterm infants poses considerable challenges for all mothers. These challenges are further compounded in Taiwan, where women are traditionally required to practise the cultural ritual (Zuo Yue Zi) which includes confinement to the house with a special balanced diet for the first month postnatally. Moreover, there is a deficit of information on mothers' experiences when their preterm infants are in neonatal intensive care units (NICUs).

AIMS

The aim of this study was to explore Taiwanese mothers' (n=26) parenting experiences when their preterm infants were in NICUs.

DESIGN

A qualitative research approach, grounded theory, was used to explore the mothers' lived reality of these experiences.

METHODS

In-depth interviews and participant observations were conducted to gain insight into the experience of parenting.

FINDINGS

A theoretical model was formulated from the findings delineating Taiwanese mothers' parenting experiences during their preterm infants stay in hospital. The findings indicated that the preterm birth, together with the admission of their infants to a NICU, presented mothers with an unexpected crisis. The particular cultural postnatal ritual posed this group of Taiwanese mothers with an additional difficulty in establishing physical interactions. However, the Taiwanese mothers created alternative channels of contact with their hospitalised infants using emotional connections, while the physical interactions were certainly limited. Despite all the difficulties this group of Taiwanese mothers faced and resolved, they all gradually captured and embraced the parenting role. The finding of this study further indicated that the support the mothers received from the healthcare professionals and the social networks the mothers made helped to create the connections that developed between the mothers and infants, making their journey towards parenthood possible.

CONCLUSION

The theoretical model developed in this study is the first of its kind to contribute to the field of neonatal nursing in Taiwan. This would help Taiwanese women come to terms with becoming mothers of VLBW infants and subsequently enhance their parenting role.

Patterns of help-seeking behavior for anxiety disorders among the Chinese speaking Australian community

BACKGROUND

The utilization of mental health services is low among Chinese immigrants in Australia, yet their help-seeking pattern has not been investigated. The aims of this study were to describe the delay among Chinese immigrants in seeking treatment for an anxiety disorder and to compare the results with previous research from the general population in Australia.

METHODS

Forty-nine participants were recruited from the community. Their demographic data, DSM-IV diagnosis and help-seeking patterns were assessed by a self-report questionnaire and the CB-SCID (Chinese-bilingual Structured Clinical Interview Schedule for the DSM-IV).

RESULTS

The average length of the delay for treatment was 7.04 years and the average time to problem recognition was 8.07 years. The most common barriers to help-seeking reported by Chinese immigrants include a lack of knowledge about available treatment, being unable to afford the cost of the treatment, and having no transportation to access the service. The most frequently endorsed reason for help-seeking was "I recognized the problem was anxiety". General medical practitioners were most commonly their first professional contact.

CONCLUSIONS

The time taken for Chinese immigrants in Australia to seek help was typically long, suggesting a similar help-seeking delay to the Australian general population. However, different barriers to help-seeking emerged, suggesting that Chinese immigrants would benefit from education about the symptoms of psychiatric disorders and available treatments.

Secrets to success: a qualitative study of perceptions of childhood immunisations in a highly immunised population

AIM

The aim of this study was to explore childhood immunisations with a sample of parents from a population where children have high vaccination coverage and to identify factors which might encourage uptake in other populations.

METHODS

This research was conducted as part of a larger study on childhood immunisations in Hong Kong. In-depth interviews were conducted with a subsample of parents (n = 15) to further explore general perceptions and health beliefs about childhood immunisations. Interview data were analysed using content analysis techniques.

RESULTS

Three core themes emerged from the data: individual influences factors, family and social factors, and system factors. [Correction added after online publication 21/8/08: sentence corrected from "Four core themes emerged from the data: individual influences, family influences and system influences."] Parents readily admitted knowledge deficits concerning childhood vaccines but believed that the benefits of immunisation outweighed the risks. Family members and peers were a source of pro-immunisation advice and comprehensive public health programmes and mandatory vaccination requirements for school entry ensured that childhood immunisation recommendations were followed.

CONCLUSIONS

Overall, Hong Kong parents are highly supportive of immunisation programmes and insight gained from this study could prove helpful to providers trying to improve uptake rates among other populations.