1
|
Hebert-Beirne J, Camenga DR, James AS, Brady SS, Newman DK, Burgio KL, Kane Low L, Hardacker CT, Gahagan S, Williams BR. Social Processes Informing Toileting Behavior Among Adolescent and Adult Women: Social Cognitive Theory as an Interpretative Lens. QUALITATIVE HEALTH RESEARCH 2021; 31:430-442. [PMID: 33427071 PMCID: PMC8053251 DOI: 10.1177/1049732320979168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Little is known about social processes shaping adolescent and adult women's toileting behaviors. The "Study of Habits, Attitudes, Realities, and Experiences" (SHARE) examines adolescent and adult women's experiences related to bladder health across the life course. Forty-four focus groups with 360 participants organized by six age groups were conducted across seven sites. A transdisciplinary team used social cognitive theory as an interpretive lens across a five-stage analysis. The act of observing was identified as the overarching social process informing women's toileting behaviors in three ways: (a) observing others' toileting behavior, (b) being aware that one's own toileting behaviors are monitored by others, and (c) observing oneself relative to others. We found that underlying processes of toileting behaviors, seemingly private are, in fact, highly social. We suggest, given this social embeddedness that health promotion efforts should leverage interpersonal networks for "social norming" interventions and policies to promote healthy toileting behaviors.
Collapse
Affiliation(s)
| | | | | | - Sonya S Brady
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Diane K Newman
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathryn L Burgio
- University of Alabama, Birmingham, Alabama, USA
- Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Birmingham, Alabama, USA
| | | | | | - Sheila Gahagan
- University of California San Diego, La Jolla, California, USA
| | - Beverly Rosa Williams
- University of Alabama, Birmingham, Alabama, USA
- Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Birmingham, Alabama, USA
| |
Collapse
|
2
|
Lin ZX, Chan NHT, Kwan YK, Chan YT, Zhang H, Tam KYS, Lai MK, Lee CK, Ngan K, Tsoi SYY, Lau YW, Xian YF, Ching J, Guo Y. A randomized controlled trial to assess the effectiveness and safety of acupuncture for overactive bladder: a study in Hong Kong population. Chin Med 2020; 15:108. [PMID: 33062044 PMCID: PMC7545560 DOI: 10.1186/s13020-020-00388-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Around 15% of the Hong Kong population was found to suffer from overactive bladder (OAB), but the current available treatments, such as medication, behavioral therapy and physical therapy are unsatisfactory. Previous studies have suggested that acupuncture may have promising effect for OAB, but some limitations on the study design render the evidence questionable. This study aimed to evaluate the effectiveness and safety of acupuncture treatment for patients with OAB in Hong Kong. METHODS One hundred patients with OAB were enrolled. The patients were randomized to receive either active acupuncture or sham needle intervention twice a week for 8 consecutive weeks, and had a follow-up consultation 12 weeks after the completion of acupuncture intervention. The primary outcome assessment was the 3-Day Voiding Diary, which records daytime and night-time urinary frequency and symptoms, at the baseline, the end of the 8-week intervention and 12 weeks after acupuncture intervention. Secondary outcomes included Urine NGF level, Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6), as well as Overactive Bladder Symptom Score (OABSS). RESULTS After 16 sessions of treatment, when compared with the baseline, both active and sham acupuncture significantly reduced the frequency of urgency urinary incontinence (UUI), daytime and night-time urinary frequency as well as the scores of IIQ-7, UDI-6 and OABSS. Moreover, the treatment effects could last for at least 3 months. However, no significant difference in frequency of UUI and daytime urinary frequency was found between the active and sham acupuncture groups. On the other hand, the night-time urinary frequency decreased more significantly during the treatment and follow-up in the active acupuncture group than in the sham control group after controlling baseline night-time urinary frequency. Urine NGF level could not be detected by ELISA method in our experiments. CONCLUSION This study suggests a beneficial effect of acupuncture on improving OAB symptoms. Both active and sham acupuncture treatment were able to improve the symptoms of frequency of urgency urinary incontinence, and the daytime and night-time urinary frequency, while only mild adverse effects were found. This project was unable to establish the specific effect of acupuncture for OAB.Trial registration Chinese Clinical Trial Registry, ChiCTR-INR-16010048. Registered on 29 Nov 2016.
Collapse
Affiliation(s)
- Zhi-Xiu Lin
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR China
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR China
| | - Ngai Ho Tony Chan
- Department of Medicine & Geriatrics, Pok Oi Hospital, Yuen Long, N.T., Hong Kong SAR China
| | - Yiu-Keung Kwan
- Department of Medicine & Geriatrics, Tuen Mun Hospital, Tuen Mun, N.T., Hong Kong SAR China
| | - Yu Tat Chan
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR China
| | - Hongwei Zhang
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR China
| | - Kam-Yuk Sylvia Tam
- Yan Oi Tong - The Chinese University of Hong Kong Chinese Medicine Centre for Training & Research, Tuen Mun, N.T., Hong Kong, SAR China
| | - Mei Kwan Lai
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR China
| | - Chun-Kam Lee
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR China
| | - Kit Ngan
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR China
| | - Stella Yin Yuen Tsoi
- Yan Oi Tong - The Chinese University of Hong Kong Chinese Medicine Centre for Training & Research, Tuen Mun, N.T., Hong Kong, SAR China
| | - Yiu Wa Lau
- Yan Oi Tong - The Chinese University of Hong Kong Chinese Medicine Centre for Training & Research, Tuen Mun, N.T., Hong Kong, SAR China
| | - Yan-Fang Xian
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR China
| | - Jessica Ching
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR China
| | - Yuanqi Guo
- Pok Oi Hospital - The Chinese University of Hong Kong Chinese Medicine Centre for Training & Research, Shatin, N.T., Hong Kong SAR China
| |
Collapse
|
3
|
Williams BR, Nodora J, Newman DK, Kane Low L, James AS, Camenga DR, Hebert-Beirne J, Brady SS, Hardacker CT, Smith AL, Cunningham SD, Burgio KL, Prevention Of Lower Urinary Tract Symptoms Plus Research Consortium. I never knew anyone who peed on themselves on purpose: Exploring adolescent and adult women's lay language and discourse about bladder health and function. Neurourol Urodyn 2020; 39:225-236. [PMID: 31578778 PMCID: PMC8126963 DOI: 10.1002/nau.24174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/09/2019] [Indexed: 11/06/2022]
Abstract
AIMS This analysis explored and characterized adolescent and adult women's lay language and discourse related to bladder health/function. METHODS Forty-four focus groups were conducted across seven United States research centers with 360 adolescents and adult women, organized by six age categories. Multilevel content analyses classified emergent themes. A transdisciplinary lens and inductive approach guided data interpretation. Interpretive insights were validated by a community engagement panel. RESULTS A repertoire of bladder function terms emerged, including explicit functional terms, formal and polite euphemistic terms, and informal familiar terms, as well as cultural and regional metaphors and idioms. Terminology usage was historically grounded, developmental, and cumulative across the life course. Lay discourse was contextual and affectively valent, suggesting unspoken, commonly understood, situation-based "rules" for talking about bladder function. Discourse appeared to be siloed within family and friendship circles. Adolescents and adult women often described, rather than named, bladder sensations or problems. Terminology for bladder issues tended to minimize severity and frequency, with medical language only relevant to extreme examples and not applicable to mild episodes. CONCLUSIONS A definitional discordance between medical and lay views of bladder problems was identified, signifying a need to clarify the meaning of medical terms for lay persons. Adolescents and adult women do not have or use standardized precise terminology for bladder health and function, relying instead on social convention and interpersonal context. Findings can be used to foster shared understandings between lay persons and health professionals, informing development of clinical, research, and public health initiatives to promote bladder health.
Collapse
Affiliation(s)
- Beverly Rosa Williams
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB), Alabama
| | - Jesse Nodora
- Department of Family Medicine and Public Health, University of California-San Diego Moores Cancer Center, San Diego, California
| | - Diane K Newman
- Adjunct Professor of Urology in Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania
| | - Lisa Kane Low
- Women's Studies and Department of Obstetrics and Gynecology, University of Michigan, Michigan
| | - Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington
| | - Deepa R Camenga
- Department of Emergency Medicine (Pediatrics), Section of Research, Yale School of Medicine, Connecticut
| | - Jeni Hebert-Beirne
- Community Health Sciences, School of Public Health, University of Illinois at Chicago, Illinois
| | - Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minnesota
| | - Cecilia T Hardacker
- Department of Education, Center for Education, Research and Advocacy, Howard Brown Health, Chicago, Illinois
- Adjunct Instructor, Rush University College of Nursing, Illinois
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Pennsylvania
| | - Shayna D Cunningham
- Social and Behavioral Sciences Department, Yale School of Public Health, Connecticut
| | - Kathryn L Burgio
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, Geriatric Research, Education and Clinical Center, Department of Veterans Affairs, University of Alabama at Birmingham (UAB) and Birmingham/Atlanta, Alabama
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | | |
Collapse
|
4
|
Chan YT, Zhang HW, Guo YQ, Chan TNH, Kwan YK, Lee CK, Ngan K, Lin ZX. Effectiveness and safety of acupuncture for elderly overactive bladder population in Hong Kong: study protocol for a randomized controlled trial. Trials 2018; 19:376. [PMID: 30005707 PMCID: PMC6045827 DOI: 10.1186/s13063-018-2706-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 05/24/2018] [Indexed: 12/02/2022] Open
Abstract
Background Overactive bladder (OAB) is defined as “urgency, with or without urge incontinence, usually with frequency and nocturia”. Acupuncture is one of the most popular alternative treatment methods for OAB. Little established evidence is available to support the effectiveness of acupuncture for OAB. This study is a pioneer randomized, double-blinded, sham-controlled trial to assess the effectiveness and safety of acupuncture in the elderly population with overactive bladder in Hong Kong. Methods/design This is a randomized, double-center, patient and outcome assessor blinded, sham-controlled trial. The study sample size is 100 patients. Eligible subjects aged between 60 to 90 years old will be recruited into this study. All subjects will be randomly allocated into the active acupuncture group or sham acupuncture group in a 1: 1 ratio. Participants who are allocated into the active acupuncture group will receive a standardized 30-min real acupuncture treatment session for a total of 16 sessions on the top of standard routine care, whilst those who are randomized to the sham acupuncture arm will receive sham acupuncture in addition to standard routine care. Non-penetrating needles will be utilized as sham acupuncture. The primary outcome measure is the 7-day voiding diary and the secondary outcome measures are urine nerve growth factor (NGF) level, the Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6) and OAB Symptom Score (OABSS). All outcome measures will be collected at baseline, the end of treatment and 3 months after treatment completion. Discussion The objectives of this study include (1) to evaluate the effectiveness and safety of acupuncture treatment in patients with OAB on reduction in the frequency of incontinence episodes as derived from a 7-day voiding diary, (2) to evaluate whether acupuncture treatment could improve subjective symptoms in patients with OAB and (3) to examine the feasibility of using NGF as a biomarker for overactive bladder and test correlation with the effectiveness of acupuncture intervention. The finding of this study will provide preliminary evidence on the effectiveness and safety of acupuncture for treatment of OAB. Trial registration Chinese Clinical Trial Registry, ChiCTR-INR-16010048. Registered on 29 Nov 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2706-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yu Tat Chan
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Hong Wei Zhang
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Yuan Qi Guo
- Pok Oi Hospital - The Chinese University of Hong Kong Chinese Medicine Centre for Training & Research (Shatin), New Territories, Hong Kong, China
| | - Tony Ngai Ho Chan
- Department of Medicine & Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong, China
| | - Yiu-Keung Kwan
- Department of Medicine & Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong, China
| | - Chun-Kam Lee
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Kit Ngan
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Zhi-Xiu Lin
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China. .,Hong Kong Institute of Integrative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.
| |
Collapse
|
5
|
Imprisoned in the Cultural Stereotypes of Overactive Bladder: Cultural Meanings of Disease and Sick Role Adaptation in Hong Kong. Nurs Res 2017; 65:352-61. [PMID: 27579503 DOI: 10.1097/nnr.0000000000000177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diseases often carry cultural meanings and metaphors, and these meanings can influence illness experiences and behavioral responses. OBJECTIVES This research investigated how old cultural stereotypes and new social understandings of overactive bladder (OAB) intertwined to influence sick role adaptation and behavioral responses among those with OAB. METHODS A qualitative approach using in-depth individual, semistructured interviews was adopted. Thirty patients having OAB were purposively sampled from a patient self-help group for people with OAB. RESULTS The cultural stereotypes about OAB-as an "old people" disease, as a hopeless disease without cure, as a sexually related disease, and as a disease of substance use-had significant impact on the social and illness experiences of participants, leading to difficulty in adapting to their sick role, indicated by behavioral responses of denial, concealment, resignation, and self-seclusion. DISCUSSION Cultural stereotypes of OAB significantly influenced sick role adaptation, which affected illness experiences of persons with OAB. These cultural stereotypes were associated with behavioral responses that led to difficulties in coping with OAB.
Collapse
|
6
|
Siu JYM. Coping with patients suffering from overactive bladder: experiences of family caregivers in Hong Kong. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:83-91. [PMID: 26417721 DOI: 10.1111/hsc.12278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 06/05/2023]
Abstract
This article examines the experiences of family caregivers working with patients affected by overactive bladder (OAB) in Hong Kong. Chronic diseases create physical and emotional burdens not only for patients but also for family caregivers, who often experience physical and emotional burnout and social impairment. Extensive literature has pertained to caregiver experiences in western and non-western settings; however, few studies have addressed the livelihoods and experiences of family caregivers of patients with OAB in ethnic Chinese communities. Because of the increasing prevalence of OAB worldwide, this study investigated the experiences of such caregivers in Hong Kong, examining their emotional and social needs. A qualitative research design with individual semistructured interviews was adopted, and snowball sampling was used to recruit 35 family caregivers who were referred by patients with OAB. The participants were interviewed individually from May to August 2013. A phenomenological approach was adopted in the data analysis. The data revealed that all participants had unpleasant experiences in caring for family members with OAB. A sense of powerlessness, helplessness, confusion and guilt, as well as grievances and social withdrawal, was prevalent, causing great physical and emotional suffering and subsequent physical and emotional burnout. These negative experiences were often caused by confusion regarding caretaking duties. The negative emotions of the participants and their family members also caused a lack of communication and mutual understanding about the disease, causing care-giving to be even more confusing and difficult. Furthermore, because of traditional Chinese cultural values and gender expectations, male participants experienced the triple burden of employment, domestic duties and care-giving. More holistic social and healthcare support services should be provided for care-giving family members of patients with OAB patients, empowering such caregivers to attend to family members and care for their own emotional well-being.
Collapse
Affiliation(s)
- Judy Yuen-Man Siu
- David C. Lam Institute for East-West Studies (Environment, Health, and Sustainability Working Group), Hong Kong Baptist University, Kowloon, Hong Kong
| |
Collapse
|
7
|
Siu JYM. Communicating with mismatch and tension: treatment provision experiences of primary care doctors treating patients with overactive bladder in Hong Kong. BMC FAMILY PRACTICE 2015; 16:160. [PMID: 26519163 PMCID: PMC4628250 DOI: 10.1186/s12875-015-0380-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/28/2015] [Indexed: 12/05/2022]
Abstract
BACKGROUND Overactive bladder (OAB) is a common chronic bladder dysfunction worldwide. As the first contact point of health care, primary health care providers are often consulted by patients seeking initial consultation for OAB. The relatively short history of the existence of OAB in medicine and low public awareness of OAB in Hong Kong, however, often serve as a challenge to primary health care providers in treating patients with OAB. The experiences of patients and health care providers are often influenced by the interaction between these two groups, hence both health care providers and patients are key determinants of the entire treatment experience, and the perspectives of health care providers should not be overlooked. However, patient experiences have been the main focus of related studies, few of which have examined the treatment provision experiences and perspectives of health care providers. This research gap is notable considering that the satisfaction and morale of health care providers can influence treatment outcome. METHODS This study adopted a qualitative research approach by conducting semistructured individual interviews with 30 private practice primary care doctors in Hong Kong between November 2013 and May 2014. RESULTS Lacking confidence in treating OAB patients, encountering mismatch with patients in treatment expectations and communication style, and feeling embarrassed when communicating with OAB patients were the experiences reported by the sampled doctors. CONCLUSION The sampled doctors' treatment provision experiences revealed a general lack of knowledge about OAB among primary care doctors in Hong Kong. Furthermore, the negative stereotype of and lack of trust in private practice doctors created tension between the doctors and patients. This lack of mutual trust was particularly unfavourable for the doctors to provide long-term treatment and support to patients with OAB. The embedded distrust of private practice doctors also affected the prescribing behaviour of the doctors, who prescribed medication only to satisfy patient demands, which may lead to antibiotic abuse and resistance. Finally, the expectations of doctor professionalism and behaviour in Chinese cultures and the cultural perceptions of urinary diseases caused challenging treatment provision experiences for the sampled doctors.
Collapse
Affiliation(s)
- Judy Yuen-Man Siu
- David C. Lam Institute for East-West Studies (Environment, Health, and Sustainability working group), Hong Kong Baptist University, Kowloon Tong, KLN, Hong Kong.
| |
Collapse
|
8
|
Siu JYM. Communicating under medical patriarchy: gendered doctor-patient communication between female patients with overactive bladder and male urologists in Hong Kong. BMC Womens Health 2015; 15:44. [PMID: 26021313 PMCID: PMC4448299 DOI: 10.1186/s12905-015-0203-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 05/22/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Gender differences between patients and doctors markedly influence the quality of communication in treatment processes. Previous studies have shown that communication between patients and doctors of the same gender is usually more satisfactory, particularly for female patients. However, in Hong Kong, where urology is a male-dominated specialty, female patients typically require medical care from male doctors for diseases such as overactive bladder (OAB). The literature about gender-related doctor-patient communication predominantly involves people in non-Chinese communities, with few studies conducted with Chinese populations. However, the differences between Western and Chinese cultures are expected to result in different treatment and communication experiences. Furthermore, OAB has received little attention in many Chinese communities; few studies in the literature address the communication quality between OAB patients and their urologists in Chinese communities, particularly regarding female OAB patients' experiences when seeking treatment from male urologists. This study, therefore, investigated the doctor-patient communication between female OAB patients and male urologists in Hong Kong. METHODS This study adopted a qualitative research approach by conducting semistructured interviews with 30 female OAB patients on an individual basis from April 2012 to July 2012. The participants were purposively sampled from a patient self-help group for OAB patients in Hong Kong. RESULTS The participants' communication experiences with male urologists were unpleasant. Embarrassment, feelings of not being treated seriously, not being understood, and not being given the autonomy to choose treatment approaches prevailed among the participants. Furthermore, the perceived lack of empathy from their urologists made the participants' communication experiences unpleasant. CONCLUSIONS The gender and power differential between the participants and their urologists, which was contributed by the social and cultural values of patriarchy and doctors' dominance in Hong Kong, made the participants' communication with the urologists unpleasant and difficult. Poor doctor-patient communication can endanger patients' treatment compliance and thus the treatment outcome. Although altering such social and cultural values would be difficult, providing complementary chronic care services, such as nurse-led clinics as well as support and sharing from patient self-help groups, might be a possible solution.
Collapse
Affiliation(s)
- Judy Yuen-Man Siu
- David C. Lam Institute for East-West Studies (Environment, Health, and Sustainability working group), Hong Kong Baptist University, Hong Kong, China.
| |
Collapse
|