The influence of value reference point and risk preference on adherence in hypertensive patients in a low-income area of China

Effectiveness of patient decision aid supported shared decision-making intervention in in-person and virtual hybrid pulmonary rehabilitation in older adults with chronic obstructive pulmonary disease: A pilot randomized controlled trial

INTRODUCTION

Tele-pulmonary rehabilitation is increasingly advocated but cannot completely substitute for in-person services for chronic conditions. Adherence to Pulmonary rehabilitation (PR) remains low in chronic obstructive pulmonary disease (COPD) patients. Shared decision-making (SDM) promotes patients' participation in PR decisions and helps patients and healthcare providers to jointly make decisions that patients are informed and aligned with patient preferences and values, which are critical for patient adherence to PR.

OBJECTIVE

This study aimed to develop a hybrid in-person and virtual model of home-based PR services for older COPD patients and study the effectiveness of the patient decision aid (PDA)-supported recurring SDM intervention on patient adherence to PR, rehabilitation outcomes, and decision-related outcomes, as well as to explore the mechanisms of the intervention on PR adherence.

METHODS

A total of 78 older COPD patients were randomly assigned to the PR group (n = 39) or PDA-PR group (n = 39). Both groups were conducted hybrid in-person and virtual PR intervention for 3 months. The primary outcomes were patients' quality of life and PR adherence. The secondary outcomes were dyspnea symptoms, exercise self-efficacy, knowledge, and decision-related outcomes.

RESULTS

A total of 72 participants completed the 3-month PR program. There were statistically significant differences in PR adherence (p = 0.033), COPD assessment test (CAT) scores (p = 0.016), PR knowledge (p < 0.001), decision self-efficacy (p < 0.001), decision conflict (p < 0.001), and decision regret scores (p = 0.027) between the two groups. The modified Medical Research Council Dyspnoea scale (mMRC) score was significantly decreased only in PDA-PR group (p = 0.011). No statistically significant differences were observed in St George's Respiratory Questionnaire (SGRQ) score (p = 0.078), Exercise Self-Regulatory Efficacy Scale (Ex-SRES) score (p = 0.29) and COPD knowledge (p = 0.086) between the two groups. PR value score had a significant effect on adherence to PR (p = 0.007) and CAT score (p = 0.028).

CONCLUSIONS

PDA supported recurring SDM intervention was helpful in maintaining older COPD patients' PR adherence and had advantages in improving quality of life, enhancing PR knowledge, decision self-efficacy, and reducing decision conflict and decision regret, but did not improve SGRQ and Ex-SRES. PR value score influenced patients' rehabilitation adherence and quality of life.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR): ChiCTR1900028563; http://apps.who.int/trialsearch/default.aspx.

Guanxi, overconfidence and corporate fraud in China

Purpose

This study aims to combine two fraud-related streams of the literature on guanxi and overconfidence into an integrated framework, which is the fraud triangle, to interpret the mechanism of fraud commission and detection.

Design/methodology/approach

A bivariate probit model with Partial Observability (POBi Probit) is applied. Moreover, the POBi Probit model is adjusted to the Chinese context. The China-specific POBi Probit model is constructed using data of Chinese A-share listed companies from 2008 to 2014, with a total of 15,109 firm-year observations.

Findings

Overconfidence induces fraud commission and worsens fraud detection; overconfidence mediates the relationship between fraud and guanxi; the “white side” of guanxi comes from alumni networks, while the “dark side” is derived from relatives-based networks; overconfidence induces fraud commission in accounting and disclosure and benefits the detection of disclosure frauds. Guanxi suppresses fraud commission in management and disclosure, however, it worsens fraud detection given fraud in management and disclosure; overconfidence induces fraud commission in both state-owned enterprises (SOE) and non-SOEs, and benefits fraud detection in SOEs. Guanxi suppresses fraud commission and worsens fraud detection in SOEs and city-owned firms.

Research limitations/implications

There are two drawbacks of the partial observable bivariate probit (POBi-Probit) method that must be mentioned here. On one hand, the ex ante variable selection is one of the most difficult parts of applying the POBi-Probit model and different variables are included in different studies. On the other hand, the POBi-Probit model might not converge if too many variables are included. Thus, many widely accepted factors can be included in the model. Thus, this study initially sets the POBi-Probit model based mainly on Khanna et al. (2015) and then adjusts the model for the Chinese context (e. g. considering government ownership) according to Yiu et al. (2018) and Zhang (2018) and the local study of Meng et al. (2019). Considering the observability of fraud, on one hand, the observability of fraud commission is a widely accepted limitation, especially when accounting opacity comes across with regulatory efficiency (Yiu et al. (2018). On the other hand, the observability of relationships is another obstacle to this study. Future studies can go further by revealing the presently unobservable relationships using Big Data technology.

Originality/value

This paper theoretically and practically contributes to the literature on both corporate fraud and corporate governance. Theoretically, by introducing integrated principal-agent resource-reliance theory (IPRT) and upper echelon theory (UET), this paper broadens the framework of fraud triangle theory (FTT) and testifies the availability of the broaden FTT in the transitional and emerging-market context of China. Practically, this paper provides evidence that guanxi and overconfidence are two of the factors affecting corporate fraud. Thus, this paper provides a governance approach opposing corporate fraud in China, which may help the other emerging economies in transition.