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Angie Ho Yan Lam,1 Yee Tak Derek Cheung,1 Kwan Ho Wong,2 Sau Fong Leung,3 Wai Tong Chien4 1School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; 2Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; 3School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region; 4The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative RegionCorrespondence: Angie Ho Yan LamSchool of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative RegionEmail angielam@hku.hkIntroduction: Studies have shown that rumination plays a significant mediating role between dispositional mindfulness (DM) and psychopathological symptoms in both clinical and non-clinical populations. However, no studies have examined this pathway in people with schizophrenia spectrum disorders (SSDs).Methods: A cross-sectional, clinician-administered survey was conducted among people with SSDs (n = 52) in a community setting. Participants completed the Chinese versions of the Depression Anxiety Stress Scale, Five Facet Mindfulness Questionnaire-Short Form, Psychotic Symptom Rating Scale and Scale for the Assessment of Negative Symptoms. Structural equation modelling was performed to examine the pathways of mindfulness facets, rumination, negative emotions and psychotic symptoms.Results: Two facets of mindfulness (nonjudging and acting with awareness) reduced rumination and negative emotional status. Rumination fully mediated the relationship between nonjudging and negative emotions and partially mediated the relationship between acting with awareness and negative emotions. Furthermore, rumination and negative emotions sequentially mediated the relationship between acting with awareness and hallucination (B = − 0.44, 95% confidence interval [CI] = − 0.338 to − 0.045, p = 0.01) and between nonjudging and hallucination (B = − 0.356, 95% CI = − 0.255 to − 0.008, p = 0.034). The model fit the data well (χ2(2) = 1.318, p = 0.517, Tucker–Lewis index = 1.075, comparative fit index = 1, standardised root mean residual = 0.0251, root mean square error of approximation = 0.0001).Conclusion: Rumination and negative emotions serially mediated the relationship between DM and hallucination. The findings support the contribution of changes across transdiagnostic mediators underlying the therapeutic effects of mindfulness training. Further research examining the transdiagnostic processes of DM in influencing clinical outcomes in SSDs is warranted.Keywords: schizophrenia spectrum disorders, psychosis, negative emotions, depression, anxiety, stress, rumination, psychotic symptoms, mindfulness

Mindfulness-based psychoeducation program (MBPP) has been proposed as a new approach to improve the overall outcomes for individuals with schizophrenia spectrum disorders. However, to date, limited studies have examined the participants' experiences of MBPP for schizophrenia.The aim of this study was to explore the experiences of individuals with schizophrenia spectrum disorders (SSDs) who underwent an 8-week MBPP with respect to their perception of the benefits and unusual challenges of mindfulness training and self-practices.Twenty-four (Five themes emerged: developing a state of mindfulness, empowering illness management, learning a new way to regulate emotion, encountering barriers in self-practising mindfulness and preference for bodily mindfulness.The findings provide comprehensive knowledge and deeper insights into treatment processes of mindfulness psychoeducation as an intervention for schizophrenia spectrum disorders.This study establishes a body of knowledge regarding people with schizophrenia spectrum disorders who received mindfulness psychoeducation intervention. The results suggest that patients can develop a new way to regulate emotion and manage their illness through mindfulness psychoeducation. The perceived negative experience of some patients also warrants closer attention in mindfulness practice, especially for individuals with schizophrenia spectrum disorders. Further research could focus on factors leading to the negative consequences of mindfulness practice and the ways to minimize the negative consequeces.

Hong Kong parents’ psychological control is evident as relatively high, which might have a negative impact on their children’s life orientation and attitude. Optimism plays a central role in young people’s development, psychological well-being, and health. This study aimed to examine 1) the relationship between parental psychological control and optimism; 2) the mediating role of self-mastery between these two concepts. A cross-sectional study was employed to collect/measure Hong Kong middle-school students’ socio-demographic information, parent psychological control (measured by The Chinese Paternal Psychological Control Scale), self-mastery (measured by The Mastery Scale), and optimism (measured by The Chinese version of the 6-item Revised-Life Orientation Test). Multivariate regression analysis and Baron and Kenny’s four-step approach were adopted for the relationships/mediation analyses. A total of 9244 middle school adolescents were included in the data analysis. The average age of the adolescents was 15.11 (SD, 1.79) years (ranges from 11 to 18). The regression analysis showed that both paternal psychological control (β = -0.036, p

Background Chronic pain is highly prevalent in the working population. People tend to attempt self-initiated treatments to manage their pain. The self-efficacy of behavioural change is a suitable model for guiding the development of an electronic pain management programme (ePain). The aim in this study is to develop ePain and to evaluate its effectiveness at improving pain self-efficacy, reducing pain intensity and negative emotions, and increasing quality of life. Methods This study will be a randomized controlled trial. ePain will take the form of a 6-week online pain management programme. Participants will be aged 15 years or above, have chronic pain, and be employed. They must complete the baseline questionnaire and will be randomized into intervention and control groups. They will receive notifications to encourage their participation in ePain and complete the evaluation questionnaires. They will complete the process evaluation at week 3, the post assessment at week 6, and the follow-up assessment at week 12. The study will focus on pain self-efficacy; pain situations; negative emotions including levels of depression, anxiety, and stress; and quality of life. The participants’ opinions of ePain will be collected as feedback. Data will be analysed on an intention-to-treat basis and generalized estimating equations will be used to investigate the time-averaged difference and differences at each follow-up time. Discussion The study will provide information about the pain situations of online users in the working population. The participants will benefit from improvements in pain self-efficacy, pain situations, emotional status, and quality of life. The study will illustrate whether online learning is an effective intervention for improving the pain self-efficacy of the working population. Trial registration ClinicalTrials.gov, NCT03718702. Registered on 23 October 2018.

Background Pain is common in older adults. To maintain their quality of life and promote healthy ageing in the community, it is important to lower their pain levels. Pharmacological pain management has been shown to be effective in older adults. However, as drugs can have various side effects, non-pharmacological pain management is preferred for community-dwelling older adults. This systematic review evaluates the effectiveness, suitability, and sustainability of non-pharmacological pain management interventions for community-dwelling older adults. Methods Five databases, namely, CINHAL, Journals@Ovid, Medline, PsycInfo, and PubMed, were searched for articles. The criteria for inclusion were: full-text articles published in English from 2005 to February 2019 on randomized controlled trials, with chronic non-cancer pain as the primary outcome, in which pain was rated by intensity, using non-pharmacological interventions, and with participants over 65 years old, community-dwelling, and mentally competent. A quality appraisal using the Jadad Scale was conducted on the included articles. Results Ten articles were included. The mean age of the older adults was from 66.75 to 76. The interventions covered were acupressure, acupuncture, guided imagery, qigong, periosteal stimulation, and Tai Chi. The pain intensities of the participants decreased after the implementation of the intervention. The net changes in pain intensity ranged from − 3.13 to − 0.65 on a zero to ten numeric rating scale, in which zero indicates no pain and ten represents the worst pain. Conclusions Non-pharmacological methods of managing pain were effective in lowering pain levels in community-dwelling older adults, and can be promoted widely in the community.

Objectives To examine levels of knowledge about dementia and attitudes towards dementia in low- and middle-income countries (LMICs), identify sources to turn to for help, and explore the relationship between knowledge and attitudes. Methods This mixed methods study with both quantitative (a cross-sectional survey) and qualitative (focus group interviews) components was conducted in Cambodia, the Philippines, and Fiji in 2017-18. A survey was completed by the citizens of the three countries, and two focus group interviews were conducted in each country to generate a context-specific understanding of dementia literacy within the local LMIC setting. The quantitative component utilized the Alzheimer's Disease Knowledge Scale and the Dementia Attitude Scale, while knowledge, attitudes, and views on seeking help for dementia was discussed in the focus group interviews (qualitative component). Results A total of 476 participants completed the survey. Another 54 participants (39 females and 15 males) were invited to join six focus group interviews to express their views on dementia. Positive attitudes were noted despite the level of dementia knowledge was low. Families and religious figures were viewed as the sources for help. Controlling for demographics, country-specific predictors of positive attitudes towards dementia were found. Conclusions The involvement of family members and religious leaders in dementia education could enhance the recognition of dementia. Specific kinds of dementia knowledge should be targeted to educate the public in different countries.

Background Laughter Yoga (LY) is a group-based intervention involving simulated laughter, gentle stretching, rhythmic breathing and meditation. There is some limited evidence that LY reduces depressive symptoms over the short term. However, the quality of previous LY studies is poor and none involved working-aged people with a clinical diagnosis of depression. Therefore, this study aimed to investigate the feasibility and potential efficacy of LY for improving residual mood, anxiety and stress symptoms in adults diagnosed with depression. Methods Fifty participants were randomised to the group LY intervention (n = 23) consisting of eight sessions over four weeks, or treatment-as-usual (n = 27). Participants completed the Depression Anxiety Stress Scale and the Short Form 12 item Health Survey at baseline (T0), post-intervention (T1) and at 3 months follow-up (T2). LY participants also completed a Client Satisfaction Questionnaire (CSQ8) at T1 and eleven participated in individual qualitative interviews at T2. Results The LY group had statistically greater decreases in depression and improvements in mental health related quality of life compared to the control group from T0 to T1. The CSQ8 scores indicated a favourable level of satisfaction with the LY intervention. The qualitative interviews highlighted aspects of the intervention that were effective and those requiring modification. Limitations Limitations include the small sample size and treatment-as-usual control group. Conclusions A full scale RCT of LY could be feasible if some modifications were made to the protocol/intervention. The intervention may be effective to improve depression and mental health related quality of life immediately post intervention.

Aim: This study aims to explore fourth-year nursing students’ knowledge of schizophrenia and their attitudes, empathy, and intentional behaviours towards people with schizophrenia. Design: This will be a descriptive qualitative study using focus-group interviews. Methods: Fourth-year nursing students on clinical placement in a hospital in Hunan province will be invited for focus-group interviews. Snowball and purposive sampling will be used to recruit nursing students for this study. Five focus-group interviews, each including six participants, will be conducted to explore participants’ knowledge, attitudes, intentional behaviours, and empathy towards schizophrenia. The interview will be conducted through the online Tencent video conference platform and the interview data will be collected through the same platform. All interviews will be recorded and transcribed verbatim and analysed with the approach of the content analysis supported by NVivo 12. Simultaneous data collection and analysis will be performed, and the interviews will be continued until data saturation is met. The findings of this study will be helpful in developing effective interventions to decrease the stigma toward schizophrenia among nursing students and those who study healthcare disciplines.

BACKGROUND Globally, more than 300 million people suffer from depressive disorders. Despite a wide range of conducted research, information on the mobility and daily routines of persons with depression remains lacking. OBJECTIVE To describe a preliminary explication of the association between mobility, well-being, and community participation of people with depression as they occur in real-time settings. METHODS We used a multivariate, time-series, single-subject, repeated measures (MRSRM) design. People with depression (N=33) were invited to use a GPS device for over two weeks for continuous mobility tracking, while information on their well-being was collected with paper surveys before and after two-weeks periods. The tracking records from 32 participants were imported into Geographical Information Systems (GIS) to extract the specific mobility information. Socio-demographic and environmental information (building density, greenness index and PM2.5) was derived for statistical analysis to explore the relationship between mobility, community participation and mental health using correlation coefficients and logistic regression analysis. RESULTS The more hours participants stayed at home, the more often they had depressive symptoms (r=0.47, P CONCLUSIONS Our study showed that having signs of depression is associated with mobility area and time spent at home among persons with depression, which may mean that their activity level in society is limited. Staying home may be a solution for avoiding extra stress, problems with self-esteem and maintaining satisfaction with life. Low-threshold access to health services should be tailored for each person based on their needs. More information based on studies using robust design, bigger sample size, and more accurate measurement methods, however, is required before individualized services can be fully achieved. Although using GPS may be a feasible data collection method, more effort should be put into collecting the data with easy-to-use technology to avoid extra stress in the participants.

WHAT IS KNOWN ON THE SUBJECT?: The quality of life (QoL) of people with severe mental illness (SMI) is a growing international concern. Many earlier studies report the determinants and correlates of QoL and functioning in people with SMI in Western countries. The QoL and functioning of Asian inpatients with SMI are largely unknown, particularly at the point where they have been assessed as being ready for hospital discharge. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Physical health, social functioning and community living skills, and negative symptoms are important areas of concern immediately pre-discharge. Social relationship related QoL, overall symptoms, unemployment, education level, living situation, physical illness and treatment duration predict functioning levels. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses should consider interventions beyond the traditional focus on psychopathology to improve functioning outcomes in people with SMI recently discharged from hospital. Inpatient services should utilise the opportunity to monitor and address physical health problems before discharge from inpatient care. Abstract Introduction There is a lack of evidence on quality of life (QoL) and functioning in Asian people with severe mental illness (SMI) immediately prior to hospital discharge. This information could have major implications for treatment. Aim To profile perceived quality of life, symptom severity and level of functioning among people with SMI. Methods A cross-sectional study involving 347 adult inpatients with SMI. QoL (WHO Quality of Life - Brief Form), symptom severity (Positive and Negative Syndrome Scale) and level of functioning (Specific Level of Functioning) were measured immediately pre-discharge. Results Participants reported low social relationship-related QOL. Weak correlations were found between functioning, QoL and symptoms. Regression analysis identified the social relationship QoL domain, employment status, education level, living situation, physical illnesses, overall symptoms and the duration of receiving psychiatric services were statistically significant predictors of functioning levels. Discussion The findings may highlight a need for interventions beyond the traditional emphasis on psychiatric symptoms in order to improve functioning following an inpatient admission. Implications for practice Interventions to improve functioning in recently discharged people with SMI may need to be specifically designed to improve patients' social relationships, support return to employment and minimise the risk of physical illness.

Angie Ho Yan Lam,1 Sau Fong Leung,2 Jessie Jingxia Lin,1 Wai Tong Chien3 1School of Nursing, The University of Hong Kong, Hong Kong; 2School of Nursing, The Hong Kong Polytechnic University, Hong Kong; 3The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong KongCorrespondence: Angie Ho Yan LamSchool of Nursing, the University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong KongTel +852 3917 6975Fax +852 2872 6079Email angielam@hku.hkBackground: Emotion dysregulation has emerged as a transdiagnostic factor that potentially exacerbates the risk of early-onset, maintenance, and relapse of psychosis. Mindfulness is described as the awareness that emerges from paying attention to the present moment without judgment. It gently pulls the mind out of the negative emotions induced by the disparity between expectation and reality by focusing on the present moment, instead of worrying about the future or regretting the past. However, only a few research has ever focused on the efficacy of using a mindfulness-based intervention to improve emotion regulation in schizophrenia spectrum disorders.Purpose: The purpose of this study was to examine the effectiveness of a Mindfulness-Based Psychoeducation Programme (MBPP) on the emotion regulation of individuals with schizophrenia, in particular, to access emotion regulation strategies. The objective of this study was to find out whether MBPP is feasible for improving emotion regulation strategies, in terms of rumination, cognitive reappraisal, and expressive suppression, with a sustainable effect at a three-month follow-up.Patients and Methods: A single-blinded pilot randomised controlled trial with repeated-measures designs was adopted. Forty-six participants diagnosed with schizophrenia and its subtypes were randomised in either the 8-week mindfulness-based psychoeducation programme or treatment-as-usual (control) group.Results: The results of the Generalised Estimating Equations test indicated that the MBPP group showed a significant improvement in reappraisal at a three-month follow-up (β = − 6.59, Wald’sχ2=4.55, p=0.033), and a significant reduction in rumination across time. However, the Generalised Estimating Equations indicated no significant difference in rumination and expressive suppression in the MBPP group. Two participants reported having unwanted experiences, including feelings of terror and distress during the mindfulness practice.Conclusion: The MBPP appeared to be effective for improving emotion regulation, which will contribute to future large-scale RCT to confirm the treatment effects in more diverse groups of schizophrenic patients.Keywords: schizophrenia, mindfulness, emotion regulation, reappraisal, suppression, rumination

Background Pain affects a person’s physical and psychological well-being, work performance and productivity. Working population bear their pain and continue to work which may contribute to the worsening of their pain condition. However, their pain situation was not well-examined. Objective The aim of the study was to explore the prevalence of acute and chronic pain in the working population in Hong Kong, understand their pain management strategies and determine their preferences with regard to the use of electronic pain management materials. Methods This was an exploratory online survey. The participants’ pain history, their preferences in methods of pain management, the source of the pain management education that they had received, sources and preferences in relation to the use of the Internet for pain education, and the participants’ demographic characteristics were collected. Results A total of 210 participants joined the study, 67% of whom were experiencing pain. Of the group in pain, 71.6% were in chronic pain that has persisted for 3 months or more. Pain intensities ranged from 2.82 to 3.82 on a 10-point numeric scale. Of the participants, 85.7% reported not receiving adequate pain management education, and 91.4% of those agreed pain services were inadequate. Websites and health care professionals were the sources from which they obtained their pain management education. Conclusions The high prevalence of pain in the working population requires special attention. Health care professionals should be proactive and an online pain management programme can be a solution to address the critical problem of pain in the working population.

Introduction The nine‐item Patient Health Questionnaire (PHQ‐9) is widely used to determine the severity of depression in adult populations, but its psychometric properties with regard to adolescents has been poorly explored. The present study aims to identify the factor structure and examine the measurement invariance of this instrument across genders and age groups in a Chinese adolescent sample. Methods A large sample of Chinese schoolchildren completed the PHQ‐9 in a cross‐sectional survey in Hong Kong (N = 10 933). A confirmatory factor analysis (CFA) to test the factor structure and a multiple group CFA to test the gender and age invariances of the PHQ‐9 in adolescents were conducted. Cronbach alpha was used to assess the reliability of the questionnaire, and Pearson correlations with anxiety, self‐esteem, and perceived control were used to assess its construct validity. Results The CFA results indicate that a one‐factor model with three pairs of item correlations fitted the PHQ‐9 data well, and measurement invariances by age and gender were supported. The PHQ‐9 also possesses adequate internal consistency (>.84) and is strongly correlated with anxiety (>.77), self‐esteem (

Introduction Studies have found that increased mobile phone use (MPU) is associated with multiple health issues such as depression, disordered sleep and pain. However, the current situation and interrelationships of these problems remain unexplored in the Hong Kong population. Objectives This study aimed to understand the situation and problematic use of mobile phones by Hong Kong secondary school students and to investigate depressive symptoms, bodily pain and daytime sleepiness and the associations of these factors with MPU in Hong Kong secondary school students. Methods This quantitative cross-sectional design study was based on self-administered questionnaires completed at five secondary schools. The questionnaire comprised five sections: MPU as measured by the Chinese version of the 10-Item Mobile Phone Problem Use Scale (CMPPUS-10); depressive symptoms according to the Depression Anxiety Stress Scale-21 Chinese Version (DASS-21); bodily pain according to the Brief Pain Inventory Short Form Chinese (BPISF-C); daytime sleepiness as measured using the Chinese version of the Epworth Sleepiness Scale (CESS) and socio-demographic questions. Results A total of 686 students were recruited. The CMPPUS-10 score correlated positively with the average daily duration of MPU and the presence of depression, daytime sleepiness and bodily pain. Problematic mobile phone users received significantly higher scores for depression severity, bodily pain and daytime sleepiness. Health problems were significantly more severe in female than in male students. Bodily pain and daytime sleepiness mediated the relationship of MPU with depression. Conclusions Problematic MPU was associated with depression, bodily pain and daytime sleepiness. These findings will inform further studies of MPU-related health problems.

Depression literacy refers to the ability to recognize depression and make informed decisions about its treatment. To date, relatively little research has been done to examine depression literacy in the Western Pacific region. Given the pervasiveness of depression and the need to enhance mental health care in this region, it is important to gain a better understanding of depression literacy and health-seeking behaviors in this part of the world. This mixed-methods study utilized a convergent parallel design to examine depression literacy and the associated health-seeking attitudes among urban adults from three countries—Cambodia, Philippines, and Fiji. A total of 455 adults completed a quantitative survey on depression knowledge, attitudes, and professional help seeking. Separately, 56 interviewees from 6 focus groups provided qualitative data on their impression and knowledge of depression and mental illness within the context of their local communities. Overall, results showed that depression knowledge was comparatively lower in this region. Controlling for differences across countries, higher knowledge was significantly associated with more positive attitudes towards mental illness (B = − 0.28, p = 0.025) and professional help seeking (B = 0.20, p

Schizophrenia is a disabling psychiatric illness associated with disruptions in cognition, emotion, and psychosocial and occupational functioning. Increasing evidence shows that psychosocial interventions for people with schizophrenia, as an adjunct to medications or usual psychiatric care, can reduce psychotic symptoms and relapse and improve patients’ long-term outcomes such as recovery, remission, and illness progression. This critical review of the literature was conducted to identify the common approaches to psychosocial interventions for people with schizophrenia. Treatment planning and outcomes were also explored and discussed to better understand the effects of these interventions in terms of person-focused perspectives such as their perceived quality of life and satisfaction and their acceptability and adherence to treatments or services received. We searched major health care databases such as EMBASE, MEDLINE, and PsycLIT and identified relevant literature in English from these databases. Their reference lists were screened, and studies were selected if they met the criteria of using a randomized controlled trial or systematic review design, giving a clear description of the interventions used, and having a study sample of people primarily diagnosed with schizophrenia. Five main approaches to psychosocial intervention had been used for the treatment of schizophrenia: cognitive therapy (cognitive behavioral and cognitive remediation therapy), psychoeducation, family intervention, social skills training, and assertive community treatment. Most of these five approaches applied to people with schizophrenia have demonstrated satisfactory levels of short- to medium-term clinical efficacy in terms of symptom control or reduction, level of functioning, and/or relapse rate. However, the comparative effects between these five approaches have not been well studied; thus, we are not able to clearly understand the superiority of any of these interventions. With the exception of patient relapse, the longer-term (eg, >2 years) effects of these approaches on most psychosocial outcomes are not well-established among these patients. Despite the fact that patients’ perspectives on treatment and care have been increasingly concerned, not many studies have evaluated the effect of interventions on this perspective, and where they did, the findings were inconclusive. To conclude, current approaches to psychosocial interventions for schizophrenia have their strengths and weaknesses, particularly indicating limited evidence on long-term effects. To improve the longer-term outcomes of people with schizophrenia, future treatment strategies should focus on risk identification, early intervention, person-focused therapy, partnership with family caregivers, and the integration of evidence-based psychosocial interventions into existing services., Video abstract

The study reported herein a randomized controlled trial was conducted to test the effectiveness of a nurse-led, needs-based psycho-education program for Chinese patients with first-onset mental illness over a 6-month follow-up. Ninety-six families of Chinese patients with schizophrenia newly referred to one outpatient clinic in Hong Kong were randomly assigned to a nurse-led psycho-education program or usual outpatient care, each comprising 48 subjects. The patients' mental health, illness insight, self-efficacy, services utilization, and hospitalization rates were measured at recruitment and at one week and six months post-intervention. The patients in the psycho-education program reported significantly greater improvements in mental health, insights into treatment and illness, and hospitalization rates over the 6-month follow-up, when compared with those who received usual care. The findings provide evidence that the needs-based, nurse-led psycho-education program can improve the health conditions and treatment insights of Chinese out-patients with first-onset mental illness.

Ambivalence to change is a major obstacle to treating people with eating disorders. Enhancing motivation to change can contribute to recovery from the disorders. This study used an Internet-based self-help program developed in the Asia-Pacific region to identify the motivational stages of change in people with eating disorders. It explored their perceptions of the benefits and costs of taking action against their eating disorders, and assessed their involvement in motivational enhancement exercises and their improvement in eating disorder psychopathology. A total of 185 participants, aged 16-50 years (mean age, 26.5) were involved in the open-trial program with a motivational enhancement component and completed the Motivational Stages of Change Questionnaire (MSCARED), the Eating Disorder Examination Questionnaire version 5 (EDE-Q5) and the Eating Disorder Inventory version 3 (EDI-3). The results show that more participants perceived the benefits of taking action against their eating disorders than the costs. Completer analysis shows that they experienced significant improvement in motivational stages of change and eating disorder psychopathology, from a baseline assessment to 1-month and 3-month follow ups. The self-help program has potential benefit for people with eating disorders and its use could be encouraged by health-care professionals to enhance the motivation to change and facilitate recovery.

Perceptions of coronary heart disease (CHD) influence individual health behavior, which is central to preventing the disease. Not enough is known about the demographic differences in perceptions of CHD among Chinese communities. This study examined these differences in the perceived seriousness and risk of CHD among Hong Kong Chinese. A self-developed questionnaire was administered to a convenient sample (n = 236). Significant differences were identified in the perceived seriousness and risk of CHD between younger and older age groups (p0.001) and groups with lower and higher education levels (p0.001), but not between genders (p0.05). Over 50% of participants expressed greater concern about infectious disease than about CHD, while two-thirds to over half of female, older, and less educated participants were more concerned about stroke. This study highlighted populations with lower levels of CHD perception that need increased public education. The findings have implications for the societal readiness to establishing ongoing public healthcare strategies to increase awareness of CHD.

Aim. The aim of this study was to evaluate the self-help behaviour of individuals with eating disorders in an Internet-based self-help programme developed in the Asia-Pacific region and to determine their compliance with the programme. Background. Eating disorders represent a growing health problem affecting both Western and Asian countries. Without timely and adequate treatment, individuals with eating disorders are at risk of premature death. Self-help approaches for treating eating disorders offer therapeutic promise. Design. An open trial design was used. Method. This study, conducted from August 2006–July 2011, included 280 participants recruited from outpatient eating disorder clinics and treatment units and through a university student newspaper and Internet websites. This open trial evaluated an Internet-based self-help programme, which included components on healthy eating, family education, health assessment, motivation enhancement, self-help strategies, and psychological health promotion. The progress of participants was followed up via monthly e-mails. A tracking system was implemented to determine their compliance with the programme. Findings. A small majority of the participants (56·9%) were already undergoing treatment for their eating disorders. About 63% (n = 176) demonstrated self-help behaviour, as manifested by their completion of health assessment questionnaires, involvement in motivation enhancement exercises, or the use of self-help strategies such as monitoring, normalizing eating behaviour, and stress management. Improvements were observed in their eating disorder psychopathology, motivational stage of change and psychological health from baseline to the 1-month follow up. Conclusion. Internet-based self-help programmes for eating disorders are helpful adjuncts to professional treatment.

To shorten the waiting time for psychiatric treatment, nurse-led services may help in the first-line mental health consultation and interventions for patients with recent first onset of mental illness.The study evaluated the effectiveness of a six-session nurse-led, needs-based psycho-education program for Chinese patients with mental health problems newly referred to an outpatient clinic in Hong Kong, when compared with routine outpatient care.A randomized controlled trial with a pre- and post-test, control group design was conducted. Seventy-nine patients were randomly assigned to either the nurse-led psycho-education program (N = 39), or to usual psychiatric outpatient care (N = 40). Multiple patient outcomes and services utilization were measured at recruitment and 2 weeks after the intervention.The results of a multivariate analysis of variance test indicated that the psycho-education group had significantly greater improvements in mental and overall health status, insights into their treatment and illness, and hospitalization rates at the post-test.The findings provide evidence that nurse-led, needs-based psycho-education can improve mental health, self-efficacy and insights into mental illness in Chinese first-onset mentally ill patients. A future multi-center controlled trial of this nurse-led intervention is recommended.

In the original publication of this article, Acknowledgements Section was not included. The Acknowledgements are given below. The original article has been corrected.

This research aimed to test the validity and reliability of the 'World Health Organization Mental Disorders Checklist' for use in a telehealth clinic in Hong Kong. The Checklist adopted four subscales: (i) depression; (ii) anxiety; (iii) alcohol use disorders; and (vi) functioning and disablement, and was translated from English into Chinese. It was validated by a panel of five experts to confirm its content validity (content validity index = 0.98) and cultural appropriateness in Hong Kong. The reliability of the checklist was supported by the findings of a test-retest procedure (Pearson correlation = 0.66-0.88, P < 0.01), internal consistency reliability (Cronbach's alpha = 0.54-0.83), and interrater reliability (Kendall's coefficient of concordance = 0.58-1.00, P < 0.01) involving a sample of 197 subjects from one telehealth clinic in Hong Kong.

Sociodemographics affect health through pathways of lifestyle choices. Using data from a survey of 467 Hong Kong Chinese, this study aims to examine the prevalence of their lifestyle behaviors, identify profiles based on their sociodemographic and lifestyle variables, and compare differences among the profile groups. Two-step cluster analysis was used to identify natural profile groups within the data set: only 37% of the participants engaged in regular physical exercises, and less than 50% monitored their dietary intake carefully. The analysis yields 2 clusters, representing a “healthy” and a “less-healthy” lifestyle group. The “less-healthy” group was predominantly male, younger, employed, and had high-to-middle levels of education. The findings reveal the lifestyle behavior patterns and sociodemographic characteristics of a high-risk group, which are essential to provide knowledge for the planning of health promotion activities.

Background Internet-based interventions can facilitate an anonymous environment for the management of eating disorders and there is a need for online assessment tools to be readily available. The present study aimed to validate an online version of the Eating Disorder Examination Questionnaire (EDE-Q) and to compare the goodness-of-fit of five models of EDE-Q data, using a sample of university students in Hong Kong. Methods The EDE-Q data were collected online from 310 Hong Kong university students. Confirmatory factor analysis was used to compare the validity of the original four-factor EDE-Q with that of the three-factor, two-factor, one-factor and brief one-factor models. The superior model was further examined for scale reliability, convergent validity and construct validity using contrast-group comparisons. Results The brief one-factor model consisting of eight Weight and Shape Concern items was the only model to provide an acceptable fit to the data. Estimations of internal consistency and scale validity were conducted using contrast-group comparisons and convergent validity, with satisfactory results. Conclusions The brief one-factor model was the only one among the alternate models that provided good fit to the data. The brief model is promising for use in research and has good practical application because the model was satisfactorily tested in terms of internal consistency, ability to discriminate between genders, and good association with other measures of similar constructs. By validating an online version of the EDE-Q using a university sample with a cultural background different from Western culture, the present study complements findings from previous research on the EDE-Q.

Eating disorders are a serious debilitating health problem, causing impairments in physical and psychosocial functioning and significantly affecting sufferers' quality of life. New technologies are being developed to meet the diverse treatment needs of people with eating disorders. This qualitative study examined participants' views of an Internet-based self-help programme developed in the Asia-Pacific region for people with eating disorders. The aim of the study was to explore how the self-help programme facilitated individuals' recovery and identify the factors that contribute to the success in the programme. A purposive sample of 12 people with anorexia nervosa (N = 4), bulimia nervosa (N = 2), binge eating disorder (N = 1) and eating disorder not otherwise specified (N = 5) participated in the study. The data were collected primarily by telephone interview. The programme was found to improve individuals' awareness of eating disorders, their motivation, eating disorder symptoms and health. Recovery was enhanced by individuals' determination and motivation to get better, the support available, their perseverance, sense of control, and personal confidence, and facilitating living environment.

The aim of this study was to evaluate the self-help behaviour of individuals with eating disorders in an Internet-based self-help programme developed in the Asia-Pacific region and to determine their compliance with the programme.Eating disorders represent a growing health problem affecting both Western and Asian countries. Without timely and adequate treatment, individuals with eating disorders are at risk of premature death. Self-help approaches for treating eating disorders offer therapeutic promise.An open trial design was used.This study, conducted from August 2006-July 2011, included 280 participants recruited from outpatient eating disorder clinics and treatment units and through a university student newspaper and Internet websites. This open trial evaluated an Internet-based self-help programme, which included components on healthy eating, family education, health assessment, motivation enhancement, self-help strategies, and psychological health promotion. The progress of participants was followed up via monthly e-mails. A tracking system was implemented to determine their compliance with the programme.A small majority of the participants (56·9%) were already undergoing treatment for their eating disorders. About 63% (n = 176) demonstrated self-help behaviour, as manifested by their completion of health assessment questionnaires, involvement in motivation enhancement exercises, or the use of self-help strategies such as monitoring, normalizing eating behaviour, and stress management. Improvements were observed in their eating disorder psychopathology, motivational stage of change and psychological health from baseline to the 1-month follow up.Internet-based self-help programmes for eating disorders are helpful adjuncts to professional treatment.

Computerized mental health assessment is gaining popularity. It enables the standardization of assessment of clinical problems, increases the capacity to collect sensitive or confidential information, facilitates personal assessment at one's own pace, and offers rapid screening of mental health status. The use of computer technology to conduct mental health assessment was an initiative proposed for two nurse-led integrative health clinics affiliated to a University in Hong Kong. It was intended to provide an efficient screening for depression, anxiety, alcohol abuse, and problem gambling common in the primary health-care settings to facilitate early intervention. This study was conducted to assess the effectiveness of using a computerized health assessment kiosk to perform mental health assessment. The assessment items were derived from an abbreviated World Health Organization Mental Disorders Checklist and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Criteria for Pathological Gambling. The study involved an opportunity sample of 31 subjects who volunteered to complete the computerized mental health assessment during their waiting time in the clinics. The results showed that most subjects had positive feelings about using a computer to perform a mental health assessment and had increased understanding of their mental health. Suggestions made to improve computerized mental health assessments included touch screen, voice instructions, and enlarged print font size.

Assessment methods can influence the learning approaches of nursing students. Assessments designed to assess understanding rather than rote learning can contribute to a deep learning approach. Multiple-choice questions can be formulated at high cognitive levels for nursing assessments. This study aimed to examine the effect of high quality multiple-choice tests on the learning approaches of students enrolled in a mental health nursing course as measured by the revised two-factor study process questionnaire (R-SPQ-2F). Data were collected from 136 students in a higher diploma (HD) in nursing programme and 142 baccalaureate (BSN) nursing students. Two-step cluster analysis yielded three clusters represented by students who were predominantly deep, predominantly surface or intermediate in their orientation to learning. There was a general decrease in the deep learning score and an increase in the surface learning score of the students on the course, possibly related to the excessive workload in nursing studies. However, there was no direct association with multiple-choice assessment. The academic achievement of students correlated negatively with their surface learning approach. Students (n=31) in four focus group interviews believed that assessments constructed using scenario-based questions, simulated role-play situations and case studies could direct desired learning in order to facilitate their understanding of knowledge, their use of critical thinking, and their application of knowledge.

This paper describes the psychometric analysis of the alcohol use disorders identification test (AUDIT) after it was modified for use in Hong Kong and administered to examine the patterns of hazardous and harmful drinking. The modified version of AUDIT was an 18-item instrument in which 10 items were completely adopted from the original version and 8 items were added to improve its cultural sensitivity. It was translated into Chinese and back translation was undertaken to confirm the equivalence of the Chinese and English versions. Following a pilot study the instrument was administered to 450 subjects who were recruited from two acute general hospitals, a University Health Clinic and three community health centres. The content validity was judged as adequate by a panel of five international and local experts and the instrument achieved a high reliability coefficient of 0.99 during a test–retest procedure conducted with 20 subjects. Factor analysis was performed on the responses obtained from 450 subjects which supported the construct validity of the 18-item instrument. The modified instrument had a consistently high internal consistency reliability (Cronbach's alpha=0.96–0.97) when tested in the different settings. It was found that a higher percentage of respondents from the hospitals (14.5%) drank at a hazardous or harmful levels compared to those from the community (6.2%) or the University (5.3%).The AUDIT proved a reliable and valid measure with potential applications in Chinese cultures. Early intervention and identification of ‘at risk’ drinking by the AUDIT is supported as a strategy to be implemented by nurses in primary and secondary health care settings in Hong Kong, where there are indications of increasing alcohol overuse.

Background Eating disorders are serious mental illnesses that have a significant effect on afflicted individuals’ quality of life. Evidence has shown that they can be improved with treatment. Internet-based interventions are useful in engaging individuals with eating disorders in self-management and treatment. This study aimed primarily to identify the change in quality of life of individuals with disordered eating after participating in an open trial of an Internet-based self-help programme, and compared their quality of life at assessment with that of healthy controls. Factors affecting their quality of life were examined. Secondary outcomes related to symptom improvement were also reported. Methods This study included 194 individuals with disordered eating and 50 healthy controls. The former group was recruited from eating disorder outpatient clinics and treatment units, as well as via information disseminated through various Internet websites, while the healthy controls were recruited from university student newspapers and university campuses. The Medical Outcomes Study Short Form Survey (SF-36v2) was used to assess participants’ quality of life. Other measures were used to assess their symptoms and motivational stages of change to recover from an eating disorder. The Wilcoxon signed ranks test and one-way repeated measures ANOVA were used to identify the change in quality of life of individuals with disordered eating from baseline to 1-, 3- and 6-month follow-ups. The Mann–Whitney U test was employed to compare the difference in quality of life between participants with disordered eating and the healthy controls. Spearman rank order correlations were performed to examine the factors associated with quality of life. Results The participants with disordered eating had significantly poorer quality of life than the healthy controls in both physical and psychological domains. The factors associated with their poor quality of life included dieting behaviour, use of laxatives, severe eating disorder psychopathology, depression and anxiety. Over a six-month follow-up period, a significant number of participants engaged in self-help behaviours using the Internet-based programme. They experienced improvements in their quality of life, eating disorder psychopathology, depression severity, anxiety level and motivational stages of change. Conclusions Internet-based self-help programmes have the potential to enhance quality of life in individuals with disordered eating and could be useful adjuncts to professional treatment.

University students are a high risk population for eating disorder symptomatology. The risk can be related to increased demand for academic achievement, high stress and anxiety, dating relationships, peer influence, struggle with self-concept, and role and identity changes. Given the surging risk of eating disorders among university students, it is essential to identify the factors correlate with disordered eating and develop effective intervention strategies. This study examined Chinese university students' disordered eating, body image dissatisfaction and psychological health, and their associated relationships. The participants were recruited through personal approach at different university campuses and social network sampling using strategies, such as e-mails, facebook, whatsapp and electronic promotional posters. 521 university students from various institutions completed several online questionnaires including the EDE-Q, the SCOFF questionnaire, the Stunkard's Figure Rating Scale, the Body Shape Questionnaire and DASS-21 administered through a "Smart ehealth" website. The result showed that 4% participants were at high risk for eating disorders, many had body image dissatisfaction (81.6%), and some had symptoms of anxiety (41.7%), depression (27.4%) and stress (20.5%). Their eating disorder psychopathology was significantly correlated with their body shape dissatisfaction (r2=0.809, P