WS2/Polyethylene Glycol Nanostructures for Ultra-Efficient MCF-7 Cancer Cell Ablation and Electrothermal Therapy.

Developing novel nanostructures and advanced nanotechnologies for cancer treatment has attracted ever-increasing interest. Electrothermal therapy offers many advantages such as high efficiency and minimal invasiveness, but finding a balance between increasing stability of the nanostructure state and, at the same time, enhancing the nanostructure biodegradability presents a key challenge. Here, we modulate the biodegradation process of two-dimensional-material-based nanostructures by using polyethylene glycol (PEG) via nanostructure disrupt-and-release effects. We then demonstrate the development of a previously unreported alternating current (AC) pulse WS2/PEG nanostructure system for enhancing therapeutic performance. A decrease in cell viability of ∼42% for MCF-7 cells with WS2/PEG was achieved, which is above an average of ∼25% for current electrothermal-based therapeutic methods using similar energy densities, as well as degradation time of the WS2 of ∼1 week, below an average of ∼3.5 weeks for state-of-the-art nanostructure-based systems in physiological media. Moreover, the incubation time of MCF-7 cells with WS2/PEG reached ∼24 h, which is above the average of ∼4.5 h for current electrothermal-based therapeutic methods and with the use of the amount of time harnessed to incubate the cells with nanostructures before applying a stimulus as a measure of incubation time. Material characterizations further disclose the degradation of WS2 and the grafting of PEG on WS2 surfaces. These WS2-based systems offer strong therapeutic performance and, simultaneously, maintain excellent biodegradability/biocompatibility, thus providing a promising route for the ablation of cancer.

Ultrasensitive Detection of MCF-7 Cells with a Carbon Nanotube-Based Optoelectronic-Pulse Sensor Framework.

Biosensors are of vital significance for healthcare by supporting the management of infectious diseases for preventing pandemics and the diagnosis of life-threatening conditions such as cancer. However, the advancement of the field can be limited by low sensing accuracy. Here, we altered the bioelectrical signatures of the cells using carbon nanotubes (CNTs) via structural loosening effects. Using an alternating current (AC) pulse under light irradiation, we developed a photo-assisted AC pulse sensor based on CNTs to differentiate between healthy breast epithelial cells (MCF-10A) and luminal breast cancer cells (MCF-7) within a heterogeneous cell population. We observed a previously undemonstrated increase in current contrast for MCF-7 cells with CNTs compared to MCF-10A cells with CNTs under light exposure. Moreover, we obtained a detection limit of ∼1.5 × 103 cells below a baseline of ∼1 × 104 cells for existing electrical-based sensors for an adherent, heterogeneous cell population. All-atom molecular dynamics (MD) simulations reveal that interactions between the embedded CNT and cancer cell membranes result in a less rigid lipid bilayer structure, which can facilitate CNT translocation for enhancing current. This as-yet unconsidered cancer cell-specific method based on the unique optoelectrical properties of CNTs represents a strategy for unlocking the detection of a small population of cancer cells and provides a promising route for the early diagnosis, monitoring, and staging of cancer.

Ultralong recovery time in nanosecond electroporation systems enabled by orientational-disordering processes.

The growing importance of applications based on molecular medicine and genetic engineering is driving the need to develop high-performance electroporation technologies. The electroporation phenomenon involves disruption of the cell for increasing membrane permeability. Although there is a multitude of research focused on exploring new electroporation techniques, the engineering of programming schemes suitable for these electroporation methods remains a challenge. Nanosecond stimulations could be promising candidates for these techniques owing to their ability to generate a wide range of biological responses. Here we control the membrane permeabilization of cancer cells using different numbers of electric-field pulses through orientational disordering effects. We then report our exploration of a few-volt nanosecond alternating-current (AC) stimulation method with an increased number of pulses for developing electroporation systems. A recovery time of ∼720 min was achieved, which is above the average of ∼76 min for existing electroporation methods using medium cell populations, as well as a previously unreported increased conductance with an increase in the number of pulses using weak bias amplitudes. All-atom molecular dynamics (MD) simulations reveal the orientation-disordering-facilitated increase in the degree of permeabilization. These findings highlight the potential of few-volt nanosecond AC-stimulation with an increased number of pulse strategies for the development of next-generation low-power electroporation systems.

Factor Structure and Psychometric Properties of the Family Communication Scale in the Chinese Population.

Purpose: To evaluate the factor structure and psychometric properties of the 10-item Family Communication Scale (FCS) in the Chinese population. Methods: Study 1 was a population-based survey [N = 687, 61.1% female; mean age (SD) 56.6 (19.1)]. Study 2 was a community-based intervention (N = 1983, 76.7% female; 57.8% aged 20-59 years). We conducted exploratory factor analysis (EFA) in Study 1 and replicated the model by confirmatory factor analysis (CFA) in Study 2. Psychometric properties were evaluated, including internal consistency, test-retest reliability, convergent and discriminant validity, and known-group validity. We identified how the FCS scores differed by sociodemographic characteristics and communication methods including face to face and Information and Communication Technologies (ICTs) in Study 1. Results: The EFA and CFA supported a one-factor structure. The Chinese FCS showed a good internal consistency (Cronbach's alpha = 0.91; McDonald's Omega = 0.91) and was stable over 1-month (intraclass correlation coefficient = 0.69, P < 0.001). Convergent validity was supported by positive correlations of FCS with the Subjective Happiness Scale, Family Adaption, Partnership, Growth, Affection, Resolve (APGAR) Scale, family health, harmony, and happiness, and perceived family communication sufficiency and quality (All P < 0.001). Discriminant validity was supported by the stronger correlation of FCS with Short Form-12 Health Survey Version 2 Mental Component than that with Physical Component (P < 0.001). Higher household income, frequent face-to-face communication, and frequent use of phone calls, instant messaging, and social networking sites were associated with higher FCS scores. Conclusion: The one-factor structure of the Chinese FCS can be a reliable and valid measurement of positive family communication, in the context of ICT integration into family communication. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT02563613].

A Randomized Controlled Trial of a Positive Family Holistic Health Intervention for Probationers in Hong Kong: A Mixed-Method Study.

Introduction: Probationers, offenders with less serious and non-violent offences, and under statutory supervision, have low levels of self-esteem and physical health, and high level of family conflict, and poorer quality of family relationships. This study examined the effectiveness of the existing probation service and the additional use of a positive family holistic health intervention to enhance physical, psychological, and family well-being in probationers and relationships with probation officers. Methods: Probationers under the care of the Hong Kong Social Welfare Department were randomized into a care-as-usual control group (CAU), a brief intervention group (BI) receiving two 1-h individual sessions [of a brief theory-based positive family holistic health intervention integrating Zero-time Exercise (simple and easy-to-do lifestyle-integrated physical activity) and positive psychology themes of "Praise and Gratitude" in the existing probation service], or a combined intervention group (CI) receiving BI and a 1-day group activity with family members. The outcomes were physical activity, fitness performance, self-esteem, happiness, anxiety and depression symptoms, life satisfaction, quality of life, family communication and well-being, and relationships with probation officers. Self-administered questionnaires and simple fitness tests were used at baseline, 1-month and 3-month follow-up. Linear mixed model analysis was used to compare difference in the changes of outcome variables among groups, adjusted of sex, age, and baseline values. Focus group interviews were conducted. Thematic content analysis was used. Results: 318 probationers (51% male) were randomized into CAU (n = 105), BI (n = 108), or CI (n = 105) group. CAU showed enhanced physical activity, fitness performance and psychological health, and family communication with small effect sizes (Cohen's d: 0.19-0.41). BI and CI showed further improved physical activity, family communication and family well-being (Cohen's d: 0.37-0.70). Additionally, CI reported greater improvements in the relationships with probation officers than CAU with a small effect size (Cohen's d: 0.43). CI also reported greater increases in physical activity and family communication than BI with small to moderate effect sizes (Cohen's d: 0.38-0.58). Qualitative feedbacks corroborated the quantitative findings. Conclusion: Our trial provided the first evidence of the effectiveness of probation service and the additional use of an innovative, relatively low-cost, theory-based brief positive family holistic health intervention. This intervention may offer a new model for enhancing probation service. Trial Registration: The research protocol was registered at the National Institutes of Health (identifier: NCT02770898).

Ultrasensitive two-dimensional material-based MCF-7 cancer cell sensor driven by perturbation processes.

Changes in lipid composition and structure during cell development can be markers for cell apoptosis or various diseases such as cancer. Although traditional fluorescence techniques utilising molecular probes have been studied, these methods are limited in studying these micro-changes as they require complex probe preparation and cannot be reused, making cell monitoring and detection challenging. Here, we developed a direct current (DC) resistance sensor based on two-dimensional (2D) molybdenum disulfide (MoS2) nanosheets to enable cancer cell-specific detection dependent on micro-changes in the cancer cell membrane. Atomistic molecular dynamics (MD) simulations were used to study the interaction between 2D MoS2 and cancer lipid bilayer systems, and revealed that previously unconsidered perturbations in the lipid bilayer can cause an increase in resistance. Under an applied DC sweep, we observed an increase in resistance when cancer cells were incubated with the nanosheets. Furthermore, a correlation was observed between the resistance and breast cancer epithelial cell (MCF-7) population, illustrating a cell population-dependent sensitivity of our method. Our method has a detection limit of ∼3 × 103 cells, below a baseline of ∼1 × 104 cells for the current state-of-the-art electrical-based biosensors using an adherent monolayer with homogenous cells. This combination of a unique 2D material and electrical resistance framework represents a promising approach for the early detection of cancerous cells and to reduce the risk of post-surgery cancer recurrence.

Ultralong-Time Recovery and Low-Voltage Electroporation for Biological Cell Monitoring Enabled by a Microsized Multipulse Framework.

Long-term nondestructive monitoring of cells is of significant importance for understanding cell proliferation, cell signaling, cell death, and other processes. However, traditional monitoring methods are limited to a certain range of testing conditions and may reduce cell viability. Here, we present a microgap, multishot electroporation (M2E) system for monitoring cell recovery for up to ∼2 h using ∼5 V pulses and with excellent cell viability using a medium cell population. Electric field simulations reveal the bias-voltage- and gap-size-dependent electric field intensities in the M2E system. In addition to excellent transparency with low cell toxicity, the M2E system does not require specialized components, expensive materials, complicated fabrication processes, or cell manipulations; it just consists of a micrometer-sized pattern and a low-voltage square-wave generator. Ultimately, the M2E system can offer a long-term and nontoxic method of cell monitoring.

Helping hospitalized smokers in Hong Kong quit smoking by understanding their risk perception, behaviour, and attitudes related to smoking.

AIM: To understand the risk perceptions, behaviour, attitudes, and experiences related to smoking among hospitalized Chinese smokers. BACKGROUND: Understanding hospitalized smokers' perceptions of risks associated with smoking, along with their behaviour, attitudes, and smoking-related experiences, is essential prerequisite to design effective interventions to help them quit smoking. DESIGN: A phenomenological research design was adopted. METHODS: A purposive sampling approach was used. Between May 2016-January 2017, 30 hospitalized smokers were invited for an interview. RESULTS: Four themes were generated: (a) associations between perception of illness and smoking; (b) perceived support from healthcare professionals to quit smoking; (c) impact of hospitalization on behaviour, attitudes, and experiences; and (d) perceived barriers to quitting smoking. CONCLUSION: Development of an innovative intervention that helps to demystify misconceptions about smoking through brief interventions and active referrals is recommended to enhance the effectiveness of healthcare professionals promoting smoking cessation for hospitalized smokers. IMPACT: To date, no study examining smoking behaviour among hospitalized patients in Hong Kong has been conducted. Misconceptions about smoking and health, barriers to quitting that outweighed perceived benefits, lack of support from healthcare professionals, and difficulty overcoming withdrawal symptoms or cigarette cravings precluded hospitalized smokers sustaining smoking abstinence after discharge. Smoking is detrimental to physical health. Smoking cessation has beneficial effects on treatment efficacy and prognosis and helps to reduce the economic burden on society from smoking-attributable diseases.

Chat-based instant messaging support integrated with brief interventions for smoking cessation: a community-based, pragmatic, cluster-randomised controlled trial.

BACKGROUND: Mobile instant messaging apps offer a modern way to deliver personalised smoking cessation support through real-time, interactive messaging (chat). In this trial, we aimed to assess the effect of chat-based instant messaging support integrated with brief interventions on smoking cessation in a cohort of smokers proactively recruited from the community. METHODS: In this two-arm, pragmatic, cluster-randomised controlled trial, we recruited participants aged 18 years or older who smoked at least one cigarette per day from 68 community sites in Hong Kong, China. Community sites were computer randomised (1:1) to the intervention group, in which participants received chat-based instant messaging support for 3 months, offers of referral to external smoking cessation services, and brief advice, or to the control group, in which participants received brief advice alone. The chat-based intervention included personalised behavioural support and promoted use of smoking cessation services. Masking of participants and the research team was not possible, but outcome assessors were masked to group assignment. The primary outcome was smoking abstinence validated by exhaled carbon monoxide concentrations lower than 4 parts per million and salivary cotinine concentrations lower than 10 ng/mL at 6 months after treatment initiation (3 months after the end of treatment). The primary analysis was by intention to treat and accounted for potential clustering effect by use of generalised estimating equation models. This trial is registered with ClinicalTrials.gov, number NCT03182790. FINDINGS: Between June 18 and Sept 30, 2017, 1185 participants were randomly assigned to either the intervention (n=591) or control (n=594) groups. At the 6-month follow-up (77% of participants retained), the proportion of validated abstinence was significantly higher in the intervention group than in the control group (48 [8%] of 591 in intervention vs 30 [5%] of 594 in control group, unadjusted odds ratio 1·68, 95% CI 1·03-2·74; p=0·040). Engagement in the chat-based support in the intervention group was low (17%), but strongly predicted abstinence with or without use of external smoking cessation services. INTERPRETATION: Chat-based instant messaging support integrated with brief cessation interventions increased smoking abstinence and could complement existing smoking cessation services. FUNDING: Hong Kong Council on Smoking and Health.

Training to implement a community program has positive effects on health promoters: JC FAMILY Project.

To ease the shortage of professionals, lay volunteers were trained to become health promoters and role models for a large community program to enhance physical activity, well-being, and neighborhood cohesion in socioeconomically disadvantaged groups in Hong Kong. This study aimed to examine the effects on health promoters (trainees) and the feasibility and acceptability of capability-building train-the-trainer workshops (TTTs) using Zero-time Exercise (ZTEx) to implement a community program for about 1,000 participants. A four-session (totally 8 hours) TTT introduced an evidence-based ZTEx intervention to enhance physical activity and well-being, and build capacity for community program implementation. Twenty-eight trainees actively participated in the TTT. Twenty-five and 21 trainees completed the 1- and 3-month questionnaires, respectively. Eleven trainees attended the 1-year focus group interview. Repeated measures analysis of variance and Friedman test were used to compare the parametric and nonparametric data, respectively. Qualitative data were analyzed using thematic content analysis. The trainees reduced their sedentary behavior and improved their interpersonal communication skills, knowledge, and attitude toward ZTEx, grip strength, balance, and perceived well-being. The community participants reported improvements in neighborhood cohesion and grip strength. The 1-year qualitative results supported the 3-month quantitative findings. This brief and innovative TTT affirmed the feasibility of using ZTEx and the role modeling approach for lay health promoters to reduce sedentary behavior and enhance physical activity, fitness, and well-being. They then contributed to the successful implementation of community programs that benefited many. This study provides a new model for building capacity for health promotion in the community.

Recruitment and Lessons Learned from a Community-Based Intervention Program: The Learning Families Project in Hong Kong.

BACKGROUND: Recruitment is central to any research project, and recruitment itself should be well documented and researched. We describe our recruitment efforts for a community-based research project-entitled the Learning Families Project-conducted in Hong Kong. METHODS: In collaboration with community stakeholders, residents from a public housing estate were recruited to participate in family programs aimed at enhancing family well-being. Various recruitment strategies were employed including the distribution of 19,200 leaflets, 688 posters, a banner, a kick-off ceremony, 10 promotion activities, 1,000 direct calls, word of mouth, 51 mobile counters, and 10 door-to-door visits. Drawing on field notes, research logs, short questionnaires, and focus group conducted with our community partners and residents, we describe and discuss our recruitment strategies, challenges, and lessons learned. RESULTS: Over a 9-month period, 980 participants were recruited and participated in our study, exceeding our recruitment goal (860 participants). Several observations were made including active recruitment strategies (i.e., door-to-door and mobile counter) being more effective than passive strategies (i.e., posters and leaflets); the importance of raising project awareness to facilitate recruitment; and the challenges encountered (i.e., burn-out and loss of motivation of staff, decreased community capacity in collaborating in research projects). CONCLUSION: The lessons learned include the importance of engaging Chinese communities, utilizing a positive outreach approach, and setting realistic expectations. Although similar recruitment strategies have been reported the West, a number of cultural differences should be taken into account when working with Chinese population. Further research is needed to examine the effectiveness of tailoring recruitment strategies to various populations.

Helping cancer patients quit smoking using brief advice based on risk communication: A randomized controlled trial.

This randomized controlled trial aimed to examine the effectiveness of a smoking cessation intervention using a risk communication approach. A total of 528 smoking cancer patients were randomly allocated either into an intervention group (n = 268) to receive brief advice based on risk communication by a nurse counselor or a control group (n = 260) to receive standard care. Subjects in both groups received a smoking cessation booklet. Patient follow-ups were at 1 week and at 1, 3, 6, 9 and 12 months. No significant differences were found in self-reported point-prevalence 7-day abstinence between the intervention and control groups at 6 months (15.7% vs 16.5%; OR 0.94, 95% CI 0.59-1.50). The rate of at least 50% self-reported reduction of smoking at 6 months, was higher in the intervention group than in the control group (16.8% vs 12.3%; OR 1.43, 95% CI 0.88-2.35). The biochemically validated quit rate at the 6-month follow-up was higher in the intervention group than in the control group (5.2% vs 3.8%; OR 1.38, 95% CI 0.60-3.16). These data suggest that advice based on risk communication was not effective for quitting but improved the rate of smoking reduction among smoking cancer patients.

Comparison of two approaches in achieving smoking abstinence among patients in an outpatient clinic: A Phase 2 randomized controlled trial.

OBJECTIVES: To compare the effectiveness of quitting immediately and cutting down to quit in promoting smoking abstinence among smokers in an outpatient clinic. METHODS: A total of 100 subjects were randomized into two groups, 50 in the quit immediately group, who received an intervention on abruptly quitting, and 50 in the cut down to quit group, who received an intervention on gradual reduction. All subjects were followed up at 6 and 12 months via telephone. The intention-to-treat principle was used. RESULTS: At the 6-month follow-up, the self-reported quit rate of subjects in the quit immediately group was significantly higher than in the cut down to quit group (18.0% vs. 4.0%, p = 0.04). However, this difference was not significant at the 12-month follow-up (12.0% vs. 4.0%, p = 0.16). CONCLUSION: These data suggest that quitting immediately might be more effective than cutting down to quit at 6 months but not at 12 months. PRACTICE IMPLICATIONS: It is crucial to allow smokers to select quitting immediately or reducing the number of cigarettes smoked. Further studies are warranted to compare the effectiveness of various approaches for achieving smoking abstinence.

Ultra-High Signal Detection of Human Embryonic Stem Cells Driven by Two-Dimensional Materials.

We observed a unique bioelectric signal of human embryonic stem cells using direct current-voltage measurements facilitated by few-layered 2D-MoS2 sheets. A 1.828 mA cell signal was achieved (2 orders of magnitude higher than previous electrical-based detection methods) as well as multiple cell reading cycles demonstrating I ∼ 1.9 mA. Native stem cell proliferation, viability, and pluripotency were preserved. Molecular dynamics simulations elucidated the origin of the 2D-MoS2 sheet-assisted increase in current flow. This paves the way for the development of a broadly applicable, fast, and damage-free stem cell detection method capable of identifying pluripotency with virtually any complementary-metal-oxide-semiconductor circuits.

Intervention With Brief Cessation Advice Plus Active Referral for Proactively Recruited Community Smokers: A Pragmatic Cluster Randomized Clinical Trial.

Importance: Most smoking cessation (SC) clinics are costly, passive, and underused. Objective: To compare the SC effect of a combined intervention involving brief, model-guided SC advice plus active referral to SC services (active referral group) with those of brief, model-guided SC advice only (brief advice group) and general SC advice only (control group). Design, Setting, and Participants: A single-blind, 3-arm, pragmatic cluster randomized clinical trial was conducted including 1226 adult daily smokers in the general Hong Kong community proactively recruited to participate in the Quit-to-Win Contest held in 2015. The study was conducted from June 20 to September 24, 2015. Participants were randomly allocated to the active referral (n = 402), brief advice (n = 416), and control (n = 408) groups. Intention-to-treat analysis was used. Interventions: Brief telephone counseling was offered to the active referral and brief advice groups at 1 and 2 months. Interventions were delivered by SC ambassadors who had undergone a short training period. Main Outcomes and Measures: The primary outcome was the self-reported past 7-day point prevalence of abstinence (PPA) at 6 months. The secondary outcomes were carbon monoxide level-validated abstinence, smoking reduction, and SC service use. Results: Participants included 991 (80.8%) men; mean (SD) age was 42.0 (14.8) years. The response rate was 68.2% at 3 and 72.3% at 6 months. The corresponding PPAs were 18.9% and 17.2% in the active referral group-higher than in the brief advice (8.9% and 9.4%; both P ≤ .001) or control (14.0% and 11.5%; P = .03 at 6 months) groups. Compared with the other 2 groups, the active referral group had significantly higher validated abstinence rates (10.2% at 3 months and 9.0% at 6 months, all P < .05) with odds ratios of 2.84 (95% CI, 1.57-5.15) and 2.61 (95% CI, 1.46-4.68) at 3 months, and 1.85 (95% CI, 1.06-3.23) and 1.81 (95% CI, 1.04-3.16) at 6 months in the brief advice and control groups, respectively. The SC service use rate was significantly higher in the active referral group (25.1%) than in either brief advice (2.4%) or control (3.4%) groups at 6 months (P < .001). Conclusions and Relevance: An intervention involving brief advice and active referral delivered to smokers in the community by volunteers can increase quitting in places where SC services are available but underused. Trial Registration: clinicaltrials.gov Identifier: NCT02539875.

A community based intervention program to enhance neighborhood cohesion: The Learning Families Project in Hong Kong.

BACKGROUND: Neighborhood cohesion, which refers to the extent of the connectedness and solidarity among residents in a community or neighborhood, is an important determinant of human health. To enhance neighborhood cohesion, the "Learning Families Project" was developed with a series of intervention programs in Kwun Tong in Hong Kong, a district with low neighborhood cohesion. This project, based on the social ecological model, provided a platform for neighbors to learn, communicate and interact with each other. METHODS: This quasi-experimental study included two nearby government subsidized low rent housing estates separated by busy main roads. One served as the intervention (Tsui Ping (South) Estate) and one as the control (Shun Tin Estate) estate. The intervention included promotion, resident training and learning programs, embodied by a series of community activities such as talks, day camp, thematic activities and horticulture class. Baseline (before the programs) and follow-up (one year after the programs) surveys were conducted both in the intervention and control estate to assess the impact of the programs on neighborhood cohesion. RESULTS: The number of residents who completed both the baseline and follow-up surveys was 502 in the intervention estate and 476 in the control estate. Neighborhood cohesion significantly improved in the intervention group after the programs (Cohen effect size d: 0.15). Compared with the control group, the improvements in closeness of the neighborhood and trust in neighbors were significantly greater in the intervention group (Cohen effect size d: 0.13 and 0.14, respectively). CONCLUSION: This brief intervention program using a quasi-experimental study design increased neighborhood cohesion in a low rent housing estate. TRIAL REGISTRATION: ClinicalTrials.gov NCT02851667.

Development and evaluation of a training workshop for lay health promoters to implement a community-based intervention program in a public low rent housing estate: The Learning Families Project in Hong Kong.

This paper presents the development and evaluation of the train-the-trainer (TTT) workshop for lay resident leaders to be lay health promoters. The TTT workshop aimed to prepare the trainees to implement and/or assist in conducting a series of community-based family well-being activities for the residents in a public low rent housing estate, entitled "Learning Families Project", under the FAMILY project. The four-hour TTT workshop was conducted for 32 trainees (72% women, 43% aged ≥ 60, 41% ≤ elementary school education). The workshop aimed to promote trainees' knowledge, self-efficacy, attitude and practice of incorporating the positive psychology themes into their community activities and engaging the residents to join these activities and learn with their family members. Post-training support was provided. The effectiveness of the TTT was examined by self-administered questionnaires about trainees' reactions to training content, changes in learning and practice at three time points (baseline, and immediately and one year after training), and the difference in residents' survey results before and after participating in the community activities delivered by the trainees. The trainees' learning about the general concepts of family well-being, learning family, leadership skills and planning skills increased significantly with medium to large effect sizes (Cohen's d: 0.5-1.4) immediately after the training. The effects of perceived knowledge and attitude towards practice were sustained to one year (Cohen's d: 0.4-0.6). The application of planning skills to implement community activities was higher at one year (Cohen's d: 0.4), compared with baseline. At one year, the residents' survey results showed significant increases in the practice of positive communication behaviours and better neighbour cohesions after joining the family well-being activities of LFP. Qualitative feedback supported the quantitative results. Our TTT workshop could serve as a practical example of development and evaluation of training programs for lay personnel to be lay health promoters. TRIAL REGISTRATION: ClinicalTrials.gov NCT02844244.

An Evaluation of a Train-the-Trainer Workshop for Social Service Workers to Develop Community-Based Family Interventions.

INTRODUCTION: Evaluation studies on train-the-trainer workshops (TTTs) to develop family well-being interventions are limited in the literature. The Logic Model offers a framework to place some important concepts and tools of intervention science in the hands of frontline service providers. This paper reports on the evaluation of a TTT for a large community-based program to enhance family well-being in Hong Kong. METHODS: The 2-day TTT introduced positive psychology themes (relevant to the programs that the trainees would deliver) and the Logic Model (which provides a framework to guide intervention development and evaluation) for social service workers to guide their community-based family interventions. The effectiveness of the TTT was examined by self-administered questionnaires that assessed trainees' changes in learning (perceived knowledge, self-efficacy, attitude, and intention), trainees' reactions to training content, knowledge sharing, and benefits to their service organizations before and after the training and then 6 months and 1 year later. Missing data were replaced by baseline values in an intention-to-treat analysis. Focus group interviews were conducted approximately 6 months after training. RESULTS: Fifty-six trainees (79% women) joined the TTT. Forty-four and 31 trainees completed the 6-month and 1-year questionnaires, respectively. The trainees indicated that the workshop was informative and well organized. The TTT-enhanced trainees' perceived knowledge, self-efficacy, and attitudes toward the application of the Logic Model and positive psychology constructs in program design. These changes were present with small to large effect size that persisted to the 1 year follow-up. The skills learned were used to develop 31 family interventions that were delivered to about 1,000 families. Qualitative feedback supported the quantitative results. CONCLUSION: This TTT offers a practical example of academic-community partnerships that promote capacity among community social service workers. Goals included sharing basic tools of intervention development and evaluation, and the TTT offered, therefore, the potential of learning skills that extended beyond the lifetime of a single program. CLINICAL TRIAL REGISTRATION: The research protocol was registered at the National Institutes of Health (identifier number: NCT01796275).

Exploring Community Stakeholders' Perceptions of the Enhancing Family Well-being Project in Hong Kong: A Qualitative Study.

BACKGROUND: Community engagement is a powerful tool in bringing about positive social and community change. Community stakeholders possess critical experience and knowledge that are needed to inform the development of community-based projects. However, limited literature is available on the practical experience involved with planning and implementing community-based family programs. Even less has been published documenting efforts in Chinese communities. This paper explores community stakeholders' experiences with the enhancing family well-being project-part of a citywide project entitled the "FAMILY Project," aimed at promoting family health, happiness, and harmony in Hong Kong. METHODS: This qualitative evaluation examined the perspectives of community stakeholders. Four focus groups with social workers (n = 24) and six in-depth interviews with steering committee members were conducted from December 2012 to May 2013 in Hong Kong. Focus groups and in-depths interview were audiotaped, transcribed, and analyzed using thematic analysis techniques. RESULTS: Rich accounts were given by our respondents on various aspects of the project. Main themes and subthemes were identified and grouped into four categories (project conception, project implementation, project consolidation, and the overall impact of the project). Respondents described the practical challenges associated with the project (e.g., recruitment, balancing scientific research, and lack of resources) and identified the elements that are important to the success of the project. These included the commitment to a shared goal, multi-agency collaboration, and a platform for knowledge exchange. Finally, respondents perceived benefits of the project at both the individual and community level. CONCLUSION: Our project sheds light on many of the practical considerations and challenges associated with a designing and implementing a community-based family intervention project. Community stakeholders input provided important information on their perceived benefits and barriers and can inform and improve future development of community-based family intervention programs.