Lessons Learned From a Knowledge-Matching Participatory Research Approach Involving Law Students and Older Adults as Peer Researchers.

The popularity of engaging community members as peer researchers is growing. The existing participatory research involving older adults appears to suffer from two main issues. First, older adults are rarely positioned as equitable research partners. Second, a paradox may exist between capacity building and an authentic lay perspective of older adults. This article adopted a knowledge-matching participatory approach to address these two issues. Seven older adults and four law students were trained as peer researchers to work with two academic researchers on a project about financial well-being in retirement. This article documented the research process and reflected the benefits, challenges, and best practices associated with this approach by analyzing transcripts from three reflective meetings, written reflections, and field notes from all peer and academic researchers using a thematic analysis approach. Results outline the experiences and reflections of using knowledge-matching participatory research for academic researchers and peer researchers, as well as for research processes and outcomes. The advantages of extending methodological amplitude, leveraging older adults' capacity, partnership matching, and empowerment are shown by the knowledge-matching participatory methodology. The establishment of capacity building, partnership development, and agenda flexibility are essential elements of success. We further discussed power disparity, partnership conflicts, and ethical dilemmas. Researchers and practitioners can utilize the findings, methodological approaches, and lessons learned in their studies aiming at engaging older adults in improving health and social well-being in later life.

Students' interaction anxiety and social phobia in interprofessional education in Hong Kong: mapping a new research direction.

BACKGROUND: Interprofessional education (IPE) has been promoted as a breakthrough in healthcare because of the impact when professionals work as a team. However, despite its inception dating back to the 1960s, its science has taken a long time to advance. There is a need to theorize IPE to cultivate creative insights for a nuanced understanding of IPE. This study aims to propose a research agenda on social interaction by understanding the measurement scales used and guiding researchers to contribute to the discussion of social processes in IPE. METHOD: This quantitative research was undertaken in a cross-institutional IPE involving 925 healthcare students (Medicine, Nursing, Social Work, Chinese Medicine, Pharmacy, Speech Language Pathology, Clinical Psychology, Food and Nutritional Science and Physiotherapy) from two institutions in Hong Kong. Participants completed the Social Interaction Anxiety Scale (SIAS-6) and Social Phobia Scale (SPS-6). We applied a construct validation approach: within-network and between-network validation. We performed confirmatory factors analysis, t-test, analysis of variance and regression analysis. RESULTS: CFA results indicated that current data fit the a priori model providing support to within-network validity [RMSEA=.08, NFI=.959, CFI=.965, IFI=.965, TLI=.955]. The criteria for acceptable fit were met. The scales were invariant between genders, across year levels and disciplines. Results indicated that social interaction anxiety and social phobia negatively predicted behavioural engagement (F = 25.093, p<.001, R2=.065) and positively predicted behavioural disaffection (F = 22.169, p<.001, R2=.057) to IPE, suggesting between-network validity. CONCLUSIONS: Our data provided support for the validity of the scales when used among healthcare students in Hong Kong. SIAS-6 and SPS-6 have sound psychometric properties based on students' data in Hong Kong. We identified quantitative, qualitative and mixed methods research designs to guide researchers in getting involved in the discussion of students' social interactions in IPE.Key MessagesThe Social Anxiety Scale (SIAS-6) and Social Phobia Scale (SPS-6) scales have sound psychometric properties based on the large-scale healthcare students' data in IPE in Hong Kong.Social interaction anxiety and social phobia negatively predicted students' behavioural engagement with IPE and positively predicted behavioural disaffection. The scales are invariant in terms of gender, year level and discipline.Quantitative, qualitative and mixed methods studies are proposed to aid researchers to contribute in healthcare education literature using the SIAS-6 and SPS-6.

The Experience of Participating in Remotely Delivered Online Exercise Classes During the COVID-19 Pandemic Among Community-Dwelling Older Adults and Its Postpandemic Implications.

The COVID-19 pandemic has accelerated the use of videoconferencing-delivered online exercise classes among community-dwelling older adults. This phenomenon is new, and no research has investigated older adults' relevant experiences and postpandemic perspectives. This study is situated in a naturalistic paradigm and adopted a descriptive qualitative methodology to understand the phenomenon. In-depth interviews were conducted with 23 older adults (aged 55-89 years) who have participated in videoconferencing-delivered online exercise since the COVID-19 pandemic. Utilizing thematic analysis, eight key themes were identified. Older adults experienced convenience, exercise regularity, technological transformation, and motivation when using this new form of exercise delivery. At the same time, they also experienced certain technological barriers and compromised quality of instructor supervision. Looking forward, older adults welcomed the increased opportunity for supervised exercise due to increased virtual capacity. They also envisaged that mobility-restricted groups such as frail older adults and caregivers would benefit from this form of exercise delivery.

Collaborative community mental health and aged care services with peer support to prevent late-life depression: study protocol for a non-randomised controlled trial.

BACKGROUND: Late-life depression is common, modifiable, yet under-treated. Service silos and human resources shortage contribute to insufficient prevention and intervention. We describe an implementation research protocol of collaborative stepped care and peer support model that integrates community mental health and aged care services to address service fragmentation, using productive ageing and recovery principles to involve older people as peer supporters to address human resource issue. METHODS/DESIGN: This is a non-randomised controlled trial examining the effectiveness and cost-effectiveness of the "Jockey Club Holistic Support Project for Elderly Mental Wellness" (JC JoyAge) model versus care as usual (CAU) in community aged care and community mental health service units in 12 months. Older people aged 60 years and over with mild to moderate depressive symptoms or risk factors for developing depression will be included. JoyAge service users will receive group-based activities and psychoeducation, low-intensity psychotherapy, or high-intensity psychotherapy according to the stepped care protocol in addition to usual community mental health or aged care, with support from an older peer supporter. The primary clinical outcome, depressive symptoms, and secondary outcomes, self-harm risk, anxiety symptoms, and loneliness, will be measured with the Patient Health Questionnaire-9 (PHQ-9), Self-Harm Inventory, Generalized Anxiety Disorder 7-item scale (GAD-7), and UCLA Loneliness 3-item scale (UCLA-3) respectively. Cost-effectiveness analysis will assess health-related quality of life using the EQ-5D-5L and service utilisation using the Client Service Receipt Inventory (CSRI). We use multilevel linear mixed models to compare outcomes change between groups and calculate the incremental cost-effectiveness ratio in terms of quality-adjusted life years. DISCUSSION: This study will provide evidence about outcomes for older persons with mental health needs receiving collaborative stepped care service without silos and with trained young-old volunteers to support engagement, treatment, and transitions. Cost-effectiveness findings from this study will inform resource allocation in this under-treated population. TRIAL REGISTRATION: ClinicalTrials.gov NCT03593889. Registered on 20 July 2018.

Exploring the acceptance of tablets usage for cognitive training among older people with cognitive impairments: A mixed-methods study.

This study investigated the acceptance of tablets technology among cognitively impaired older adults from individual and contextual levels when used in cognitive training. A convergent parallel mixed-methods design, comprising a post-usage questionnaire survey and focus groups, was used for data collection. A number of 57 community-dwelling cognitively impaired older people in Hong Kong completed an eight-week, home-based cognitive training using tablets delivered by older volunteers. The acceptance of the tablet usage for cognitive training was evaluated using questionnaire survey. Focus groups were conducted with participants, volunteers, and social workers to explore their experiences of tablet usage for cognitive training. Results indicated that attitudes toward tablets and facilitating conditions were predictors of intention to use tablets at the individual level. Tablets were perceived as beneficial on cognition, enjoyment, learning, social relationships, and communication. Contextual level factors that can encourage tablets usage include capacity building, empowerment, supports from the organization, and trust.

Burnout and intention to leave among care workers in residential care homes in Hong Kong: Technology acceptance as a moderator.

Care workers in residential care settings for older adults often experience job burnout, resulting in a high turnover rate. Previous studies offered contradictory findings on technology use in the workplace and its relationship with burnout. This study aimed to explore the moderator role technology acceptance plays in the relationship between burnout and intention to leave among care workers in residential care settings in Hong Kong. The study was based on a multicenter, cross-sectional questionnaire survey. The acceptance of general, and three specific, technologies (i.e., tablets, social robots and video gaming) was measured based on the scale of the Technology Acceptance Model. Two dimensions of burnout (exhaustion and disengagement) were measured using the Oldenburg Burnout Inventory scale. Intention to leave was measured using a self-reported item. Data collection took place from July to December 2018. We analysed data from 370 care workers from seven non-private residential care homes for older people in Hong Kong. A hierarchical multiple regression approach was used for moderator analysis. The results revealed that two measures of burnout (exhaustion and disengagement) were significantly and positively associated with intention to leave. The four measures of technology acceptance were negatively associated with intention to leave. The interaction of video-gaming acceptance and exhaustion was predictive of intention to leave (standardized beta = -0.20, p = .011). Acceptance of video gaming changed the strength of the relationship between exhaustion and intention to leave among participants. No significant moderating effects were observed in the relationship between disengagement and intention to leave. We highlight the importance of integrating technology variables, especially subjective appraisal of technology, in the issues of burnout and intention to leave. These findings shed new light on policies and practices that consider implement technology in routine care in residential care settings without unanticipated negative impacts for care staff.

Changes in technology acceptance among older people with dementia: the role of social robot engagement.

OBJECTIVE: Emerging technologies such as social robots have shown to be effective in reducing loneliness and agitation for older people with dementia. However, the acceptance of technology (specifically social robots) was found to be low for older people with dementia. The current understanding of changes in technology acceptance following direct exposure is limited and lacks rigorous study design. This study examined the change in technology acceptance after a direct interaction with a humanoid social robot (Kabochan) that was deployed for long-term care facilities' residents with dementia. METHODS: The technology acceptance was assessed using randomised control trials for a time frame of 32 weeks. A total of 103 residents clinically diagnosed with dementia, with a mean age of 87.2 years (SD = 7.4), were recruited from seven long-term care facilities in Hong Kong and were randomly allocated to either Kabochan-engagement group or control group. Participants in the engagement group interacted with Kabochan in an individual, non-facilitated approach. The behavioural engagement with Kabochan was observed by care workers and recorded into constructive engagement and non-engagement. Questionnaire surveys were taken placed at pre- and post-exposure with Kabochan to measure attitudes and beliefs towards technology. The questionnaire was based on previous studies on technology acceptance and included attitudes towards technology, perceived usefulness, perceived ease of use, technology self-efficacy, technology anxiety, and facilitating conditions. RESULTS: Perceived ease of use was improved at week 32 for participants who interacted with Kabochan (F = 4.239, p = 0.042) with a small effect (ηp2 = 0.043) in comparison to usual care group. Results further demonstrated that the magnitude of belief changes was related to the intensity of constructive behavioural engagement. Specifically, resident-robot behavioural engagement moderately improved attitudes towards technology (F = 11.62, p < 0.001, ηp2 = 0.11) and perceived usefulness (F = 5.75, p = 0.02, ηp2 = 0.06). CONCLUSIONS: The study tentatively supports that exposure to Kabochan has potential for changing perceived ease of use but not for other beliefs and attitudes towards technology among long-term care residents with dementia. Direct engagement with a humanoid social robot might be promising in improving the perceived ease of use towards technology.

Effects of a Humanoid Companion Robot on Dementia Symptoms and Caregiver Distress for Residents in Long-Term Care.

OBJECTIVES: To test the effects of deploying a humanoid companion robot (Kabochan) in comparison with usual care for long-term care facilities' residents with dementia. DESIGN: A 2-arm, randomized controlled trial with ABAB withdrawal design, lasting 32 weeks. After an 8-week baseline period, Kabochan was introduced in a nonfacilitated, individual approach with experimental-group participants (n = 52) for 8 weeks, then removed for 8 weeks, and then reintroduced for another 8 weeks. The control group (n = 51) received the usual standardized care. SETTING AND PARTICIPANTS: Seven long-term care facilities in Hong Kong. 103 residents (76% women, 87.2 ± 7.4 years) with a clinical diagnosis of dementia. MEASURES: Outcome assessments occurred at 5 time points: baseline (week 1) and the end of each phase (weeks 8, 16, 24, and 32). Primary outcomes were assessed with the Neuropsychiatric Inventory Questionnaire (symptom severity and caregiver distress subscales) and the Geriatric Depression Scale; secondary outcomes were measured by the Hong Kong Montreal Cognitive Assessment 5-minute Protocol, the Modified Barthel Index for Activities of Daily Living, and the Quality of Life-Alzheimer's disease scale. RESULTS: A multivariate analysis of variance indicated a statistically significant group × time interaction for neuropsychiatric-related caregiver distress at week 16 (F = 6.72, P = .011), with a moderate effect size (ηp2 = 0.06). When Kabochan was removed in the withdrawal phase (weeks 17-24), the neuropsychiatric symptoms became more severe at week 24 for the intervention group (F = 4.68, P = .003), although the effect size was small to moderate (ηp2 = 0.04). No statistical between-group differences were found in other health outcomes. CONCLUSIONS AND IMPLICATIONS: The Kabochan was potentially effective at reducing short-term neuropsychiatric symptoms and relevant caregiver distress for residents with dementia. An individualized care plan with continuous monitoring is required to integrate the humanoid robot into routine dementia care.

Measuring Senior Technology Acceptance: Development of a Brief, 14-Item Scale.

BACKGROUND AND OBJECTIVES: Technology has the potential to provide assistance and enrichment to older people; however, the desired outcomes are dependent on users' acceptance and usage. The senior technology acceptance model (STAM) was developed as a multidimensional measure assessing older people's acceptance of general technology. It contained 11 constructs measured by 38 items and had shown satisfactory psychometric properties. However, the length of the questionnaire increased respondent burden and limited its utilization. The study aimed to develop a brief, reliable, and valid version of scale to measure older people's technology acceptance by shortening the full, 38-item STAM questionnaire. RESEARCH DESIGN AND METHODS: The research method included (1) a sequential item-reduction strategy maximizing internal consistency, (2) convergent and discriminant validity analysis based on confirmative factor analysis, and (3) an expert review of resultant items. Data previously collected for developing the original STAM questionnaire were used to create the brief version. The data were collected from 1,012 community-dwelling individuals aged 55 and older in Hong Kong. Internal consistency and construct validity of the shortened questionnaire were examined. Two experts were invited for reviewing content validity. RESULTS: The final 14-item, brief version of the STAM questionnaire consisted of a 4-factor structure, representing classical technology acceptance constructs and age-related health characteristics. Theoretical relationships in the brief version showed similar patterns to the original STAM. The 14-item STAM demonstrated robustness in psychometrics by preserving the reliability and validity of the original STAM questionnaire. DISCUSSION AND IMPLICATIONS: The availability of a reliable and valid assessment tool of the short STAM can help researchers and practitioners to measure older adults' acceptance of technology and its effective usage. The short STAM could save administration time, reduce the burden on respondents, and be included in large-scale surveys.

Non-pharmacological depression therapies for older Chinese adults: A systematic review & meta-analysis.

PURPOSE: To conduct a systematic review of randomized controlled trials to evaluate the evidence for the use of non-pharmacological depression therapies in older Chinese adults. MATERIALS AND METHODS: The population was individuals of Chinese extraction over the age of 60 who meet the criteria for depression. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Six healthcare databases were systematically searched for publications to the end date July 2018. Included study variables were extracted and methodological quality assessments were performed. Ten studies reported sufficient data for meta-analysis. RESULTS: Fifteen experimental and quasi-experimental studies fulfilled the selection criteria (N = 904 participants). Twelve studies provided sufficient data to evaluate the therapies using Effect Size (ES) (Cohen'sd); ranged from low to high. In the Qigong studies ES varied d = 0.31-0.81, Reminiscence d = 0.20-2.37, and for single studies of Tai Chi d = 1.7 and for Life Story d = 1.46. From the meta-analyses, Qigong was the only treatment that had a significant effect on the severity of depression (Z = -4.47, p < 0.01) with acceptable statistical heterogeneity between studies (I2 = 52 %). CONCLUSION: Overall, there was a large methodological heterogeneity between studies attributed to differing treatments, duration and designs. Reminiscence and Life Story showed an overall effect from a range of measures, as did the exercise therapies Qigong and Tai Chi. Qigong was the only therapy having a significant effect on depression. This therapy may be useful to alleviate depression due to the group and social interaction.

Older Adults' Perceptions of Age-friendliness in Hong Kong.

BACKGROUND AND OBJECTIVES: There is little understanding about how rapid urban development has affected the extent to which communities are able to optimize health and participation opportunities for older adults in Hong Kong. Our objective was to examine what older residents perceive to be the shortcomings of their communities in meeting their psychosocial and physical needs as they age. RESEARCH DESIGN AND METHODS: In reference to the WHO Age-Friendly Cities Project Methodology: Vancouver Protocol, we conducted nine focus groups comprising 65 participants for an Age-Friendly City baseline assessment in two districts in Hong Kong, China. Participants were asked to share their views on their respective district of residence, and identify aspects of the city they found unfriendly. Data generated from interviews were analyzed using thematic analysis. RESULTS: Five of the following key themes were identified: the failure of public transportation to cater to the needs of older adults; a lack of public space for recreation and socializing; diminishing human interactions in welfare services; physical and financial challenges relating to housing; and workplace discrimination against older adults. DISCUSSION AND IMPLICATIONS: These findings underscore the importance of prioritizing the social welfare of older adults in building a more inclusive and age-friendly city. They also highlight the difficulties in fostering an inclusive environment while ensuring efficiency and profit maximization.

Enhancing homework adherence of Chinese older adults: A case study using Instrumental Reminiscence Intervention.

AIM: The present study aimed to examine effective clinical strategies that facilitate homework adherence among Chinese older adults who participated in group therapy using Instrumental Reminiscence Intervention (IRI) to reduce depressive symptoms. METHODS: Examination was based on IRI for 15 groups of older adults, with four to eight participants in each group. Homework assignment was included as a core component of the intervention in each session, except the first session. Particular emphasis was put on both homework design and assignment strategies. RESULTS: Two effective strategies were developed. The first was the development of a tactic card as a tool for homework content and assignment. The second strategy was interventionist training. Clinical examples are used to illustrate how these strategies can enhance homework adherence in a Chinese context. CONCLUSIONS: The two clinical strategies were found to be effective in enhancing homework adherence among Chinese older participants in a group therapy setting. These strategies are recommended for use in group clinical settings for Chinese participants. Geriatr Gerontol Int 2016; 16: 1153-1160.

Development and validation of the Chinese Health Literacy Scale for Chronic Care.

This study aims to develop and test the psychometric properties of the Chinese Health Literacy Scale for Chronic Care (CHLCC). This is a methodological study with a sample of 262 patients 65 years of age and older who had chronic illnesses. Pearson's correlation, independent sample t tests, and analyses of variance were used. The CHLCC showed a significant positive correlation with Chinese literacy levels (r = 0.80; p < .001) but was negatively correlated with age (r =-0.31; p <.001). Respondents who were male (t =4.34; p <.001) and who had reached Grade 12 or higher in school (F = 51.80; p <.001) had higher CHLCC scores than did their counterparts. Individuals with high levels of health literacy had fewer hospitalizations than did their counterparts (ß =-0.31; incidence rate ratio = 0.73; p <.05). The CHLCC also displayed good internal reliability (Cronbach'sα =0.91) and good test-retest reliability (intraclass correlation coefficient = 0.77; p <.01). The CHLCC is a valid and reliable measure for assessing health literacy among Chinese patients with chronic illness. The scale could be used by practitioners before implementing health promotion and education.