A Nurse-Led Web-Based Home Asthma Education Program for Children and their Families: A Randomized Controlled Trial.

BACKGROUND: Education is the most essential component for effective asthma control and is endorsed by guidelines worldwide. However, multiple caregivers are often jointly involved in child care, and educating them is often a challenging task. This study determines the effectiveness of a web-based asthma education program in enhancing knowledge, attitude and practice of caregivers and reducing unscheduled hospital visits of children for asthma. METHODS: A two-arm, randomized controlled trial was carried out between November 2018 and December 2019. Child-parent dyads were recruited when the children (4-11 years of age) were admitted due to asthma exacerbations. A nurse-led web-based home asthma education program was developed and implemented before discharge. Outcomes included parents' knowledge, attitude and practice regarding asthma and frequency of unscheduled visits and readmissions in children. RESULTS: 112 child-parent dyads were enrolled. The parents' knowledge, attitude and practice and the number of unscheduled visits of the children were found to be significantly different between two groups at different time points (Ps < 0.001) with a large effect size (Cohen's d > 0.8). CONCLUSION: This intervention was shown to be an effective strategy to educate caregivers who are jointly involved in their child's asthma control after discharge from hospital. TRIAL REGISTRATION: The Chinese Clinical Trial Registry, World Health Organization (ChiCTR1800019706).

Prospective Validation of the Chinese Version of the Self-Efficacy for Exercise Scale Among Middle-Aged Patients With Coronary Heart Disease.

PURPOSE: The aim of this study was to further evaluate the psychometric properties of the Chinese version of the Self-Efficacy for Exercise Scale (SEE-C) among middle-aged outpatients with coronary heart disease (CHD). DESIGN: Psychometric evaluation design. METHODS: A convenience sample of 355 CHD patients was recruited and followed up at 3 and 6 months. Cronbach's alpha, construct validity (exploratory factor analysis), and concurrent and predictive validity were examined. FINDINGS: The SEE-C had a single-factor structure that was stable over time and had high internal consistency. Baseline SEE-C scores were significantly and positively associated with quality of life and total exercise time per week and significantly and negatively associated with anxiety and depression. They also significantly predicted total exercise per week at the 3- and 6-month follow-ups. CONCLUSIONS: The SEE-C is a robust, reliable, and valid measure of exercise self-efficacy for middle-aged Chinese CHD outpatients. CLINICAL RELEVANCE: The SEE-C can assess patients' exercise self-efficacy, so that appropriate interventions to improve exercise self-efficacy can be provided.

Promoting healthy ageing through light volleyball intervention in Hong Kong: study protocol for a randomised controlled trial.

BACKGROUND: Our pilot study has demonstrated improvements in health outcomes through participation in a new sport, light volleyball (LVB), among older adults. In response to the promising results of the LVB pilot study and the priority of allocating resources to the prevention of age-related fitness degradation by the Hong Kong (HKG) government, the present study aims to investigate the effectiveness of a LVB intervention on physical and psychological health attributes among older adults at a larger scale in HKG. METHODS/DESIGN: This study will apply both quantitative and qualitative methods with a large sample (approximately 315 participants). We will adopt a randomized controlled trial (RCT) design to further evaluate the effectiveness of a LVB intervention on health outcomes against a comparison group, Tai Chi (TC), and a control group (C). Older adults will be eligible to join the intervention if they are (a) aged 65 years and above; (b) living in the community independently; (c) absent of diagnosed cognitive impairment; (d) not regular participants in a structured PA program for two years preceding the study; and (e) able to achieve a passing score on the Timed-up-and-go test (TUG) and Abbreviated Mental Test (AMT).About 315 participants will be randomly assigned into 3 groups in 1:1:1 ratio. LVB group participants will receive 16-week LVB program; TC group will utilize a simplified 24-form Yang Style TC, and C group participants will be instructed to maintain their normal daily activity and join regular non-exercise social gatherings. Measurements will be collected before and after the intervention, and 6 months and 12 months after completion of the intervention. DISCUSSION: This intervention, if effective, will enhance older adult's physical and psychological health, and provide the data and evidence to support policymaking in relation to future PA promotion for older adults. TRIAL REGISTRATION NUMBER: ChiCTR1900026657.

Learning experience of nursing students in a clinical partnership model: An exploratory qualitative analysis.

BACKGROUND: Clinical teaching models are crucial for nursing students' learning experiences as students learn and socialise in a complex clinical context. An innovative clinical partnership model, employing hospital-based clinical teachers to provide supervision and university teachers to liaise with students, has been developed to facilitate clinical teaching and enhance learning experiences. OBJECTIVES: The study aims to explore nursing students' learning experiences under this clinical partnership model. DESIGN: An exploratory qualitative study using focus group interviews. PARTICIPANTS: Twenty-eight pre-registration nursing students at undergraduate and postgraduate level participated in this study. METHODS: Students formed four groups with each consisting of six to eight students. Semi-structured interviews were conducted to explore students' experiences and perceptions of clinical learning in the clinical partnership model. The data analysis was guided by an inductive approach using content analysis. RESULTS: The narrative data relates to the clinical learning environment and experience. Nursing students found the clinical partnership model provided a conducive learning context facilitating their adaption to the new environment and integration with the healthcare team. Though students spent time developing mutual understanding with their clinical teachers, they were satisfied with the ample opportunities to practise and learn from their teachers. They appreciated the fact that teachers enriched their learning through bridging the theory-practice gap and acting as role models. CONCLUSION: The clinical partnership model enriches students' learning experiences. It provides a student-centred learning approach and supportive clinical environment which engages nursing students in learning.

Clinical learning experiences of nursing students using an innovative clinical partnership model: A non-randomized controlled trial.

BACKGROUND: Clinical practicum is a major learning component for pre-registration nursing students. Various clinical practicum models have been used to facilitate students' clinical learning experiences, employing both university-based and hospital-based clinical teachers. Considering the strengths and limitations of these clinical practicum models, along with nursing workforce shortages, we developed and tested an innovative clinical partnership model (CPM) in Hong Kong. OBJECTIVE: To evaluate an innovative CPM among nursing students actual and preferred clinical learning environment, compared with a conventional facilitation model (CFM). DESIGN: A non-randomized controlled trial examining students' clinical experiences, comparing the CPM (supervised by hospital clinical teacher) with the CFM (supervised by university clinical teacher). SETTING: One university in Hong Kong. PARTICIPANTS: Pre-registration nursing students (N = 331), including bachelor of nursing (n = 246 year three-BN) and masters-entry nursing (n = 85 year one-MNSP). METHODS: Students were assigned to either the CPM (n = 48 BN plus n = 85 MNSP students) or the CFM (n = 198 BN students) for their clinical practice experiences in an acute medical-surgical ward. Clinical teachers supervised between 6 and 8 students at a time, during these clinical practicums (duration = 4-6 weeks). At the end of the clinical practicum, students were invited to complete the Clinical Learning Environment Inventory (CLEI). Analysis of covariance was used to compare groups; adjusted for age, gender and prior work experience. RESULTS: A total of 259 students (mean age = 22 years, 76% female, 81% prior work experience) completed the CLEI (78% response rate). Students had higher scores on preferred versus actual experiences, in all domains of the CLEI. CPM student experiences indicated a higher preferred task orientation (p = 0.004), while CFM student experiences indicated a higher actual (p < 0.001) and preferred individualization (p = 0.005). No significant differences were noted in the other domains. CONCLUSIONS: The CPM draws on the strengths of existing clinical learning models and provides complementary methods to facilitate clinical learning for pre-registration nursing students. Additional studies examining this CPM with longer duration of clinical practicum are recommended.

Effects of Promotional Materials on Attitudes and Fear towards Colorectal Cancer Screening among Chinese Older Adults: An Experimental Study.

Colorectal cancer (CRC) screening is a cost-effective prevention and control strategy. However, the promotion of CRC screening for older adults may be difficult because reading CRC prevention information may evoke embarrassment, fear, and anxiety towards the screening procedure and cancer diagnosis. This study aims to (1) examine the effects of three promotional materials for CRC screening on the attitudes toward CRC screening tests (screening interest, screening effectiveness, and trust in the screening results) and cancer fear, and (2) to explore the interaction effect of cancer fear with screening effectiveness and trust in the screening results on screening interest of the three screening tests (fecal occult blood test (FOBT), flexible sigmoidoscopy, and colonoscopy) among Chinese older adults. A total of 114 community-dwelling older adults were asked to look at the corresponding promotional materials (pamphlet, cartoon, and video) of one of the three study groups. The pamphlet and video represent convention strategies and the cartoon represents an innovative strategy. No significant difference was observed in the screening interest and cancer fear across groups. FOBT was the most preferred screening modality. The video group has a large proportion agreed screening effectiveness of flexible sigmoidoscopy than pamphlet and cartoon groups and trusted in the screening results for FOBT and flexible sigmoidoscopy than the pamphlet group. Logistic regression results showed that the effect of trust in the screening results on screening interest for colonoscopy was greater among participants with higher cancer fear than those with lower cancer fear level. In conclusion, the three promotional groups had produced similar results in their attitudes toward CRC screening and cancer fear. The use of cartoons may be a comparable approach with conventional methods in the promotion of CRC screening. Additional components that can arouse fear and boost response efficacy simultaneously might also be useful for the effective promotion of colonoscopy among Chinese older adults.

Promoting Holistic Well-Being in Chronic Stroke Patients Through Leisure Art-Based Creative Engagement.

PURPOSE: To examine the potential value of a creative art-based activity as a caring modality for promoting holistic well-being among chronic stroke patients, and to explore the feelings and meanings that stroke patients derived from their experience in leisure art-based creative engagement (LACE). DESIGN: Qualitative design. METHOD: Participants were recruited through purposive and snowball sampling. Individual semi-structured interviews were conducted. Qualitative content analysis was performed. The design and implementation of LACE was guided by Watson's theory of caring. FINDINGS: Twenty-four participants completed the study. Four themes emerged from participants' account of experiences with the LACE: (1) appreciation of opportunities, (2) appreciation of self, (3) appreciation of others, and (4) appreciation of life. CONCLUSION: From the perspective of the participants, engaging in LACE enhances their sense of enjoyment and self-expression. Furthermore, they perceived LACE as an affirmation of life and an empowering process strengthening their connection and appreciation with the self and others. CLINICAL RELEVANCE: This study adds evidence to existing literature on Watson's theory-guided design and implementation of caring initiatives for community rehabilitation and has laid the groundwork for developing further evidencebased research in leisure art-based caring occasions for promoting holistic well-being in stroke rehabilitation.

An Age-Friendly Living Environment as Seen by Chinese Older Adults: A "Photovoice" Study.

"Ageing in place" is a policy initiative strongly advocated by the World Health Organization to face the challenge of an ageing population. This pilot study used a "photovoice" approach, aiming to explore aspects of the housing environment considered by older people as important in facilitating ageing in place. It enabled participants to express their ideas through photographs. Each participant was asked to take photos that illustrated age-friendly features they considered crucial for supporting their lives in the community. A total of 44 older people participated in the pilot study, and 300 photos were collected. Participants were invited to describe the reasons for taking these photos by filling in a journal sheet. A semi-structured interview was then conducted with individual participants, who were asked to elaborate on the meaning of their photos. The analysis revealed three themes: (1) age-friendly housing design; (2) supportive neighborhood; and (3) connection to family and the community. These three themes are pillars of an age-friendly city, which are important to seniors to facilitate ageing in place.

Evaluation of the Effectiveness of Tai Chi versus Brisk Walking in Reducing Cardiovascular Risk Factors: Protocol for a Ranomized Controlled Trial.

Physical inactivity is one of the major modifiable lifestyle risk factors for cardiovascular disease (CVD). This protocol aims to evaluate the effectiveness of Tai Chi versus brisk walking in reducing CVD risk factors. This is a randomized controlled trial with three arms, namely, Tai Chi group, walking group, and control group. The Tai Chi group will receive Tai Chi training, which consists of two 60-min sessions each week for three months, and self-practice for 30 min every day. The walking group will perform brisk walking for 30 min every day. The control group will receive their usual care. 246 subjects with CVD risk factors will be recruited from two outpatient clinics. The primary outcome is blood pressure. Secondary outcomes include fasting blood for lipid profile, sugar and glycated haemoglobin (HbA1c); body mass index, waist circumference, body fat percentage; perceived stress level and quality of life. Data collections will be conducted at baseline, 3-month, 6-month and 9-month. Generalized estimating equations model will be used to compare the changes in outcomes across time between groups. It is expected that both the Tai Chi and walking groups could maintain better health and have improved quality of life, and that Tai Chi will be more effective than brisk walking in reducing CVD risk factors.

The sustaining effects of Tai chi Qigong on physiological health for COPD patients: a randomized controlled trial.

OBJECTIVES: To evaluate the sustaining effects of Tai chi Qigong in improving the physiological health for COPD patients at sixth month. DESIGN: A randomized controlled trial. Subjects were in three randomly assigned groups: Tai chi Qigong group, exercise group, and control group. SETTING: The 206 subjects were recruited from five general outpatient clinics. INTERVENTIONS: Tai chi Qigong group completed a 3-month Tai chi Qigong program. Exercise group practiced breathing and walking as an exercise. Control group received usual care. MAIN OUTCOME MEASURES: Primary outcomes included six-minute walking distance and lung functions. Secondary outcomes were dyspnea and fatigue levels, number of exacerbations and hospital admissions. RESULTS: Tai chi Qigong group showed a steady improvement in exercise capacity (P<.001) from baseline to the sixth month. The mean walking distance increased from 298 to 349 meters (+17%). No significant changes were noted in the other two groups. Tai chi Qigong group also showed improvement in lung functions (P<.001). Mean forced expiratory volume in 1s increased from .89 to .99l (+11%). No significant change was noted in the exercise group. Deterioration was found in the control group, with mean volume decreased from .89 to .84l (-5.67%). Significant decreased in the number of exacerbations was observed in the Tai chi Qigong group. No changes in dyspnea and fatigue levels were noted among the three groups. CONCLUSIONS: Tai chi Qigong has sustaining effects in improving the physiological health and is a useful and appropriate exercise for COPD patients.

Evaluation of the sustaining effects of Tai Chi Qigong in the sixth month in promoting psychosocial health in COPD patients: a single-blind, randomized controlled trial.

OBJECTIVES: To evaluate the sustaining effects of Tai Chi Qigong (TCQ) in improving the psychosocial health in chronic obstructive pulmonary disease (COPD) patients in the sixth month. BACKGROUND: COPD affects both physical and emotional aspects of life. Measures to minimize patients' suffering need to be implemented. METHODS: 206 COPD patients were randomly assigned into three groups: TCQ group, exercise group, and control group. The TCQ group completed a three-month TCQ program, the exercise group practiced breathing and walking exercise, and the control group received usual care. RESULTS: Significant group-by-time interactions in quality of life (QOL) using St. George's respiratory questionnaire (P = 0.002) and the perceived social support from friends using multidimensional scale of perceived social support (P = 0.04) were noted. Improvements were observed in the TCQ group only. CONCLUSIONS: TCQ has sustaining effects in improving psychosocial health; it is also a useful and appropriate exercise for COPD patients.

Tai chi Qigong improves lung functions and activity tolerance in COPD clients: a single blind, randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of a Tai chi Qigong (TCQ) program in enhancing respiratory functions and activity tolerance in clients with chronic obstructive pulmonary disease (COPD). DESIGN: A single-blind, randomized controlled trial. SETTING: Five general outpatient clinics in Hong Kong. INTERVENTION: In total, 206 COPD clients were randomly assigned into one of the three groups, namely, TCQ, exercise, and control group. Subjects in the TCQ group received a TCQ program consisting of two 60-min sessions each week for three months. Subjects in the exercise group were taught to practice breathing techniques combined with walking as an exercise. Subjects in the control group were instructed to maintain their usual activities. Data collection was performed at baseline and at the 6-week and 3-month marks. OUTCOMES: Lung functions, 6-min walk test, and COPD exacerbation rate. RESULTS: Results of repeated measures of analysis of covariance demonstrated that there were significant interaction effects between time and group in forced vital capacity (p=.002, η(2)=.06), forced expiratory volume in 1s (p<.001, η(2)=.02), walking distance (p<.001), and exacerbation rate (p=.006, η(2)=.06) at 3 months. Improvements were noted in the TCQ group. No changes were observed in the exercise group, while a decline in lung functions was noticed in the control group. CONCLUSION: Tai chi Qigong was able to improve respiratory functions and activity tolerance level in COPD clients. The breathing and walking exercise helped maintain lung functions and slow down disease progression.

Effectiveness of a Tai chi Qigong program in promoting health-related quality of life and perceived social support in chronic obstructive pulmonary disease clients.

PURPOSE: This paper evaluates the effectiveness of a 3-month Tai chi Qigong (TCQ) program in promoting the psychosocial functional health of clients with chronic obstructive pulmonary disease (COPD) in Hong Kong. METHODS: This study employed a single-blind, randomized controlled trial. Two hundred and six COPD clients were randomly assigned into three groups, namely, TCQ group, exercise group, and control group. Subjects in the TCQ group received a TCQ program, consisting of two 60-min sessions each week for 3 months. Subjects in the exercise group were taught to practice breathing techniques combined with walking as an exercise. Subjects in the control group received their usual care. Data collections were performed at baseline, on the sixth week and on the third month. The primary outcomes were health-related quality of life using St. George Respiratory Questionnaire-Hong Kong Chinese version and perceived social support using the Multidimensional Scale of Perceived Social Support-Chinese version. RESULTS: The TCQ group showed greater improvements in the symptom (F4, 404=3.351, P=0.010) and activity domains (F4, 404=2.611, P=0.035). No differences were detected in perceived social support among the three groups. CONCLUSIONS: Tai chi Qigong promoted health outcomes with respect to clients' perception of their respiratory symptoms. Moreover, TCQ decreased disturbances to their physical activities.