Layperson-Delivered Telephone-Based Behavioral Activation Among Low-Income Older Adults During the COVID-19 Pandemic: The HEAL-HOA Randomized Clinical Trial.

Importance: Older adults are particularly vulnerable to loneliness and its physical and psychosocial sequelae, but scalable interventions are lacking, especially during disasters such as pandemics. Objective: To compare the effects of layperson-delivered, telephone-based behavioral activation and mindfulness interventions vs telephone-based befriending on loneliness among at-risk older adults. Design, Setting, and Participants: This assessor-blinded, 3-arm randomized clinical trial screened Chinese older adults through household visits and community referrals from April 1, 2021, to April 30, 2023, in Hong Kong. Eligible participants (≥65 years of age) who were lonely, digitally excluded, living alone, and living below the poverty line and provided consent to participate were randomized into behavioral activation, mindfulness, and befriending groups. Assessments were conducted at baseline, 1 month, and 3 months. Intervention: As part of the Helping Alleviate Loneliness in Hong Kong Older Adults (HEAL-HOA) dual randomized clinical trial, 148 older laypersons were trained to deliver a twice-weekly 30-minute intervention via telephone for 4 weeks. Main Outcomes and Measures: The primary outcome was loneliness measured by the UCLA Loneliness Scale (range, 20-80) and the De Jong Gierveld Loneliness Scale (range, 0-6), with higher scores on both scales indicating greater loneliness. Secondary outcomes were depression, perceived stress, life satisfaction, psychological well-being, sleep quality, perceived social support, and social network. Results: A total of 1151 participants (mean [SD] age, 76.6 [7.8] years; 843 [73.2%] female) were randomized to the behavioral activation (n = 335), mindfulness (n = 460) or befriending (n = 356) group. Most were widowed or divorced (932 [81.0%]), had primary education or below (782 [67.9%]), and had 3 or more chronic diseases (505 [43.9%]). Following intention-to-treat principles, linear mixed-effects regression model analyses showed that loneliness measured by the UCLA Loneliness Scale was significantly reduced in the behavioral activation group (mean difference [MD], -1.96 [95% CI, -3.16 to -0.77] points; P < .001]) and in the mindfulness group (MD, -1.49 [95% CI, -2.60 to -0.37] points; P = .004) at 3 months compared with befriending. Loneliness measured by the De Jong Gierveld Loneliness Scale was not significantly reduced at 3 months in the behavioral activation group (MD, -0.06 [95% CI, -0.26 to 0.13] points; P > .99]) but was in the mindfulness group (MD, 0.22 [95% CI, 0.03 to 0.40] points; P = .01) at 3 months compared with befriending. In the behavioral activation and mindfulness groups, sleep quality improved compared with befriending, but perceived stress increased. Psychological well-being and perceived social support improved in the behavioral activation group. No statistically significant between-group differences were observed in depression, life satisfaction, or social network. Conclusion and Relevance: In this randomized clinical trial, scalable psychosocial interventions delivered remotely by older laypersons appeared promising in reducing later life loneliness and addressing the pressing mental health challenges faced by aging populations and professional geriatric mental health workforce shortages. Further research should explore ways to maximize the clinical relevance and cost-effectiveness of these interventions. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2300072909.

An exploratory study on material deprivation and loneliness among older adults in Hong Kong.

BACKGROUND: Poverty, as a risk factor for loneliness, has been understudied, and there is a need to gain a better understanding of the relationship between poverty examined by material deprivation and loneliness among older adults in Hong Kong. It also aimed to explore the possible mediation and moderation effects of social support, social networks, neighborhood collective efficacy, and social engagement in the link between material deprivation and loneliness. METHODS: 1696 Chinese older adults aged 60 years and above (Mage = 74.61; SD = 8.71) participated in a two-wave study. Older adults reported their loneliness level, material deprivation, perceived level of social support, social network, neighborhood collective efficacy, social engagement, and sociodemographic information. Logistic regression was conducted to examine the effect of material deprivation on loneliness, as well as the mediation and moderation models. RESULTS: The results indicated that material deprived older adults reported a significantly higher level of loneliness 2 years later when controlling for demographic variables, health-related factors, and loneliness at baseline. We also found that engagement in cultural activities partially mediated the effect of material deprivation and loneliness. Furthermore, neighborhood collective efficacy and engagement in cultural activities were significant moderators that buffer the relationship between material deprivation and loneliness. CONCLUSIONS: Our results suggested the need to alleviate the negative impact of material deprivation on loneliness by developing interventions focused on promoting neighborhood collective efficacy and social engagement, which could be aimed at building meaningful bonds among Chinese older adults in Hong Kong.

Study protocol of the 'HEAL-HOA' dual randomized controlled trial: Testing the effects of volunteering on loneliness, social, and mental health in older adults.

Background: Interventions to reduce loneliness in older adults usually do not show sustained effects. One potential way to combat loneliness is to offer meaningful social activities. Volunteering has been suggested as one such activity - however, its effects on loneliness remain to be tested in randomized controlled trials (RCT). Methods: This planned Dual-RCT aims to recruit older adults experiencing loneliness, with subsequent randomization to either a volunteering condition (6 weeks of training before delivering one of three tele-based loneliness interventions to older intervention recipients twice a week for 6 months) or to an active control condition (psycho-education with social gatherings for six months). Power analyses require the recruitment of N = 256 older adults to detect differences between the volunteering and the active control condition (128 in each) on the primary outcome of loneliness (UCLA Loneliness Scale). Secondary outcomes comprise social network engagement, perceived social support, anxiety and depressive symptoms, self-rated health, cognitive health, perceived stress, sleep quality, and diurnal cortisol (1/3 of the sample). The main analyses will comprise condition (volunteering vs. no-volunteering) × time (baseline, 6-, 12-, 18-, 24-months follow-ups) interactions to test the effects of volunteering on loneliness and secondary outcomes. Effects are expected to be mediated via frequency, time and involvement in volunteering. Discussion: If our trial can show that volunteers delivering one of the three telephone-based interventions to lonely intervention recipients benefit from volunteer work themselves, this might encourage more older adults to volunteer, helping to solve some of the societal issues involved with rapid demographic changes.

Effects of volunteering over six months on loneliness, social and mental health outcomes among older adults: The HEAL-HOA Dual Randomized Controlled Trial.

OBJECTIVE: To determine the beneficial effects of volunteering as lay counselor via telephone on own loneliness, social network engagement, perceived social support, stress, anxiety, and depressive symptoms among Chinese older adults in Hong Kong during the COVID-19 pandemic. DESIGN, SETTING, INTERVENTION, AND PARTICIPANTS: "Helping Alleviate Loneliness in Hong Kong Older Adults" (HEAL-HOA), a dual randomized controlled trial, was implemented to test effects of telephone-based psychosocial interventions delivered by older-adult volunteers for low-income lonely older adults. To evaluate the effects of volunteering on loneliness, we randomized 375 individuals ages 50-70 into a volunteering condition versus an active control (psychoeducation with social gatherings). Following a 6-week training, participants in the volunteering condition, delivered tele-interventions to older intervention recipients. MEASUREMENT: The primary outcome was loneliness measured with the UCLA Loneliness Scale. Secondary outcomes were loneliness measured with the De Jong Gierveld Scale (DJG), social network engagement, perceived social support, perceived stress, anxiety, and depressive symptoms. Assessments were completed before training (baseline) and immediately after the 6-month volunteering period. RESULTS: Results from linear mixed models show significant positive effects of volunteering (significant interactions of condition × time) on both measures of loneliness (dppc2 = -0.41 ULCA Loneliness score, dppc2 = -0.70 total DJG score), social network engagement, stress and depressive symptoms as compared to control participants. CONCLUSIONS: The HEAL-HOA trial demonstrates beneficial effects of volunteer-delivered tele-interventions on decreasing loneliness on the volunteer interventionists themselves. Communicating these benefits for volunteers may attract more older adults into volunteering. This effective tele-based volunteer program is scalable for wider implementation. SUMMARY: This RCT tested effects of volunteering on loneliness in Hong Kong during the COVID-19-pandemic. Three hundred seventy-five individuals ages 50-70 were randomized into volunteering (delivering tele-interventions against loneliness) versus an active control condition. After 6 months, volunteers compared to controls, showed benefits on loneliness, social network engagement, stress and depressive symptoms. A program engaging lonely older adults in loneliness intervention delivery has beneficial effects on volunteers themselves and could be a scalable solution for our loneliness epidemic.

Health Outcomes of Social Pension Expansion: A Quasi-Experiment Among Older Adults in Hong Kong.

A social pension, regarded as a reliable source of income, has the potential to significantly influence the overall wellbeing of vulnerable older adults. This study aimed to extend the understanding of the effects of social pension expansion beyond its economic impacts to encompass recipients' health status. Using three-wave data from a representative sample of older adults, we employed a quasi-experimental assessment model to evaluate the impact of a recent social pension expansion in Hong Kong on health-related consumption and health outcomes among older adults. The results of the triple difference estimations revealed that an increased social pension significantly enhanced older people's engagement in entertainment activities, utilization of healthcare services, and expenditures on preventive health products. Furthermore, the increased social pension was found to have a significant positive effect on mitigating poor self-rated health and poor sleep quality. However, it did not have a significant impact on the prevalence of depression. These findings suggest that social pension expansion should be coordinated with other policy initiatives to comprehensively improve the physical and mental health of older adults.

Multiphase optimization of a multicomponent intervention for informal dementia caregivers: a study protocol.

BACKGROUND: Family caregiver interventions are essential to support dementia caregiving. However, such interventions are typically complex and consist of multiple components. Existing evidence rarely delineates the effectiveness and interactions between individual components. To optimise intervention, we adopt the multiphase optimisation strategy (MOST) to test the implementation fidelity and determine the effect of each component and the interactions between each component and the corresponding outcome. METHODS: A prospective, assessor-blinded, randomised clinical trial with fractional factorial design using the MOST principle. Two hundred fifty family dementia caregivers will be randomised to one of 16 experimental conditions in a fractional factorial design involving six intervention components: (1) dementia and caregiving education; (2) self-care skills; (3) behavioural symptom management; (4) behavioural activation; (5) modified mindfulness-based cognitive therapy; and (6) support group. The first one is the core component, and the five remaining will be examined. Physical health, caregiver burden, stress, psychological well-being, anxiety and depressive symptoms, and social support will be assessed over the 12-month study period. Following the intention-to-treat principle, linear mixed models and regression analyses will be used to examine the specific effect of the five components and their two-way interactions to propose the most effective combination. DISCUSSION: This is the first study adopting the multiphase optimisation strategy to identify the most active and engaging components of a psychological intervention for caregivers of patients with dementia. In view that dementia caregiver interventions are increasingly diversified and complex, such knowledge is important to maximise the intervention efficacy and allow the intervention to be implemented within an efficient timeframe and dosage. The optimisation of caregiver support interventions is critical to enhance the health outcomes of caregivers and care recipients, thereby, delaying possible institutionalisation and reducing the costs of long-term dementia care. TRIAL REGISTRATION: This study was retrospectively registered in the WHO Primary Registry - Chinese Clinical Trials Registry (ChiCTR2300071235). (Protocol date 30/10/2020; version identifier 2020-2021-0045). Registered on 9 May, 2023. REPORTING METHOD: SPIRIT guideline was followed. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement.

Sequential multiple assignment randomised controlled trial protocol for developing an adaptive intervention to improve depressive symptoms among family caregivers of people with dementia.

OBJECTIVES: Family caregivers of people with dementia (FC-of-PWD) suffer from a high level of stress and depressive symptoms, which usually require different interventions at different stages. Although some standalone interventions such as behavioural activation (BA) and mindfulness practice (MP) have been shown to be potentially effective at reducing depressive symptoms, the best sequence and combination of these interventions for caregivers are unknown. This study aims to develop and identify a two-stage adaptive intervention with prespecified rules guiding whether, how or when to offer different interventions initially/over time to reduce depressive symptoms in FG-of-PWD. METHODS: A sequential multiple assignment randomised trial design will be adopted. 272 FG-of-PWD with mild to moderate depressive symptoms will be recruited from the community. Four two-stage, embedded adaptive interventions involving BA and MP of different sequences and dosages (eg, 8 weeks of BA followed by booster sessions for responders and 8 weeks of MP for non-responders) will be assigned to the participants following a set of decision rules. The primary outcomes will be depressive symptoms (measured using the Patient Health Questionnaire-9), assessed after the second stage of the intervention. Other outcomes, such as positive aspects of caregiving (measured using the Positive Aspects of Caregiving Scale), sleep quality (measured using the Pittsburgh Sleep Quality Index) and time points will also be assessed. The analyses will follow the intention-to-treat principle. Several process indicators (eg, engagement in meaningful activities and level of mindfulness) will also be assessed. The findings will have strong implications for the further development of psychosocial adaptive interventions to reduce depressive symptoms among FC-of-PWD. ETHICS AND DISSEMINATION: This study has received ethical approval from the Human Research Ethics Committee at The Hong Kong Polytechnic University (HSEARS20211223001). The findings will be presented at academic conferences and submitted to peer-reviewed journals for publication. TRIAL REGISTRATION NUMBER: NCT05634317.

Willingness to Purchase Hypothetical Private Long-Term Care Insurance Plans in a Super-ageing Society: Evidence from Hong Kong.

Despite the soaring demand for long-term care (LTC) services in aging societies, dedicated risk-pooling mechanisms are largely absent. Private insurance has been advocated but the market remains small. This study seeks to unravel this paradox through an empirical study in Hong Kong, a super-aging society. We analyzed middle-aged individuals' willingness to purchase hypothetical private LTC insurance plans derived from a discrete choice experiment. A survey was conducted in 2020 and sampled 1,105 respondents. We noted a fairly encouraging level of acceptance but also found clear barriers toward potential purchase. The desire for self-sufficiency and preference for formal care powerfully increased individuals' interest. Cognitive difficulty, habitual adherence to out-of-pocket payment, and unfamiliarity with the LTC insurance market reduced such interest. We explained the results with reference to the changing social dynamics and drew policy implications for LTC reforms in Hong Kong and beyond.

The Effects of Multidimensional Poverty on Life Satisfaction Among Older Adults in Hong Kong.

Poverty indicators such as income-based poverty, material deprivation, asset-based poverty, and expenditure-based poverty each carries an aspect of economic deprivation. This current study examined and compared the unique effects of each poverty dimension on life satisfaction during old age. We measured four poverty indicators-life satisfaction, social resources, physical health, and mental well-being-in a three-wave sample of older Hong Kong adults (N = 563). Panel data were fitted to a structural model that involved the constraints of the path coefficients (e.g., effects of poverty indicators on life satisfaction). The model results indicate that while material deprivation and asset-based poverty reduce life satisfaction, income-based poverty and expenditure-based poverty do not significantly shape life satisfaction. Based on these findings, we suggest implementing future-oriented interventions into policy agendas to promote current working adults' financial preparation for retirement to reduce their risk of falling into asset-based poverty and thus material deprivation after retirement.

Meaning Making as a Lifebuoy in Dementia Caregiving: Predicting Depression from a Generation Perspective Using a Fuzzy-Set Qualitative Comparative Analysis.

Depressive symptomatology is associated with caregiver burden and poor health outcomes among dementia caregivers. Scholars called for a paradigm shift to focus on positive aspects of caregiving, in particular, meaning making during the caregiving journey. This study draws on the meaning making model and a generation perspective to predict depression among dementia caregivers from two generations, including Baby Boomers who were born between 1946 and 1964 and Generation X who were born between 1965 and 1980, using a configuration approach. Data was collected in a two-wave longitudinal design, from December 2019 to March 2021 in Hong Kong. A fuzzy-set qualitative comparative analysis resulted in six configurations with an overall solution consistency and overall solution coverage of 0.867 and 0.488, respectively. These configurations consist of a different combination of conditions that predict high depressive symptomatology among dementia caregivers in two generations. Specifically, generation is related to five out of six configurations. This study is the first to predict depression among dementia caregivers using a meaning making model from a generation perspective. It advances the understanding of factors contributing to high depressive symptomatology among dementia caregivers from two generations, thus contributing to the future development of generation-responsive assessments, interventions, and policies.

Executive functions as mediators between socioeconomic status and academic performance in Chinese school-aged children.

Background: It is well-documented that socioeconomic status (SES) and academic performance in school-aged children are closely related. However, little is known about how the three core executive functions (EFs), inhibition, working memory, and cognitive flexibility, mediate the association between the two. Moreover, most previous studies examined SES disparities in Western countries, how such disparities in EF and academic performance manifest in the Chinese context, where a distinctive EF profile and learning experience are observed, remains uncertain. The current study explored: (1) the mediating effects of the three core EFs in the association between SES and academic performance; and (2) the differences in EF and academic performance in three core subjects between Chinese children who are below and above the poverty line. Methods: Of the 385 students sampled, 205 are in the low-SES group and 180 are in the middle-high SES group. Results: A structural equation model showed that the SES-academic performance relationship was fully mediated by cognitive flexibility and working memory but not inhibition. Working memory was a much stronger mediator than cognitive flexibility, suggesting that working memory may correlate with childhood SES and academic performance in Chinese children. An analysis of covariance suggested that compared to the middle-high SES group, the low-SES group demonstrated poorer working memory and academic performance in all three subjects after controlling for age and IQ. Interestingly, children with low-SES were found to have better cognitive flexibility than children with middle-high SES. Conclusions: These findings suggest that interventions targeting working memory may be an important area to improve children's academic performance.

Family-Friendly Policies: Extrapolating A Pathway towards Better Work Attitudes and Work Behaviors in Hong Kong.

The need for family-friendly policies to balance work and life demands is growing. Many studies have addressed how family-friendly policies relate to a variety of employees' work attitudes and behavioral outcomes, but not how they (positively or negatively) affect them, especially the affective components of family-friendly policies that provide "felt" support to an employee. To fill this gap, this study adopts a moderated mediating mechanism to analyze how affective components of family-friendly policies impact employees' attitudes and behaviors through signaling and social exchange theory. We examined how this impact is mediated by factors such as work-life conflict, perceived organizational support, and control over working hours, as well as whether having a supportive supervisor moderates the mediated effect through further limiting the degree of work-life conflict or strengthening control over working hours. Data were collected through a survey with 401 employee-supervisor dyads from organizations in Hong Kong. We found that family-friendly policies do not necessarily affect work attitude and behavior, but they work through the sequential mediators of having more control over working hours and perceived organizational support. The role of supportive supervisors is also significant, in that they are likely to be key in molding the organizational environment for the gradual provision and uptake of family-friendly policies. The results of this study contribute to the development of signaling and social exchange theory and have theoretical implications for supervisors regarding them utilizing their position to improve employee work attitudes and behavioral outcomes.

Depression among poor older adults: The role of social support.

RATIONALE: Depression should be investigated not only as a psychiatric symptom but also as a social issue. This research responds to recent calls and contributes to an understanding of the role played by social factors in the route toward the development of depressive symptoms. OBJECTIVE: Our aim was to elaborate on the impact of poverty on depressive symptoms among Hong Kong's older people. To do this, we examined the potential of social support to both mediate and moderate the effect of poverty on symptoms of depression. METHODS: Three waves of data were collected from a sample of Hong Kong's older adults (N = 563). Poverty was assessed as being either income-poor, expenditure-poor, asset-poor, or as experiencing material deprivation. Social support was measured in terms of instrumental support, financial support, and informational support. RESULTS: When moderation and mediation were compared in the same model, only the role of moderation was identified as being significant. Instrumental support mitigated the effect of material deprivation on depression, while all three types of social support buffered the impact of expenditure-based poverty on depression. CONCLUSIONS: Social support involves supplying coping resources to weaken the negative impacts of poverty rather than supplying social capital that the poor are deprived of. By its nature, the social support offered to the poor does not aim to provide them with the resources enjoyed by the rich, but to equip them with appropriate tools by which they can handle their own problems.

Preferences for private long-term care insurance products in a super-ageing society: A discrete choice experiment in Hong Kong.

There is a stark contrast between rising long-term care (LTC) demands and limited financing capacity in many ageing societies. Despite the theoretical potential of private insurance in LTC financing reforms, the reality is that the market remains remarkably underdeveloped. This study adopts a novel two-phase approach to quantitatively examine the market demand for private long-term care insurance (LTCI) in Hong Kong, one of the world's super-ageing societies. In order to examine people's preferences regarding private LTCI in Hong Kong, which has been exploring alternative LTC financing mechanisms to relieve the overburdened public system, we conducted a discrete choice experiment (DCE) in 2019 to elicit the preferences of a representative sample of 410 middle-aged adults. At first, we used data from the US National Longterm Care Survey to perform an actuarial projection for Hong Kong. In the first phase, we computed the indicative premiums based on various attributes of hypothetical private LTCI products. Undertaken in the second phase and using two econometric techniques, the DCE suggested that the most preferred hypothetical LTCI product in Hong Kong was associated with the following features: 1) a monthly benefit level of HK$20,000 or HK$25,000, 2) 3% inflation protection, and 3) 15 years of contribution. These attributes led to a monthly premium of HK$1237 (US$160)/HK$1546 (US$200) for men and HK$2150 (US$278)/HK$2687 (US$348) for women. Furthermore, we also found that the preference for LTCI products varied across people with different socioeconomic and health characteristics. These insights could inform initial market segmentation, LTCI product design, and targeted marketing in the future. This paper concludes with cautious optimism regarding the market demand for private LTCI in Hong Kong, and recommends concrete policy instruments to nurture the LTCI market, including information campaign, premium subsidies, and tax benefits.

Benefits of volunteering on psychological well-being in older adulthood: evidence from a randomized controlled trial.

Objectives: Long-term volunteering has been associated with better physical, mental, and cognitive health in correlational studies. Few studies, however, have examined the longitudinal benefits of volunteering with randomized experimental designs (e.g., intervention studies). Even fewer studies have examined whether such benefits can be shown after short-term volunteering. To fill this gap, we conducted four 1-hour volunteering intervention sessions to promote volunteering among a group of older adults with limited volunteering experience and examined the impact of volunteering on depressive symptoms, meaning in life, general self-efficacy, and perceived autonomy.Methods: A total of 384 participants aged 50-96 years were assigned at random to either an intervention group to promote volunteering behaviors or an active control group to promote physical activity. The participants' monthly volunteering minutes, depressive symptoms, meaning in life, general self-efficacy and perceived autonomy were measured at baseline and six weeks, three months, and six months after the intervention.Results: Being in the volunteering intervention condition was not directly associated with depressive symptoms, meaning in life, general self-efficacy, or perceived autonomy at the 6-week, 3-month, or 6-month follow-ups after the intervention. However, there was an indirect effect of the intervention on depressive symptoms: participants in the intervention group, who had increased their volunteering at the 3-month follow-up, reported fewer depressive symptoms at the 6-month follow-up.Discussion: Our randomized controlled trial suggests that short-term volunteering does not reliably lead to short-term changes in psychosocial health measures as correlational studies would suggest. Efforts need to be made to encourage older adults to maintain long-term volunteering.

What Affects the Demand for Long-Term Care Insurance? A Study of Middle-Aged and Older Adults in Hong Kong.

Despite the potential of private insurance in financing long-term care (LTC), its coverage remains rather limited. This study is built on a comprehensive framework to examine the demand for LTC insurance in Hong Kong, a rapidly aging Asian society. A telephone survey was conducted in 2016 to collect data that formed a sample of 1,474 middle-aged and older adults. Multivariate analysis reveals more nuanced characteristics of Hong Kong middle-aged and older adults who tend to show a demand for LTC insurance, including: (a) being younger, better educated, relatively high status, and financially literate; (b) living with children but reluctant to be a burden on the family; (c) being in a better financial situation and able to afford premiums; and (d) anticipation of LTC needs and dependence, and a preference for formal care. This study offers preliminary evidence to understand the demand structure of the LTC insurance market in an Asian society.

Promoting Volunteering Among Older Adults in Hong Kong: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Volunteering has consistently been associated with better mental, physical, and cognitive health in older adulthood. However, the volunteering rate of older adults in Hong Kong is much lower than in Western countries. Few studies have examined whether interventions can be effective in motivating older adults to volunteer in Hong Kong. To fill this gap, we conducted a randomized controlled trial to examine the impact of a theory-based social-cognitive intervention on volunteering. RESEARCH DESIGN AND METHODS: A total of 264 community-dwelling older adults in Hong Kong (Mage = 69.95 years, SDage = 6.90 years, 81.06% female) were randomly assigned to either an experimental group or an active control group. Participants in the experimental group received 4 weekly 1-hr face-to-face volunteering intervention sessions. Those in the active control group received parallel sessions targeting physical activity instead of volunteering. The time spent on volunteering per month was self-reported and measured at baseline, 6 weeks, 3 months, and 6 months after the intervention. Self-efficacy, intention, action planning, and self-monitoring of volunteering were measured as mediators. RESULTS: Monthly volunteering minutes increased among participants in the experimental group when compared with the active control group at 6-week, 3-month, and 6-month follow-ups. Self-efficacy, intention, and action planning consistently mediated the effect of the intervention on volunteering minutes. DISCUSSION AND IMPLICATIONS: The findings demonstrate the effectiveness of the intervention on volunteering behavior in older adults in Hong Kong through well-established behavior change techniques.

Creative social media use and political participation in young people: The moderation and mediation role of online political expression.

INTRODUCTION: Educators and policymakers promote political participation in young people as a means to strengthen the legitimacy of democracy. Creative social media use has grown in popularity in the digital age; however, this creative usage still receives inadequate attention in the literature-particularly its association with political participation. METHOD: This study collected three-wave panel data from a sample of young people living in Hong Kong (56.9% male, mean age = 18.81, standard deviation = 2.70) and used cross-lagged structural equation modeling to evaluate the mediating and moderating roles of online political expression in the link between creative social media and political participation. RESULTS AND CONCLUSIONS: The results showed that creative social media use positively predicted political participation indirectly by the full mediation of enhanced online political expression. Findings did not reveal the moderation role of online political expression in the link between creative use of social media and political participation. Findings make important theoretical contributions in the field linking social media usage to political engagement.

Study protocol of a multi-center RCT testing a social-cognitive intervention to promote volunteering in older adults against an active control.

BACKGROUND: Volunteering could be a win-win opportunity for older adults: Links between volunteering and societal improvements as well as older adults' own health and longevity are found in several observational studies. RCTs to increase volunteering in older adults are however sparse, leaving the question of causality unanswered. This study protocol describes a theory-based social-cognitive intervention with multiple behavior change techniques to increase volunteering among community-dwelling older adults in Hong Kong. METHODS: In a parallel group, two-arm, randomized controlled trial, an initial N = 360 are assigned to receive either the volunteering intervention or the active control intervention (parallel content targeting physical activity). The primarily outcome measure is self-reported volunteering minutes per month at baseline, six weeks, three months and six months after the intervention. Participants in the treatment group are expected to increase their weekly volunteering minutes over time as compared to participants in the control group. Possible active ingredients of the intervention as well as mental and physical health outcomes of increased volunteering are investigated by means of mediation analyses. DISCUSSION: Like many industrialized nations, Hong Kong faces a rapid demographic change. An effective psychological intervention to encourage retirees to engage in formal volunteering would alleviate some of the societal challenges a growing proportion of older adults entails. TRIAL REGISTRATION: Primary Registry and Trial Identifying Number ChiCTR-IIC-17010349 , secondary CCRB trial number CUHK_CCRB00543, registration date 2016/12/28.

Poverty, deprivation, and depressive symptoms among older adults in Hong Kong.

OBJECTIVES: Examine the association of income poverty and material deprivation with depression in old age. METHODS: Our data contains a survey of 1,959 older Chinese adults in Hong Kong. We used the Geriatric Depression Scale - Short Form to assess their depressive symptoms. Income poverty was defined as having household income below half the median household income (adjusted by household size); material deprivation was measured by a validated 28-item material deprivation. In addition to income poverty and material deprivation, we also assessed the effect of socio-demographic variables, financial strain, health indicators, and social and community resources on depressive symptoms. RESULTS: Those who experienced material deprivation reported a significantly more severe depressive symptoms, even after income poverty and all other covariates were controlled for; the bivariate association between income poverty and depressive symptoms disappeared once material deprivation was controlled for. Further, we found a significant interaction effect between income poverty and material deprivation on depressive symptoms; and both engagement in cultural activities and neighborhood collective efficacy moderated the impact of being materially deprived on depressive symptoms. CONCLUSION: Our results have important policy implications for the measurement of poverty and for the development of anti-poverty measures for materially deprived older adults.