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精神健康護理

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精神健康護理

MentalHealth
精神健康問題是全世界最常見的殘疾成因之一。估計未來十年,十大致死或致病的成因,精神健康問題將會佔一席位。精神健康護理對於促進本地、區域及全球精神健康,並為有精神健康問題人士及其家人提供及時干預,都相當重要。

本研究小組專門探討精神健康護理方案,研究團隊致力提升研究質量,並制定重點研究策略,集中兩個研究範疇,探討精神健康需求、服務和教育發展。
開展創新及國際先導的精神健康護理研究,造福本地、區域和國際社群。
  • 識別臨床和社區患者的新近精神健康需求;
  • 為嚴重精神病患者制訂循證為本的干預措施;
  • 在各種醫療護理環境,向處於各生命階段的人推廣精神健康。

嚴重精神病患者的干預措施

在當今社會中,嚴重精神病患者經常受到邊緣化及歧視,並處於弱勢。這些病患者需要以循證為本、患者為中心、切合社區和醫療環境的干預措施。本團隊以嚴重精神病患者及其家人為服務對象,致力發掘科研證據,掌握主要技巧,並且開發、設計和測試各項生理和心理社交干預措施,以助服務對象提升自我管理,並且改善病況。

研究專注於各方面,例如:自助能力干預措施的成效、電子健康、改善身體健康、家庭心理教育及互助或支持性干預措施,以至專門的心理治療。

我們十分尊重和重視服務對象的需要和經驗,以確保科研項目和干預措施以人為本。

 

人際關係的挑戰,社會逆境與精神健康

不良的人際關係和社會逆境經常於任何環境中發生,例如:家庭、學校、工作場所和社區,並直接和持久地影響各人的精神健康。本團隊的研究旨在了解人際關係的挑戰和社會逆境影響精神健康的原因、風險因素和精神健康後遺症。我們亦關注在不良和敏感環境中成長的個人和群體,致力促進這些服務對象的精神健康及預防早期精神疾病。

此外,我們目前研究在醫療及護理健康機構發生的暴力或攻擊性行為,向較少接受服務的人群推廣精神健康。我們積極推動不同的專業人士,鼓勵患者及其家人參與我們的研究和教育活動。

本研究小組從事高質素的研究,提供干預措施及推行健康促進計劃,期望能達到以下的目的:

  • 加強個人、家庭及社會對精神健康的認識;
  • 就精神健康服務和政策發表意見;
  • 促進社會大眾與精神病患者共融;
  • 提供顧問服務,以促進精神健康教育,提升服務和干預成效。

研究範疇主任

成員

名譽研究主題成員

Prof Richard GRAY

Professor of Clinical Nursing Practice and Director. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia

項玉濤教授

教授, 澳門大學健康科學院

秦競剛博士

副顧問醫生, 葵涌醫院

梅杏春女士

護理總經理, 青山醫院及小欖醫院

潘恩榮先生

總護理行政經理, 香港醫院管理局

智慧健康研究中心

智慧健康研究中心運用科技創新醫護服務,促進醫護實踐及提升護理質素。我們善用科技專長 (如虛擬實境和人工智慧),開展跨專業應用研究,並把研究成果應用於實踐,以促進醫護教育,診斷和治療。

研究的影響

在治療過程中改善嚴重精神病患者的護理和支持

精神病佔全球疾病負擔32%以上 (指帶著殘障生活) 。嚴重精神病患者康復的主要障礙是不遵守醫生給予的治療,沒有在患病早期利用網上資料自助,以致康復情況不佳及殘障機會增加。為處理本地住院精神病人不依從問題,團隊整合護士的循證干預措施。此外,設計了網上飲食失調早期干預計劃,向公眾開放,以回應未得到處理的健康需求。研究直接改善了患者的健康並影響了本地/國際治療指引和政策。

主要研究人員:
白承丹博士(副教授)
梁秀芳博士(副教授)
錢惠堂教授(教授,香港中文大學)
R Gray教授(訪問教授)

 

進食障礙自助干預
飲食失調人士需要迅速接受干預以促進康復,但是他們往往未能接觸早期資訊自助干預。我們設計精明進食網上自助計劃,使飲食失調人士能早期接受干預。團隊並以222名服務使用者 [R1]為對象,研究他們在三個月跟進期的情況,測試計劃成效。結果顯示對象飲食失調心理病理的嚴重程度降低,抑鬱和焦慮症狀下降,生活質素改善,益處顯著。此研究顯示早期干預和增加渠道給予自助治療資訊的重要。經測試的網上干預計劃已開放予公眾使用。

 

處理不依從治療 改善患者健康

嚴重精神病患者復發和再入院的其中一個主要原因是不遵從服用處方藥物。我們在香港進行了一項大規模的橫斷面調查(2008年)以了解不依從醫囑的臨床問題嚴重程度,並識別影響精神病患者藥物依從的因素(R2)。結果顯示超過30%(175/484)患者故意不依從治療。團隊指出護士有助患者明白治療與個人相關並改變對藥物的態度 。根據這些初步發現,我們以90多名早期精神病患者(R3)為對象,進行第一項隨機對照試驗,以了解切合文化依從的療法結合由護士主導的社會心理干預計劃之成效。結果顯示在12個月的跟進期,與常規精神科護理相比,依從療法顯著改善患者症狀,對疾病了解,再入院率,以及生活質素。這項研究提供資訊有助制訂藥物管理人員培訓計劃。
一項前瞻性病例研究亦探討在九個月患者跟進期(R4),依從療法干預結合藥物管理培訓如何影響香港護士的理解和努力,使患者依從用藥。結果顯示護士認為干預措施對患者和護理實踐均有好處。此外,我們以134名社區嚴重精神病患者為對象進行了第二項對照試驗[R5],測試一個以動機和訪談為基礎的依從療法改進版。結果證實在18個月內,依從療法可有效降低症狀嚴重程度和再入院時期。為鞏固依從療法的最新知識,研究小組領導國際研究團隊(成員來自八個國家),用系統性回顧及整合分析方法,探討依從療法對對精神分裂症(R6)患者的成效。結果顯示依從療法是有效的輔助治療,可以改善精神分裂譜系障礙的症狀,並挑戰現時某些臨床指引。
上述研究的結果指導了初步發展和持續提供資訊使藥物管理人員培訓計劃完善。自2013年以來,香港精神病治療服務已廣泛及有系統地實施以上干預措施。

R1 Leung, S.F., Ma, J., & Russell, J. (2013). Self-help behaviours of clients with eating disorders in an online programme: An open trial.Journal of Advanced Nursing, 69 (1), 66-76.
Initial conference presentation:Leung, S.F., Ma, J., Russell, J., & Spence, I (2006). The “Smart Eating” self-help programme for people with eating disorders.Proceedings of the 2006 Conference of the Institute of Mental Health, Castle Peak Hospital: From Hospital to Community – Psychiatric Care in the New Era, Hong Kong, 10 November, p. 13

 

R2 Bressington, D., Mui, J. andGray, R. (2012). Factors associated with antipsychotic medication adherence in community based patients with Schizophrenia in Hong Kong – a cross sectional study.International Journal of Mental Health Nursing. 22(1), 35-46.

 

R3 Chien, W T.andBressington, D.(2015). A randomized controlled trial of a nurse-led structured psychosocial intervention program for people with first-onset mental illness in psychiatric outpatient clinics.Psychiatry Research, 229, 277-286.

 

R4 Bressington, D.,Mui, J., & Wells, H. (2013). The effects of medication-management training on clinicians' understanding and clinical practice in Hong Kong.Nurse education today, 33(9), 969-975.

 

R5 Chien, W. T.,Mui, J.,Gray, R.,& Cheung, E. (2016). Adherence therapy versus routine psychiatric care for people with schizophrenia spectrum disorders: a randomised controlled trial.BMC psychiatry, 16(1), 1.

 

R6 Gray, R., Bressington, D., Ivanecka, A., Hardy, S., Jones, M., Schulz, M., ... &Chien, W. T.(2016). Is adherence therapy an effective adjunct treatment for patients with schizophrenia spectrum disorders? A systematic review and meta-analysis.BMC psychiatry,16(1), 90.

影響臨床服務 改善患者健康成效
研究結果直接影響香港醫院管理局為精神健康專業人員制定切合文化的依從療法藥物管理培訓計劃。自2013年起,局方推行改進藥物管理計劃,約550名臨床職員接受了依從療法培訓。團隊在葵涌醫院(2013年和2015年)和青山醫院(2018年)共提供了三個導師培訓課程。至今大約有30名護士導師向其他臨床職員提供培訓。受訓職員在葵涌醫院和青山醫院的住院、門診部門,以及社區環境實施干預措施。
以上兩間醫院高級護理經理表示干預/培訓的好處是:“職員非常積極評估培訓,他們指出培訓有助提升知識和技能,使他們處理患者不依從藥物治療時更有信心”,“藥物管理干預措施使患者大大受益,現已推廣到常規臨床護理服中”“干預措施仍提供給所有住院者和社區服務使用者”。這些意見正反映培訓的重要。
醫院記錄顯示,自2013年以來,已為728名急性住院人士提供干預。循證為本的精神分裂症藥物治療指引廣泛引用以上的研究結果,其他指引,例如:英國心理藥物協會和Maudsley精神病高級處方的指引亦受研究結果影響。

 

協助飲食失調人士早期獲得資訊自助干預
團隊探討飲食失調人士的早期自助干預措施,以研究結果為基礎,設計 “精明進食”網上計劃。網頁是公眾可使用的干預措施,內容持續,其清晰,可靠和全面。公眾廣泛使用並給予良好評價。網頁亦獲得澳洲 聯邦政府老年健康署五星的最高評分。“精明進食”網正面影響使用者康復。用家評價自助干預的好處,例如:“該計劃幫助了我,確保我理性思考,不讓暴食症取去我最好一面”和“感謝計劃,我的治療旅程結束了,現處於精神和生理恢復狀態”。自2013年以來,8萬9千名人士已瀏覽“精明進食”網。自2014年12月起,網頁開放給香港理工大學結合保健診所的求診者使用。

Barnes, T. R., Drake, R., Paton, C., Cooper, S. J., Deakin, B., Ferrier, I. N., ... & Joyce, E. M. (2020). Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology.Journal of Psychopharmacology, 34(1), 3-78.

 

Morrison, P., Taylor, D. M., & McGuire, P. (2019).The Maudsley Guidelines on Advanced Prescribing in Psychosis. John Wiley & Sons.

 

“Eating Disorders Information and Support for Australians – Resource review 2010” (p.75), accessible from:https://www.nedc.com.au/assets/NEDC-Publications/NEDC-Resources-Review-Final.pdf
http://www.smart-eating.com/en/Introduction/Welcome.asp

 

Smart Eating website recovery stories (website):http://www.smart-eating.com/en/recovery_story/recovery_story.asp

在學研究生

陳熙

博士生

林頌恩

博士生 (Part-time)

鍾文漢

博士生 (Part-time)

校外資助計畫

Effectiveness of caregiver-administrated acupressure intervention for community-dwelling spinal cord patients with constipation A randomized controlled trial

Investigators Name:
PI: Dr Yan LI
Co-I: Dr Wing Fai YEUNG, Dr Yuen Shan HO, Dr Yu Lok WONG, Dr Shi Ping ZHANG, Dr Wai Kit WONG, Dr Yiu Cho KWAN

Funding Scheme/ Source of Funding: Chinese Medicine Development Fund - Industry Support Programme

Total Grant: HK$810,590

Commencement Date: 1-Apr-22

Effects of a Physical-Psychological Integrative (PPI) intervention on Physical inactivity, Depression and Chronic pain for Community-Dwelling Spinal Cord Injury Survivors: a Pilot Randomized Controlled trial

Investigators Name:
PI: Dr Yan LI
Co-I: Dr Wing Fai YEUNG, Dr Yu Lok WONG, Prof. Alexandros MOLASIOTIS, Dr Zonghao MA, Dr Pui Kin KOR, Ms Chor Pik Rabi YIM, Dr Daniel Thomas BRESSINGTON

Funding Scheme/ Source of Funding: HMRF Research Fellowship Scheme

Total Grant: HK$952,685

Commencement Date: 1-Sep-21

Objectives: To examine the feasibility, acceptability, and preliminary effects of a Physical-Psychological Integrative (PPI) online group intervention on Physical inactivity, Depression, and Chronic pain for Community-Dwelling Spinal Cord Injury Survivors over a 3-month follow-up. Design and subjects: An assessor-blind two-arm (i.e., 36 per study group) randomized controlled trial with repeated measures (pre-, post-intervention, and 3-month follow-up) design. Intervention: The PPI intervention includes a DVD programme for physical activity training and eight-week online group psychological interventions using skills of motivational interviewing and mindfulness-based stress reduction. Main outcome measure: Duration of being physically active, depression, and chronic pain. Data analysis: Generalized estimating equations with covariate adjustments will be employed to examine the preliminary effects of PPI intervention. Expected results: Participants showed perceived benefits of the PPI intervention, and they will indicate enhanced engagement in physical activity and improvements in depressive symptoms and chronic pain, which will further lead to improved quality of life.

Time to Change Hong Kong: Reducing Stigma Around Mental Health in Hong Kong – A Service Evaluation

Investigators Name:
PI: Dr Wing Ka Grace HO
Co-I: Mr Man Hon CHUNG, Prof. Daniel Thomas BRESSINGTON, Ms Odile THIANG

Funding Scheme/ Source of Funding: Mind Mental Health Hong Kong Limited

Total Grant: HK$73,238

Commencement Date: 1-Jun-21

Background
It is estimated that one in six Hong Kong adults suffer from a diagnosable mental illness and the number of people requiring treatment have been rising over the last 5 years. However, negative stigmatized attitudes towards mental illness and its treatment are still commonplace locally, leading to discriminatory behaviour and isolation. This creates stigma, dissuades those suffering from a mental illness to seek help, and prevents their re-integration into the community. Improving the public’s attitudes towards mental illness and its treatment is therefore crucial.
Previous studies have shown that a variety of educational interventions can have positive effects, but it is still very unclear how best to reduce stigmatized attitudes of Hong Kong citizens. The Time to Change Hong Kong programme is offered by Mind HK. This is a new campaign that involves training ambassadors with personal experience of mental health challenges to facilitate face-to-face educational events with the public.

Study aims

  • Explore the ambassadors’ experiences and views of the programme in focus groups before starting their training and 3-months later.
  • Measure changes in the attendees’ attitudes and understanding towards mental illness, and their attitudes towards people with mental health problems both currently, and in their intended behaviour at three time points (before attending the story telling events, immediately following the events, and three months after attending).
  • Evaluate the achievement of Mind HK’s defined key performance indicators over a 6-month period.

Design and methods
This service evaluation will adopt a prospective cohort mixed-methods study design. All attendees from September 2020 to March 2021 will be invited to take part. Participants will complete a set of questionnaires measuring their attitudes towards mental illness and treatment using paper based questionnaires or the online system. They will be asked to re-complete these questionnaires immediately after their visit and at 3-months follow-up. Focus group interviews will be also be conducted with the ambassadors before their training and at 3-months follow up to explore their experiences of attending the training and delivering the workshop events.

Relevance
The findings are expected to provide essential information about the effectiveness of Time to Change Hong Kong programme in reducing stigma and increasing public understanding, and highlight experiences of the ambassadors in participating in the programme.

The Impact of Video Gaming on Cognitive Functioning of People with Schizophrenia (GAME-S)

Investigators Name:
PI: Prof. Maritta Anneli VAELIMAEKI
Co-I: Dr Daniel Thomas BRESSINGTON, Dr Hing Chiu Charles CHANG, Dr Eric CHEUNG, Dr Tella LANTTA, Dr Hong LEE, Dr Simon Sai-Yu LUI, Dr Matias PALVA, Dr Satu PALVA, Mrs Jolene MUI, Mr Dan YU, Prof. Min YANG

Funding Scheme/ Source of Funding: General Research Fund

Total Grant: HK$1,161,999

Commencement Date: 1-Jan-19

Schizophrenia is severe chronic disease. Cognitive impairments, a core feature of schizophrenia, is the strongest predictor of functioning and psychosocial outcomes and single most important factor in determining a patient's ability to engage in daily life and adhere to treatment. Prior approaches to improve functional outcomes in schizophrenia are limited in their efficacy and they have high dropout rates. Recently video gaming has opened new opportunities for patients in improving attention, working memory, problem-solving, feedback, emotional expression, and socialization. If video gaming is targeted in a brain-disorder-specific manner to improve dysfunctional brain circuits and renormalizing healthy brain dynamics, it might be suited to be a well scaling and low-cost therapeutic intervention. In this randomised, exploratory, single-blind, pragmatic, three-arms parallel-group trial, patients with schizophrenia will be enrolled and randomly assigned using an internet-based randomisation and stratification across study sites with a computer-generated block randomisation to either (1) cognitive training with computerized exercises, (2) entertainment gaming or (3) non-gaming “treatment-as-usual”. This study will be one of the first trials to address the effectiveness of video gaming on improving cognitive and neurocognitive functioning in people with schizophrenia. It would be of key importance to discover an individual co-variation in the cognitive measures, clinical indicators and the brain data. The study will offer new information to confirm short and long-term benefits of using video gaming to patients’ health and well-being and new approaches to patient care in mental health services in Hong Kong. It hold promise for other health conditions in which motivational problems are related to health outcomes.

An Evaluation of the Effectiveness of a Professional-supported Problem-solving-based Self-learning Program for Family Carers of People with Recent-onset Psychosis: A Randomized Controlled Trial

Investigators Name:
PI: Prof. Wai Tong CHIEN
Co-I: Dr Daniel Thomas BRESSINGTON, Ms Shuk Yi CHAN, Ms Lai King YIP, Prof Thanos KARATZIAS, Prof Dan I. LUBMAN 

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK$697,060

Commencement Date: 1-Aug-18

Objectives:This RCT is to test the effects of a professional-supported problem-solving-based self-learning program(PBSP) on family carers' and patients' outcomes over a 12-month follow-up. Hypotheses:When compared with psycho-education group and/or routine family care only, the PBSP participants will indicate significantly greater improvements in carers' coping, social problem-solving skills, caregiving experiences, and family functioning, and reductions of perceived burden and patients' symptom severity, re-hospitalization rate and level of recovery, at 1-week, 6-month and/or 12-month post-interventions. Design and subjects:A multi-center randomized controlled trial with repeated-measures, three-arm design will be adopted to evaluate/compare the effects between two alternative interventions(PBSP and PG, in addition to routine care) and TAU only for family carers (66 per group) of people with recent-onset psychosis (ROP) attending one of 6 family centres over a 12-month follow-up, with outcome and process evaluation. lnstruments:Family Burden Interview Schedule and Revised Social-Problem-Solving Inventory (primary outcomes); Experience of Caregiving Inventory, frequency and length of re-hospitalizations, Questionnaire about Process of Recovery, Family Assessment Device, and focus-group interviews (for formative evaluation of two treatment programs) Data analysis: Family and patients outcomes will be compared over 12-month follow-up (baseline and 3 posttests) using MANOVA/Mixed-model technique/ANOVAs; their clinical significant differences will be assessed. Group interview data for two treatment modalities will be content analyzed. Expected results:The findings provide evidence of the effectiveness of the problem-solving, self-learning family intervention (PBSP) on improving carers', families' and patients' psychosocial health and well-being over 12-month follow-up, thus reducing family burden/distress in caregiving, patients' relapse and medical costs.

Mental Health Literacy and Health Seeking Behavior in the Western Pacific

Investigators Name:
PI: Prof. Maritta Anneli VAELIMAEKI
Co-I: Dr Daniel Thomas BRESSINGTON, Dr Wing Ka Grace HO, Dr Sau Fong LEUNG, Dr Yee Man Angela LEUNG, Prof. Alexandros MOLASIOTIS

Funding Scheme/ Source of Funding: World Health Organization

Total Grant: HK $170,757

Commencement Date: 25-Nov-16

Background: Mental health disorders are highly prevalent in all regions of the world. However, it is estimated that less than 25% of people with mental disorders from low income countries receive appropriate treatment. Even when mental health support services are available, many people have a strong reluctance to seek professional help. This reluctance may be attributed to low levels of mental health literacy, which is broadly defined as the knowledge and beliefs about mental disorders that may influence how they are recognized, treated, and prevented in different communities. Currently, there is very limited information on mental health literacy in developing countries within the Western Pacific Region. Consequently, little is known about the types and extent of mental health knowledge and support people in this region need, and how best to promote their mental health given the limited resources that are available to them. As a starting point, this study focused on examining mental health literacy related to two highly prevalent forms of mental health disorders, depression and dementia, which combine to affect close to 400 million people worldwide. Aim: The overall aim of the study was to describe mental health literacy and health seeking behavior across three countries within the Western Pacific region (Cambodia, Philippines, and Fiji). Methods: In collaboration with local implementing partners, data were collected between November 2016 and May 2017 from three countries in the Western Pacific region: Cambodia (Phnom Penh, Kandal Province), Philippines (Manila, Quezon and Caloocan City), and Fiji (Suva). A mixed-methods design was used to capture mental health literacy both quantitatively and qualitatively. Survey questionnaires were used to measure knowledge, attitudes, and help seeking behaviors related to depression and dementia. In parallel, focus group discussions were held to generate in-depth explorations on knowledge, attitudes, and patterns of health seeking behaviors within the context of their culture and local communities. In total, this study includes findings from 12 focus group discussions and over 900 completed surveys across the three countries. Findings from surveys and focus group discussions were analyzed and merged to draw a fuller picture on mental health literacy related to depression and dementia in each of these three countries. Findings: In generally, participants viewed mental illness as a common occurrence in their communities, but high levels of stigma towards mental illness were evident. For example, 17% of respondents in Cambodia, 44% in Fiji, and 46% in the Philippines believed that people with mental illness commonly have a propensity for violence. The focus group discussions also support this finding, where some participants expressed negative attitudes towards mental illness (e.g. blaming people for developing depression). Additionally, many participants reported having no previous contact with someone with a mental illness, and this may explain some of the misconceptions and fears that were expressed. Across the three countries, most people could identify the common signs/symptoms of depression. However, many also attributed unrelated symptoms (e.g. hearing voices, being reckless) to the illness. Both the survey and focus group discussions revealed that participants recognized the need to be empathetic and supportive towards people with depression, but struggled most with understanding which treatments are most effective. On the other hand, knowledge about Alzheimer’s disease, a leading cause of dementia, was quite low in all three countries. There were a number of misunderstandings about dementia; particularly in relation to its causes and treatment. Participants were concerned about the safety of people with dementia living in the community, and were generally able to identify the need to help provide for their basic needs, but they underestimated the potential abilities of people with dementia and consequently may adopt unhelpful supportive strategies. There was some clear reluctance towards seeking professional psychological help in the three countries. The focus group discussions showed that people in these countries commonly identify families as the first source of help for mental health issues. Although participants generally viewed health care professionals as a trusted source of help, seeking professional help often remained a last resort and would only be considered if family members, friends, or neighbors could not cope with helping the mentally ill. Barriers towards seeking professional help may relate to a belief that families should be able to cope, a lack of recognition that professional help is needed, and concerns about the overall negative views towards people with mental illness.

Power Dynamics in the Student-Teacher Relationship: the Voices of Nursing Students

Investigators Name:
PI: Dr Chung Yee Zenobia CHAN
Co-I: Prof. Wai Tong CHIEN, Dr Saras HENDERSON

Funding Scheme/ Source of Funding: General Research Fund

Total Grant: HK $205,440

Commencement Date: 1-Jan-16

Power relations are inherent in the interaction between experts, referred to here as teachers, and non-experts, referred to as students. In nursing education the teacherstudent relationship is still an under-explored area of power dynamics. In this study, nursing students’ perspectives on the power dynamics between themselves and their teachers will be explored, as well as their understanding of the context of the power relations within the campus and in clinical settings. A descriptive qualitative study will be conducted over a period of 18 months using two methods of collecting data (focus group interviews and personal essays). Through convenience sampling, a total of 90 nursing students from one university, with 30 each from Years 1, 3, and 5, will be invited to participate in the study. They will first be asked to write a personal essay using a metaphor of their subjective experience of the teacher-student relationship in the realm of power dynamics. They will then participate in a focus group interview in groups of 6-8. Two semi-structured interview guides exploring the power dynamics within the teacher-student relationship have been designed. Each guide will have a central theme based on the students’ exposure and the relevance of their learning experiences. Year 1 students and final year (Year 5) students will be asked questions about power dynamics in the teacher-student relationship in a campus learning context, while the questions put to Year 3 students and final year students will focus on a clinical learning context. The data will be analysed using a content analysis approach. The PI and RA will separately conduct an initial analysis. A comparison of their findings will then be made.

A final thematic analysis will constitute the core themes, which will be authenticated by the nursing students. It is hoped that a power model for teacher-student relationships that is specific to the discipline of nursing can be developed. In addition to publishing the research results, to strengthen the impact of this study, training workshops and seminars for nursing educators will be held to disseminate the meanings of power locally and in Australia, the 2nd Co-I’s home country. A short-term goal is to increase awareness of embedded power relations within teacher-student relationships that will lead to the promotion of active learning and student-centred teaching. A long-term goal is to make students aware of power issues in the nurse-patient relationship after they have graduated and become registered nurses.

A Randomized Controlled Trial of the Effectiveness of a Mindfulness-Based Psycho-Education Program for People with Recent-onset Psychosis

Investigators Name:
PI: Prof. Wai Tong CHIEN
Co-I: Prof. Sally W.C. CHAN, Prof. Terence V. McCANN, Prof. David Robert THOMPSON, Mr Eric F.C. CHEUNG, Ms Lai King YIP

Funding Scheme/ Source of Funding: General Research Fund

Total Grant: HK $688,222

Commencement Date: 1-Jan-16

Many people with recent-onset (≦6 months) psychosis often experience disruptive residual symptoms, impaired psychosocial functioning and high illness relapse rate. A few psychoeducatonal and motivational illness management programs in the U.S. and Europe for early-stage psychosis have reported significant improvements on patients' functioning and relapse. Yet few intervention studies have focused on patients’ mindfulness, changing their negative thoughts towards their symptoms and related suffering, which has been shown to empower patients' self-management of their illness and functioning and distressing thoughts and perception. This proposed research is designed to test the effects of a Mindfulness-Based Psycho-education program (MBPP) for Chinese patients with schizophrenia on their mental state, psychosocial functioning and insight into illness/treatment. A randomized controlled trial will be conducted with 144 Chinese patients diagnosed with psychotic disorders (within the past six months) at two psychiatric outpatient clinics using repeated-measures, three-arm design. They will be randomly selected from the patient lists and after baseline measurement, randomly assigned to either the MBPP, a psycho-education group or usual psychiatric care (n=48 in each group). The MBPP consists of 12 bi-weekly, 2-hour group sessions and is designed to teach patients about illness management skills and help them attain more awareness of, relating differently to and accepting and/or managing their thoughts and perceptions towards their symptoms and make positive changes to their thoughts and behaviors concerning the illness and its symptoms. The psycho-education program also consists of twelve 2-hour group sessions (every two or three weeks) based on the research team’s psychoeducation programs for psychosis care in 2008-2010. Patients' symptom severity and re-hospitalization rates (primary outcomes), and their functioning, social support and insight into illness/treatment, will be measured at recruitment and at one week and six and 12 months after the interventions. Based on an intention-to-treat principle, multivariate analyses of variance(or covariance) followed by Helmert contrasts test on individual post-tests will be performed to compare changes in all patient outcomes within-group and between-groups over the 12-month follow-up. Semi-structured interviews will be conducted with 10 MBPP and 10 psycho-education group participants after the first post-test and their contents analyzed to identify their perceived benefits and weaknesses, therapeutic components of the interventions, and major difficulties in their participation. If any significant positive patient outcomes found, this innovative MBPP can be adopted by community mental health teams in Hong Kong and/or Chinese populations to improve early-stage psychosis sufferers’ mental state and functioning and thus their illness relapses.

An Evaluation of the Effectiveness of a Mindfulness-based Illness Management Program for Chinese People with Schizophrenia: A Randomised Controlled Trial

Investigators Name:
PI: Prof. Wai Tong CHIEN
Co-I: Prof. Sally W.C. CHAN, Prof. Thanos KARATZIAS, Ms Shuk Yi CHAN, Ms Jolene H.C. MUI, Ms Lai King YIP

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK $653,270

Commencement Date: 1-Jul-15

Objectives:This controlled trial is to test the effects of a Mindfulness-based Care for Schizophrenia Program(MBCSP) on a variety of patient outcomes over a 12-month follow-up.

Hypotheses: When compared with those in a psychoeducation group and routine psychiatric outpatient care, the MPCSP participants will indicate significant greater reduction in patients' re-hospitalization and remission rates, improvements in levels of recovery, functioning, symptom severity, and insights into illness/treatment at 2-week, 6-month and/or 12-month after completed the interventions.

Design and subjects: A randomized controlled trial with repeated-measures, three-group design on the community-based MBCSP will be conducted with outcome (and cost-effectiveness) and process(formative) evaluation. Instruments: Questionnaire of Process of Recovery, Positive and Negative Syndrome Scale(for severity and remission), frequency and length of hospitalization, InsightlTreatment Attitude Questionnaire, and Specific Level of Functioning Scale.

Interventions: Two treatment groups (MBCSP and psychoeducation group) and routine psychiatric outpatient care(control).

Main outcome measures: Primary outcomes include frequency and length of re-hospitalization, level of recovery and symptom remission; secondary outcomes are patients' functioning, symptom severity and insight into illness/treatments. Four focus group interviews for formative evaluation of two treatment programs will be conducted.

Data analysis: Patient outcomes will be compared over 12-month follow-up(pretest and 3 posttests) using multivariate ANOVA or Mixed Model technique. Focus group interview data will be content analyzed and cost-effectiveness analysis of the MBCSP will also be conducted.

Expected results: The findings provide evidence of the effectiveness(cost-effectiveness) of the integrated MBCSP on improving schizophrenia sufferers' psychosocial and mental conditions over 12-month follow-up, thus reducinQ relapses and medical costs.

A Randomized Controlled Trial of Problem-solving Based Bibliotherapy Program for Family Caregivers of People with Schizophrenia Spectrum Disorders

Investigators Name:
PI: Prof. Wai Tong CHIEN
Co-I: Prof. Dan I. LUBMAN, Prof. David Robert THOMPSON, Prof. Eric F.C. CHEUNG, Prof. Terence V. McCANN, Ms Lai King YIP

Funding Scheme/ Source of Funding: General Research Fund

Total Grant: HK $537,662

Commencement Date: 1-Jan-15

Family caregivers of people with schizophrenia-spectrum disorders are confronted by a various physical, psychosocial and financial hardships. This can adversely affect family members’ caregiving experiences, psychological distress, general well-being, and family relationships or emotional involvement, which in turn may contribute to a greater risk of patient relapse and non-recovery. While family psycho-education and mutual support groups are effective in reducing caregivers’ burden of care, these approaches usually require regular meetings and encounter difficulties in extensive training of group leaders/facilitators and engaging participants to actively share their caregiving experiences due to time inconvenience and fear/inability of expression of feelings. By virtue of the above, an alternate model of self-help program in book form named bibliotherapy, which is a guided reading and self-practice program with problem-solving training facilitated by a psychiatric nurse, has recently demonstrated evidences in clinical trials for families of depressive and psychotic patients by the research team, and other researchers. This proposed randomized controlled trial will test the effectiveness of a problemsolving based bibliotherapy program (PSBBP) for Chinese family caregivers in schizophrenia spectrum disorders. A repeated-measures, three-group design will be used to evaluate and compare the effects between two treatment groups(PSBBP and psychoeducation group) and routine outpatient service and family support(controls with a selfhelp booklet) for 129 randomly selected family caregivers of outpatients with schizophrenia-spectrum disorders over a 12-month follow-up. Primary outcomes include caregivers’ burden of care, caregiving experiences and coping and social problem-solving skills using validated instruments. Secondary outcomes are patients’ mental state, functioning, perceived expressed emotion, and re-hospitalization rate. They will be measured at recruitment, one week, and 6 and 12 months following the interventions. Kaplan-Meier survival analysis will be used to analyze the relative risks of rehospitalizations amongst the treatment and control groups over 12-month follow-up. It is hypothesized that the PSBBP participants will produce significantly better improvements in caregivers’ perceived burden, caregiving experience and coping and problem-solving skills than those in psycho-education and control groups over 12-month follow-up. Focus group interviews will be conducted after the first post-test with 20 caregivers (10 participants per group) in both treatment groups. Their data will be content analyzed to identify their perceived benefits, limitations and difficulties encountered and therapeutic ingredients of the two programs. With significant positive outcomes found in the PSBBP, this program will be adopted by community mental healthcare services in Hong Kong, and replicated in other Asian countries, to improve family-based care in schizophreniaspectrum disorders.

Testing the Psychometric Properties of a Chinese Version of Dementia Management Strategies Scale among Family Caregivers in Hong Kong

Investigators Name:
PI: Prof. Wai Tong CHIEN
Co-I: Ms Lai King YIP, Prof. Richard GRAY, Prof. Sally W.C. CHAN

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK $79,992

Commencement Date: 2-Jan-14

Objectives: This study aims at validating a Chinese version of Dementia Management Strategies Scale (DMSS) that is useful for assessing the educational needs of family caregivers in dementia care. Hypothesis to be tested: It is hypothesized that family caregivers who adopted adaptive management strategies in dementia care (e.g., giving encouragement, using home modification, etc.) can alleviate the caregiver's distresses and the progression of neuropsychiatric symptoms among people with dementia. Design and subjects: A cross-sectional design will be used to test the psychometric properties of DMSS. A 6·month prospective cohort, nested in the cross-sectional design, will be used to examine the prognostic factors affecting the progression of illness among people with dementia. Subjects will include 200 dyads of family caregivers and their elderly relatives with dementia. Study instruments: Mainly include DMSS, Task Management Strategies Index (TMSI), and Neuropsychiatric Inventory (NPI). Main outcome measures: Subscale scores of DMSS and total scores of TMSI and NPI. Data analysis: The factor structure of DMSS will be extracted by principal component analysis with varimax rotation. The internal consistency (Cronbach's alpha), test-retest reliability (ICC), reproducibility (ICC), and responsiveness to change will be examined. Expected results: Subscales in DMSS that measure frequencies of adaptive strategies in dementia care will be convergent with the total score in TMSI, and vice versa for the subscales that measure non-adaptive strategies (e.g. criticism). The changes in the subscale scores of DMSS and TMSI will predict the improvement! deterioration of neuropsychiatric symptoms among people with dementia across the 6-month interval.

An Evaluation of the Effectiveness of Adherence Therapy for Patients with Schizophrenia: A Randomized Controlled Trial

Investigators Name:
PI: Prof. Wai Tong CHIEN
Co-I: Dr Eric F.C. CHEUNG, Ms Glendy IP, Ms Jolene H.C. MUI, Prof. Richard GRAY

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: $611,120

Commencement Date: 1-Mar-13

Background: Despite the advent of newer antipsychotic medication with less severe side-effects, there is little progress has been made in medication adherence. Poor adherence with anti psychotics is associated with a substantial increase in illness relapse and poor psychosocial outcomes such as poor functioning. Motivational interviewing(+cognitive approach) suggested by Kemp and colleagues(1998) have demonstrated sustained gains in medication adherence and insights into treatment. Design:A randomized controlled trial, using a repeated-measures control group design. Sample and settings:134 people with psychotic disorders served by the CPNS in the NT and Kowloon regions(n=67 each setting) will be randomly selected from the patient lists. After baseline measurement, they will be randomly assigned either to the treatment (n=67;6-session Adherence Therapy) or control group(n=67;usual care). They will be assessed on levels of adherence, insight and attitude to treatment, mental state, functioning, and re-hospitalization rates at recruitment, one week and 6 and 15 months after intervention. Field observation and semi-structured interviews with 22 patients and six nurses will be conducted to identify their perceived benefits and difficulties in the intervention. Data analysis:On an intention-to-treat basis, multivariate repeated-measures analyses of co-variance will be used to assess the outcome changes between two groups/settings over 15-month follow-up. Content analysis will be used to identify therapeutic components and limitations of the Adherence Therapy from interview data. Conclusion: lf significant outcome improvements are found in the treatment group, the Adherence Therapy can be adopted by other community care teams in Hong Kong to increase medication adherence rates in psychotic patients, thus reducing their relapse rates.

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