精神健康護理

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.

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.

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.

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.

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 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.

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.

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.

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.

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.

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.