The health behaviours of Chinese people with chronic illness

Factors affecting lung cancer patients' intention to perform early postoperative exercise: a qualitative study based on theory of planned behavior

BACKGROUND

Early postoperative exercise is effective in improving the prognosis of postoperative lung cancer patients, but compliance was lower than expected. Factors affecting lung cancer patients' intention to perform early postoperative exercise were unclear.

PURPOSE

To discuss the factors affecting lung cancer patients' intention to perform early postoperative exercise based on the Theory of Planned Behavior.

METHODS

This was a qualitative study. Twenty-five lung cancer patients were recruited using purposive sampling, and semi-structured face-to-face interviews were performed. The reflexive intuitive thematic analysis method was used, and triangulation was employed to ensure the credibility of the study.

RESULTS

Results of this study identified 8 themes from 3 aspects. For behavioral attitudes, two themes emerged: (1) Aware of the benefits of postoperative exercise, (2) Underestimate the importance of postoperative exercise. For subjective norms, four themes emerged: (1) Influence of caregiver support on carrying out postoperative exercise, (2) Short-term supervision of medical staff, (3) Positive driving effect from other patients, and (4) Motivation due to family responsibility. For perceived behavior control, two themes and six sub-themes emerged: (1) Obstacles before actual exercise (Lack of adequate knowledge of postoperative pulmonary exercise, Less active in seeking related knowledge about rehabilitation exercise, and Misconceptions about rehabilitation exercise); (2) Unpleasant experiences during exercise (Physical discomfort, Limited space and depressive atmosphere, and Psychological burden).

CONCLUSIONS

Several factors could affect lung cancer patients' early postoperative exercise behavior. Healthcare professionals should fully understand these factors from patients' perspectives. Special interventions should be designed for the patients and their caregivers to correct cognitive bias, reduce obstacles, and promote compliance with exercise.

Diet and Culture Among Chinese Patients Undergoing Hemodialysis: A Qualitative Study

A growing body of research showed that diet management, such as promoting protein and vitamin intake and food restriction play a crucial role in extending time to morbidity and mortality in patients undergoing hemodialysis. However, the current dietary recommendations in nutrition guidelines lack examination of cultural factors. The study aimed to understand the diet influenced by culture in Chinese patients undergoing hemodialysis. Semi-structured interviews were conducted for 23 patients, aged 23–75 years, undergoing hemodialysis in a local tertiary hospital. Interview questions mainly focused on patients' real experience about diet, and their perceptions and attitudes toward diet. Each interview was digitally recorded, and conventional content analysis was used to attain information. The majority of patients reserved Chinese traditional dietary habits about salt and calcium intake. Although Chinese herbal medicine was not consumed, dietary therapy including brown sugar and dates was included in the participants' diet. Eggs, broth, and seafood were three prominent preferences and taboos profoundly impacted by culture. Additionally, Chinese social culture influenced patients' dietary behavior of eating at home and knowledge attainment. Diet in Chinese patients undergoing hemodialysis was still strongly influenced by culture. Culturally sensitive interventions regarding the improvement of diet intake are urgently needed.

Facilitators and Barriers to Exercise Influenced by Traditional Chinese Culture: A Qualitative Study of Chinese Patients Undergoing Hemodialysis

Introduction: Exercise is recommended for patients undergoing hemodialysis to decrease morbidity and mortality. However, their exercise level is lower than healthy people. Understanding reasons behind their sedentary lifestyle is required. Traditional Chinese culture may have a profound impact on patients’ perceptions of exercise, particularly with regard to the relationship of overwork and kidney function and family members’ attitudes toward patients’ participation in exercise. Therefore, we sought to explore the facilitators and barriers to exercise influenced by traditional Chinese culture. Methods: We conducted semistructured interviews with 44 Chinese patients residing in Nantong of Jiangsu Province undergoing hemodialysis, aged 25 to 77 years. Interview questions focused on their perceptions of, attitudes to, and experiences with exercise. Each interview was digitally recorded and lasted from 40 to 60 minutes. Conventional content analysis was used to understand facilitators and barriers to exercise within their experience and perceptions. Findings: We found that specific Chinese cultural health beliefs informed by traditional Chinese medicine strongly affected patients’ attitudes and behaviors toward exercise. Participants in this study tended to believe that overwork impairs kidney functions and viewed strenuous exercise as overwork. Although participants admitted the benefits of exercise, they rejected strenuous exercise and regarded nearly all modalities of exercise with or without facilities (except walking) as strenuous exercise. The most common barriers to exercise were lack of motivation, bad weather, negative attitudes of family members toward patients’ doing exercise, and insufficient exercise information resources. The most common facilitators found in this study were their increased physical well-being and confidence from exercise. Group exercise supported by family members and positive attitudes toward obtaining exercise information were also motivators. Discussion: Chinese patients undergoing hemodialysis reported more barriers than facilitators to exercise. Perceptions and attitudes toward exercise informed by traditional Chinese culture may be hidden barriers to exercising. Our findings indicated that culturally sensitive and patient-centered exercise interventions for Chinese patients are urgently needed.

The Meaning of Health and Health Promotion Practices of Taiwanese Elders with Chronic Illness

In Taiwan, populations age 65 years and older are increasing. Of those 65 and older, 76.06% have more than one chronic disease. How to promote health has been an important concern for both the chronically ill elderly themselves and health care providers. The purposes of this study were to explore the meaning of health and health promotion practices of Taiwanese elders with chronic illness. A descriptive qualitative study design was used to obtain information from 76 chronically ill Taiwanese elders about their definitions of health and health-promoting practices. Content analysis revealed 3 health definition categories and 15 types of health promotion practices. It is hoped that findings in this study can be used as a basis for successful planning and provision of culturally appropriate health care services for Taiwanese elders with chronic illness.

The dynamic process of adherence to a renal therapeutic regimen: perspectives of patients undergoing continuous ambulatory peritoneal dialysis

BACKGROUND

The nature of end-stage renal disease and the need for continuous ambulatory peritoneal dialysis require patients to manage various aspects of the disease, its symptoms and treatment. After attending a training programme, patients are expected to adhere to the renal therapeutic regimen and manage their disease with the knowledge and skills learned. While patients are the stakeholders of their health and related behaviour, their perceptions of adherence and how they adhere to their renal therapeutic regimen remains unexplored.

AIMS

To understand adherence from patients' perspectives and to describe changes in adherence to a therapeutic regimen among patients undergoing continuous ambulatory peritoneal dialysis.

DESIGN

This study used a mixed methods design with two phases - a survey in phase I and semi-structured interviews in phase II. This paper presents phase II of the study.

SETTINGS

The study was conducted at a renal unit of an acute hospital in Hong Kong.

PARTICIPANTS

Based on the phase I survey results, maximum variation sampling was employed to purposively recruit 36 participants of different genders (18 males, 18 females), ages (35-76 years), and lengths of dialysis experience (11-103 months) for the phase II interviews.

METHODS

Data were collected by tape-recorded semi-structured interviews. Content analysis was employed to analyse the transcribed data. Data collection and analysis were conducted simultaneously.

FINDINGS

Adherence was a dynamic process with three stages. At the stage of initial adherence, participants attempted to follow instructions but found that strict persistent adherence was impossible. After the first 2-6 months of dialysis, participants entered the stage of subsequent adherence, when they adopted selective adherence through experimenting, monitoring and making continuous adjustments. The stage of long-term adherence commenced after 3-5 years of dialysis, when participants were able to assimilate the modified therapeutic regimen into everyday life.

CONCLUSIONS

The process of adherence was dynamic as there were fluctuations at each stage of the participants' adherence. With reference to each stage identified, nursing interventions can be developed to help patients achieve smooth transition throughout all the stages.

The experiences of women of reproductive age regarding health-promoting behaviours: a qualitative study

Background

Health promotion is critical for community and family health. Health-promoting behaviours provide solutions for maintaining and promoting health. Although several studies have addressed the frequency and different types of health-promoting behaviours in women, little information is available about their experiences. This study aimed to explore the experiences of women of reproductive age regarding health-promoting behaviours.

Methods

In the present study, which was conducted in Tehran, Iran, 15 females, who were selected purposefully, participated in individual in-depth, semi-structured interviews. The interviews were recorded, transcribed verbatim, and analysed using conventional content analysis.

Results

Nine main categories were derived from the analysis, including establishing an appropriate eating pattern, establishing a balanced rest/activity pattern, spirituality, stress management, personal sensitivity and responsibility, establishing an appropriate pattern of social interactions, practicing safe and healthy recreations, feeling improvement in physical-functional health, and feeling improvement in emotional and psychological health. The first 7 categories represent the nature and types of real health-promoting behaviours in women of reproductive age, whereas the last 2 constitute feeling and understanding of the implementation of these behaviours.

Conclusion

The study findings show that the women experience improvement in physical-functional, emotional, and psychological health by implementing health-promoting behaviours. It is therefore necessary to introduce strategies in the context of the community culture for improving different aspects of health-promoting behaviours in women of reproductive age to maintain and improve their overall health.

Physical distress and cancer care experiences among Chinese-American and non-Hispanic White breast cancer survivors

OBJECTIVE

The number of Chinese-American breast cancer survivors (BCS) is increasing as a result of increasing incidence rates. There has been little research on Chinese BCS' follow-up cancer care. This qualitative study aims to understand how Chinese-American BCS experience and cope with physical distress relative to non-Hispanic White (NHW) survivors.

METHODS

Seventy-one BCS (37 Chinese immigrant, 7 US-born Chinese, 27 NHW) were recruited from the Greater Bay Area Cancer Registry to participate in focus group discussions or one-on-one interviews about their survivorship experiences. All BCS were diagnosed with breast cancer at stage 0-IIA between 2006 and 2009, and had survived for 1-4 years without recurrence. Interviews were conducted in Cantonese, Mandarin, or English. Data analyses followed established qualitative methods of content analysis.

RESULTS

BCS experienced pain and side effects from radiation, surgery, and hormonal therapy. Physical distress subsequently caused emotional concerns about recurrence or metastasis. Most BCS consulted physicians about their physical distress. Chinese immigrant BCS were less likely to have their issues resolved compared to NHW and US-born Chinese who were more likely to question physicians, ask for referrals, and make repeat attempts if their problems were not resolved. Some Chinese immigrant BCS turned to Traditional Chinese Medicine for relief or accepted the idea that physical distress was part of survivorship.

CONCLUSION

Chinese immigrant BCS may be at risk for greater distress compared with US-born Chinese and NHW BCS because of cultural norms that make them less inclined to express their needs to physicians or challenge physicians when their needs are not met. Furthermore, they may express symptoms in culturally unique ways (e.g., hot-cold imbalances). Further research is needed to determine how to best improve survivorship care experiences in this understudied population, with the goal of decreasing BCS' physical distress and improving quality of life.

Health-seeking beliefs of cardiovascular patients: a qualitative study

OBJECTIVES

The study aims were to (a) describe the experiences of Chinese Australians with heart disease following discharge from hospital for an acute cardiac event; (b) identify patterns and cultural differences of Chinese Australians following discharge from hospital; and (c) illustrate the illness/health seeking behaviors and health beliefs of Chinese Australians.

DESIGN

Qualitative study.

METHODS

Interview data were obtained from the following sources: (a) focus groups of Chinese community participants without heart disease; (b) interviews with patients recently discharged from hospital following an admission for an acute cardiac event; and (c) interviews with Chinese-born health professionals working in Australia. Qualitative thematic analysis was undertaken.

RESULTS

Study themes generated from the data were: (1) linking traditional values and beliefs with Western medicine; (2) reverence for health professionals and family; and (3) juxtaposing traditional beliefs and self-management.

CONCLUSIONS

Considering the influence of cultural values in developing health care plans and clinical decision making is important.

Impact of Taiwanese culture on beliefs about expressing anxiety and engaging in physical activity: a discursive analysis of the literature

AIMS AND OBJECTIVES

This paper analysed the scholarly discourse about the influence of Taiwanese culture on beliefs about expressing anxiety and engaging in physical activity from literature review.

BACKGROUND

The well-being of individuals with mental illness is promoted by the World Health Organization. Reducing barriers to treatment and care in community health-service systems requires cultural understanding. However, little is known about the influence of Taiwanese culture on physical activity programmes for people with anxiety disorders in Taiwan.

DESIGN

A discursive analysis of the literature.

METHOD

Literature was used to examine the impact of Taiwanese culture on beliefs about anxiety and physical activity from historical, economic, social, political and geographical perspectives.

RESULTS

Taiwanese cultural beliefs about anxiety and physical activity can be summarised into six themes. Beliefs about anxiety are reflected in three themes: anxiety and shame, beliefs against direct communication and beliefs about anxiety and external forces. Beliefs about engaging in physical activity are reflected in three themes: beliefs about human action, the relationship between health and physical activity and priority of academic achievement.

CONCLUSION

This paper exposes the hidden power of culture to influence Taiwanese beliefs about anxiety and physical activity. Three negative beliefs about anxiety influence the expression of anxiety symptoms and help-seeking behaviours. Two positive and one negative belief about physical activity significantly affect choice of activity type and level of participation in physical activity. Anxiety and physical activity have a dynamic relationship and both are deeply influenced by Taiwanese culture.

RELEVANCE TO CLINICAL PRACTICE

An awareness of cultural influences on beliefs about anxiety and physical activity is important when encouraging Taiwanese people with anxiety disorders to engage in physical activity. This awareness may help nurses understand better how their patients perceive anxiety and physical activity, leading to more appropriate physical activity programmes to improve both physical and psychological well-being.

Development and Validation of a Life Satisfaction Scale for Chinese Elders

This study reports the development and validation of a culturally sensitive, domain-specific measure of life satisfaction for Chinese Elders — The Life Satisfaction Scale — Chinese ( LSS-C). The LSS-C was administered to 1,502 randomly-selected older Chinese persons in three newly developed towns in Mainland China. Confirmatory factor analysis supported a conceptually meaningful two-factor model—one of instrumental needs of daily life and one of social and relational needs. Criterion-related validity was satisfactory when positively correlated with a single-item global life satisfaction measure and the Life Satisfaction Index A, and negatively correlated with the Center for Epidemiological Studies Depression Scale. The reliability of the eight-item scale was satisfactory, with the internal consistency coefficient equal to .78 and the split half coefficient equal to .81. LSS-C was direct and easy to administer, and it is recommended for use on Chinese elders.

Development and evaluation of a culturally tailored educational video: changing breast cancer-related behaviors in Chinese women

This study developed and evaluated a culturally tailored video guided by the health belief model to improve Chinese women's low rate of mammography use. Focus-group discussions and an advisory board meeting guided the video development. A 17-min video, including a soap opera and physician-recommendation segment, was made in Chinese languages. A pretest/posttest pilot was conducted to evaluate the efficacy of the video in changing knowledge, beliefs, and screening intentions among Chinese women (age >or= 40) who were nonadherent to current National Cancer Institute's mammography guidelines (n=52). The results showed that the video significantly increased these women's screening intentions, knowledge, perceived risk for breast cancer, and perceived benefits of mammography. Chinese immigrant women were less likely to hold an Eastern view of health care and report barriers to screening after viewing the video. This video might have the potential to increase adherence to mammography screening in Chinese women.

LAY BELIEFS ABOUT HEPATITIS AMONG NORTH AMERICAN CHINESE: IMPLICATIONS FOR HEPATITIS PREVENTION

The objective was to learn about the hepatitis prevention behavior of relatively unacculturated North American Chinese adults, along with their knowledge, beliefs, and perceptions with regard to hepatitis, screening, and vaccination. Forty Chinese men and women, aged 18-64, were recruited from immigrant communities in Seattle, Washington, and Vancouver, British Columbia. Semi-structured interviews (Cantonese or Mandarin) were audiotaped, translated, transcribed verbatim, and coded. Open coding, axial coding, constant comparison methods, and QSR NUD*IST 5 software was used for analysis. Findings were validated using eight focus groups. Findings indicated that many interviewees lack accurate knowledge with regard to hepatitis, often confusing the different types. Perceived causes of hepatitis included potentially harmful food (e.g., fried foods or potentially contaminated foods), alcohol, contact with infected individuals, stress, and inadequate rest. Preventive strategies associated with Chinese health beliefs included the use of Chinese herbal medicine, maintaining a stress-free mind, strengthening the body's natural defenses, and getting enough sleep. Other preventive strategies were the practice of good hygiene, vaccination, and the avoidance of contact with infected persons. Vaccination was not seen as primary, as 65% of those who had heard of hepatitis vaccination did not cite it as a means for hepatitis prevention until asked. Also, participants lacked information about the types and purposes of hepatitis vaccination and were worried about side effects. In conclusion, any attempt to promote hepatitis testing and vaccination among the North American Chinese should take traditional beliefs and practices into consideration.

The concept of health scale: developed for Chinese people with chronic illness

BACKGROUND

As the concept of health in Chinese people with chronic illness had not been previously explored, a scale to measure this concept in this client group was developed.

OBJECTIVE

To develop and test the psychometric integrity of the Concept of Health Scale (CHS) for use with Chinese people.

METHODS

Previous nursing experience and a literature review were used to inform the initial development of the CHS. It was revised following scrutiny by a panel of experts. Two studies tested the psychometric integrity of the scale. In Study One the data gathered from 80 Chinese people with a chronic illness were subjected to item analysis and exploratory factor analysis. In Study Two, with a convenience sample of 372 chronically ill Chinese people, confirmatory factor analysis was conducted.

RESULTS

Instrument analysis in Study One resulted in a 34-item scale with a Cronbach alpha of 0.94. The results of an exploratory factor analysis showed that physical, psychosocial, and spiritual factors were represented by the CHS. The hypothesized model of the CHS was tested in Study Two using confirmatory factor analyses. The results of this study indicated that the concept of health was comprised of six first-order and three second-order factors.

CONCLUSION

The results of this study demonstrated that Chinese people with chronic illness held a broad frame of reference in gauging the concept of health. The development of the CHS brings us one step closer to understanding how Chinese people with chronic illness regard the concept of health.