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Liu D, Ge P, Li X, Hong W, Huang M, Zhu L, Kaierdebieke A, Yu W, Qi J, Pu K, Ling R, Pan L, Sun X, Wu Y, Feng Q. Status of self-medication and the relevant factors regarding drug efficacy and safety as important considerations among adolescents aged 12-18 in China: a cross-sectional study. Sci Rep 2024; 14:9982. [PMID: 38693178 PMCID: PMC11063147 DOI: 10.1038/s41598-024-59204-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 04/08/2024] [Indexed: 05/03/2024] Open
Abstract
The objective of this study was to investigate self-medication behavior among Chinese adolescents aged 12-18 years and explore the factors associated with whether adolescents prioritize drug efficacy or safety when engaging in self-medication behavior. In 2021, a questionnaire investigation was conducted in the Chinese mainland using a multi-stage sampling approach. After a statistical description, logistic regression was used to analyze the factors associated with considering drug efficacy and safety. The self-medication rate among Chinese adolescents aged 12-18 years was 96.61%. Of these, 65.84% considered drug safety to be essential, while 58.72% prioritized drug efficacy. Regression analysis showed that individuals with better healthcare were more likely to consider drug efficacy an important factor. Additionally, those with a healthier family lifestyle were more likely to prioritize efficacy. When individuals engage in self-medication, those residing in urban areas and possessing advanced preventive health literacy and ample family health resources tend to prioritize drug safety to a greater extent. Conversely, those with higher monthly household incomes and only children exhibit a decreased inclination towards prioritizing safety during self-medication. Self-medication is a frequently observed practice among Chinese adolescents aged 12-18. Several factors, such as demographic and sociological characteristics, health literacy, and family health status, have been found to be associated with the extent to which adolescents prioritize medication safety and efficacy when engaging in self-medication practices. Higher levels of health literacy and better family health status were positively correlated with considering both the efficacy and safety of drugs as important factors when self-medicating.
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Affiliation(s)
- Diyue Liu
- International School of Public Health and One Health, Hainan Medical University, Hiaikou, China
| | - Pu Ge
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xialei Li
- School of Pharmaceutical Sciences, Shandong University, Jinan, China
| | | | - Mengjie Huang
- School of Public Health, ShanDong University, Jinan, China
| | - Lijun Zhu
- College of Communication and Art Design, University of Shanghai for Science and Technology, Shanghai, China
| | | | - Wenbian Yu
- Zhuhai Institute of Social Development, Zhuhai, China
| | - Jiale Qi
- International School of Journalism and Communication, Zhengzhou University, Zhengzhou, China
| | - Keping Pu
- Institute of School of Nursing, China Medical University, Shenyang, China
| | - Rong Ling
- Jilin University School of Pharmaceutical Sciences, Jilin University, Changchun, China
| | - LuTong Pan
- School of Public Health, Shandong University, Beijing, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China.
| | - Qiqin Feng
- International School of Public Health and One Health, Hainan Medical University, Hiaikou, China.
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Cheong PL, Lam MI, Wang H, Cheong W, Man Lei LS. The Effect of an Online Health Literacy Promotion Program for Filipino Domestic Workers: A Mixed Method Study. SAGE Open Nurs 2024; 10:23779608241246872. [PMID: 38746077 PMCID: PMC11092547 DOI: 10.1177/23779608241246872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/22/2023] [Accepted: 03/23/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Health literacy refers to acquiring and utilizing health information to make health-related actions and decisions. Filipino domestic workers with low health literacy are often vulnerable to health problems due to poor living and working conditions. Objective This study examined the effect of an online health literacy promotion program on health literacy and health knowledge of Filipino domestic workers in Macao. Methods The mixed method combined quantitative findings of a quasi-experimental study with qualitative results applied. The quasi-experiment included three parallel groups: a synchronous online education group (videoconference group), an asynchronous online education group (video group), and a control group. A total of 88 Filipino domestic workers were assigned to one of these groups, and eight respondents participated in two focus-group interviews respectively after the intervention. Results For quantitative data, both synchronous and asynchronous online education interventions had positive effects. While comparing with the control group, participants in the videoconference group were more likely to have better health promotion health literacy after the intervention (β = 5.36, p = .02), and participants in the video group were more likely to have better general health literacy (β = 5.17, p = .01), disease prevention health literacy (β = 5.31, p = .04), health promotion health literacy (β = 5.97, p = .01). For qualitative data, three themes and eight subthemes were extracted after the online health literacy promotion program. After integrating the findings of this study, the study found that this program was essential and beneficial for Filipino domestic workers' health knowledge and health literacy. Conclusion Overall, online health literacy promotion programe had positive impacts on participants revealed in this study. Asynchronous online education has made significant progress in overall health literacy, which may be more suitable as a widely promoted education method because of the characteristics and working conditions of this population.
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Affiliation(s)
- Pak Leng Cheong
- Education Department, Kiang Wu Nursing College of Macau, Macau, China
| | - Mei Ieng Lam
- Education Department, Kiang Wu Nursing College of Macau, Macau, China
| | - Hui Wang
- Education Department, Kiang Wu Nursing College of Macau, Macau, China
| | - Wan Cheong
- Education Department, Kiang Wu Nursing College of Macau, Macau, China
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Wang J, Mo C, Sheng Q, Huang Y, Lin D, Liang Y, Zhang N. Association of length of service and job category with occupational health literacy of port employees in Shenzhen, China. BMC Public Health 2023; 23:1223. [PMID: 37353781 PMCID: PMC10288714 DOI: 10.1186/s12889-023-15769-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/26/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Health literacy (HL) is associated with health outcomes, but little is known about the occupational HL (OHL) for port employees and its link to the length of service and job category. METHOD A cross-sectional survey was conducted on 3492 port employees from the Occupational Health Survey for Port Employees project, and a special questionnaire was utilized to measure the OHL status. Binary and ordinal logistic regressions were used to estimate the association. RESULT Among the participants, 72.90% had sufficient OHL with a mean score (standard deviation) of 53.10 (7.26). Binary logistic regression results indicated that the association between length of service (33-40 years group Adjusted OR = 1.11; 41-49 years group Adjusted OR = 1.14; ≥50 years group Adjusted OR = 1.19) and job category (longshoremen Adjusted OR = 0.90; driver Adjusted OR = 0.91) with OHL were statistically significant. Ordinal logistic regression results indicated that, for OHL, Adjusted OR was increased in different lengths of service level (33-40 years group, Adjusted OR = 1.50; 41-49 years group, Adjusted OR = 1.75; ≥50 years group, Adjusted OR = 2.19), and the Adjusted OR of skilled workers was 1.60. CONCLUSION Most port participants had sufficient OHL, and the length of service and job category could affect OHL. The effect of the length of service may be more obvious; the length of service can promote the improvement of OHL continuously.
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Affiliation(s)
- Jinlin Wang
- Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, 518020, Guangdong, China
| | - Chunbao Mo
- School of medicine, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, China
| | - Qiujie Sheng
- Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, 518020, Guangdong, China
| | - Yuehong Huang
- Shenzhen Chiwan Port Development Co., Ltd, Shenzhen, 518000, Guangdong, China
| | - Dafeng Lin
- Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, 518020, Guangdong, China
| | - Yuan Liang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Naixing Zhang
- Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, 518020, Guangdong, China.
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Ge P, Zhang ZW, Zhang JZ, Lyu K, Niu YY, Tong YT, Xiong P, Ling R, Li QY, Yu WL, Min HW, Deng YQ, Wang YJ, Sun XN, Sun XY, Yu L, Wu YB. The self-medication behaviors of residents and the factors related to the consideration of drug efficacy and safety-A cross-sectional study in China. Front Pharmacol 2023; 14:1072917. [PMID: 36925637 PMCID: PMC10011170 DOI: 10.3389/fphar.2023.1072917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Background: Over-the-counter (OTC) drugs facilitates residents self-medication. However, inappropriate self-medications have become a serious problem in China and even all over the world. Objectives: To make an investigation on the current status of Chinese residents' self-medication behaviors and important considerations, and to explore the factors related to the considerations of drug efficacy and safety. Design: A quantitative, cross-sectional study. Methods: Multi-stage sampling was used to conduct a cross-sectional investigation in China 22 provinces, 5 autonomous regions and 4 municipalities directly under the Central Government. State that an interviewer-administrated questionnaire, was used for data collection. The questionnaire that was used in the investigation included demographic sociological characteristics, health literacy scale-short form (HLS-SF), the 10-item Big Five Inventory (BFI-10), the EuroQol-5D visual analogue scale (EQ-5D VAS), self-medication status and important considerations when self-medicating. Descriptive statistics were performed, and the Chi-square test was used for univariate analysis. Log-binomial regression was used for multivariate analysis on whether residents regard drug efficacy or safety as an important consideration. Results: 9256 respondents were included in the data analysis. The self-medication rate of Chinese adults was as high as 99.1%. Paracetamol and other analgesics were the most common types of OTC medication that respondents purchased, followed by vitamins/minerals. Medical staff recommendations, drug safety and efficacy were the top three important considerations. The residents in the east, central and western regions who consider safety is 63.5%, 61.5%, and 66.8% respectively. The proportion of curative effect was 60.2%, 55.7%, and 61.4% respectively. Log-binomial regression showed that western respondents, retired people, those who mainly used ways including basic medical insurance for employees, commercial medical insurance, free medical treatment to cover their medical cost, respondents with high neuroticism, high health literacy were more likely to consider drug safety as an important factor (p < 0.05). Eastern respondents, employed, main way of medical expenses borne was Out-of-pocket Payment, those with chronic disease were more likely to consider drug efficacy as an important factor (p < 0.05). Female, respondents with high levels of agreeableness, conscientiousness, openness, and self-rated health status were more likely to regard both drug safety and efficacy as important considerations (p < 0.05). Conclusion: Self-medication is practiced by most Chinese adults. Whether Chinese adults take drug efficacy or safety as an important consideration is related to their demographic and sociological characteristics, Big Five personality characteristics, health literacy and self-assessed health status. There is a need to strengthen the management of OTC drugs and public education about self-medication.
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Affiliation(s)
- Pu Ge
- Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Zi-Wei Zhang
- School of Public Health, Peking University, Beijing, China
| | - Jin-Zi Zhang
- School of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Ke Lyu
- China Medical University, Liaoning, China
| | - Yu-Yao Niu
- Department of English, Faculty of Arts and Humanities, University of Macau, Macao, China
| | - Yu-Ting Tong
- School of Public Health, Shandong University, Jinan, China
| | - Ping Xiong
- Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Rong Ling
- Jilin University School of Pharmaceutical Sciences, Jilin University, Changchun, China
| | - Qi-Yu Li
- School of Humanities and management, Jinzhou Medical University, Jinzhou, China
| | - Wen-Li Yu
- School of Foreign Languages, Weifang University of Science and Technology, Weifang, China
| | - He-Wei Min
- School of Public Health, Peking University, Beijing, China
| | - Yu-Qian Deng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yu-Jia Wang
- School of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Xiao-Nan Sun
- School of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Xin-Ying Sun
- School of Public Health, Peking University, Beijing, China
| | - Lian Yu
- Health Care system Reform and Development Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yi-Bo Wu
- School of Public Health, Peking University, Beijing, China
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Ge P, Li Q, Dong M, Niu Y, Han X, Xiong P, Bao Y, Min H, Liu D, Wang S, Zhang J, Zhang Z, Yu W, Sun X, Yu L, Wu Y. Self-medication in Chinese residents and the related factors of whether or not they would take suggestions from medical staff as an important consideration during self-medication. Front Public Health 2022; 10:1074559. [PMID: 36620260 PMCID: PMC9814121 DOI: 10.3389/fpubh.2022.1074559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the status of Chinese residents' self-medication behavior and the important factors to consider when purchasing OTC drugs, and to explore the related factors of the possibility that Chinese residents take medical staff's suggestions as important factors to consider when purchasing OTC drugs. Study design A cross-sectional survey. Methods A questionnaire was developed for exploring the sociodemographic characteristics of the respondents, their self-medication status, and important considerations. The questionnaire includes several scales including Health Literacy Scale-Short Form (HLS-SF), EQ-5D Visual Analog Scale (EQ-5D-VAS), Big Five Inventary-10 Items (BFI-10), and New General Self Efficacy Scale (NGSES). After carrying out a multi-stage sampling method, the questionnaire was conducted nationwide from July 10 to September 15, 2021. Next, descriptive statistics were conducted to analyze the general features. Logistic regression was then used to analyze the related factors of the possibility that the respondents took the suggestions of medical staff as an important consideration when purchasing OTC drugs. Results Nine thousand two hundred fifty-six qualified questionnaires were received. 99.06% of Chinese adults had self-medication behaviors. The types of OTC drugs purchased most by the respondents were NSAIDs (5,421/9,256 people, 58.57%) and vitamins/minerals (4,851/9,256 people, 52.41%). 86.2% of the respondents took the suggestions of medical staff as an important consideration when purchasing OTC drugs. The results of multi-factor logistic regression showed that women, those living in the central and western regions of China, those suffering from chronic diseases, those with high agreeableness, high conscientiousness, high neuroticism and openness, high health literacy, high EQ-5D-VAS, and those with high self-efficacy are more likely to take medical staff's suggestions as important factors to consider. Conclusion The vast majority of Chinese adults have self-medication behavior. Important considerations when purchasing OTC drugs include medical staff's suggestions, drug safety and drug efficacy. Whether residents take the suggestions of medical staff as an important consideration is related to their sociological characteristics, agreeableness, conscientiousness, neuroticism, openness, health literacy, self-assessment health status, and self-efficacy. When purchasing and using OTC drugs, residents should carefully listen to the suggestions from medical staff. They should also carefully consider their own conditions before buying OTC drugs.
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Affiliation(s)
- Pu Ge
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China
| | - Qiyu Li
- School of Humanities and Health Management, Jinzhou Medical University, Jinzhou, China
| | - Murong Dong
- Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia
| | - Yuyao Niu
- Faculty of Arts and Humanities, University of Macau, Taipa, Macao SAR, China
| | - Xiao Han
- Department of Pharmacy, The Fifth Affiliated Hospital of Sun Yat-sat University, Zhuhai, China
| | - Ping Xiong
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China
| | - Yuhan Bao
- Health Clinic, Changzhou Institute of Technology, Changzhou, China
| | - Hewei Min
- School of Public Health, Peking University, Beijing, China
| | - Diyue Liu
- International School of Public Health and One Health, Hainan Medical University, Haikou, China
| | - Suqi Wang
- School of Philosophy, Anhui University, Hefei, China
| | - Jinzi Zhang
- School of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Ziwei Zhang
- School of Public Health, Peking University, Beijing, China
| | - Wenli Yu
- School of Foreign Languages, Weifang University of Science and Technology, Weifang, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing, China
| | - Lian Yu
- School of Public Health, Xi'an Jiaotong University, Xi'an, China,*Correspondence: Lian Yu ✉
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China,Yibo Wu ✉
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Lau SSS, Shum ENY, Man JOT, Cheung ETH, Amoah PA, Leung AYM, Dadaczynski K, Okan O. Assessing COVID-19-related health literacy and associated factors among school teachers in Hong Kong, China. Front Public Health 2022; 10:1057782. [PMID: 36568746 PMCID: PMC9769126 DOI: 10.3389/fpubh.2022.1057782] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives The coronavirus disease 2019 (COVID-19) pandemic developed rapidly, with changing guidelines, misinformation, inaccurate health information and rumors. This situation has highlighted the importance of health literacy, especially among educators. The aims of this study were (i) to assess COVID-19-specific health literacy among school teachers in Hong Kong and (ii) to examine its association with demographic factors, self-endangering work behaviors (i.e., work intensification, work extensification and work quality reduction), secondary burnout symptoms (i.e., exhaustion related to work and psychosomatic complaints), the level of knowledge of COVID-19- or pandemic-related information and the level of confusion about COVID-19-related information. Methods A self-report survey was administered to 366 Hong Kong school teachers from April 2021 to February 2022. COVID-19-specific health literacy was measured using the HLS-COVID-Q22 instrument. Other instruments, including self-endangering work behavior scales (i.e., extensification of work, intensification of work and work quality reduction) and two dimensions of the Burnout Assessment Tool (i.e., psychosomatic complaints and exhaustion) were also used for assessment. Data were analyzed using an independent samples Student's t-test, analysis of variance, correlation analysis and adjusted multilinear regression models. Results The results showed that 50.8% of school teachers had sufficient health literacy, 38.3% had problematic health literacy and 10.9% had inadequate health literacy. The HLS-COVID score did not vary by sex, but varied according to the type of school, the number of working hours per week and the number of students attending the school. Teachers with sufficient health literacy scored significantly lower for two types of self-endangering work behavior-intensification of work (p = 0.003) and work quality reduction (p = 0.007)-than those with insufficient health literacy. After excluding those who had already been vaccinated, respondents with sufficient health literacy felt more positive about COVID-19 vaccination than those with insufficient health literacy (t[180] = 4.168, p < 0.001). In addition, teachers with sufficient health literacy felt more informed (p < 0.001) and less confused (p < 0.001) about COVID-19-related information than those with insufficient health literacy. Multiple linear regression analysis revealed that age (β = 0.14, p = 0.011) and the number of teaching hours per week (β = -0.206, p < 0.001) were significant predictors of the HLS-COVID score. Conclusions The findings of this study may serve as a guide for addressing health literacy gaps among school teachers.
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Affiliation(s)
- Sam S. S. Lau
- Research Centre for Environment and Human Health, School of Continuing Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
- College of International Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
- Multidisciplinary Research Centre, School of Continuing Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
- Institute of Bioresource and Agriculture, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Eric N. Y. Shum
- Research Centre for Environment and Human Health, School of Continuing Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Jackie O. T. Man
- Research Centre for Environment and Human Health, School of Continuing Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
- Multidisciplinary Research Centre, School of Continuing Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Ethan T. H. Cheung
- Research Centre for Environment and Human Health, School of Continuing Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
- Multidisciplinary Research Centre, School of Continuing Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Padmore Adusei Amoah
- Department of Applied Psychology, School of Graduate Studies, Institute of Policy Studies, Lingnan University, Tuen Mun, China
| | - Angela Y. M. Leung
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Kevin Dadaczynski
- Public Health Centre Fulda, Fulda University of Applied Sciences, Fulda, Germany
- Center for Applied Health Science, Leuphana University Lueneburg, Lueneburg, Germany
| | - Orkan Okan
- Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
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Oktavianus J, Sun Y, Lu F. Understanding Health Information Behaviors of Migrant Domestic Workers during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12549. [PMID: 36231845 PMCID: PMC9566466 DOI: 10.3390/ijerph191912549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
Migrant domestic workers (MDWs) in Hong Kong remain vulnerable during the COVID-19 pandemic. Obtaining accurate information is essential for MDWs as it helps them understand their predicament and protect themselves. Therefore, this study delves into the MDWs' health literacy by scrutinizing how they acquire, verify, and respond to pandemic-related information. Semi-structured interviews were conducted with 32 Indonesian MDWs, recruited through purposive and snowball sampling. The data were examined using a constant comparative approach in grounded theory. The findings reveal that the participants engaged in information seeking and scanning to obtain health crisis information, mainly through their friends, family members, and community organizations. The participants also verified the information using their judgment or by consulting other actors, such as local organizations and media outlets. The messages they obtained informed the means to protect themselves, which motivated them to adopt preventive measures. However, some also engaged in maladaptive coping, such as taking ineffective preventive actions. The participants also disseminated health crisis information throughout their social circle. This study concluded that MDWs performed four health information behaviors during the pandemic, namely information acquisition, authentication, sharing, and adoption of preventive measures. However, their information practices may change at different stages of the pandemic.
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Affiliation(s)
- Jeffry Oktavianus
- The Centre for Communication Research, City University of Hong Kong, Hong Kong 999077, China
| | - Yanqing Sun
- School of Journalism and Communication, Hunan University, Changsha 410082, China
| | - Fangcao Lu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong 999077, China
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