Assessing the effect of culturally specific audiovisual educational interventions on attaining self-management skills for chronic obstructive pulmonary disease in Mandarin- and Cantonese-speaking patients: a randomized controlled trial

BACKGROUND

Patient education is a key component in the management of chronic obstructive pulmonary disease (COPD). Delivering effective education to ethnic groups with COPD is a challenge. The objective of this study was to develop and assess the effectiveness of culturally and linguistically specific audiovisual educational materials in supporting self-management practices in Mandarin- and Cantonese-speaking patients.

METHODS

Educational materials were developed using participatory approach (patients involved in the development and pilot test of educational materials), followed by a randomized controlled trial that assigned 91 patients to three intervention groups with audiovisual educational interventions and one control group (pamphlet). The patients were recruited from outpatient clinics. The primary outcomes were improved inhaler technique and perceived self-efficacy to manage COPD. The secondary outcome was improved patient understanding of pulmonary rehabilitation procedures.

RESULTS

Subjects in all three intervention groups, compared with control subjects, demonstrated postintervention improvements in inhaler technique (P<0.001), preparedness to manage a COPD exacerbation (P<0.01), ability to achieve goals in managing COPD (P<0.01), and understanding pulmonary rehabilitation procedures (P<0.05).

CONCLUSION

Culturally appropriate educational interventions designed specifically to meet the needs of Mandarin and Cantonese COPD patients are associated with significantly better understanding of self-management practices. Self-management education led to improved proper use of medications, ability to manage COPD exacerbations, and ability to achieve goals in managing COPD.

CLINICAL IMPLICATION

A relatively simple culturally appropriate disease management education intervention improved inhaler techniques and self-management practices. Further research is needed to assess the effectiveness of self-management education on behavioral change and patient empowerment strategies.

Using community-based participatory research to address Chinese older women's health needs: Toward sustainability

Although community-based participatory research (CBPR) has been recognized as a useful approach for eliminating health disparities, less attention is given to how CBPR projects may address gender inequalities in health for immigrant older women. The goal of this article is to share culturally sensitive strategies and lessons learned from the PINE study—a population-based study of U.S. Chinese older adults that was strictly guided by the CBPR approach. Working with Chinese older women requires trust, respect, and understanding of their unique historical, social, and cultural positions. We also discuss implications for developing impact-driven research partnerships that meet the needs of this vulnerable population.

Assessing the feasibility, acceptability and impacts of an education program on hepatitis B testing uptake among ethnic Chinese in Australia: results of a randomised controlled pilot study

BACKGROUND

In Australia, Chinese migrants are among the populations most affected by hepatitis B virus (HBV) infection but often experience late diagnosis or access to clinical care. This study aims to explore approaches to increase HBV testing in Australia's Chinese community and inform evaluation planning, specifically to i) assess the feasibility and acceptability of HBV educational programs, and ii) compare HBV testing uptake in people receiving a tailored education resource focussing on liver cancer prevention compared with a standard HBV education package.

METHODS

This is a pre-post mixed-methods pilot and feasibility study. People of Chinese ethnicity and unsure of their HBV infection or immunity status were recruited from ten community sites in Melbourne, Australia in 2019-2020. Participants were randomised to receive an education package (comprised of a leaflet and in-person one-on-one educational session) with a focus on either 1) standard HBV-related information, or 2) liver cancer prevention. Participants completed a baseline questionnaire prior to receiving the intervention and were followed up at 6 months' time for a questionnaire and an opt-in semi-structured interview. Primary study outcomes included feasibility of study procedures, measured by recruitment, participation, and retention rates; acceptability of the education program assessed by acceptability scores; and HBV testing uptake rate in each arm. Secondary outcomes include HBV-related knowledge change, assessed by pre-post comparison; and factors affecting participants' testing behaviour analysed using qualitative data.

RESULTS

Fifty-four participants received an education package; baseline and follow-up data from 33 (61%) were available. The study procedures of recruitment and retention were feasible; the acceptability of the education program was moderate with improved HBV-related knowledge observed. Four participants self-reported being tested: one (1/15, 7%) in the standard HBV information group and three (3/18, 17%) in the liver cancer prevention information group. Factors identified as affecting testing included perceived relevance and seriousness of HBV, healthcare access and costs of testing, and perceptions of the role of primary care providers in HBV-related care.

CONCLUSION

A tailored education program targeting ethnic Chinese in Australia was feasible with moderate acceptability. A larger study is required to determine if a liver cancer prevention message would improve HBV testing uptake in Chinese community than standard HBV education message. Supports from healthcare providers, community-based testing programs, and public health education programs are likely needed to motivate diagnostic testing among Chinese people at risk of HBV infection.

Validation and Application of the Positive Play Scale Adapted for Chinese Gamblers: Its Relation to Disordered Gambling and Gambling Attitudes

The Positive Play Scale (PPS) was designed to track the effectiveness of responsible gambling (RG) policy, with a focus on positive changes in beliefs and behaviors instead of the absence of problem gambling symptoms. The current study aimed to (1) validate the Positive Play Scale Adapted for Chinese gamblers (PPS-AC) using a probability Chinese community sample in Macao, (2) explore the relationships between the PPS-AC and symptoms of gambling disorder (GD), and (3) evaluate the associations of gambling attitudes with the PPS-AC. Through a two-step random sampling procedure, we interviewed 1,002 locally dwelling Macao Chinese adults (44.3% males; M_age = 44.28 years, SD_age = 17.35 years) by phone, in which 237 were past-year gamblers (49.8% males; M_age = 40.76 years, SD_age = 15.78 years). Results showed that a two-dimension structure fitted the data well for both the positive play behaviors scale and the positive play beliefs scale of the PPS-AC among past-year gamblers. In addition to findings of satisfactory internal consistency, the convergent validity of the PPS-AC was supported by its significant association with RG self-efficacy. All four PPS-AC constructs were negatively correlated with GD symptoms, whereas two behavior constructs of the PPS-AC significantly explained the variance of GD symptoms with negative valences. All gambling attitude dimensions were associated with at least one PPS-AC construct. The current study was the first to adapt the PPS on a probability Chinese community sample and extended its applicability. The findings support the PPS-AC as a reliable and valid tool for assessing positive play, which was negatively associated with symptoms of disordered gambling. Further, the significant associations between gambling attitudes and the PPS-AC provide insights for RG policies.

Improve Bystander Cardiopulmonary Resuscitation in the Chinese Community

Though many community cardiopulmonary resuscitation (CPR) training classes are available throughout the United States, disparities exist in training and receipt of bystander CPR for Chinese immigrants with limited English proficiency. To increase the number of persons prepared to respond to a cardiac emergency, a Chinese language CPR training program was offered in the community in collaboration with the Stanford Department of Community Partnership. Program leaders imported the American Heart Association approved Chinese version of Heartsaver® for Adult CPR and AED from the China Mainland to make the training accessible to Chinese immigrants with LEP. In 2018, two CPR training events were conducted with 47 participants. All participants successfully demonstrated bystander (hands-only) CPR skills with 91% of participants reporting confidence and 97% willingness to perform CPR. As the first known CPR class offered in the Chinese language in the San Francisco Bay Area using official AHA products, this project provides valuable information regarding community interest and feasibility for expanding this educational program.

Chinese heritage language motivation: a study of motivation development in a multicultural context

This study investigated motivation of Chinese heritage language (CHL) learners with diverse Chinese language backgrounds at an American university. Using a mixed-methods design, it examined the factors that motivated CHL learners to enroll in Chinese courses and continue their studies. The Study explored interactions that enhanced the learning experience and self identity development. A survey was conducted, followed by individual interviews. The results identified five motivation factors significantly correlated to the ideal L2 self, which functions as an anchor. The ideal L2 self was the strongest predictor of intended effort via positive attitude. The classroom-related experience was another significant predictor of intended effort. Interview data highlighted the dynamic interplay between sociocultural contexts and learner-environment interactions which provokes motivation development and strengthens identity reconstruction and future self-guides. In the process, the learner continuously constructs and consolidates the identity as "Chinese" relating to family and culture. Lastly, the anti-ought-to L2 self, characterized by reactions to "others," emerged in dynamic interactions between learners and contexts. This motive inspired the learner to continuously develop the possible self and gain positive learning experiences.

Associations of obesity and novel lipid indicators in the risk of type 2 diabetes mellitus in Chinese elderly hypertensive patients

Background

The associations of waist circumference (WC), body mass index (BMI), lipid accumulation product (LAP), Chinese visceral adiposity index (CVAI), and triglyceride-glucose Index (TyG) with the risk of type 2 diabetes mellitus (T2DM) remained uncertain in Chinese middle-aged and elderly hypertensive patients.

Methods

A total of 1,965 hypertensive participants aged 45 years and elderly were included in the cross-sectional analysis, and 1,576 hypertensive participants without T2DM for the cohort analysis. In the cross-sectional study, binary logistic regression, restricted cubic splines (RCS), and receiver operating characteristic (ROC) were used to analyze the relationships between WC, BMI, LAP, CVAI, and TyG with and T2DM in hypertensive patients. In the cohort study, Kaplan-Meier survival analyses and Cox regression were further performed to determine the associations of these indicators with incident T2DM risk.

Results

In the cohort study, there were 101 incident T2DM cases occurred during a median follow-up of 30 months, with an incident rate was 2.78 per 100 person-years. The cross-sectional study showed that the risk of T2DM increased significantly with higher quartiles of WC, BMI, LAP, CVAI, and TyG (all P -trend < 0.001). In the cohort study, Cox regression model showed that WC (Q4 vs. Q1, HR = 3.30, 95% CI = 1.66-6.59), BMI (Q4 vs. Q1, HR = 2.38, 95% CI = 1.30-4.36), LAP (Q4 vs. Q1, HR = 5.15, 95% CI = 2.40-11.02), CVAI (Q4 vs. Q1, HR = 3.38, 95% CI = 1.76-6.50), and TyG (Q4 vs. Q1, HR = 5.76, 95% CI = 2.82-11.77) were associated with a higher risk of incident T2DM. RCS confirmed the positive dose-response relationships of WC, BMI, CVAI and TyG with T2DM in both study design, except for LAP in the cohort study. Additionally, ROC analysis revealed that TyG had the strongest area under the curve (AUC) of 0.70 (95% CI = 0.67-0.72) in the cross-sectional study, and the AUC of other indicators ranged from 0.55 to 0.57.

Conclusion

Higher levels of WC, BMI, LAP, CVAI, and TyG are associated with a higher riskof developing incident T2DM in Chinese elderly hypertensive patients, and TyG might be the most effective predictive indicator.

Reliability and validity of Chinese version of the Simplified Nutritional Appetite Questionnaire (SNAQ) in community-dwelling old people

OBJECTIVE

To investigate the reliability and validity of the Chinese version of simplified nutritional appetite questionnaire (SNAQ).

METHODS

The SNAQ was translated and back-translated for the study population. We surveyed 122 community-dwelling residents aged ≥60 years in Beijing's residential communities. Participants underwent face-to-face surveys including the SNAQ, mini-nutritional assessment short-form (MNA-SF), FRAIL scale, Sarcopenia-Five (SCAR-F), 15-item Geriatric Depression Scale (GDS-15), 7-item Generalized Anxiety Disorder (GAD-7), 8-item Oral Frailty Index (OFI-8), 10-item Eating Assessment Tool (EAT-10), and Mini-Mental State Examination (MMSE). Cronbach's alpha was used to measure the internal consistency and the relationship between individual items. The construct validity was verified using the KMO-Bartlett. Concurrent validity was established to validate measures of the same constructs.

RESULTS

Cronbach's alpha measured the internal consistency of the questionnaire at 0.694. The split-half reliability stood at 0.725. The construct validity of the SNAQ was confirmed using a KMO-Bartlett value of 0.648 (P <0.001). The MNA-SF, as validation benchmark, has a correlation coefficient of 0.345 (P =0.001).

CONCLUSION

The Chinese version of the SNAQ has good reliability and validity for older adults in community settings.