研究背景：便秘被過往的研究確認為世界各地老年人的一個常見健康問題，尤其是居住在安老院的長者。香港一項人口普查亦指出便秘也是香港老年人的一個常見健康問題。便秘對長者的生理、心理和社會功能等各方面都產生不良影響。此外，醫療體制亦因處理便秘及其衍生的健康問題而面對沉重的負擔。目前所採用的常規方案是生活模式改變及使用軟便劑，但兩者均未能有效地紓緩便秘的徵狀。由於香港老齡人口持續增長，便秘將會是一個具有潛在持續性的老年健康問題，故尋找一個能有效地紓緩便秘徵狀的方案甚為迫切。耳穴療法是一項普及的中醫療法，亦屬於互補療法。過往在中國進行的研究顯示，耳穴療法能有效地治療便秘，惟此等療效尚未被確實。耳穴療法應是一個對處理便秘具有潛在療效的治療方案。現時，香港尚未有研究評價耳穴療法對處理便秘的療效。 / 研究目的：本研究旨在評價耳穴療法的互補療效，對安老院內的長者便秘徵狀及便秘相關的健康生活品質的干預效果。 / 研究方法：本研究是一個採取混合研究法的臨床研究。先進行化研究，評價耳穴療法對安老院內長者的便秘徵狀及便秘相關的健康生活品質的互補療效；接著進行質化研究，探討面談者對接受耳穴療法的經驗及感受。量化研究是一個隨機對照及雙盲的研究。安老院內的院友被取錄為參與者後，便隨機地獲分配一個研究組別。本研究共有三個研究組別，每名組員分別接受一個預定的干預措施，包括磁珠耳貼療法 (干預組)，王不留行籽耳貼療法 (對照A組) 及耳貼療法 (對照B組)，干預措施是在七個選定的耳穴上進行耳穴療法，共維持十天。研究指標包括便秘徵狀及便秘相關的健康生活品質。此等研究指標分別在干預前 (基線資料)、十天後 (干預措施結束) 和二十天後 (干預措施結束後十天) 進行資料蒐集。統計推斷方法是採用廣義估計方程模型檢驗組間和組內在便秘徵狀及便秘相關的健康生活品質之差異。質化研究的面談者必須是完成整個研究過程的干預組組員，並在量化檢驗的便秘徵狀指標中取得最高分及最低分的各四位組員。透過個別面談，探討面談者對接受耳穴療法以處理便秘的經驗及感受。 / 研究結果：本研究共有99名參與者。祇有90名參與者接受干預措施 (干預組=31；對照A組=28；對照B組=31)，其中的81名參與者完成整個療程 (干預組=29；對照A組=25；對照B組=27)。本研究結果顯示耳穴療法在十天 (p=0.016)及二十天 (p=0.016) 的研究時期內，便秘相關的健康生活品質中的滿意度在干預組及對照A組間有顯著的差異 (十天及二十天均是p=0.016)。然而，本研究證實磁珠耳貼療法能顯著地紓緩便秘徵狀 (十天：p=0.013；二十天：p<0.001)，提升與便秘相關的健康生活品質 (十天：p=0.005；二十天：p<0.001)，並於三個研究組別中取得最大的療效。此外，質化研究結果顯示，耳穴療法確是一項安全及具認受性的療法，適用於安老院內的院友，可作為處理便秘的治療方案。 / 研究結論：本研究是香港首個通過隨機對照的臨床研究，以評價耳穴療法對處理便秘的互補療效。研究結果顯示磁珠耳貼療法對安老院內的院友具有正向的臨床價值：磁珠耳貼療法能紓緩便秘徵狀及提升便秘相關的健康生活品質；安老院內的院友認為耳穴療法是一項安全及具認受性的療法；對住在安老院內年長的中國人而言，耳穴療法是一項與其文化相關的照護方式。本研究就處理安老院內院友的便秘問題為護理專業提供了有關耳穴療法的新知，並作為日後於護理實務及護理研究方面的參考和方向。 / Background: Constipation has been identified in previous studies as a worldwide health problem among elderly people, especially those living in residential care homes (RCHs). Similarly, constipation is also reported as a common health problem among elderly people in Hong Kong in a local population survey. Constipation adversely affects the biopsychosocial well-being of elderly people. In addition, heavy burden has been imposed on the health care system in dealing with constipation and its related health problems. Constipation is currently managed by laxatives and lifestyle modification. However, constipation is not effectively relieved by these two management strategies. In Hong Kong, the aging population is seen to have an increasing trend. Constipation will then be a potentially expanding health problem among elderly people. All these data indicate an urgent need for effective alternatives to manage this health problem. Auriculotherapy is one popular treatment modality in Chinese medicine, which is also a form of complementary therapy. Previous studies conducted in Mainland China reported promising results in managing constipation with auriculotherapy, although its effectiveness was not affirmed. Auriculotherapy appears to be a promising management strategy for constipation. Until now, no study has been conducted in Hong Kong to evaluate the effectiveness of auriculotherapy in managing constipation. / Aim: The current study aims to evaluate the complementary effects of auriculotherapy in relieving constipation symptoms and in promoting disease-specific health-related quality of life (HRQOL) among elderly RCH residents. / Methods: The present study is a clinical trial that adopts the mixed-method design. A randomized placebo-controlled trial was first conducted to evaluate the complementary effects of auriculotherapy in relieving symptoms of constipation and in promoting disease-specific HRQOL in elderly RCH residents. After the completion of the randomized placebo-controlled trial, the qualitative approach was conducted to explore the participants’ experience and perceptions on the use and complementary effects of auriculotherapy with magnetic pellets in managing constipation. The randomized placebo-controlled trial was a double-blind study. The participants were recruited from elderly RCH residents and then randomly assigned to one of the three study groups. The participants received the assigned intervention, namely, auriculotherapy using auricular plaster with magnetic pellet (experimental group), auriculotherapy using auricular plaster with Semen Vaccariae (placebo-controlled group A), or auriculotherapy using only auricular plaster (placebo-controlled group B). Auriculotherapy was applied onto seven selected auricular acupoints for 10 days. Two outcome variables, namely, constipation symptoms and disease-specific HRQOL, were measured before the implementation of intervention (baseline), on Day 10 (at the completion of the intervention), and on Day 20 (at the 10th-day follow-up after the intervention). The generalized estimating equation model was adopted to evaluate the between-group and within-group differences in the complementary effects of auriculotherapy on constipation symptoms and disease-specific HRQOL. In the qualitative approach, the informants were recruited from participants of the experimental group who had successfully completed the study with mean scores in constipation symptoms at the top- or bottom-four ranking. The informants were individually interviewed to explore their experience and perceptions on the use and complementary effects of auriculotherapy in managing constipation. / Results: Ninety-nine participants were recruited in the study. Ninety participants received the intervention as assigned, and eventually, 81 participants completed the intervention. When the interaction effects of time and group were simultaneously considered, statistical significant differences were only found in the satisfaction subscale of the disease-specific HRQOL between the experimental group and placebo-controlled group A on both Day 10 (p=0.016) and Day 20 (p=0.016). For the experimental group, significant time effects were found in constipation symptoms (Day 10：p=0.013; Day 20：p<0.001) and disease-specific HRQOL (Day 10：p=0.005; Day 20：p<0.001) after receiving auriculotherapy. Most importantly, the participants who received auriculotherapy with magnetic pellets showed the greatest improvement in constipation symptoms and disease-specific HRQOL after the intervention compared with the two placebo-controlled groups. The qualitative findings further revealed that auriculotherapy is a safe, well-accepted therapy in managing constipation among elderly RCH residents. / Conclusion: The current study is the first known randomized placebo-controlled trial that evaluates the complementary effects of auriculotherapy in managing constipation in Hong Kong. The current findings indicate positive clinical value of auriculotherapy with magnetic pellets in managing constipation in elderly RCH residents. Auriculotherapy with magnetic pellets was found to provide favourable therapeutic effects in relieving constipation symptoms and in promoting disease-specific HRQOL among elderly RCH residents. This therapy is also considered by elderly people as a safe and acceptable therapy with minimal side effects. In addition, auriculotherapy is considered as a culturally relevant care modality for Chinese elderly RCH residents. The current study contributes new knowledge to nursing for future reference and directions in both nursing practice and nursing research with regard to the complementary effects of auriculotherapy in managing constipation among elderly RCH residents. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Li, Mei Kuen. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 273-305). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendixes also in Chinese. / Chapter CHAPTER 1 --- INTRODUCTION / Introduction --- p.1 / Background of the study --- p.2 / Aim and significances of the study --- p.6 / Overview of the thesis --- p.6 / Chapter CHAPTER 2 --- LITERATURE REVIEW / Introduction --- p.8 / Constipation: Potentially expanding health problem in elderly population --- p.9 / Prevalence of constipation --- p.9 / Definition of constipation --- p.11 / Physiology and pathophysiology of defecation --- p.13 / Effects of constipation --- p.15 / Adverse individual health consequences --- p.15 / Economic burden in health care system --- p.18 / Contributory factors for constipation --- p.20 / Roles of nurses in managing constipation in current practice --- p.22 / Cautious use of laxatives --- p.24 / Lifestyle modification --- p.24 / Promoting dietary fiber intake --- p.25 / Encouraging oral fluid intake --- p.26 / Promoting physical activity --- p.26 / Integration of complementary therapy into nursing practice in managing constipation --- p.28 / Auriculotherapy --- p.30 / Historical overview of auriculotherapy --- p.30 / Conceptual framework of auriculotherapy --- p.31 / Approaches of auriculotherapy --- p.36 / Mechanism of auriculotherapy --- p.37 / Clinical applications of auriculotherapy in managing constipation --- p.39 / Complementary effects of auriculotherapy in managing constipation: Review of previous studies --- p.41 / Subject characteristics --- p.41 / Intervention protocol --- p.45 / Therapeutic outcome criteria and effectiveness --- p.50 / Strengths and limitations of the reviewed studies --- p.56 / Recommendations for future studies --- p.59 / Significances of the current study --- p.60 / Summary --- p.61 / Chapter CHAPTER 3 --- METHODS / Introduction --- p.63 / Overview of study design --- p.65 / Mixed-method study design --- p.66 / Quantitative approach --- p.66 / Qualitative approach --- p.68 / Research aim and objectives --- p.68 / Research aim --- p.68 / Research objectives --- p.68 / Null hypotheses --- p.69 / Operational definitions --- p.71 / Rationale of the study design --- p.73 / Rationale for adopting the mixed-method design --- p.73 / Rationale for adopting the randomized controlled trial design --- p.75 / Rationale for adopting double-blindness --- p.75 / Rationale for adopting random assignment --- p.76 / Rationale for adopting a pretest and repeated post-test design --- p.78 / Rationale for recruiting placebo-controlled groups --- p.79 / Quantitative approach --- p.81 / Sample --- p.81 / Accessible population --- p.81 / Sampling method and selection of participants --- p.82 / Sample size determination --- p.85 / Experimental intervention --- p.87 / Content of the experimental intervention --- p.87 / Integrity of experimental intervention --- p.92 / Qualification of the intervener --- p.92 / Consistency of implementation of intervention --- p.93 / Compliance of the participants to study instructions --- p.84 / Data collection --- p.95 / Study Instruments and records --- p.95 / Patient Assessment of Constipation Symptom Questionnaire (Cantonese Chinese for Hong Kong) (PAC-SYM) --- p.96 / Patient Assessment of Constipation Quality of Life Questionnaire (Cantonese Chinese for Hong Kong) (PAC-QOL) --- p.97 / Abbreviated Mental Test (Hong Kong version; AMT) --- p.98 / Physical Activity Questionnaire (Hong Kong version; PAQ) --- p.98 / Screening for eligibility of the participant --- p.99 / Demographic and Clinical Data Sheet --- p.99 / Assessment of Clinical Syndrome of Constipation --- p.99 / Assessment of oral intake of Fruits and Vegetables (AFV) --- p.100 / Bowel Movement Record (BMR) --- p.100 / Drug Administration Record (DAR) --- p.101 / Data collection procedure --- p.101 / Qualitative approach --- p.104 / Rationale for adopting criterion sampling --- p.105 / Pilot Study --- p.106 / Feasibility of the sampling method --- p.107 / Feasibility of the data collection instruments and procedure --- p.107 / Feasibility of implementation of the study intervention --- p.108 / Characteristics of the pilot sample --- p.109 / Sample size recalculation --- p.113 / Appropriateness of the interview guide --- p.114 / Recommendations for the main study --- p.115 / Data Analysis --- p.115 / Quantitative data --- p.115 / Assessment of accuracy of data entry --- p.116 / Description of sample characteristics --- p.117 / Assessment of homogeneity of the study groups --- p.117 / Detection of the intervention effect --- p.118 / Justification for choosing parametric statistical tests over non-parametric statistical tests --- p.118 / Adoption of the Generalized Estimating Equations (GEE) model --- p.119 / Rationale for adopting the GEE model --- p.119 / Choosing the appropriate link function and working correlation matrix --- p.121 / Control of possible covariates in data analysis --- p.123 / Qualitative data --- p.124 / Ethical considerations --- p.125 / Principle of respect for persons --- p.126 / Principle of beneficence --- p.127 / Principle of justice --- p.128 / Summary --- p.129 / Chapter CHAPTER 4 --- RESULTS / Introduction --- p.132 / Recruitment and characteristics of participants --- p.133 / Recruitment of participants --- p.133 / Characteristics of the participants --- p.137 / Characteristics of the study sample and homogeneity among study groups --- p.140 / Characteristics of the study sample --- p.141 / Homogeneity of the characteristics of participants who received and those who did not receive the intervention in the study --- p.145 / Homogeneity of the characteristics of participants in the experimental and the placebo-controlled groups --- p.145 / Complementary effects of auriculotherapy in managing constipation --- p.149 / Adopting the GEE model --- p.152 / Checking the missing data --- p.152 / Identifying the covariates --- p.152 / Choosing the appropriate link function --- p.153 / Choosing the appropriate working correlation matrix --- p.160 / Complementary effects of auriculotherapy on constipation symptoms and disease-specific HRQOL --- p.160 / Complementary effects of auriculotherapy on constipation symptoms --- p.161 / Constipation symptoms (PAC-SYM) --- p.161 / Subscales of constipation symptoms --- p.165 / Abdominal symptoms subscale --- p.165 / Rectal symptoms subscale --- p.168 / Stool symptoms subscale --- p.172 / Summary of the complementary effects of auriculotherapy on constipation symptoms --- p.175 / Complementary effects of auriculotherapy on disease-specific HRQOL --- p.177 / Disease-specific HRQOL (PAC-QOL) --- p.177 / Subscales of disease-specific HRQOL --- p.181 / Physical discomfort subscale --- p.181 / Psychosocial discomfort subscale --- p.185 / Worries and concerns subscale --- p.186 / Satisfaction subscale --- p.190 / Summary of the complementary effects of auriculotherapy on disease-specific HRQOL --- p.193 / Effect size calculation --- p.196 / Findings revealed from study records --- p.197 / Monitoring of the intervention dose --- p.198 / Change of bowel movement pattern --- p.198 / Change in drug administration --- p.200 / Reporting of side effects associated with auriculotherapy --- p.202 / Reporting of unexpected beneficial effects after receiving auriculotherapy --- p.202 / Qualitative findings revealed from interview --- p.203 / Recruitment of informants --- p.203 / Characteristics of the informants --- p.204 / Qualitative findings --- p.207 / Benefits of auriculotherapy in managing constipation --- p.208 / Minor discomforts associated with auriculotherapy --- p.210 / Life as usual with the use of auriculotherapy --- p.210 / Willingness to adopt and recommend auriculotherapy to others --- p.213 / Summary of the qualitative findings --- p.214 / Summary --- p.215 / Chapter CHAPTER 5 --- DISCUSSION / Introduction --- p.217 / Profile of participants --- p.217 / Demographic and clinical characteristics of the participants --- p.218 / Baselines outcome variables of the participants --- p.224 / Clinical value of auriculotherapy with magnetic pellets in managing constipation --- p.226 / Summary of the key findings --- p.226 / Complementary effects in relieving constipation symptoms and in promoting disease-specific HRQOL --- p.228 / Safe and well-accepted intervention --- p.236 / Culturally relevant care modality --- p.239 / Challenges associated with recruiting elderly participants --- p.241 / Strengths and limitations of the current study --- p.246 / Strengths of the study --- p.246 / Limitations of the study --- p.253 / Summary --- p.257 / Chapter CHAPTER 6 --- CONCLUSION / Introduction --- p.258 / Contribution of new knowledge to nursing --- p.258 / Implications for nursing practice --- p.259 / Clinical application of auriculotherapy in nursing practice --- p.261 / Strategies to promote integration of auriculotherapy into nursing practice --- p.263 / Implications for nursing research --- p.266 / Recommendations for further studies --- p.268 / Conclusion of the whole study --- p.269 / REFERENCES (ENGLISH) --- p.273 / REFERENCES (CHINESE) --- p.303

Wong, King Moses. / "August 2010." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 158-172). / Abstracts in English and Chinese. / Chapter Chapter One: --- Introduction --- p.1 / Chapter 1.1 --- Background --- p.1 / Chapter 1.2 --- Research objectives --- p.5 / Chapter 1.3 --- Research hypothesis --- p.7 / Chapter 1.4 --- Research questions --- p.7 / Chapter 1.5 --- Research structure --- p.9 / Chapter Chapter Two: --- Literature Review --- p.10 / Chapter 2.1 --- "Health geography: knowledge of population, people, places and health" --- p.10 / Chapter 2.2 --- Understanding geographies of diseases: mapping and modeling diseases and health --- p.17 / Chapter 2.3 --- Healthcare services provision and utilization --- p.22 / Chapter 2.4 --- Hong Kong: facts and context --- p.31 / Chapter 2.4.1 --- Demographics --- p.32 / Chapter 2.4.2 --- Key challenges arising from population ageing --- p.37 / Chapter 2.4.2.1 --- Implications to medico-social agenda --- p.38 / Chapter 2.4.2.2 --- Implications to health status --- p.38 / Chapter 2.4.2.3 --- Implications to disease pattern --- p.39 / Chapter 2.4.3 --- Healthcare service delivery system in Hong Kong --- p.41 / Chapter 2.4.3.1 --- Financing and expenditure --- p.42 / Chapter 2.4.3.2 --- Organizational framework and healthcare policy --- p.44 / Chapter 2.4.3.3 --- Healthcare resources --- p.49 / Chapter 2.4.3.4 --- Utilization and provision of public healthcare services --- p.50 / Chapter Chapter Three: --- Material & Methods --- p.55 / Chapter 3.1 --- Background of main source of data --- p.55 / Chapter 3.2 --- Sources of data --- p.57 / Chapter 3.2.1 --- Hospital services utilization data --- p.57 / Chapter 3.2.2 --- Healthcare resources data --- p.61 / Chapter 3.2.3 --- Population data --- p.62 / Chapter 3.3 --- Spatial scale of analysis --- p.62 / Chapter 3.4 --- Statistical analyses --- p.63 / Chapter 3.4.1 --- Service utilization ratios --- p.63 / Chapter 3.4.2 --- Provision of healthcare resources to population --- p.65 / Chapter 3.4.3 --- Adequacy of healthcare services provision --- p.65 / Chapter 3.4.4 --- Mortality analysis --- p.67 / Chapter 3.4.5 --- Multi-level analysis --- p.69 / Chapter 3.4.6 --- Mapping of health services utilization ratio and mortality ratio --- p.70 / Chapter 3.5 --- Statistical packages used --- p.73 / Chapter 3.6 --- Cautions on interpretation --- p.74 / Chapter 3.6.1 --- Confounding and ecological fallacy --- p.74 / Chapter 3.6.2 --- Problem with the use of Standardized Mortality Ratio --- p.75 / Chapter 3.6.3 --- Problem with mapping and visualization --- p.76 / Chapter Chapter Four: --- Results --- p.78 / Chapter 4.1 --- Socio-spatial variation in mortality --- p.78 / Chapter 4.2 --- Statistical analysis and mapping of health services utilization ratio --- p.80 / Chapter 4.3 --- Statistical and cartographic analysis in Standardized Mortality Ratio --- p.88 / Chapter 4.4 --- Provision of healthcare resources to population --- p.91 / Chapter 4.5 --- "Multi-level analysis of hospital services utilization, provision and mortality" --- p.92 / Chapter 4.6 --- Further analysis --- p.95 / Chapter Chapter Five: --- Discussion --- p.100 / Chapter 5.1 --- Geographic variations in health services utilization ratios --- p.101 / Chapter 5.2 --- Geographic variation in Standardized Mortality Ratio --- p.107 / Chapter 5.3 --- "Multi-level models on health services utilization, provision and mortality" --- p.121 / Chapter 5.3.1 --- Socio-demographic characteristics of health services utilization --- p.121 / Chapter 5.3.1.1 --- Age --- p.121 / Chapter 5.3.1.2 --- Gender --- p.124 / Chapter 5.3.2 --- Health services utilization in relation to services provision --- p.129 / Chapter 5.3.3 --- Health services utilization in relation to mortality --- p.132 / Chapter 5.3.4 --- Adequacy of healthcare services provision --- p.134 / Chapter 5.3.4.1 --- Adequacy of hospital care provision --- p.134 / Chapter 5.3.4.2 --- Adequacy of primary care provision --- p.139 / Chapter 5.4 --- Implications --- p.143 / Chapter 5.5 --- Strengths of study --- p.146 / Chapter 5.6 --- Limitations of study --- p.148 / Chapter 5.7 --- Recommendations for future research --- p.151 / Chapter Chapter Six: --- Conclusion --- p.154 / References --- p.158