王博. / "2013年8月". / "2013 nian 8 yue". / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 134-153). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in Chinese and English. / Wang Bo.

由於慢性疾病的流行程度有著全球性上升的趨勢，它經已成為一個公共衛生的問題，為醫療系統帶來沉重的負擔。慢性疾病的發病率以老年人為最高，慢性疾病對老年人的生理、心理、社交及經濟等，構成尤其嚴重的後果。由於香港的人口持續老化，所以預計患有慢性疾病的人口數目在將來幾十年會不斷增加。但是，現時對患有慢性疾病的老年人所提供的照顧不足，再加上本地老年人擁有的多種特徵，例如社會經濟地位較低，健康讀寫能力較弱，及同時患有多重疾病，都有可能對醫護人員提供的護理造成障礙。提升慢性病患者掌管健康的能力，例如提供自我管理的支援，增強他們的信心，及協助他們作出有關健康的判斷及決策，有機會能解決慢性疾病所引起的問題。雖然過往的研究已經發現自我管理教育課程能夠改善慢性病患者的生理、心理及社交健康，及提升患者的健康行為，可是這類課程對老年人的成效，依然缺乏足夠科研證據的支持。 / 作者在這論文中進行了兩項研究，去探討自我管理教育課程對患有慢性疾病的長者的健康行為、生理、心理、社交、生活質素及醫療服務的使用的影響。甲項研究是一個半實驗性研究，探討¬「慢性疾病自我管理課程」對患有不同種類慢性疾病的長者的效果。乙項研究是一個隨機控制實驗，研究「糖尿病自我管理課程」對患有非胰島素依賴的長者的效果。 / 甲項研究招募了患有一種或以上慢性疾病，及居住在社區的長者進行研究。三百零二名治療組的參加者接受了一個為期六星期的「慢性疾病自我管理課程」，當中包括六課以小組模式進行的課堂，每堂為兩小時三十分。課程由專業人員或非專業的長者義工組長帶領。二百九十八名對照組的參加者則繼續接受六個月慣常的護理。每位參加者都會在基線及六個月後接受測試，測試包括自我管理行為、自我效能感、健康狀況及醫療服務的使用。 / 利用單向共變數分析法，結果顯示治療組的所有的自我管理行為和自我效能感測試都有顯著改善 (p < .05)。在十項健康狀況測試中，有五項有明顯改善 (p < .05)。另外，醫療服務的使用則沒有明顯改變。 / 乙項研究是利用隨機方法，分別把九十位及八十七位患有非胰島素依賴的長者分配到治療組及對照組。治療組的參加者參與了為期八堂，每星期一堂，每堂兩小時的「糖尿病自我管理課程」。對照組參加者則在八星期內繼續接受慣常的護理。所有參加者都會在基線及八星期後接受測試，測試包括身高體重指數、腰臀比例、血糖及血壓水平、糖尿病相關的認識、糖尿病指定及總稱的生活質素、及營養攝取。 / 利用單向共變數分析法，結果顯示治療組的糖尿病相關的認識 (p < .0005)，糖尿病指定生活質素的滿意分類 (p = .045)，及總稱生活質素的精神健康分類 (p = .003)皆有明顯的改善。治療組的總能量 (p = .018)及飽和脂肪攝取 (p = .03)都有明顯減少。在各生理及人體測量指標及其他生活質素測試，則沒有明顯改變。 / 此研究增加對疾病指定及非疾病指定的自我管理教育課程於社區上患有慢性疾病的長者的成效的認識。研究結果發現針對長者而設計的課程有機會改善長者的行為、心理及社交狀況，長者亦可以通過課程學習自我管理技巧及改變健康行為，從而改善健康。由長者義工組長帶領的課程有可能跟由專業人員帶領的課程的效果相近。研究結果象徵著自我管理課程需要融入醫療系統的慣常服務當中，以達致最大的成效。本論文亦為如何於各個護理層面及本地環境推行自我管理課程作出詳細討論。對於將來的研究發展，本論文建議加長跟進測試的時間及利用更大的實驗樣本探討自我管理課程於長者身上的成效，疾病指定及非疾病指定課程的效果亦需要作出比較，個別自我管理課程的特徵對課程成效的影響亦需要詳盡地探討。 / The global epidemic of chronic disease has become a public health issue and created a huge burden on health care systems and societies. Older population is highly susceptible to chronic disease. The high prevalence of chronic disease among older adults results in a series of physical, psychosocial and financial consequences in this patient group. In Hong Kong, as the population continues to age, the number of people having chronic disease is expected to increase rapidly in next few decades. The care for older adults with chronic disease is yet suboptimal. Local older people are predisposed to a number of characteristics, such as low socioeconomic status, poor health literacy and multiple morbidities, which may hinder professionals to provide effective care. Empowering patients through supporting self-management, increasing confidence and assisting decision-making of people with chronic disease has been found to be a solution to the problem. Although literature has suggested that self-management education programmes may improve physical and psychosocial outcomes, and promote health-related behaviours among people with chronic disease, the evidence of the effects of such programmes in older adults is still lacking. / Two studies have been conducted to examine the effects of self-management education programmes in improving health behaviours, physical and psychological status, quality of life and health care utilization in older people with chronic disease. Study One is a quasi-experimental trial exploring the effects of the Chronic Disease Self-Management Programme (CDSMP) in older adults with a wide range of chronic diseases. Study Two is a randomized controlled trial evaluating the effects of the Diabetes Mellitus Self-Management Programme (DMSMP) in older adults with non-insulin-dependent diabetes mellitus. / In Study One, community-dwelling older people with one or more chronic disease were recruited. The intervention group (n = 302) received the 6-week CDSMP, which consisted of 6 group sessions with each session lasting for 2.5 hours. The programme was facilitated either by professional and older lay leaders. The control group (n = 298) continued their usual care for 6 months. Self-management behaviours, self-efficacy, health status, and health care utilization of participants were assessed at baseline and 6 months. / The one-way analysis of covariance showed that the intervention group has significant improvements in all self-management behaviours and self-efficacy outcomes, and 5 out of 10 health status measures (all p < .05). No significant change was detected in the use of health care services. / In Study Two, older people with non-insulin-dependent diabetes mellitus were randomly assigned to either the intervention (n = 90) or control (n = 87) group. The intervention group attended the DMSMP comprising 8 weekly 2-hour sessions. The control group received usual care for 8 weeks. Body mass index, waist-to-hip ratio, blood glucose and blood pressure levels, diabetes-related knowledge, disease-specific and generic quality of life, and nutritional intakes were measured at baseline and 8 weeks. / Using the one-way analysis of covariance, the intervention group found significant improvements in diabetes-related knowledge (p < .0005), the satisfaction subscale score in the diabetes-specific quality of life measure (p = .045), and the mental health score in the generic quality of life measure (p = .003). Significant reductions of total energy (p = .018) and saturated fat intakes (p = .03) were also demonstrated in the intervention group. No significant change was detected in the physiological outcomes, anthropometric indices and other quality of life and nutritional measures. / The present studies enrich the knowledge of the effects of disease-specific and generic self-management education programmes for older adults with chronic disease living in the community. It demonstrated that the programmes specifically tailored for older adults may improve a wide range of behavioural and psychosocial outcomes. Older adults may be able to learn new skills for self-management and change behaviours to improve their health. The effects of using older lay persons to lead such programmes may be similar with those using professional staff. The findings imply that self-management programmes need to be integrated into the routine service of health care systems and community care in order to have maximal effects. The implementation of self-management support at different levels of care and under the local context was discussed. Further studies should be conducted to explore the effects of self-management programmes on older people using prolonged follow-ups and larger sample size. The comparative effects of disease-specific and generic self-management programme should be evaluated. The individual influences of various essential features of self-management interventions need to be determined explicitly. / 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. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chan, Lap Sun. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 265-302). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; some appendixes also in Chinese. / Chapter CHAPTER ONE --- INTRODUCTION / The epidemiology of chronic disease --- p.1 / Causes of the epidemiology of chronic disease --- p.3 / Risk factors of chronic disease --- p.4 / Self-management approach in managing chronic disease --- p.5 / The research problem --- p.8 / Chapter CHAPTER TWO --- LITERATURE REVIEW / Challenges in managing chronic disease --- p.10 / Specific concerns for older people --- p.12 / Chronic disease management --- p.16 / Introduction --- p.16 / Patient-centred care --- p.18 / Frameworks for improving care of chronic disease --- p.20 / Chronic Care Model --- p.20 / Innovative Care for Chronic Conditions --- p.22 / Service delivery model of chronic disease management --- p.24 / Global strategies in chronic disease management --- p.26 / Empirical evidence of the Chronic Care Model --- p.29 / Self-management --- p.34 / Definitions --- p.34 / Conceptualizing self-management --- p.37 / Patient-professional relationship --- p.37 / The goal of self-management --- p.40 / Self-management tasks and skills --- p.41 / Perspectives and barriers of self-management in older adults with chronic disease --- p.44 / Self-management education and support --- p.50 / Introduction --- p.50 / Comparison with traditional patient education --- p.51 / Characteristics of self-management education --- p.53 / Theoretical basis in self-management education --- p.53 / Self-efficacy theory --- p.56 / Teaching problem-solving skills and making action plans --- p.58 / Individualizing self-management education --- p.59 / Continuity of self-management support --- p.60 / Framework of delivering self-management support services --- p.62 / Global implementation of self-management education --- p.65 / Empirical evidence of the effects of self-management interventions --- p.70 / Effects of self-management interventions in general --- p.71 / Effects of self-management interventions for older adults with chronic disease --- p.77 / Effects of self-management interventions for patients with chronic disease in Hong Kong --- p.85 / Methodological issues in self-management studies --- p.88 / Establishing self-management interventions for older adults --- p.90 / Establishing self-management interventions under the local context --- p.93 / Summary of Literature Review --- p.94 / Chapter CHAPTER THREE --- METHODS (STUDY ONE) / Introduction --- p.97 / Methodology --- p.98 / Research objectives --- p.98 / Null hypotheses --- p.99 / Study design --- p.100 / Participants --- p.101 / Recruitment and procedure --- p.101 / Intervention --- p.103 / Adaptations of programme delivery for local older participants --- p.106 / Sample size calculation --- p.107 / Outcome measures --- p.108 / The questionnaire --- p.108 / The Abbreviated Mental Test, Hong Kong version (AMT) --- p.109 / Frailty Index (FI) --- p.109 / Statistical analysis --- p.112 / Primary analysis --- p.112 / Secondary analysis --- p.112 / Focus group --- p.114 / Chapter CHAPTER FOUR --- RESULTS (STUDY ONE) / Participants --- p.116 / Baseline --- p.118 / Comparing baseline and 6 months outcomes of intervention group --- p.123 / Comparing baseline and 6 months outcomes of control group --- p.125 / Comparing outcomes between intervention and control groups at 6 months --- p.127 / Subgroup analysis --- p.130 / Comparison among age subgroups --- p.132 / Comparison among education level subgroups --- p.133 / Comparison among frailty level subgroups --- p.133 / Comparing professional staff-led and older lay-led programmes at 6 months --- p.140 / Focus group --- p.142 / Chapter CHAPTER FIVE --- DISCUSSION (STUDY ONE) / Introduction --- p.145 / Demographics characteristics --- p.145 / Baseline outcomes --- p.147 / Effects of the CDSMP on older adults with chronic disease --- p.148 / Self-management behaviours and self-efficacy --- p.148 / Health status --- p.148 / Health care utilization --- p.149 / Comparing with existing literature --- p.150 / Effects of age, education level and frailty level on the outcomes --- p.154 / Age --- p.154 / Education level --- p.154 / Frailty level --- p.155 / Effects of leaders on the outcomes --- p.156 / Qualitative findings --- p.157 / Feasibility of training older people to be lay leaders --- p.160 / Summary of the discussion --- p.162 / Chapter CHAPTER SIX --- METHODS (STUDY TWO) / Introduction --- p.164 / Methodology --- p.166 / Research objectives --- p.166 / Null hypothesis --- p.166 / Study design --- p.167 / Pilot study --- p.168 / Participants --- p.169 / Recruitment and procedure --- p.170 / Intervention --- p.172 / Educational talks --- p.174 / Exercise practice --- p.174 / Goal setting and problem-solving --- p.177 / Issues of designing self-management programme for local older adults --- p.177 / Sample size calculation --- p.178 / Outcome measures --- p.179 / Diabetes Knowledge scale (DKN) --- p.179 / 24-hour food recall --- p.180 / Anthropometric measurements --- p.181 / Clinical health indicators --- p.182 / Quality of life --- p.183 / Statistical analysis --- p.185 / Primary analysis --- p.185 / Secondary analysis --- p.186 / Focus group --- p.186 / Chapter CHAPTER SEVEN --- RESULTS (STUDY TWO) / Participants --- p.188 / Baseline --- p.190 / Comparing baseline and 8 weeks outcomes of intervention group --- p.193 / Comparing baseline and 8 weeks outcomes of control group --- p.195 / Comparing outcomes between intervention and control group at 8 weeks --- p.197 / Nutritional intakes --- p.200 / Comparing baseline, 8 weeks and 6 months outcomes of intervention group --- p.203 / Focus group --- p.206 / Chapter CHAPTER EIGHT --- DISCUSSION (STUDY TWO) / Introduction --- p.208 / Demographics characteristics --- p.209 / Baseline outcomes --- p.210 / Effects of the DMSMP on older adults with type 2 DM --- p.213 / Knowledge and nutritional intakes --- p.213 / Anthropometric measures and clinical health indicators --- p.214 / Quality of life --- p.217 / Long-term effects of the DMSMP on intervention group participants --- p.219 / Comparing with existing literature --- p.220 / Comparing with a local study --- p.226 / Qualitative findings --- p.227 / Summary of the discussion --- p.231 / Chapter CHAPTER NINE --- CONCLUSION / Overall effects of self-management interventions for older adults with chronic disease --- p.232 / Strengths of the study --- p.238 / Using a more stringent study design --- p.238 / Incorporated essential features of self-management interventions into current programmes --- p.239 / Demonstrated a collaborative model between health and social sectors --- p.240 / Limitations of the study --- p.241 / The integrity of study sample --- p.241 / Issues in the representativeness of study sample --- p.241 / High attrition rate in the longitudinal follow-up (The DMSMP) --- p.243 / Unknown uptake rate --- p.244 / The study design --- p.244 / Non-randomized allocation of participants (The CDSMP) --- p.244 / The lack of control for attention effect --- p.246 / The implementation of study intervention --- p.247 / Using multiple components --- p.247 / The absence of blinding (The DMSMP) --- p.248 / The evaluation and statistical analysis --- p.248 / Short duration of follow-up --- p.248 / Limitations of post-hoc analyses --- p.249 / Diffusion of self-management interventions for older adults --- p.250 / Considerations to the adoption of current self-management interventions --- p.251 / Relative advantage --- p.251 / Compatibility --- p.251 / Complexity --- p.252 / Trialability --- p.252 / Observability --- p.253 / Experience of implementing self-management interventions in the UK and the US --- p.254 / Considerations to the implementation of current self-management interventions --- p.256 / Strategies applied in promoting the adoption and implementation of current self-management interventions --- p.257 / Recommendations for local implementation of self-management interventions --- p.259 / Recommendations for future research --- p.261 / Conclusion --- p.264

Conclusions. Regardless the method the information on benefit was provided, the maximum amount of money which people are willing to pay for antihypertensive varied substantially. Using relative risk to present the benefit would distort the viewpoint of the public regarding the importance of drug treatment. Residents were much more conservative in antihypertensive drugs than physicians. Most hypertensive patients in China would probably not accept drugs treatment for primary prevention if they are adequately informed. Rural residents were on average, less willing to take antihypertensive drugs than urban residents. Residents had a poor perception of their cardiovascular risk due to hypertension and the benefit of drug treatment. Most physicians in our study did not have good knowledge on overall risk approach and Chinese national guidelines. They had also very poor knowledge and skills related to evidence based medicine. (Abstract shortened by UMI.) / Objective. To assess the maximum amount of money residents are willing to pay for antihypertensive drugs given the actual benefit of treatment. To decide the minimum benefit (expressed in NNT) above which people are willing to pay for antihypertensive drugs at the current cost. To determine the minimum risk of cardiovascular disease (CVD) above which people would be willing to pay for antihypertensive at the current cost. To assess whether reporting of study results by using relative risk reduction and NNT affects people's willingness to pay for and physicians' willingness to prescribe antihypertensive drugs. To evaluate patients' and physicians' perception of perceived CVD risk due to hypertension and benefit of treatment. To assess knowledge, attitude and perception of the public and physicians regarding antihypertensive drugs and physicians' knowledge and skills on evidence based medicine. / Results. The response rate for residents was 91%. 95% of respondents reported that they would be willing to take antihypertensive drugs if they found to have high blood pressure. The majority of residents did not know the ultimate goal of blood pressure lowering was to reduce the risk of CVD. 91% said that they had not enough knowledge and information to make drug-taking decisions. The perceived 5-year baseline risk in the absence of treatment, absolute risk reduction and relative risk reduction was 70%, 40% and 60% respectively. Rural residents tended to over-rate their risk and benefit more than urban residents. Overall, 2%, 3% and 47% of residents were not willing to pay anything for antihypertensive drugs when information on benefit of treatment was described in general, with RRR and with NNT respectively. The median cost the residents were willing to pay was $500, $700 and $100 respectively for responding three ways of describing the benefit. / The response rate for physicians was 95%. The perceived 5-year baseline risk, absolute risk reduction and relative risk reduction was 40%, 20% and 39% respectively. Internists tended to give a slightly higher estimate of the 5-year risk (40% vs 30%, p&lt;0.05) and of the RRR (39 vs 29, p&lt;0.05). Overall, physicians were more likely to prescribe antihypertensive drugs when the benefit information was expressed in RRR than when it was expressed in NNT (p&lt;0.001). The median minimum NNT and the 5-year CVD risk above which physicians are willing to prescribe was 200 and 1.5% respectively. / Wang Weizhong. / "November 2006." / Adviser: Jinling Tang. / Source: Dissertation Abstracts International, Volume: 68-08, Section: B, page: 5119. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 105-114) / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest dissertations and theses, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

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

University of Macau / Faculty of Social Sciences and Humanities / Department of Government and Public Administration

published_or_final_version / Social Work / Master / Master of Social Sciences