published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / abstract / Social Work and Social Administration / Doctoral / Doctor of Philosophy

by Ho Yuk Mei. / Thesis (M.S.W.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 107-113). / Acknowledgements / Abstract / Chapter Chapter I --- Introduction --- p.1 / Chapter Chapter II --- Family Caregiving of Elderly in Hong Kong --- p.5 / Chapter 1 --- Characteristics and Needs of Elderly Population in Hong Kong --- p.5 / Chapter 2 --- Social Services for the Elderly in Hong Kong --- p.8 / Chapter 3 --- Family Caregiving in Hong Kong --- p.11 / Chapter 4 --- Local Researches on Family Caregivers of Frail Elderly --- p.13 / Chapter Chapter III --- Literature Review on Family Caregivers of Frail Elderly --- p.18 / Chapter 1 --- Elderly --- p.18 / Chapter 2 --- Frail Elderly --- p.19 / Chapter 3 --- Family Caregivers of Frail Elderly --- p.22 / Chapter 4 --- Caregiving as a Stressful Experience --- p.25 / Chapter 5 --- Stress and Coping Model --- p.29 / Chapter Chapter IV --- Conceptual Framework of Stress and Coping Strategies of Family Caregivers of Frail Elderly --- p.40 / Chapter 1 --- Definitions of Major Variables --- p.40 / Chapter 2 --- Interrelationships of Major Variables (Hypotheses) --- p.43 / Chapter Chapter V --- Research Methodology --- p.46 / Chapter 1 --- Sampling --- p.46 / Chapter 2 --- Measuring Instruments --- p.48 / Chapter 3 --- Data Collection Procedure --- p.56 / Chapter 4 --- Data Analysis --- p.57 / Chapter Chapter VI --- Findings on the Characteristics of Family Caregivers and their Frail Elderly Relatives --- p.58 / Chapter 1 --- Characteristics of Family Caregivers --- p.58 / Chapter 2 --- Characteristics of the Frail Elderly --- p.67 / Chapter Chapter VII --- "Findings on Level and Areas of Family Caregiving, Stress, Appraisal, Coping Strategies and Life Satisfaction of Family Caregivers" --- p.78 / Chapter 1 --- Level and Areas of Family Caregiving of Frail Elderly --- p.78 / Chapter 2 --- Level of Stress of Family Caregivers --- p.81 / Chapter 3 --- Appraisal of Caregiving Situation by Family Caregivers --- p.82 / Chapter 4 --- Coping Strategies of Family Caregivers --- p.85 / Chapter 5 --- Level of Life Satisfaction of Family Caregivers --- p.89 / Chapter Chapter VIII --- Findings on Hypotheses Testing --- p.91 / Chapter Chapter IX --- Summary and Limitations --- p.95 / Chapter Chapter X --- Recommendations --- p.101 / Bibliography --- p.107 / Appendix 1 Eligibility Criteria of Day Care Centre for the Elderly --- p.114 / Appendix 2 Eligibility Criteria of Elderly Cases of Home Help Service --- p.115 / Appendix 3 Description of the Coping Scale --- p.116 / Appendix 4 Questionnaire (Chinese Version) --- p.117 / Appendix 5 Questionnaire (English Version) --- p.131 / Appendix 6 Percentage of Responses to the Items in the Ways of Coping Questionnaire --- p.147

published_or_final_version / Gerontology / Master / Master of Social Sciences

published_or_final_version / Social Work / Master / Master of Social Sciences

作為當代中國老年照顧服務領域以社區為基礎的服務項目典型，社區居家養老服務於2003年已在一批城市化速度較快、經濟發展較好的城市範圍內示範性地開展了，由此促成了本次採用質化研究方法、以廣州荔灣區A街道及南京建鄴區B街道兩個示範社區所做的探索性地對比研究。 / 研究問題包涵宏觀、中觀、微觀三個不同的層面，旨在考察兩地在社區老年照顧服務情境建設中的路徑選擇、對社區居家養老服務項目的概念化和操作化、以及關鍵性專業服務理念（參與理念、增權理念）在具體服務輸送環節中的滲透情況。因此，研究主要發現主要有以下三大面向：宏觀層面提出了“服務情境服務項目的互動論，並展示了宏觀層面與中觀層面的雙向關係；中觀層面既分析服務項目內部服務理念與服務實踐的關係，又揭示了服務項目及其所能發揮的服務效益之間的關係，提出了中觀層面與微觀層面的互動可能性；微觀層面歸納出了專業服務理念對未來制度化建設的的倡導，顯示了微觀理念發展對宏觀制度建設的影響。在此基礎之上，研究員進一步提出了我國城市社區居家養老服務概念框架，以及相應的政策啟示和實務建議，共同形成了本次研究的主要研究貢獻。 / As a typical programs within the domain of the contemporary Chinese eldercare, home- and community-based services for the elderly has been experimentally implemented in dozens of relatively urbanized and economically developed cities since 2003, which promotes this exploratory qualitative comparative study between Guangzhou and Nanjing. / Research questions encompass macro, mezzo, and micro levels, designating to the constructive paths of community’s eldercare setting, the conceptualization and operationalization of home- and community-based services for the elderly, and the involvement of professional service concepts (participation, empowerment) into the concrete service delivery section. Hence, the main research findings are correspondingly based on three dimensions: at the macro level, an interactionism between “service setting--service program has been inducted, demonstrating the bidirectional relationships between the macro and mezzo levels; at the mezzo level, not only does the researcher analyze the relationship between the service concept and the service practice, she also further points out the relationship between the service program and its service effectiveness, revealing the interactive possibilities between the mezzo and micro levels; at the micro level, an advocacy for the future institutional construction put forward by the professional service concepts aforementioned has also been inducted, depicting the impetus given to the macro institutional construction by the micro conceptual development. In a nutshell, this study is mainly devoted to the dimensional relationships which are readily accessible or potential, from which a conceptual framework steering the home- and community-based services for the elderly in contemporary urban China has been abstracted, together with corresponding social policy implications and practice suggestions as a consequences. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 陳偉. / "2013年3月". / "2013 nian 3 yue". / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 367-386). / Abstract in Chinese and English. / Chen Wei. / 論文摘要 --- p.iii / Abstract --- p.iv / 致謝 --- p.vi / 目錄 --- p.ix / Chapter 第一部分 --- 理論與方法 / Chapter 第一章 --- 導論 --- p.2 / Chapter 一、 --- 研究背景 --- p.2 / Chapter 二、 --- 研究目標 --- p.2 / Chapter 三、 --- 研究理論 --- p.5 / Chapter 四、 --- 研究問題 --- p.7 / Chapter 五、 --- 研究章節概述 --- p.7 / Chapter 第二章 --- 文獻回顧 --- p.9 / 相關的理論與理念支持 / Chapter 一、 --- 福利多元主義理論指導之下的“混合經濟福利 --- p.11 / Chapter (一) --- 福利多元組合（welfare mix） --- p.11 / Chapter 1. --- 三分法 --- p.11 / Chapter 2. --- 四分法 --- p.12 / Chapter (二) --- 福利三角（welfare triangle） --- p.13 / Chapter (三) --- 福利多元主義理論（welfare pluralism） --- p.14 / Chapter 1. --- 對福利多元主義的樂觀看法 --- p.15 / Chapter 2. --- 對福利多元主義的批評 --- p.17 / Chapter 3. --- 福利多元主義對我國福利體制轉變的啟示 --- p.22 / Chapter 二、 --- 英國社區照顧 --- p.28 / Chapter (一) --- 英國社區照顧的源起 --- p.29 / Chapter 1. --- 對“社區照顧一詞的使用 --- p.29 / Chapter 2. --- 社區照顧作為社會政策 --- p.29 / Chapter 3. --- 社區照顧服務對象的轉變 --- p.30 / Chapter 4. --- 社區照顧內涵的三個面向 --- p.31 / Chapter (二) --- 福利國家危機與執政理念轉換之下的英國社區照顧 --- p.34 / Chapter (三) --- 福利多元主義之下的英國社區照顧及其爭議性 --- p.36 / Chapter (四) --- 理念與模式的並行、正式與非正式照顧資源的並行 --- p.39 / Chapter 三、 --- 批判老年學與批判老年學社會工作 --- p.41 / Chapter (一) --- 批判老年學：增權在理論間的串聯 --- p.42 / Chapter (二) --- 批判老年社會工作 --- p.45 / Chapter 1. --- 需要？還是風險與資格標準？ --- p.45 / Chapter 2. --- 從照顧者角度出發的反思 --- p.48 / 我國現有的實證資料回顧 / Chapter 一、 --- 中國人口老齡化現狀及變動趨勢 --- p.53 / Chapter 二、 --- 對以社區為基礎的服務項目的政策倡導 --- p.54 / Chapter 三、 --- 社區居家養老服務重要性的萌芽 --- p.55 / Chapter 四、 --- 現有文獻对社区居家养老服务的理解 --- p.57 / Chapter 五、 --- 我國現有的社區居家養老服務實踐 --- p.61 / Chapter (一) --- 中央及地方的政策支持 --- p.61 / Chapter (二) --- 經濟支持與硬件設施建設 --- p.62 / Chapter (三) --- 服務方面的實務進展 --- p.64 / Chapter 第三章 --- 研究問題與概念框架 --- p.68 / Chapter 一、 --- 研究問題 --- p.68 / Chapter (一) --- 宏觀層面的研究問題 --- p.69 / Chapter (二) --- 中觀層面的研究問題 --- p.69 / Chapter (三) --- 微觀層面的研究問題 --- p.69 / Chapter 二、 --- 概念框架 --- p.69 / Chapter (一) --- 概念界定 --- p.70 / Chapter 1. --- 宏觀層面的概念考察 --- p.70 / Chapter 2. --- 中觀層面的概念考察 --- p.72 / Chapter 3. --- 微觀層面的概念考察 --- p.73 / Chapter (二) --- 概念框架構想（圖一） --- p.79 / Chapter 第四章 --- 方法論與研究方法 --- p.81 / Chapter 一、 --- 研究範式 --- p.81 / Chapter (一) --- 批判理論之兩大理論流派的淺述 --- p.81 / Chapter (二) --- 批判理論學者之觀點的演進與歸納 --- p.82 / Chapter (三) --- 中國老年照顧服務情境下對批判理論的解讀 --- p.86 / Chapter 1. --- 傳統的理論範式分析路徑及其實踐意義 --- p.86 / Chapter 2. --- 理念再定義對研究實踐的補充 --- p.88 / Chapter 二、 --- 對質化研究方法的選擇依據 --- p.90 / Chapter 三、 --- 關於研究設計（表一~表四） --- p.92 / Chapter (一) --- 目標人群與研究地域的揀選 --- p.93 / Chapter 1. --- 不同類型的服務提供者與服務使用者 --- p.93 / Chapter 2. --- 對廣州A街道與南京B街道的聚焦 --- p.95 / Chapter (二) --- 訪談對象的選擇與獲取渠道 --- p.100 / Chapter (三) --- 多元資料收集 --- p.101 / Chapter 1. --- 文獻資料 --- p.102 / Chapter 2. --- 觀察法 --- p.105 / Chapter 3. --- 聚焦訪談 --- p.109 / Chapter 4. --- 深度訪談 --- p.110 / Chapter (四) --- 嚴謹度之策略詳析 --- p.114 / Chapter 1. --- 可信度的保障標準 --- p.114 / Chapter 2. --- 對可信度的干擾因素 --- p.116 / Chapter 3. --- 保障可信度的策略 --- p.117 / Chapter (五) --- 分析方法的選用 --- p.119 / Chapter (六) --- 倫理因素的考量 --- p.120 / Chapter (七) --- 反思與自我反省 --- p.122 / Chapter 第二部分 --- 資料分析與對比 / Chapter 第一章 --- 廣州地區的資料分析 --- p.126 / Chapter 一、 --- 宏觀層面的資料分析 --- p.127 / Chapter (一) --- 荔灣區“A街道家庭綜合服務中心--“A長者家園之“混合模式 --- p.128 / Chapter 1. --- 民政部門的反思 --- p.130 / Chapter 2. --- 社會組織的融入與反思 --- p.133 / Chapter 3. --- 街道辦事處/居民委員會的行政職能轉化 --- p.140 / Chapter 二、 --- 中觀層面的資料分析 --- p.142 / Chapter (一) --- “A長者家園之社區居家養老服務 --- p.142 / Chapter 1. --- 居家養老服務--到戶服務 --- p.143 / Chapter 2. --- 社區長者服務--中心服務 --- p.149 / Chapter 3. --- 日托服務 --- p.157 / Chapter 三、 --- 微觀層面的資料分析 --- p.160 / Chapter (一) --- 老年服務使用者、護老者的角度對具體服務輸送環節的評價 --- p.160 / Chapter 1. --- 老年服務使用者的角度 --- p.161 / Chapter 2. --- 部分護老者的角度 --- p.167 / Chapter (二) --- 具體服務輸送環節中的專業服務理念 --- p.170 / Chapter 1. --- 參與理念在不同服務類型中的各式表達 --- p.171 / Chapter 2. --- 增權理念在不同服務類型中的各式表達 --- p.175 / Chapter 四、 --- 廣州地區的資料分析小結 --- p.179 / Chapter 第二章 --- 南京地區的資料分析 --- p.182 / Chapter 一、 --- 宏觀層面的資料分析 --- p.184 / Chapter (一) --- 建鄴區B街道之社區管理體制改革--“一委一居一站的行政架構 --- p.184 / Chapter 1. --- 社區管理體制改革在改什麼？ --- p.185 / Chapter 二、 --- 中觀層面的資料分析 --- p.191 / Chapter (一) --- 社區管理體制改革框架下之社區居家養老服務理念面面觀 --- p.191 / Chapter 1. --- 街道幹部的角度 --- p.191 / Chapter 2. --- 街道社工的角度 --- p.195 / Chapter 3. --- 老年服務使用者的角度 --- p.199 / Chapter (二) --- 不同社區之間關於社區居家養老服務項目的不同解讀 --- p.201 / Chapter 1. --- B1社區之“失能長者的鄰里幫扶和社區日間照顧服務方案 --- p.202 / Chapter 2. --- B2社區之“Multitude托老養老助殘服務中心 --- p.205 / Chapter 三、 --- 微觀層面的資料分析 --- p.211 / Chapter (一) --- 老年服務使用者、護老者的角度對具體服務輸送環節的評價 --- p.212 / Chapter 1. --- 老年服務使用者的角度 --- p.212 / Chapter 2. --- 街道幹部、街道社工的角度 --- p.214 / Chapter (二) --- 具體服務輸送環節中的專業服務理念 --- p.218 / Chapter 1. --- B1社區之服務方案中的參與理念和增權理念 --- p.218 / Chapter 2. --- B2社區之服務實體中的參與理念和增權理念 --- p.222 / Chapter (三) --- 有關具體服務輸送環節的專業化建設 --- p.223 / Chapter 1. --- 對社區外部服務資源的援引 --- p.223 / Chapter 2. --- 對社區內部服務資源的挖掘 --- p.224 / Chapter 3. --- 對組建社會工作者專業隊伍的認知與倡導 --- p.227 / Chapter 四、 --- 南京地區的資料分析小結 --- p.229 / Chapter 第三章 --- 廣州與南京之資料對比 --- p.232 / Chapter 一、 --- 宏觀層面的資料對比（圖二~圖三） --- p.233 / Chapter (一) --- 廣州A街道：尋求服務模式的“第三條道路 --- p.233 / Chapter 1. --- 三角頂端之民政部門的表率與三角兩端之專業化與行政化的依存 --- p.234 / Chapter (二) --- 南京B街道：由“委居站架构所引发的对社区内涵的再思 --- p.239 / Chapter 1. --- 服務型社區？擬或是行政型社區？ --- p.239 / Chapter (三) --- 宏觀層面對比之小結（表五） --- p.242 / Chapter 二、 --- 中觀層面的資料對比 --- p.245 / Chapter (一) --- 社區居家養老服務的概念化 --- p.245 / Chapter 1. --- 廣州：“廣義的社區居家養老服務 --- p.245 / Chapter 2. --- 南京：“在社區裡的居家養老服務 --- p.249 / Chapter (二) --- 社區居家養老服務的操作化 --- p.252 / Chapter 1. --- 廣州：不同服務類型之間分野与独立性的彰显 --- p.252 / Chapter 2. --- 南京：服務方案的形式與實體的形式 --- p.260 / Chapter (三) --- 中觀層面對比之小結（表六） --- p.267 / Chapter 三、 --- 微觀層面的資料對比 --- p.272 / Chapter (一) --- 廣州：服務使用者的參與、增權 --- p.273 / Chapter 1. --- 服務使用者在三種服務類型中的參與 --- p.274 / Chapter 2. --- 服務使用者在三種服務類型中的增權 --- p.281 / Chapter (二) --- 南京：服務使用者的參與、增權 --- p.283 / Chapter 1. --- 服務使用者在服務中的參與 --- p.284 / Chapter 2. --- 服務使用者在服務中的增權 --- p.289 / Chapter 3. --- 從服務關係中尋找服務導向的軌跡 --- p.292 / Chapter (三) --- 微觀層面對比之小結（表七） --- p.298 / Chapter 四、 --- 廣州與南京地區之資料對比小結 --- p.303 / Chapter 第三部分 --- 討論、啟示與總結 / Chapter 第一章 --- 討論部分 --- p.311 / Chapter 一、 --- 宏觀層面的理論與理念歸納 --- p.313 / Chapter (一) --- “服務情境--服務項目的互動論 --- p.313 / Chapter 1. --- 互動結構上的服務內嵌與服務從屬 --- p.313 / Chapter 2. --- 互動關係中的行政搭橋與行政本位主義 --- p.314 / Chapter 3. --- 社區服務情境的建設與社區行政情境的建設 --- p.314 / Chapter 二、 --- 中觀層面的理論與理念歸納 --- p.316 / Chapter (一) --- 理念與實踐的交互作用 --- p.316 / Chapter 1. --- 服務項目“本質上的超越和“形式上的變換 --- p.316 / Chapter (二) --- “項目超越--理念滲透的互動效應 --- p.319 / Chapter 1. --- 廣州A街道之“服務項目的實質超越與服務效益最大化 --- p.319 / Chapter 2. --- 南京B街道之“服務項目的形式變換與服務性理念的何去何從 --- p.320 / Chapter 三、 --- 微觀層面的理論與理念歸納 --- p.321 / Chapter (一) --- 漸進式的參與階梯：宏觀與微觀之間的橋樑 --- p.321 / Chapter 1. --- 廣州A街道之“通往公民參與的制度化培養 --- p.321 / Chapter 2. --- 南京B街道之“等待參與理念的意識啟蒙 --- p.322 / Chapter (二) --- 情境中的增權 --- p.324 / Chapter 1. --- 廣州A街道之“增權情境中的理念踐行 --- p.325 / Chapter 2. --- 南京B街道之“科層式權力格局下的理念火花 --- p.326 / Chapter 四、 --- 宏觀、中觀、微觀三大層面的內在串聯（圖四圖六） --- p.327 / Chapter (一) --- 宏觀、中觀、微觀三大研究面向之內在聯動 --- p.327 / Chapter (二) --- 我國城市社區居家養老服務概念框架圖的再思：抽象化和具體化 --- p.330 / Chapter 第二章 --- 啟示部分 --- p.335 / Chapter 一、 --- 政策建議 --- p.336 / Chapter (一) --- 社區居家養老服務政策制定背後的多元意識形態再表達 --- p.336 / Chapter 1. --- 福利意識形態的政策表達 --- p.337 / Chapter 2. --- 服務意識形態的政策表達 --- p.338 / Chapter 3. --- 專業意識形態的政策表達 --- p.339 / Chapter (二) --- 多元相關政策的制定：圍繞社區居家養老服務政策的聯動效應（圖七） --- p.340 / Chapter 1. --- 政府購買服務給付標準的政策規定 --- p.341 / Chapter 2. --- 對服務型非政府組織的扶持政策 --- p.342 / Chapter 3. --- 對機構養老服務的政策再思和對“機構養老在地化的政策扶持 --- p.344 / Chapter 4. --- 策劃有關長期照顧制度的政策提議 --- p.346 / Chapter 二、 --- 實務建議 --- p.348 / Chapter (一) --- 組織進社區的過渡性服務實踐 --- p.349 / Chapter (二) --- 街道社工服務認受性的“上通下達 --- p.350 / Chapter 第三章 --- 總結部分 --- p.353 / Chapter 一、 --- 研究發現對研究問題的回應 --- p.353 / Chapter (一) --- 宏觀層面的回應：服務情境中透顯出的老年福利觀--多元性和剩餘性 --- p.353 / Chapter (二) --- 中觀層面的回應：服務項目透顯出的超越--本質的超越和形式的超越 --- p.355 / Chapter (三) --- 微觀層面的回應：關鍵性專業服務理念--維繫宏觀與微觀之間的橋樑 --- p.356 / Chapter 二、 --- 研究貢獻 --- p.357 / Chapter (一) --- 研究貢獻 --- p.357 / Chapter (二) --- 研究局限 --- p.359 / Chapter (三) --- 進一步研究的必要性 --- p.362 / Chapter 三、 --- 結語 --- p.362 / 主要參考書目 --- p.366

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

熊躍根. / 論文(博士)--香港中文大學社會工作學部, 1998. / 參考文獻: p. 192-213. / 中英文摘要. / Available also through the Internet via Dissertations & theses @ Chinese University of Hong Kong. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Xiong Yuegen. / Lun wen (Bo shi)--Xianggang Zhong wen da xue she hui gong zuo xue bu, 1998. / Can kao wen xian: p. 192-213. / Zhong Ying wen zhai yao.

Chan, Hung Yee. / Thesis submitted in: December 2007. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 121-142). / Abstracts in English and Chinese. / LIST OF TABLES --- p.xi / Chapter CHAPTER 1 --- INTRODUCTION / The Hong Kong context --- p.1 / The research problem --- p.3 / Conclusion --- p.4 / Chapter CHAPTER 2 --- LITERATURE REVIEW / Introduction --- p.6 / Different interpretations of dementia --- p.7 / Experiences of caregivers of older people with dementia --- p.10 / Factors affecting caregiving experiences --- p.15 / Needs of family caregivers --- p.20 / Summary --- p.23 / Chapter CHAPTER 3 --- METHODOLOGY / Introduction --- p.25 / Aim and objectives --- p.25 / Research design --- p.25 / Sampling method --- p.26 / Data collection method --- p.28 / Pilot study --- p.32 / Data analysis --- p.34 / Validity and reliability --- p.37 / Ethical consideration --- p.40 / Summary --- p.41 / Chapter CHAPTER 4 --- RESULTS / Introduction --- p.42 / Demographic characteristics of informants and older people with dementia --- p.43 / Reasons of caregivers for providing home care --- p.45 / Meaning of care --- p.52 / Perceived difficulties in caregiving role --- p.56 / Sources of stress in the caregiving role --- p.59 / Sources of support in caregiving role --- p.62 / Needs of caregivers --- p.65 / Conclusion --- p.69 / Chapter CHAPTER 5 --- DISCUSSION / Introduction --- p.71 / Reason of providing home care --- p.72 / Chinese cultural influences on family caregiving experiences --- p.80 / Perceived difficulties in caregiving roles --- p.91 / Sources of stress --- p.96 / Sources of support in caregiving role --- p.101 / Needs of family caregivers --- p.104 / Conclusion --- p.108 / Chapter CHAPTER 6 --- CONCLUSION / Introduction --- p.110 / Implications to nursing knowledge --- p.110 / Implications to current practice --- p.112 / Limitation of the study --- p.114 / Recommendation to future research areas --- p.116 / Conclusion --- p.118 / REFERENCES --- p.121 / APPENDICES / Chapter Appendix 1 --- "Approval letter from Survey Ethics Committee, CUHK" --- p.143 / Chapter Appendix 2 --- Information letter to informant (English) --- p.144 / Chapter Appendix 3 --- Information letter to informant (Chinese) --- p.145 / Chapter Appendix 4 --- Interview guide --- p.146 / Chapter Appendix 5 --- An example of transcript of interview and preliminary analysis --- p.147 / Chapter Appendix 6 --- Letter of Access --- p.162