No / In a developing country such as South Africa, where needs surpass resources, elderly persons living in institutional care due to dementia are generally viewed as well-cared for if their basic needs for security, food and personal hygiene are met. Due to the disabling effect of the condition, residents are often unable to engage independently in occupations that they find meaningful, requiring staff support to enable them to do this. In South Africa staff training on dementia and person-centred care (PCC) is limited, which in turn impacts on how staff interact with residents. This often results in persons with dementia being deprived of opportunities for engagement and occupation that have the potential to bring about well-being. The first author conducted an initial pilot feasibility study to assess Dementia Care Mapping (DCM), a method used internationally to help improve the quality of formal dementia care, at three identified residential care facilities in South Africa. DCM is an observational tool that involves observing care from the perspective of the person with dementia. This paper examines whether DCM could be used as a means to develop quality dementia care in formalcare settings in South Africa despite a lack of human and financial resources.

Yes / Area level factors, such as deprivation and urban/rural settings, have been associated with variation in local resources and services and health inequality in later life. The aim of this study is to investigate the potential impact of deprivation and urban/rural areas on capability to live well with dementia and to examine whether availability of informal carers modified the associations. The analysis was based on a large cohort study of 1547 community-dwelling people with dementia across Great Britain. Quality of life, life satisfaction, and well-being were measured as indices of "living well." Multivariate modelling was used to investigate differences in living well measures across deprivation quintiles and urban/rural areas adjusting for sociodemographic factors and number of comorbidities and stratifying by three groups: those living with a carer, those with a noncoresident carer and those without a carer. Negative dose-response relationships between deprivation and measures of quality of life (-2.12; 95% CI: -3.52, -0.73), life satisfaction (-1.27; 95% CI: -2.70, 0.16), and well-being (-5.24; 95% CI: -10.11, -0.36) were found in participants living with a carer. The associations were less clear in those with a noncoresident carer and those without a carer but these two groups generally reported lower scores on living well indicators than participants living with a carer. There was no urban/rural difference. The findings suggest inequalities in living well with dementia according to levels of deprivation. Additional resources are needed to improve postdiagnostic care in highly deprived areas and support those who have no informal carer.

Yes / and Objectives: There is a growing evidence base that informal caregivers can identify positive aspects of providing care and that this may have a beneficial influence on their well-being. The aim of this systematic review was to explore how positive aspects of caregiving (PAC) affects the well-being of caregivers of people with dementia. Research Design and Methods: We searched electronic databases for quantitative studies exploring the association between PAC and caregiver well-being. Studies were included if they involved informal (unpaid) caregivers of people with dementia, at least 75% of whom had to be residing in the community. A narrative synthesis was used to explore patterns within the data. Results: Fifty-three studies were included in the narrative synthesis. Most studies utilized a cross-sectional design. The majority of samples consisted primarily of spouses and female caregivers. Twenty different PAC measures were employed and studies referred to a variety of constructs, such as satisfactions, gains, meaning, and rewards. PAC was associated with lower depressive symptoms and burden. Conversely, PAC was associated with better mental health, quality of life, satisfaction with life, and competence/self-efficacy. PAC was not associated with self-rated health or personal strain/stress. Discussion and Implications: The findings suggest that identifying PAC is associated with better caregiver well-being, although further longitudinal studies are required to explore how this relationship changes over time. Interventions that enable caregivers to gain a more positive experience of caregiving could be beneficial for their well-being.

Yes / . Negative impacts of the COVID-19 pandemic on people with dementia have been widely-documented, but most studies have relied on carer reports and few have compared responses to information collected before the pandemic. Objective. We aimed to explore the impact of the pandemic on community-dwelling individuals with mild-to-moderate dementia and compare responses with pre-pandemic data. Methods. During the second wave of the pandemic we conducted structured telephone interviews with 173 people with dementia and 242 carers acting as informants, all of whom had previously participated in the IDEAL cohort. Where possible we benchmarked responses against pre-pandemic data. Results. Significant perceived negative impacts were identified in cognitive and functional skills and ability to engage in self-care and manage everyday activities, along with increased levels of loneliness and discontinuity in sense of self and a decline in perceived capability to ‘live well’. Compared to pre-pandemic data there were lower levels of pain, depression and anxiety, higher levels of optimism, and better satisfaction with family support. There was little impact on physical health, mood, social connections and relationships, or perceptions of neighbourhood characteristics. Conclusion. Efforts to mitigate negative impacts of pandemic-related restrictions and restore quality of life could focus on reablement to address the effects on participation in everyday activities, creating opportunities for social contact to reduce loneliness, and personalised planning to reconnect people with their pre-COVID selves. Such efforts may build on the resilience demonstrated by people with dementia and carers in coping with the pandemic. / ‘Identifying and mitigating the individual and dyadic impact of COVID-19 and life under physical distancing on people with dementia and carers (INCLUDE)’ was funded by the Economic and Social Research Council (ESRC) through grant ES/V004964/1. Investigators: Clare, L., Victor, C., Matthews, F., Quinn, C., Hillman, A., Burns, A., Allan, L., Litherland, R., Martyr, A., Collins, R., & Pentecost, C. ESRC is part of UK Research and Innovation (UKRI). ‘Improving the experience of Dementia and Enhancing Active Life: living well with dementia. The IDEAL study’ was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health Research (NIHR) through grant ES/L001853/2. Investigators: L. Clare, I.R. Jones, C. Victor, J.V. Hindle, R.W. Jones, M. Knapp, M. Kopelman, R. Litherland, A. Martyr, F.E. Matthews, R.G. Morris, S.M. Nelis, J.A. Pickett, C. Quinn, J. Rusted, J. Thom. ESRC is part of UK Research and Innovation (UKRI). IDEAL data were deposited with the UK data archive in April 2020 and will be available to access from April 2023. Details of how the data can be accessed after that date can be found here: http://reshare.ukdataservice.ac.uk/854293/ ‘Improving the experience of Dementia and Enhancing Active Life: a longitudinal perspective on living well with dementia. The IDEAL-2 study’ is funded by Alzheimer’s Society, grant number 348, AS-PR2-16-001. Investigators: L. Clare, I.R. Jones, C. Victor, C. Ballard, A. Hillman, J.V. Hindle, J. Hughes, R.W. Jones, M. Knapp, R. Litherland, A. Martyr, F.E. Matthews, R.G. Morris, S.M. Nelis, C. Quinn, J. Rusted. L. Clare acknowledges support from the NIHR Applied Research Collaboration South-West Peninsula. The views expressed are those of the author(s) and not necessarily those of the ESRC, UKRI, NIHR, the Department of Health and Social Care, the National Health Service, or Alzheimer’s Society. The support of ESRC, NIHR and Alzheimer’s Society is gratefully acknowledged.

Yes / Global initiatives that promote public health responses to dementia have resulted in numerous countries developing new national policies. Current policy guidelines in England, for example, recommend that people diagnosed with mild-to-moderate dementia receive information and psychosocial interventions to improve their ability to ‘live well’. However, it remains unclear to what extent these recommendations are being achieved. Methods: Self-reported information from 1537 people living with dementia and informant-reported information from 1277 carers of people living with dementia was used to quantify receipt of community-based dementia support services, including health and social care services provided by statutory or voluntary-sector organisations, in Britain from 2014 to 2016. Demographic factors associated with differences in receipt of support services were also investigated to identify particularly vulnerable groups of people living with dementia. Results: Both self- and informant reports suggested that approximately 50% of people living with dementia received support services for dementia. Receipt of support services was lower among people living with dementia who are older, female, and have fewer educational qualifications. Receipt of support services also differed according to diagnosis and carer status, but was unrelated to marital status. Conclusions: Limited receipt of dementia support services among people living with dementia in Britain provides a baseline to assess the efficacy of current policy guidelines regarding provision of information and support. Targeted efforts to facilitate receipt of support services among the particularly vulnerable groups identified in the current study could improve the efficacy of dementia support services both in Britain and internationally, and should inform policy development. / The IDEAL study’ was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health Research (NIHR) through grant ES/L001853/2. The IDEAL‐2 study’ is funded by Alzheimer's Society, grant number 348,AS‐PR2‐16‐001.

Yes / The increasing heterogeneity of the population of older people is reflected in an increasing number of people with dementia and carers drawn from minority ethnic groups. Data from the IDEAL study are used to compare indices of 'living well' among people with dementia and carers from ethnic minority groups with matched white peers. We used an exploratory cross-sectional case-control design to compare 'living well' for people with dementia and carers from minority ethnic and white groups. Measures for both groups were quality of life, life satisfaction, wellbeing, loneliness, and social isolation and, for carers, stress, relationship quality, role captivity and caring competence. The sample of people with dementia consisted of 20 minority ethnic and 60 white participants and for carers 15 and 45 respectively. People with dementia from minority ethnic groups had poorer quality of life (-4.74, 95% CI: -7.98 to -1.50) and higher loneliness (1.72, 95% CI: 0.78-2.66) whilst minority ethnic carers had higher stress (8.17, 95% CI: 1.72-14.63) and role captivity (2.00, 95% CI: 0.43-3.57) and lower relationship quality (-9.86, 95% CI: -14.24 to -5.48) than their white peers. Our exploratory study suggests that people with dementia from minority ethnic groups experience lower quality of life and carers experience higher stress and role captivity and lower relationship quality than their white peers. Confirmatory research with larger samples is required to facilitate analysis of the experiences of specific minority ethnic groups and examine the factors contributing to these disadvantages. / Economic and Social Research Council. National Institute for Health and Care Research. Grant Number: ES/L001853/2

Atualmente, as pesquisas sobre qualidade de vida relacionada à saúde (QVRS) de pacientes com câncer têm contribuído para o planejamento de cuidado integral ao paciente e familiar. Este estudo teve como objetivo avaliar a QVRS de pacientes oncológicos, sem possibilidades terapêuticas de cura, de acordo com as dimensões do instrumento EORTC QLQ C-30 e sua associação com os aspectos sociodemográficos e clínicos. O referencial adotado foi o de QVRS de Ashing-Giwa. Trata-se de um estudo analítico, de corte transversal, realizado em João Pessoa - PB, com amostragem por conveniência. As entrevistas foram norteadas por dois instrumentos, o de caracterização sociodemográfica e clínica e o de avaliação de qualidade de vida - EORTC QLQ C-30. O estudo acatou as observâncias éticas normatizadas para pesquisas com seres humanos. Participaram 127 pacientes, sendo 59,1% mulheres, idade média de 63 anos; 43,3% casados e 44,1% tinham de 1 a 3 filhos; 40,9% com ensino fundamental; 72,4% católicos; 81,9% não praticavam atividade física. Quanto à situação financeira, 52,8% eram aposentados; 85,8% recebiam mensalmente de 1 a 3 salários mínimos; e 98,4% não tinham plano de saúde privado. Na caracterização clínica, o câncer foi mais prevalente nas mulheres (58,3%), com localização primária do tumor mais citado no útero, ovário, mama e colorretal, e nos homens o tumor se apresentou significativamente na cabeça, pescoço, próstata e pulmão. Tempo de diagnóstico menor que seis meses foi encontrado em 48,8% da amostra; 58,3% tinham tumor com disseminação regional e distante; 52,8% com metástase; 63,0% realizaram biópsia; 57,5% e 51,2% não realizaram radioterapia nem quimioterapia, respectivamente, e 78,0% estavam há menos de um mês hospitalizados. Os sintomas mais prevalentes foram dor (89,8%), fadiga (70,9%) e anorexia (53,5%). Na avaliação pelo EORTC QLQ-C30, os resultados com pior avaliação foram para o Estado de Saúde Global e Função Desempenho de Papel; na Escala de Sintomas, dor, fadiga, insônia e perda do apetite tiveram destaque bem como na escala Dificuldade Financeira. Na associação dos domínios do EORTC QLQ-C30, com as variáveis sociodemográficas, houve associação significativa (p<0,05) da faixa etária e escolaridade com Função Cognitiva; e renda mensal com Estado Geral de Saúde. Já com as variáveis clínicas, houve extensão da doença e metástase com Função Física; radioterapia com Função Social; e tempo de hospitalização com Escala Funcional. Na associação dos itens da Escala de Sintomas houve associação significativa de fadiga com extensão da doença, metástase, quimioterapia e tempo de hospitalização; dor com quimioterapia e tempo de hospitalização; insônia com procedimento cirúrgico; e perda de apetite com quimioterapia. A associação dos escores da escala Dificuldade Financeira com variáveis sociodemográficas mostrou resultado significativo com situação laboral atual, fonte de renda, renda mensal e situação financeira. E com variáveis clínicas, foi encontrada associação com tempo de hospitalização e com diabetes. Os resultados mostraram que os aspectos sociodemográficos e clínicos da população do estudo afetaram de forma significativa sua QVRS, principalmente com relação aos domínios Função Física e Função Cognitiva. Assim, o prejuízo na capacidade funcional, pelo impacto de uma doença como o câncer, afeta a capacidade de desempenhar suas atividades de vida diária, suas relações sociais, e sobremaneira, sua situação financeira / Nowadays, the pieces of research on quality of life related to the health (HRQoL) of patients with cancer have contributed to the whole care plan devoted to the patient and family member. This study aimed at evaluating the HRQoL to the oncology patients, with no therapeutic healing possibilities, according to the dimensions of the EORTC QLQ C-30 and its association with the socio-demographic and clinical aspects. Ashing-Giwa´s HRQoL was the reference adopted. It is an analytical and cross-sectional study carried out in João Pessoa - PB, with convenience sampling. The interviews were guided by two instruments: the socio- demographic and clinical characterization and the evaluation of quality of life - EORTC QLQ C-30. The study accepted the ethical observance ruled by pieces of research with human beings. A total of 127 patients took part in the research, being 59,1% women, mean age 63 years old; 43,3% married and 44,1% had 1 to 3 children; 40,9% with elementary education level; 72,4% catholic; 81,9% did not practice physical activity. In regard to the financial situation, 52,8% were retired; 85,8% received 1 to 3 minimum wages monthly; and 98,4% had no private health plan. In the clinical characterization, cancer was more prevalent in women (58,3%), with tumor primary locus in the uterus, ovary, breast and colorectal whereas in men, the tumor was meaningfully present in the head, neck, prostate and lung. Diagnosis period less than six months was found in 48,8% of the sample; 58,3% had tumor with regional and distant dissemination; 52,8% with metastasis; 63,0% fulfilled biopsy; 57,5% and 51,2% were submitted neither to radiotherapy nor to chemotherapy, respectively, and 78,0% had been hospitalized for less than a month. The most prevalent symptoms were pain (89,8%), fatigue (70,9%) and anorexia (53,5%). With reference to the EORTC QLQ-C30 assessment, the results with the worst evaluation were for the Global Health Status and Performance Status; in the Symptoms Scale, pain, fatigue, insomnia and appetite loss were highlighted as well as in the Financial Difficulty Scale. In the association of EORTC QLQ-C30 domains with the socio-demographic variables, there was meaningful association (p<0,05) of age group and education level with Cognitive Function; and monthly income with Global Health Status. With the clinical variables, there was length of the disease and metastasis with the Physical Function; radiotherapy with the Social Function; and the hospitalization period with the Functional Scale. While associating the items of the Symptom Scale, there was meaningful association of fatigue with the length of the disease, metastasis, chemotherapy and the hospitalization period; pain with chemotherapy and period of hospitalization; insomnia with surgical procedure; and appetite loss with chemotherapy. Score association of the Financial Difficulty Scale, with socio-demographic variables, showed meaningful result with the current work condition, income source, monthly income and financial situation. Concerning the clinical variables, there was association with the hospitalization period and with diabetes. Results showed that the clinical and socio-demographic aspects of the studied population affected meaningfully their HRQoL, especially, with reference to the Physical Function and Cognitive Function domains. Therefore, the damage regarding the functional capacity, by the impact of a disease as cancer, affects the capacity of performing their daily life activities, their social relations, and overall, their financial situation

Fan Chi Fun, Cindy. / Thesis (M.Ph.)--Chinese University of Hong Kong, 1984 / Bibliography: leaves 236-245

Chu Kwok-chung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1991. / Includes bibliographical references. / Abstract --- p.i / Acknowledgements --- p.ii / List of Illustrations --- p.v / List of Tables --- p.vii / List of Appendix --- p.ix / Chapter / Chapter 1. --- "INTRODUCTION: THE PROBLEMS, OBJECTIVE AND ITS SETTING" --- p.1 / Chapter 1.1 --- Urbanization as a current subject of great concern --- p.1 / Chapter 1.2 --- Urbanization Policies in China --- p.2 / Chapter 1.3 --- Shift of social concern to social well-being (SWB) in national development --- p.5 / Chapter 1.4 --- The problems --- p.6 / Chapter 1.5 --- Objective of this study --- p.8 / Chapter 1.6 --- The scope of the study --- p.9 / Chapter 1.7 --- The organization of the remainder of the thesis --- p.9 / Chapter 2. --- CONCEPTUAL BACKGROUND --- p.11 / Chapter 2.1 --- Definition of Spatial inequality --- p.11 / Chapter 2.2 --- Types of spatial inequalities and different levels and units of analysis in China --- p.12 / Chapter 2.3 --- Definition of Social Well-being --- p.16 / Chapter 2.4 --- Ingredient of Social Well-being --- p.16 / Chapter 2.5 --- The present selection of the ingredient of SWB --- p.18 / Chapter 2.6 --- Characteristics of welfare goods allocation in China --- p.22 / Chapter 2.7 --- Two approaches in measuring spatial inequalities of SWB --- p.25 / Chapter 2.7.1 --- Single component approach --- p.26 / Chapter 2.7.2 --- Integrated approach --- p.27 / Chapter 3. --- RESEARCH DESIGN --- p.32 / Chapter 3.1 --- Procedure of analysis --- p.32 / Chapter 3.2 --- Assumptions and approximation --- p.34 / Chapter 3.3 --- Techniques of analysis and Treatment of Data --- p.35 / Chapter 3.3.1 --- Measuring spatial inequality via single variable --- p.35 / Chapter 3.3.2 --- Establishing the composite index of SWB --- p.37 / Chapter 3.3.3 --- Unit of analysis (UOA) and level of aggregation (LOA) --- p.41 / Chapter 3.3.4 --- Analyzing the association between the composite index and some economic variables --- p.45 / Chapter 4. --- SPATIAL INEQUALITY IN SEVERAL WELFARE INDICATORS OF CHINESE CITIES IN THE 1980s --- p.48 / Chapter 4.1 --- Spatial inequality by single indicators --- p.48 / Chapter 4.1.1 --- Income and Wealth --- p.48 / Chapter 4.1.2 --- Living facilities --- p.63 / Chapter 4.1.3 --- Education --- p.69 / Chapter 4.1.4 --- Medical facilities --- p.72 / Chapter 4.2 --- Summary --- p.76 / Chapter 5. --- SPATIAL PATTERN OF SOCIAL WELL-BEING OF CHINESE CITIES IN THE 1980s --- p.78 / Chapter 5.1 --- Spatial pattern of social well-being of individual citie --- p.78 / Chapter 5.2 --- Results of different levels of aggregation of UOA --- p.105 / Chapter 5.2.1 --- SWB by City-class level --- p.105 / Chapter 5.2.2 --- SWB by provincial level --- p.107 / Chapter 5.2.3 --- SWB by Economic regions level --- p.110 / Chapter 5.3 --- Summary --- p.113 / Chapter 6. --- POSSIBLE FACTORS AFFECTING INEQUALITY OF URBAN SWB AND IMPLICATIONS ON CHINA'S URBANIZATION POLICIES --- p.116 / Chapter 6.1 --- Economic factors -- Influence of economic variables on urban SWB --- p.116 / Chapter 6.2 --- Policy factor - the formation of the urban SWB pattern --- p.123 / Chapter 6.2.1 --- Differentials of urban development due to biased priorities and conceptualization of cities --- p.124 / Chapter 6.2.2 --- Urbanization policies -- population control polic --- p.132 / Chapter 6.2.3 --- The population control policy and the welfare services provision --- p.139 / Chapter 6.3 --- Examples -- the stories of two provincial capitals --- p.141 / Chapter 6.3.1 --- Lanzhou --- p.142 / Chapter 6.3.2 --- Kunming --- p.148 / Chapter 6.4 --- Implication on China's urbanization policies --- p.151 / Chapter 7. --- "SUMMARY, CONCLUSION AND RECOMMENDATIONS FOR FURTHER RESEARCH" --- p.158 / Chapter 7.1 --- Summary of findings --- p.158 / Chapter 7.2 --- Limitations of this study --- p.164 / Chapter 7.3 --- Directions for further research --- p.167 / Appendix / Bibliography

研究背景：婦科癌症的診斷及各種相關的治療，對性功能、生活質素及心理健康都有負面的影響。文獻指出心理教育對婦科癌症病人這方面的影響有正面的效果，但是效用的証據並不一致。 / 系統化綜述: 本研究首先進行系統化綜述，並根據喬安娜．布里格斯的方法進行，目的在於確定心理教育對婦科癌症病人的性功能、生活質素及心理健康的功效，以及辨認一套有效的心理教育課程給予婦科癌症病人。總共有十一份隨機控制實驗的文獻，包括九百七十五位婦科癌症病人，被納入本綜述，其中四份可比較的文獻進行了薈萃分析。根據兩份評估心理教育對抑鬱功效的文獻薈萃結果顯示，心理教育對改善抑鬱徵狀有顯著的改善。另外兩份文獻評估心理教育對生活質素的功效，薈萃結果顯示心理教育對身理方面的生活質素未有明顯的改善，相反地，提供資訊性的教育對婦科癌症病人心理方面的生活質素有明顯的功效。關於心理教育對性功能的功效，似乎對性生活有所改善，但是並未能在性功能的評估工具反映出來。關於心理教育對心理健康的功效，除了抑鬱以外，似乎未有足夠的証據顯示有顯著的功效。系統化綜述建議心理教育予婦科癌症病人應包括三種元素：資訊提供、行為治療及心理支持；形式可以是個人、個人及伴侶共同參予、或小組；應由護士提供；於癌症治療開始前進行，直至出院後；包括四堂課程，每堂三十分鐘至一小時完成。 / 試驗性研究目的：試驗性研究目的是測試提供一套根據系統化綜述結果設計的心理教育予香港婦科癌症病人的可行性，以及評估該課程對改善香港婦科癌症病人的性功能、生活質素、及心理健康的功效。 / 試驗性研究方法：試驗性研究採用隨機控制實驗的方法，把二十六位婦科癌症病人分配到兩個不同的組別。實驗組的參加者，接受一套心理教育；對照組的參加者於實驗組的同一時段收到研究員的訪問。不論哪個組別的參加者，都會進行指標評估，包括性功能、生活質素、不明朗、社交支持、焦慮及抑鬱的狀況。研究指標分別在手術前(T0)、手術後及住院期間(T1)，和手術後8星期(T2)。實驗組的參加者及於臨床工作的護士更會被邀請進行了簡單的傾談，從而了解她們對此心理教育的意見及感受。非參數統計推斷方法用以檢驗組內和組間於上述各指標的差異。實驗組的參加者及護士參予的面談，會進行錄音及內容分析。 / 研究結果：於兩組之間的比較，實驗組的參加者對疾病資料的不一致，有顯著的改善。但是，兩組之間的性功能、生活質素、不明朗、社交支持、焦慮及抑鬱均未有顯著的分別。參加者於面談中指出，心理教育可減低婦科癌症病人的壓力，對她們來說有著實際的用途。 / 研究結論：系統化綜述顯示心理教育對婦科癌症病人有正面的功效。雖然試驗性研究的定量資料結果指出心理教育對香港的婦科癌症病人，除了對疾病資料的不一致有所改善外，在其他各方面的評估，均未有顯著的功效，但是，品質數據的結果顯示婦科癌症病人確實需要心理教育，而此教育於臨床環境實行是可行的。 / Background: A diagnosis and treatment of gynecological cancer (GC) has adverse effects on the sexual functioning, quality of life and psychological outcomes of patients. Psychoeducational interventions (PEIs) are recommended for GC patients to improve their outcomes, but evidence for their effectiveness is far from conclusive. / Systematic review: A systematic review was first carried out according to the Joanna Briggs Institute (JBI) approach to identify the best available evidence relating to the effectiveness of PEIs for GC patients in sexual functioning, quality of life and psychological outcomes. A total of 11 randomized controlled trials (RCTs) involving 975 GC patients were included in the systematic review, but only four comparable studies were appropriate for meta-analysis. PEIs significantly improved depressive symptoms, standardized mean difference (SMD) = -0.80, 95% CI [-1.05 to -0.54], p = < .00001, among the patients. However, there was no significant benefit to the physical aspect of quality of life, SMD = -0.12, 95% CI [-0.45 to 0.20], p = .46. Conversely, information-only therapy demonstrated significant effects on the mental aspects of quality of life, SMD = -0.41, 95% CI [-0.74 to -0.08], p = .01. In addition, from qualitative data, PEIs appeared to be helpful in improving sexual life, but changes in sexual functioning scores were not statistically significant. The interventions appeared to have only limited beneficial effect on anxiety, distress, adjustment to illness and uncertainty, and had no significant effect in improving mood, self-esteem or ability to cope. The review also suggested that PEIs for GC patients would incorporate information provision, behavior therapy and psychological support. The format might be individual, with or without a partner’s participation, or in a group. A nurse was found to be the ideal provider. The interventions could be arranged at the start of cancer treatment and then be continued after discharge, and the number of sessions might be four, each lasting between 30 minutes and one hour. / Aim of pilot study: A program of PEIs was designed based on the systematic review, and piloted on Hong Kong GC patients to test the feasibility and effectiveness of implementing the interventions in Hong Kong. / Pilot research plan: The pilot study was a single-blinded RCT and mix-method design. Twenty-six subjects were randomly assigned to either the intervention or attention control group. The intervention group received the program of PEIs, while the attention control group received attention from the researcher over the same period. Data collection was carried out at baseline (T0), after the operation and during the in-hospital period (T1) and eight weeks after the operation (T2). Qualitative data was collected from the intervention group and nurses working in the clinical setting at T2. Non-parametric tests were used to compare the baseline and various outcome variables within and between groups. Audio-tapes of semi-structured interviews were transcribed verbatim, and content analysis was performed to identify significant themes. / Key findings of pilot study: Participants in the intervention group had statistically significantly less inconsistent information on illness than the attention control group, but there were no statistically significant differences in all other outcome variables including sexual functioning, quality of life, uncertainty, social support, anxiety and depression. Qualitative data from the participants indicated the program of PEIs reduced their stress level and was useful. / Conclusion: The systematic review demonstrated evidence of the positive effects of PEIs on GC patients. Although there were no significant effects appearing in most quantitative results of the intervention program in the pilot study, the qualitative results indicated that the interventions were found desirable by Hong Kong GC patients. Nurses identified implementing the program as feasible in clinical settings. / 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. / Chow, Ka Ming. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 185-204). / Abstracts also in Chinese; appendixes includes Chinese. / Chapter CHAPTER 1 --- INTRODUCTION / Chapter 1.1 --- Introduction --- p.1 / Chapter 1.2 --- Aims and significance of the study --- p.4 / Chapter 1.3 --- Overview of the thesis --- p.4 / Chapter CHAPTER 2 --- LITERATURE REVIEW / Chapter 2.1 --- Introduction --- p.6 / Chapter 2.2 --- Impact of GC on sexual functioning --- p.6 / Chapter 2.2.1 --- Mixed types of GC --- p.7 / Chapter 2.2.2 --- Ovarian cancer --- p.10 / Chapter 2.2.3 --- Cervical cancer --- p.11 / Chapter 2.2.4 --- Impact of GC on sexual functioning in Chinese culture --- p.15 / Chapter 2.3 --- Impact of GC on quality of life --- p.18 / Chapter 2.3.1 --- Mixed types of GC --- p.19 / Chapter 2.3.2 --- Cervical cancer --- p.21 / Chapter 2.3.3 --- Impact of GC on quality of life in Chinese culture --- p.24 / Chapter 2.4 --- Impact of GC on psychological well-being --- p.25 / Chapter 2.4.1 --- Mixed types of GC --- p.26 / Chapter 2.4.2 --- Cervical cancer --- p.29 / Chapter 2.4.3 --- Impact of GC on psychological well-being in Chinese culture --- p.30 / Chapter 2.5 --- Current nursing practice on sexuality with GC patients --- p.30 / Chapter 2.5.1 --- Attitudes of health-care professionals towards sexuality --- p.31 / Chapter 2.5.2 --- Information needs of GC patients --- p.33 / Chapter 2.5.3 --- Sexuality assessment --- p.35 / Chapter 2.5.4 --- Sexuality interventions --- p.37 / Chapter 2.6 --- Psychoeducational interventions (PEIs) --- p.38 / Chapter 2.6.1 --- Theoretical background --- p.38 / Chapter 2.6.2 --- Effects of PEIs on cancer patients --- p.40 / Chapter 2.6.3 --- Effects of PEIs on GC patients --- p.42 / Chapter 2.7 --- Summary --- p.44 / Chapter CHAPTER 3 --- SYSTEMATIC REVIEW (PHASE I) / Chapter 3.1 --- Introduction --- p.46 / Chapter 3.2 --- Review objectives and questions --- p.46 / Chapter 3.3 --- Inclusion criteria --- p.48 / Chapter 3.3.1 --- Types of studies --- p.48 / Chapter 3.3.2 --- Types of participants --- p.48 / Chapter 3.3.3 --- Types of interventions --- p.48 / Chapter 3.3.4 --- Types of outcome measures --- p.49 / Chapter 3.4 --- Search strategy --- p.50 / Chapter 3.5 --- Methods of the review --- p.52 / Chapter 3.5.1 --- Assessment of methodological quality --- p.52 / Chapter 3.5.2 --- Data extraction --- p.52 / Chapter 3.5.3 --- Data synthesis --- p.53 / Chapter 3.6 --- Systematic review results --- p.54 / Chapter 3.6.1 --- Description of studies’ retrieval and selection --- p.54 / Chapter 3.6.2 --- Methodological quality of the included studies --- p.57 / Chapter 3.6.2.1 --- Randomization --- p.57 / Chapter 3.6.2.2 --- Blinding --- p.57 / Chapter 3.6.2.3 --- Consent and completion rates --- p.58 / Chapter 3.6.2.4 --- Power estimation --- p.58 / Chapter 3.6.2.5 --- Result data --- p.58 / Chapter 3.6.3 --- Details of the included studies --- p.59 / Chapter 3.6.3.1 --- Country of origin --- p.59 / Chapter 3.6.3.2 --- Samples --- p.59 / Chapter 3.6.3.3 --- Components of PEIs --- p.59 / Chapter 3.6.3.4 --- Comparison group --- p.61 / Chapter 3.6.3.5 --- Format of PEIs --- p.62 / Chapter 3.6.3.6 --- Provider of PEIs --- p.62 / Chapter 3.6.3.7 --- Provision time frame of PEIs --- p.63 / Chapter 3.6.3.8 --- Duration of PEIs --- p.63 / Chapter 3.6.3.9 --- Outcome measurements --- p.64 / Chapter 3.6.4 --- Effects of PEIs on outcomes --- p.64 / Chapter 3.6.4.1 --- Sexual functioning --- p.65 / Chapter 3.6.4.2 --- Quality of life --- p.65 / Chapter 3.6.4.3 --- Psychological outcomes --- p.68 / Chapter 3.6.4.3.1 --- Anxiety and depression --- p.68 / Chapter 3.6.4.3.2 --- Distress --- p.70 / Chapter 3.6.4.3.3 --- Adjustment to illness --- p.71 / Chapter 3.6.4.3.4 --- Mood --- p.71 / Chapter 3.6.4.3.5 --- Self-esteem --- p.72 / Chapter 3.6.4.3.6 --- Uncertainty --- p.72 / Chapter 3.6.4.3.7 --- Coping --- p.72 / Chapter 3.6.4.4 --- Brief summary --- p.72 / Chapter 3.6.5 --- Design of PEIs --- p.73 / Chapter 3.6.5.1 --- Effective components --- p.73 / Chapter 3.6.5.2 --- Effective format --- p.75 / Chapter 3.6.5.3 --- Effective provider --- p.76 / Chapter 3.6.5.4 --- Effective provision time frame --- p.76 / Chapter 3.6.5.5 --- Effective duration --- p.77 / Chapter 3.7 --- Discussion --- p.78 / Chapter 3.7.1 --- Effects of PEIs on sexual functioning --- p.80 / Chapter 3.7.2 --- Effects of PEIs on quality of life --- p.82 / Chapter 3.7.3 --- Effects of PEIs on psychological outcomes --- p.84 / Chapter 3.7.3.1 --- Anxiety and depression --- p.84 / Chapter 3.7.3.2 --- Distress --- p.86 / Chapter 3.7.3.3 --- Adjustment to illness --- p.87 / Chapter 3.7.3.4 --- Mood --- p.87 / Chapter 3.7.3.5 --- Self-esteem --- p.88 / Chapter 3.7.3.6 --- Uncertainty --- p.88 / Chapter 3.7.3.7 --- Coping --- p.89 / Chapter 3.7.4 --- Design of PEIs --- p.89 / Chapter 3.7.4.1 --- Effective components and theories --- p.89 / Chapter 3.7.4.2 --- Effective format --- p.92 / Chapter 3.7.4.3 --- Effective provider --- p.93 / Chapter 3.7.4.4 --- Effective provision time frame --- p.93 / Chapter 3.7.4.5 --- Effective duration --- p.94 / Chapter 3.8 --- Summary of systematic review --- p.95 / Chapter 3.8.1 --- Implications for practice --- p.95 / Chapter 3.8.2 --- Implications for research --- p.97 / Chapter 3.9 --- Summary --- p.100 / Chapter CHAPTER 4 --- METHODOLOGY OF PILOT STUDY (PHASE II) / Chapter 4.1 --- Introduction --- p.102 / Chapter 4.2 --- Rationale for conducting a pilot study --- p.102 / Chapter 4.3 --- Aims and objectives --- p.103 / Chapter 4.4 --- Operational definition --- p.104 / Chapter 4.4.1 --- Psychoeducational interventions (PEIs) --- p.104 / Chapter 4.4.2 --- Sexual functioning --- p.105 / Chapter 4.4.3 --- Quality of life --- p.105 / Chapter 4.4.4 --- Uncertainty --- p.105 / Chapter 4.4.5 --- Anxiety --- p.106 / Chapter 4.4.6 --- Depression --- p.106 / Chapter 4.4.7 --- Social support --- p.106 / Chapter 4.5 --- Interventions --- p.107 / Chapter 4.5.1 --- Program of PEIs --- p.107 / Chapter 4.5.1.1 --- Theoretical framework underpinning the interventions --- p.107 / Chapter 4.5.1.2 --- Components of the program of PEIs --- p.113 / Chapter 4.5.1.2.1 --- Information provision --- p.113 / Chapter 4.5.1.2.2 --- Behavioral therapy --- p.113 / Chapter 4.5.1.2.3 --- Psychological support --- p.114 / Chapter 4.5.1.3 --- Design of the program of PEIs --- p.115 / Chapter 4.5.2 --- Attention control --- p.121 / Chapter 4.5.3 --- Usual care --- p.122 / Chapter 4.6 --- Methodology --- p.123 / Chapter 4.6.1 --- Study design --- p.123 / Chapter 4.6.2 --- Study setting --- p.125 / Chapter 4.6.3 --- Sample --- p.126 / Chapter 4.6.3.1 --- Sampling method --- p.126 / Chapter 4.6.3.2 --- Sample size determination --- p.127 / Chapter 4.6.3.3 --- Recruitment process --- p.128 / Chapter 4.7 --- Data collection --- p.129 / Chapter 4.7.1 --- Measures --- p.129 / Chapter 4.7.2 --- Study instruments --- p.130 / Chapter 4.7.2.1 --- Demographic data sheet --- p.130 / Chapter 4.7.2.2 --- Sexual functioning --- p.131 / Chapter 4.7.2.2.1 --- Justification for choosing the instrument --- p.134 / Chapter 4.7.2.3 --- Quality of life --- p.134 / Chapter 4.7.2.3.1 --- Justification for choosing the instrument --- p.136 / Chapter 4.7.2.4 --- Uncertainty --- p.136 / Chapter 4.7.2.4.1 --- Justification for choosing the instrument --- p.138 / Chapter 4.7.2.5 --- Social support --- p.139 / Chapter 4.7.2.5.1 --- Justification for choosing the instrument --- p.141 / Chapter 4.7.2.6 --- Anxiety and depression --- p.141 / Chapter 4.7.2.6.1 --- Justification for choosing the instrument --- p.143 / Chapter 4.7.2.7 --- Semi-structure interview --- p.144 / Chapter 4.7.2.7.1 --- Intervention recipients --- p.144 / Chapter 4.7.2.7.2 --- Health-care providers --- p.144 / Chapter 4.7.3 --- Data collection procedure --- p.145 / Chapter 4.8 --- Data analysis --- p.149 / Chapter 4.8.1 --- Quantitative data --- p.149 / Chapter 4.8.1.1 --- Comparison of baseline data --- p.151 / Chapter 4.8.1.2 --- Comparison of outcome variables --- p.151 / Chapter 4.8.2 --- Qualitative data --- p.153 / Chapter 4.9 --- Ethical considerations --- p.154 / Chapter 4.1 --- Summary --- p.155 / Chapter CHAPTER 5 --- RESULTS OF THE PILOT STUDY / Chapter 5.1 --- Introduction --- p.156 / Chapter 5.2 --- Recruitment of participants --- p.157 / Chapter 5.3 --- Characteristics of all participants --- p.159 / Chapter 5.3.1 --- Demographic and clinical characteristics --- p.159 / Chapter 5.3.2 --- Homogeneity of the participants --- p.161 / Chapter 5.4 --- Baseline outcome variables --- p.164 / Chapter 5.4.1 --- Baseline outcome variables of all participants --- p.164 / Chapter 5.4.2 --- Comparison of baseline outcome variables between intervention and attention control groups --- p.166 / Chapter 5.5 --- Outcome variables within-group changes --- p.168 / Chapter 5.5.1 --- Quality of life --- p.168 / Chapter 5.5.2 --- Uncertainty --- p.170 / Chapter 5.5.3 --- Social support --- p.174 / Chapter 5.5.4 --- Anxiety and depression --- p.179 / Chapter 5.6 --- Outcome variables between-group changes --- p.181 / Chapter 5.6.1 --- Sexual functioning --- p.181 / Chapter 5.6.2 --- Quality of life --- p.184 / Chapter 5.6.3 --- Uncertainty --- p.185 / Chapter 5.6.4 --- Social support --- p.187 / Chapter 5.6.5 --- Anxiety and depression --- p.190 / Chapter 5.7 --- Feasibility of implementing the PEI program in Hong Kong clinical settings --- p.191 / Chapter 5.7.1 --- Intervention recipients’ perspective --- p.191 / Chapter 5.7.1.1 --- Emotional support --- p.192 / Chapter 5.7.1.1.1 --- Offering psychology support --- p.192 / Chapter 5.7.1.1.2 --- Removing worries about sexual life --- p.192 / Chapter 5.7.1.2 --- Informational support --- p.193 / Chapter 5.7.1.2.1 --- Acquiring knowledge on illness --- p.193 / Chapter 5.7.1.2.2 --- Behavioral therapy helpful in post-operative care --- p.193 / Chapter 5.7.1.2.3 --- Resources available in the community --- p.194 / Chapter 5.7.1.3 --- Elements of the program --- p.194 / Chapter 5.7.1.3.1 --- Appropriate design of the interventions --- p.194 / Chapter 5.7.1.3.2 --- Content of information provided --- p.195 / Chapter 5.7.1.4 --- Feelings towards the program --- p.195 / Chapter 5.7.1.4.1 --- Appreciation of the interventions --- p.195 / Chapter 5.7.1.4.2 --- Lack of GC health education --- p.196 / Chapter 5.7.2 --- Health-care providers perspective --- p.196 / Chapter 5.7.2.1 --- Opinions regarding the program --- p.197 / Chapter 5.7.2.1.1 --- Quality of information provided --- p.197 / Chapter 5.7.2.1.2 --- Usefulness of the interventions --- p.197 / Chapter 5.7.2.2 --- Suggestions for improvement --- p.198 / Chapter 5.7.2.2.1 --- Content of information provided --- p.198 / Chapter 5.7.2.2.2 --- Format of the interventions --- p.199 / Chapter 5.7.2.2.3 --- Coverage of the patient population --- p.199 / Chapter 5.7.2.3 --- Feasibility of implementing the program in Hong Kong --- p.200 / Chapter 5.7.2.3.1 --- Anticipated barriers --- p.200 / Chapter 5.7.2.3.2 --- Solutions to the barriers --- p.201 / Chapter 5.8 --- Summary --- p.201 / Chapter CHAPTER 6 --- DISCUSSION OF THE PILOT STUDY / Chapter 6.1 --- Introduction --- p.205 / Chapter 6.2 --- Baseline characteristics of the participants --- p.205 / Chapter 6.2.1 --- Demographic and clinical characteristics --- p.206 / Chapter 6.2.2 --- Baseline outcome variables --- p.208 / Chapter 6.3 --- Effectiveness of the PEI program --- p.211 / Chapter 6.3.1 --- Quality of life --- p.211 / Chapter 6.3.2 --- Uncertainty --- p.214 / Chapter 6.3.3 --- Social support --- p.216 / Chapter 6.3.4 --- Anxiety and depression --- p.218 / Chapter 6.3.5 --- Sexual functioning --- p.221 / Chapter 6.4 --- Feasibility of implementing the PEI program in Hong Kong --- p.223 / Chapter 6.4.1 --- Intervention recipients’ perspective --- p.223 / Chapter 6.4.2 --- Health-care providers’ perspective --- p.226 / Chapter 6.5 --- Limitations of the pilot study --- p.229 / Chapter 6.5.1 --- Four types of validity threats --- p.229 / Chapter 6.5.2 --- Limitations in attention placebo, intervention format and integrity --- p.232 / Chapter 6.6 --- Summary --- p.234 / Chapter CHAPTER 7 --- CONCLUSION / Chapter 7.1 --- Introduction --- p.235 / Chapter 7.2 --- Implications for nursing practice --- p.235 / Chapter 7.3 --- Implications for future research --- p.236 / Chapter 7.4 --- Conclusion --- p.239 / REFERENCES --- p.241 / APPENDICES --- p.267