Hsiu-Hung Wang

Association Between Social Support and Health Outcomes: A Meta-Analysis

The purpose of this study was to examine the relationship between social support and health outcome variables, and the effect size of social support on health outcomes. Meta‐analysis was used to synthesize the primary studies identified initially from a computer search of the literature in Taiwan. Through preliminary screening related to the inclusion criteria, 165 dissertations and theses and 43 journal articles were included in this study. Finally, 182 primary studies, including 145 dissertations and theses and 37 journal articles, were retained after eliminating outliers of each outcome variable to achieve homogeneity. Based on Smiths four modes of health, 16 health outcome variables were used. Health status, physical symptoms and responses, psychologic symptoms and responses, and depression were categorized as clinical variables. Role function and behaviors and role burden were categorized as role‐function variables. Physical adjustment, psychosocial adjustment, adjustment of life, coping behavior, and stress were categorized as adaptive variables. Health belief, health promotion behavior, quality of life, well‐being, and self‐actualization were categorized as eudemonistic variables. Other than physical adjustment, social support could significantly predict all health outcomes (p < 0.0001). The results provided information not only on the magnitude of the sample size required to achieve statistical significance between social support and each outcome variable as a measure of health in future studies, but also on strategies to guide further intervention programs and to evaluate their effectiveness.

A Preliminary Study of a Health-Promoting Lifestyle Among Southeast Asian Women in Taiwan

The purpose of this study was to determine and understand the predicting factors of a health‐promoting lifestyle (HPL) in Southeast Asian women in Taiwan. One hundred and five Southeast Asian women in Tainan were recruited. Face‐to‐face interviews with structured questionnaires were used for data collection. The findings showed that, among the six dimensions of HPL, subjects scored highest in self‐actualization and lowest in health responsibility. Subjects who could read and write Chinese had a more positive HPL; stepwise regression analysis revealed that the ability to read Chinese could explain 26.2% of the total variance of HPL in Southeast Asian women. The results of this study can help health care professionals understand the HPL and to design appropriate health‐promoting educational programs to improve the well‐being and overall quality of life of Southeast Asian women in Taiwan.

Elderly and long-term care trends and policy in Taiwan: Challenges and opportunities for health care professionals

The purpose of this article is to address the trends and policy of elderly and long‐term care in Taiwan. In response to the increasing demand of an aging society, healthcare professionals play crucial roles in elderly and long‐term care and quality assurance of services. This article focuses on the current situation of elderly health care, demands of long‐term care, long‐term care policy in Taiwan, draft of the Long‐term Care Services Act, and draft of the Long‐term Care Insurance Act. After the 10‐year long‐term care project was proposed by the Taiwan government, the supply of health care services and demand for long‐term care have created many challenges and opportunities for innovative health professional development. Challenges consist of low old dependency ratio caused by low birth rate, lack of elderly and long‐term care related manpower, services and education reform related to long‐term care for the future society, and interprofessional collaboration and team work of long‐term care. Opportunities include expanding the roles and the career pathways of healthcare professionals, promoting the concepts of active aging and good quality of life, and developing industrial cooperation related to long‐term care services. Under these circumstances, healthcare professonals are actively involved in practice, education and research of long‐term care services that ensure elderly and disabled people can live a healthier and better life.

Testing a Model of Stress and Health Using Meta-Analytic Path Analysis

&NA; The goal of this study was to use meta-analytic path analysis to evaluate a theoretical model of stress and health. A meta-analysis technique was adopted to combine and re-analyze 477 studies that investigated stress-related topics between January 1980 and December 2003 in Taiwan. Databases searched included PerioPath-Index to Chinese Periodical Literature, Electronic Theses and Dissertations System, and NSC (National Science Council) Science and Technology Information System. Variables recorded included stress, health, social support, coping strategies, and personality traits. A correlation matrix of these variables was derived from meta-analytic data and then analyzed using structural path analysis to test the fitness of the hypothesized stress-health model to the observed aggregated data. Results showed the revised hypothesized model to be a reasonable, good fit to aggregated data. Based on the theoretical stress-health model developed in this study, subjective stress was found to have a substantively important and direct effect on health, whereas objective stress required the mediating function of subjective stress to exercise an influence on health. Such variables as social support, coping strategies, and personality traits had comparatively weaker influences, either direct or indirect, on the stress-health process. This study provided a holistic view on the relationship between stress and health in the context of stress and proposed a direction for future research and practice.

The health status of postpartum immigrant women in Taiwan

AIMS This study aims to contribute to the current body of literature by examining immigrant womens postpartum health in the context of Taiwan, in particular, their experience with postpartum stress and depression as well as the levels of social support available to them. This study also aims to identify predictors of their postpartum health status. BACKGROUND While there has been considerable research on the risk factors for poor postpartum health in the general population, research on the factors influencing immigrant womens postpartum health has been limited. DESIGN A non-experimental research design. METHODS We collected data from a sample of 340 immigrant postpartum women who could speak Mandarin Chinese, recruited from 10 general hospitals and one obstetric clinic in Taiwan from March 2005-September 2006. The Hung Postpartum Stress Scale, Beck Depression Inventory-II, Social Support Scale and Chinese Health Questionnaire were used in this study. RESULTS We found that immigrant womens postpartum health status differed significantly in relation to their key helpers, depression status, levels of postpartum stress and social support. The logistic regression analysis showed that a one-point increase in immigrant womens postpartum stress increased the probability of suffering from minor psychiatric morbidity by 1·04 times. CONCLUSIONS These findings suggest that health care professionals should pay attention not only to immigrant postpartum womens basic financial and support needs but also to their postpartum stress and stressors. RELEVANCE TO CLINICAL PRACTICE The use of trained community health advocates in partnership with registered nurses can help meet the needs of postpartum women and improve maternal and infant health through their home visits. These nursing interventions should be tailored specifically to decrease immigrant Asian womens postpartum stress and improve their overall health status and well-being.

Health Literacy and Health‐Promoting Behaviors among Multiethnic Groups of Women in Taiwan

OBJECTIVE To understand the current status of health literacy and the relationship between health literacy and health-promoting behaviors among multiethnic groups of women in Taiwan. DESIGN Convenience and snowball sampling methods were used to recruit study participants. Data were collected using a cross-sectional questionnaire survey. SETTING We recruited community female adults who lived in greater Taipei or Taoyuan areas (northern Taiwan) from January 1, 2010 through June 30, 2011. PARTICIPANTS A total of 378 female participants were contacted, of which 351 consented to participate and 347 completed valid questionnaires for analysis. METHODS Health literacy was measured with the Taiwan Health Literacy Scale, and health-promoting behaviors were measured by the Chinese version of the Health-Promoting Lifestyle Profile. RESULTS Participants had a moderate level of health literacy, and one third of them had inadequate health literacy. Participants with inadequate health literacy were more likely to be younger, not a high school graduate, and Vietnamese; to have a low monthly family income and no diagnosed diseases; to use a second language; and to regard TV/radio as the most useful source of health information. Health literacy alone could significantly predict health-promoting behaviors among the participants. CONCLUSIONS Our findings confirmed that low health literacy is prevalent among underprivileged women in Taiwan. Health-related programs that are literacy sensitive and culturally appropriate are needed to teach and encourage health-promoting behaviors.

Caring behaviors perceived by elderly residents of long-term care facilities: Scale development and psychometric assessment

BACKGROUND To meet the growing need for relationship-centered nursing practice and for nursing school accreditation in Taiwan, nursing school curricula must include training in care for elderly populations in institutional settings. However, educators lack tools for evaluating student performance in such settings. The few tools currently available for measuring the caring in nurses perceived by elderly residents of long-term care facilities (LTCFs) are either inappropriate for education purposes or are culturally inappropriate for elderly populations in Taiwan. OBJECTIVES To develop a scale for measuring the caring behaviors of caregivers or student volunteers as perceived by a Taiwanese population of elderly residents of LTCFs and to establish the psychometric characteristics of the scale. METHODS This study was conducted in two phases. In Phase 1, the researchers comprehensively reviewed the literature on caring. Based on the review, an Elderly Resident-Perceived Caring Scale (EPCS) was developed to measure the caring behaviors perceived by LTCF residents. To establish content and face validity, the items on the scale were reviewed by six experts in two rounds of Delphi study and by four elderly laypersons. In Phase 2, a convenience sample of 297 elderly residents from 18 representative elderly care facilities (i.e., skilled nursing facilities, independent living facilities, and assisted living facilities) in Taiwan were recruited to test the construct validity and reliability of the EPCS. RESULTS The 14-item, 2-dimension questionnaire developed in this study explained 64.33% of the variance in caring perceived by the residents. Factor I, Comforting, included 11 items. Factor II, Encouraging, included 3 items. Cronbachs α values were .924 for the total scale and .930 and .844 for the Comforting and Encouraging, respectively. CONCLUSION The psychometric qualities of the EPCS were supported. However, further testing of the scale is needed to confirm its psychometric properties in a larger sample.

Factors of Resilience in Emergency Department Nurses Who Have Experienced Workplace Violence in Taiwan

PURPOSE This study investigated the relationship among personality traits, social network integration (SNI), and resilience in emergency department (ED) nurses who had suffered from physical or verbal violence by patients or their families. DESIGN AND METHODS A cross-sectional study with convenience sampling was conducted for exploring the related factors of resilience on abused nurses. A total of 187 participants met our inclusion criteria and completed all questionnaires. FINDINGS Higher degrees of extraversion and peer support were associated with greater resilience among all abused nurses, whereas neuroticism was inversely associated with their resilience. CONCLUSIONS Among all forms of SNI, only peer support was shown to enhance an individuals resilience. In addition, personality traits were associated with resilience, and religions did not play an important role in enhancing resilience among our participants. CLINICAL RELEVANCE Through a clearer understanding of the role of peer support in resilience among ED nurses, healthcare managers should provide and enhance their peer support to intensify their resilience for prevention of consequences of workplace violence.

Reciprocity of service learning among students and paired residents in long-term care facilities

Many intergenerational service learning projects have been designed for service providers and recipients, few studies have analyzed the providers and recipients of such projects in terms of caring behavior. In accordance with the Taiwan Ministry of Education initiative to develop curricular service learning, a service learning project was initiated during a nursing school course before the students performed their clinical practicum. The aim of this mixed method design was to report the development of an intergenerational service learning project and to test its effects both on nursing students paired with residents and residents of facilities. A pre-and post-test with non-randomized control group design was used to evaluate the effects of the project on caring perceived by the residents, and a one-group pre- and post-test design was used to test its effects among nursing students. The analysis included valid questionnaires received from 59 eligible residents and 210 nursing stu`dents. The 20-hour project included pre-service training, service, and an end-of-project presentation. At post-test, the residents showed that perceived caring significantly differed between the intervention group and the control group (F=8.99; p=.004). Paired t test analysis of nursing students also showed significant increases in both caring and attitude scores after the project (t=8.56; p=.000; t=6.35; p=.000). The project significantly affected the caring perceived by the residents and the achievements of the junior nursing students. This experimental study provides information of interest to nursing educators, long-term care administrators, and researchers in elderly care.

Self-Care and Well-Being Model for Elderly Women: A Comparison of Rural and Urban Areas

The purposes of this study were to examine the relationships among age, social class, perceived health, self‐care, and well‐being in urban and rural elderly women and to validate and compare two models using these two groups. A causal model of self‐care and well‐being was proposed for this study based on Orems self‐care model and empirical data. Data were collected using a survey‐interview method. Of the 351 elderly women recruited, 159 were in the urban group and 192 in the rural group. Two models of self‐care and well‐being were tested using path analysis with the LISREL 8 program. The resultant models yielded a Chi‐squared of 1.98 with two degrees of freedom (p = 0.37) in the urban group and a Chi‐squared of 4.20 with three degrees of freedom (p = 0.24) in the rural group, indicating good fit between the data and the two models. These two models provide guidelines for community nurses to design appropriate self‐care programs for elderly women.