Phoenix K. H. Mo

How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review

Background: The benefits of physical exercise in reducing clinically defined depression in the general population have been established, although a review of the evidence for older adults is needed. Objectives: To assess the efficacy of physical exercise for the treatment of depressive symptoms in older adults (>60 years). Data sources: We searched: MEDLINE (1966—May 2008); EMBASE (1980—May 2008); Cumulative Index to Nursing & Allied Health Literature (CINAHL; 1982—May 2008); PsycINFO (1966—May 2008), The Cochrane Library (Issue 2, 2008), and National Research Register (NRR; Issue 2, 2008). Review methods: Randomized controlled trials and quasi-experimental studies of physical exercise interventions for depression were included where 80% or more of participants were >60 years. Abstracts were assessed to determine whether they met specified inclusion criteria. Primary analysis focused on the prevalence of diagnosable depressive disorder following intervention. Secondary outcome was depression or mood scores on standardized scales. Results: Eleven randomized controlled trials with a total of 641 participants were included in the review. Short-term positive outcome for depression or depressive symptoms was found in nine studies, although the mode, intensity and duration of intervention varied across studies. Medium- to long-term effects of intervention were less clear. Conclusion: Physical exercise programmes obtain clinically relevant outcomes in the treatment of depressive symptoms in depressed older people. Exercise, though not appropriate for all in this population, may improve mood in this group. Further research is needed to establish medium- to long-term effects and cost-effectiveness.

Exploring the communication of social support within virtual communities: a content analysis of messages posted to an online HIV/AIDS support group.

The present study examined the nature of social support exchanged within an online HIV/AIDS support group. Content analysis was conducted with reference to five types of social support (information support, tangible assistance, esteem support, network support, and emotional support) on 85 threads (1,138 messages). Our analysis revealed that many of the messages offered informational and emotional support, followed by esteem support and network support, with tangible assistance the least frequently offered. Results suggest that this online support group is a popular forum through which individuals living with HIV/AIDS can offer social support. Our findings have implications for health care professionals who support individuals living with HIV/AIDS.

Comparative stigma of HIV/AIDS, SARS, and Tuberculosis in Hong Kong

Abstract This study compares public stigma towards three types of infectious diseases— human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), severe acute respiratory syndrome (SARS), and tuberculosis (TB)—tests an attribution model of stigma, and explores the relationships between stigma and public attitudes towards government policies in Hong Kong. Using a population-based telephone survey, 3011 Hong Kong Chinese adults were randomly assigned to one of the three disease conditions and were interviewed about their attitudes and beliefs towards the assigned disease. Findings showed that public stigma was the highest towards HIV/AIDS, followed by TB and SARS. Using multi-sample model structural equation modeling, we found that the attributions of controllability, personal responsibility, and blame were applicable in explaining stigma across three disease types. Knowledge about the disease had no significant effect on stigma. Participants with less stigmatizing views had significantly more favorable attitudes towards government policies related to the diseases. The study is an important attempt in understanding the attributional mechanisms of stigma towards infectious diseases. Implications for stigma reduction and promotion of public awareness and disease prevention are discussed.

Empowering processes in online support groups among people living with HIV/AIDS: A comparative analysis of 'lurkers' and 'posters'

The proliferation of online support groups provides an opportunity for individuals living with HIV/AIDS to obtain support online. The present study aimed to explore how different levels of participation in online support groups are associated with empowering processes and outcomes for individuals living with HIV/AIDS. A total of 340 individuals living with HIV/AIDS were recruited. They completed an online questionnaire consisting of measures on satisfaction with online support groups, empowering processes, self-care self efficacy, loneliness, optimism, coping, depression, and health-related quality of life. Results revealed that compared to posters, members who only read the messages (lurkers) scored lower in receiving social support and receiving useful information in empowering processes, and lower in satisfaction with their relationship with group members. They also scored higher in distraction and lower in planning in the brief COPE. In addition, they scored lower in social function and higher in energy. There were no significant differences in self-care self efficacy, loneliness, depression, or optimism between posters and lurkers. Our results suggest that lurking in the online support groups may be as empowering as reading and posting messages to the groups. More research is needed to identify the long term effects of online support group use.

Gender differences in computer-mediated communication: a systematic literature review of online health-related support groups.

OBJECTIVE Previous research has contended that the unique characteristics of the Internet might remove some of the gender differences that exist in face-to-face healthcare. The aims of the present study were to systematically review studies that have examined gender differences in communication within online health communities. METHODS A literature search was conducted to identify studies addressing gender differences in messages posted to online health-related support groups. Out of the 1186 articles identified, twelve were retrieved for review. RESULTS Half of the studies examined gender differences by comparing male and female cancer discussion boards. The literature review revealed that some gender differences were observed in these studies. However, for studies that analysed mixed-gender communities, gender differences were less evident. CONCLUSION Results seemed to reveal gender differences in communications in single-sex online health support groups, and similarities in communication patterns in mixed-sex online health support groups. However, findings should be treated with caution due to the diversity in studies and methodological issues highlighted in the present review. PRACTICE IMPLICATIONS There is a need for health care professionals to take into account a range of situational and contextual factors that may affect how men and women use online health support groups. However, more robust research is needed before concrete guidelines can be developed to help health care professionals develop effective online support interventions.

Help-seeking for mental health problems among Chinese

The underutilization of professional care is a perennial problem among Chinese populations. To examine the social-cognitive factors that may affect help-seeking intentions, the present study applied and extended Ajzen’s theory of planned behavior (TPB) to understand the intention to seek help from mental health professionals among Chinese. The effect of mental health and perceived barriers to help-seeking were also examined. Nine hundred and forty-one Chinese were recruited using a randomized household design in Hong Kong. Results from structural equation modeling showed that attitude, subjective norm, perceived behavioral control, and perceived barriers significantly predicted help-seeking intention. Mental health showed no significant effect on help-seeking intention. In addition, subjective norm indirectly predicted intention to seek help from mental health professionals through influencing attitude and perceived behavioral control. Results from multi-group analyses revealed that all path coefficients were invariant across gender. Results supported the utilization of TPB in understanding help-seeking intentions and highlighted the importance of subjective norm among Chinese. Implications on the enhancement of mental health awareness and the promotion of mental health services through a social-cognitive approach were highlighted.

Developing a model for online support group use, empowering processes and psychosocial outcomes for individuals living with HIV/AIDS

This study examined the mechanism through which online support group (OSG) participation may promote patient empowerment among 340 individuals living with HIV/AIDS. Results from structural equation modelling revealed that greater use of OSGs was associated with more frequent occurrence of the empowering processes as measured by receiving useful information, receiving social support, finding positive meaning and helping others. Receiving useful information and finding positive meaning were related to higher levels of adaptive coping and lower levels of maladaptive coping, while receiving social support and helping others were related to higher levels of self-care self-efficacy, which in turn was related to higher levels of adaptive coping, and lower levels of maladaptive coping. Finally, higher levels of maladaptive coping were related to poorer quality of life, while higher levels of adaptive coping were related to better quality of life. Results suggest that OSG participation may offer some benefits for those living with HIV/AIDS.

Living with HIV/AIDS and use of online support groups.

The present study explores the association between online support group use and health status, coping and social support among 640 individuals with HIV/AIDS. Results suggested that frequent users tended to be female, younger, single, and in a more advanced disease stage. After controlling for covariates, frequent users reported poorer health than non-users. In addition, both frequent and infrequent users scored higher in planning, active coping, instrumental support and emotional support coping from the brief COPE. No significant difference was found for social support. Our results suggest that online support groups may potentially offer some benefits for those living with HIV/AIDS.

‘Do as I say, but not as I do’: Are next generation nurses role models for health?

Aim: Promoting healthy lifestyles plays a key role in professional nursing yet nurses do not always practice what they preach. Efforts are currently being made to improve the health of NHS staff, yet little is known about the health and lifestyle behaviours of pre-registration nurses in the UK although these individuals are our next generation of NHS employees. The aim of this study was to investigate the health behaviours and wellbeing of pre-registration nurses based at an acute NHS teaching hospital in England. Methods: In this cross-sectional questionnaire survey, 325 pre-registration nurses (50% response rate) completed a health and lifestyle questionnaire, measuring levels of physical activity, smoking and alcohol behaviour, dietary practices and general health. Results: Age ranged from 19-53 years, and 96% of the sample was female. More than half of the sample did not meet public health recommendations for physical activity. Just under one-fifth were current smokers and over three-quarters did not consume five servings of fruit/vegetables per day. Two-thirds reported exceeding the recommended maximum daily alcohol intake and around one third were classified as either overweight or obese. Those who were physically inactive were less likely to report good general health, good dietary practices and more sleep, and were more likely to report cigarette smoking and alcohol consumption than their active counterparts. Conclusions: This study indicates that the health profile of pre-registration nurses is relatively poor, and that those who are sedentary engage in other negative lifestyle behaviours also. Despite significant education relating to health promotion and health behaviours of patients being targeted at pre-registered nurses, it seems that this knowledge is not always transferred to their own behaviour. There is a need for timely intervention to establish healthy lifestyle behaviours amongst nurses early in their career.

Are online support groups always beneficial? A qualitative exploration of the empowering and disempowering processes of participation within HIV/AIDS-related online support groups

BACKGROUND Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is one of the leading concerns in healthcare. Individuals living with HIV/AIDS are often confronted with tremendous physical and psychosocial challenges. Online support groups can provide a valuable source of information, advice and support, and a medium through which individuals living with HIV/AIDS can interact with each other and share their experiences. However, very little is known about how online support group might promote empowerment and the potential disadvantages associated with online support group use among individuals living with HIV/AIDS. OBJECTIVES The present study explored the potential empowering and disempowering processes, and empowering outcomes of online support group use among individuals with HIV/AIDS. DESIGN, SETTINGS, PARTICIPANTS A total of 115 HIV-positive online support group members were recruited from HIV-related online support groups. They completed an online survey exploring their experiences of online support group use. RESULTS Thematic analysis revealed six empowering processes arising from use of online support groups: exchanging information, sharing experiences, connecting to others, encountering emotional support, finding recognition and understanding, and helping others. Six empowering outcomes were identified: increased optimism, emotional well-being, social well-being, being better informed, improved disease management, and feeling confident in the relationship with physicians. Potentially disempowering processes were also identified which included: being unable to connect physically, inappropriate behaviour online, declining real life relationships, and information overload and misinformation. CONCLUSION Findings suggest ways through which individuals with HIV/AIDS may be empowered although some problematic features specific to the online context may also be present.