Doris Yu

yu d.s.f. (2010) Insomnia Severity Index: psychometric properties with Chinese community-dwelling older people. Journal of Advanced Nursing 66(10), 2350–2359.yu d.s.f. (2010) Insomnia Severity Index: psychometric properties with Chinese community-dwelling older people. Journal of Advanced Nursing 66(10), 2350–2359.AbstractAim.  This paper is a report of a study to evaluate the psychometric properties of the Chinese version of the Insomnia Severity Index.Background.  Despite the high prevalence of insomnia in older people and its detrimental impact on well-being and healthcare costs, this problem is almost always undetected and consequently under-treated. The Insomnia Severity Index is psychometrically sound in measuring perceived insomnia severity. However, it has had very limited application in non-White populations.Methods.  An instrument validation study was carried out between October 2008 and April 2009. The Insomnia Severity Index was translated into Chinese using Brislin’s model and administered to a convenience sample of 585 older Chinese people recruited from three community centres for elders. Other instruments were also administered, including the Chinese version of the Pittsburgh Sleep Quality Index and the Geriatric Depression Scale.Results.  Cronbach’s alpha of the Chinese version of the Insomnia Severity Index was 0·81, with item-to-total correlations in the range of 0·34–0·67. Construct validity was supported by its moderate relationship with the Chinese Pittsburgh Sleep Quality Index and sleep efficiency. The Chinese version of the Insomnia Severity Index also indicated more severe level of insomnia in older people who reported depressed mood on the Geriatric Depression Scale. Discriminant validity was supported as the Chinese version of the Insomnia Severity Index could discriminate poorer sleepers from normal sleepers. Exploratory factor analysis identified a two-factor structure for the Chinese version of the Insomnia Severity Index in measuring the severity and impacts of insomnia on the Chinese older people.Conclusion.  The Chinese version of the Insomnia Severity Index is a culturally-relevant and psychometrically-sound instrument for assessing severity and impact of insomnia in Chinese community-dwelling older people. Nurses can use this tool to assess older people’s perceptions of insomnia.Aim.  This paper is a report of a study to evaluate the psychometric properties of the Chinese version of the Insomnia Severity Index.Background.  Despite the high prevalence of insomnia in older people and its detrimental impact on well-being and healthcare costs, this problem is almost always undetected and consequently under-treated. The Insomnia Severity Index is psychometrically sound in measuring perceived insomnia severity. However, it has had very limited application in non-White populations.Methods.  An instrument validation study was carried out between October 2008 and April 2009. The Insomnia Severity Index was translated into Chinese using Brislin’s model and administered to a convenience sample of 585 older Chinese people recruited from three community centres for elders. Other instruments were also administered, including the Chinese version of the Pittsburgh Sleep Quality Index and the Geriatric Depression Scale.Results.  Cronbach’s alpha of the Chinese version of the Insomnia Severity Index was 0·81, with item-to-total correlations in the range of 0·34–0·67. Construct validity was supported by its moderate relationship with the Chinese Pittsburgh Sleep Quality Index and sleep efficiency. The Chinese version of the Insomnia Severity Index also indicated more severe level of insomnia in older people who reported depressed mood on the Geriatric Depression Scale. Discriminant validity was supported as the Chinese version of the Insomnia Severity Index could discriminate poorer sleepers from normal sleepers. Exploratory factor analysis identified a two-factor structure for the Chinese version of the Insomnia Severity Index in measuring the severity and impacts of insomnia on the Chinese older people.Conclusion.  The Chinese version of the Insomnia Severity Index is a culturally-relevant and psychometrically-sound instrument for assessing severity and impact of insomnia in Chinese community-dwelling older people. Nurses can use this tool to assess older people’s perceptions of insomnia.

Background: Despite abundant evidence attesting to poor physical, psychological and social functioning of congestive heart failure (CHF) patients, little is known about the impact of the disease itself on health-related quality of life (HRQL). Most previous work has focused on general quality of life issues rather than specifically on the impact of CHF on HRQL. Aim: To identify the significant

Fatigue is a complex phenomenon associated with multiple antecedents and detrimental consequences. Although this symptom is prevalent in the older population, it is not easily recognized by nurses and has been under treated.The purpose of this review is to describe the existing research on fatigue on older adults with focus on the lived experience of fatigue, factors related to such fatigue experience and the impact of fatigue on overall health.A systematic search of the literature was undertaken to identify research evidence on fatigue among the older population. Three databases (i.e. OvidMedline, CINAHL and PsycINFO) were searched, resulting in 15 eligible studies. Three aspects about the fatigue phenomenon in older people were identified: the lived experience of fatigue, relating factors of fatigue, and impact of fatigue on overall health.The key findings suggest that fatigue is an overwhelming experience constrains physical capacity and the energy reserve required for appropriate functioning and social participation, as well as worsens their morbidity and mortality outcomes. Yet, its heterogeneous etiologies and multi-dimensional manifestations pose a huge challenge on its diagnosis and treatment. Indeed, there was inadequate research-base evidence on fatigue management for older people. This gap in literature may imply that this problem is poorly recognized and under-treated in older people.The findings highlight that fatigue is a substantial problem in older people that deserves early recognition and prompt treatment. Nurses need to be sensitive to the risk factors of fatigue in the older population and conduct a comprehensive fatigue assessment on the high risk case. Although this review only identified limited research-base evidence, the findings do give directions to the development of interventions for fatigue management for older people.

Rationale  Patient-reported outcomes such as health-related quality of life (HRQL) describe or characterize what patients have experienced as a result of their health care. However, treatment outcome comparisons among different pure or mixed populations of patients with myocardial infarction, angina or heart failure cannot be made using existing coronary heart disease (CHD)-specific HRQL instruments.Aims and objectives  The aim of this study was to evaluate the psychometric properties of the Chinese version of the MacNew in a cohort of Hong Kong patients diagnosed with CHD.Methods  Chinese translations of a CHD-specific HRQL instrument, the MacNew Heart Disease HRQL questionnaire (MacNew), the Short-form 36 Health Survey and the Hospital Anxiety and Depression Scale were administered to 365 Chinese-speaking patients with CHD at baseline and again 3 months later (n = 363). The Medical Outcomes Trust Scientific Advisory Committee criteria were used to examine the psychometric properties of the Chinese MacNew Heart Disease HRQL questionnaire.Results  The results warrant recommending the use of the MacNew as an outcome measure to enhance treatment evaluation in Chinese patients with CHD and a diagnosis of myocardial infarction, angina or heart failure, substantiating previous psychometric data on the MacNew in a number of different studies in patients speaking seven different languages.Conclusion  The MacNew questionnaire may have value as a core CHD questionnaire for treatment outcome comparisons among pure or mixed populations of patients with myocardial infarction, angina or heart failure.

Heart failure (HF) has a profound impact on patients' health-related quality of life (HRQL). Little is known about factors relating to HRQL in elderly Chinese HF patients. The objective of this cross-sectional correlational study was to identify the demographic, psychosocial, and clinical factors associated with HRQL in this group of patients. Cross-sectional data were obtained from a consecutive sample of hospitalized HF patients (n = 227) with measures of HRQL, psychological distress, perceived social support, and health perception. Functional status was measured with the New York Heart Association Classification (NYHA). In stepwise regression analysis, four variables, including psychological distress, health perception, NYHA classification, and educational level explained 51.8% (p = .01) of the variance in HRQL. These findings suggest that improving HRQL of HF patients entails improving their psychological status, functional status, and health perception. © 2004 Wiley Periodicals, Inc. Res Nurs Health 27:332–344, 2004

yu d.s.f., lee d.t.f. & woo j. (2010) Improving health-related quality of life of patients with chronic heart failure: effects of relaxation therapy. Journal of Advanced Nursing66(2), 392–403.yu d.s.f., lee d.t.f. & woo j. (2010) Improving health-related quality of life of patients with chronic heart failure: effects of relaxation therapy. Journal of Advanced Nursing66(2), 392–403.AbstractTitle. Improving health-related quality of life of patients with chronic heart failure: effects of relaxation therapy.Aim.  This paper is a report of a study conducted to examine the effects of a relaxation training programme on the health-related quality of life of Chinese patients with chronic heart failure.Background.  Despite the substantial evidence indicating the beneficial effects of relaxation therapy on the health-related quality of life of various cardiac populations, the value of this intervention in patients with chronic heart failure remains uncertain. Even less is known about its therapeutic effects in Chinese culture.Method.  A total of 121 Chinese patients with chronic heart failure and over 60 years of age were recruited in 2002–2003 and randomly allocated to a relaxation training programme (n = 59) or an attention-control intervention (n = 62). The training included two relaxation training sessions, one skill revision workshop, twice daily relaxation self-practice and biweekly telephone follow-up. The World Health Organization Quality of Life questionnaire was completed at hospital discharge and at the 8th and 14th weeks after discharge.Results.  Repeated measures analysis of covariance indicated that those who attended the relaxation training programme reported statistically significantly greater improvement in psychological (P = 0·007, η2 = 0·043) and social (P = 0·016, η2 = 0·035) health-related quality of life than those who received the attention-control intervention over the evaluative period. Comparing outcomes at timepoints showed that the statistically significant group differences in the improvement of psychological and social health-related quality of life occurred mainly during the first evaluative endpoints.Conclusion.  Relaxation techniques are beneficial to the emotional and social health-related quality of life of Chinese patients with chronic heart failure. Combining this intervention with other treatment modalities may produce a more substantial improvement in their health-related quality of life.Title. Improving health-related quality of life of patients with chronic heart failure: effects of relaxation therapy.Aim.  This paper is a report of a study conducted to examine the effects of a relaxation training programme on the health-related quality of life of Chinese patients with chronic heart failure.Background.  Despite the substantial evidence indicating the beneficial effects of relaxation therapy on the health-related quality of life of various cardiac populations, the value of this intervention in patients with chronic heart failure remains uncertain. Even less is known about its therapeutic effects in Chinese culture.Method.  A total of 121 Chinese patients with chronic heart failure and over 60 years of age were recruited in 2002–2003 and randomly allocated to a relaxation training programme (n = 59) or an attention-control intervention (n = 62). The training included two relaxation training sessions, one skill revision workshop, twice daily relaxation self-practice and biweekly telephone follow-up. The World Health Organization Quality of Life questionnaire was completed at hospital discharge and at the 8th and 14th weeks after discharge.Results.  Repeated measures analysis of covariance indicated that those who attended the relaxation training programme reported statistically significantly greater improvement in psychological (P = 0·007, η2 = 0·043) and social (P = 0·016, η2 = 0·035) health-related quality of life than those who received the attention-control intervention over the evaluative period. Comparing outcomes at timepoints showed that the statistically significant group differences in the improvement of psychological and social health-related quality of life occurred mainly during the first evaluative endpoints.Conclusion.  Relaxation techniques are beneficial to the emotional and social health-related quality of life of Chinese patients with chronic heart failure. Combining this intervention with other treatment modalities may produce a more substantial improvement in their health-related quality of life.

A striking rise in the incidence and prevalence of congestive heart failure (CHF) in the Chinese population has been reported. While promoting the quality of life (QOL) of these patients is widely recognized as an important clinical priority, there is not a validated Chinese disease-specific QOL measure for CHF patients. The aim of this study was to validate the Chinese version of Chronic Heart Failure Questionnaire (CHQ-C) which measures the disease-specific QOL of patients with CHF. A sample of 110 CHF elderly patients and a comparison group of 64 healthy elderly people was recruited. Structured questionnaires were administered by a research nurse. Criterion and construct validity of CHQ-C was demonstrated by its significant correlation with the New York Heart Association classification (Spearman r = −0.52, p Hospital Anxiety and Depression scale (Pearson r = −0.74, p

Aim.  To integrate the research evidence on quality of life of older people living in a residential care home setting.Background.  Residential care is provided for older people who are unable to live in their own home due to various health and social reasons. A number of studies have been published that have focused on diverse quality of life issues of residential care home elders. Consolidating the evidence from these studies may provide insights into enhancing quality of life of this particular group of older people.Design.  A literature review of research evidence on quality of life issues among residential care home elders.Method.  A systematic search of the literature published between 1994–January 2008 was undertaken to identify research evidence on quality of life of older people living in residential care home. Information about the study design, research objectives, study setting, sample characteristics, and key findings were extracted for comparison and integration. Three aspects about quality of life of the residential care home elders were identified: views of residential care home elders on quality of life, factors affecting quality of life of residential care home elders and methods to improve quality of life in residential care home elders.Results.  Eighteen publications were identified. Older people perceived their ability to maintain independence, autonomy and individuality as the most important criteria for determining quality of life. Interventions designed to improve quality of life of older people living in residential facilities corresponded to these criteria. A range of interventions including a walking program, mental stimulation and environmental modification were proposed and evaluated to improve quality of life of residential care home elders. Among these interventions, environmental modification that targeted at improving the residential care homes and quality of services appears to be promising.Conclusion.  Quality of life in residential care home elders is a complex issue that may be determined by the elders’ independence, individuality and autonomy, and influenced by quality of residential care and facilities. Environmental modification appears to be a way to improve the quality of life of residential care home elders.Relevance to clinical practice.  The knowledge of understanding quality of life of residential care home elders provides insights into the implementation of appropriate residential care services. Programs that aim to de-institutionalise the residential care home settings are important to the enhancement of residential care services.

The purpose of this article was to discuss the challenges of instrument translation, using the translation of the Medical Outcomes Study Social Support Survey into Chinese as an example. Brislin's model of translation, which highlights the need for forward and backward translation, was used. Major considerations in conducting translation, and the strategies used to overcome the challenges arising from cultural and linguistic differences between the source and target languages, were discussed. Examples were used to illustrate how difficulties, such as maintenance of the original intent of the questionnaire, maximization of the cultural relevancy of the concept in question, and enhancement of the comprehensibility of the translated questionnaire, were handled. The importance of literal and cultural adaptation of a developed instrument, rather than its simple word translation in the maintenance of an equivalent translation is highlighted.

Title. Living with chronic heart failure: a review of qualitative studies of older peopleAim.  This paper is a report of a systematic review of qualitative studies of how older people live with chronic heart failure.Background.  Chronic heart failure is a global epidemic mainly affecting an ageing population. Understanding how older people live with this disease is important to help promote their adjustment to the distressing illness experience.Data sources.  Eligible studies published in 1997–2007 were identified from several databases (Medline, CINAHL, PsycINFO and Sociological Abstracts). A manual search was conducted of bibliographies of the identified studies and relevant journals.Review methods.  Two researchers independently reviewed the studies and extracted the data. Key concepts from the papers were compared for similarities and differences. The transactional model of stress was used to guide data synthesis.Findings.  Fourteen qualitative studies were identified. Most described the illness experiences of older people with chronic heart failure and associated coping strategies. There was some emerging work exploring the adjustment process. The findings indicated that living with chronic heart failure was characterized by distressing symptoms, compromised physical functioning, feelings of powerlessness and hopelessness, and social and role dysfunction. There were gender differences in the way the disease was conceived. Adjustment required patients to make sense of the illness experience, accept the prognosis, and get on with living with the condition.Conclusion.  Empowering older people to manage chronic heart failure, instilling hope and bolstering support system are means of promoting successful adjustment to the disease. Further research needs to explore the cultural differences in the adjustment process.

Effective management of heart failure relies on optimal use of non-pharmacological therapy alongside medical treatment. Yet, there is an inadequate use of non-pharmacological therapy in caring for older people with heart failure. To examine the effects of relaxation therapy and exercise training on psychological outcomes and disease-specific quality of life of older heart failure patients. Subjects undertook relaxation (n = 59), exercise training (n = 32) or received attention placebo (n = 62) for 12 weeks. The relaxation group attended two training sessions, one revision workshop, and continued with twice-daily taped-directed home relaxation practice, with support from the intervener through bi-weekly telephone contact, for 12 weeks. The exercise group undertook 12 weekly sessions of resistance training and aerobic exercise and thrice weekly home exercise. The control group received regular telephone calls for general 'greetings'. The relaxation and exercise groups reported a significantly greater improvement in psychological [F(2, 149) = 6.69, p = 0.002] and various disease-specific quality of life outcomes [dyspnea: F(2, 149) = 5.72, p = 0.004; fatigue: F(2, 149) = 3.78, p = 0.25; emotion: F(2, 149) = 6.68, p = 0.001], compared with those who received the attention placebo. While relaxation therapy was more effective to reduce psychological distress, with depression in particular (p < 0.001), exercise therapy worked better to control fatigue symptoms (p = 0.03). Relaxation therapy and exercise training are effective to improve the psychological and physical health of older heart failure patients. They should be used as an individual treatment modality, or as care components of a disease management program.

The purpose of this study was to assess the psychometric properties of the Chinese version of the Medical Outcomes Study Social Support Survey (MOS-SSS-C) in a sample of 110 patients. Criterion-related and construct validities of the MOS-SSS-C were evaluated by correlations with the Chinese version of the Multidimensional Perceived Social Support Survey (r = .82) and the Hospital Anxiety and Depression Scale (r = −.58). Confirmatory factor analysis affirmed the four-factor structure of the MOS-SSS-C in measuring the functional aspects of perceived social support. Cronbach's alphas for the subscales ranged from .93 to .96, whereas the alpha for the overall scale was .98. The 2-week test–retest reliability of the MOS-SSS-C as measured by the intraclass correlation coefficient was .84. The MOS-SSS-C is a psychometrically sound multidimensional measure for the evaluation of functional aspects of perceived social support by Chinese patients with chronic disease. © 2004 Wiley Periodicals, Inc. Res Nurs Health 27:135–143, 2004

Objectives To examine the oral health status of Chinese hospitalised geriatric patients and identify its impacts on their oral health-related quality of life (OHRQoL). Design Cross-sectional correlational study. Setting Geriatric wards of a regional hospital in Hong Kong. Subjects A consecutive sample of Chinese hospitalised geriatric patients (N = 155) aged ≥ 65 years who were communicable. Measurements The Brief Oral Health Status Examination (BOHSE) was used to evaluate oral status. The General Oral Health Assessment Index (GOHAI) was used to assess OHRQoL. Results The oral health status of the Chinese hospitalised geriatric patients was fair, with the more prominent problems being decayed teeth, lack of occluded teeth, coated tongue, excessive tartar, dry and rough red oral tissue and diseased gum. The GOHAI score indicated their compromised OHRQoL. By using hierarchical regression analysis, fewer than eight pairs of occluding teeth (β = −0.33, P β = −0.26, P = 0.03) and perceived oral dryness (β = −0.18, P = 0.04) significantly accounted for 17% of variance in the OHRQoL of Chinese hospitalised geriatric patients. Conclusion This study suggests that routine screening for dental and gum problems, providing adequate adaptation of denture prosthesis and reducing oral dryness of geriatric patients may be important care to optimise the OHRQoL of Chinese hospitalised geriatric patients. The study needs to be replicated in larger-scale multicentre settings and incorporate the use of more-comprehensive oral assessment indices.