Primary Health Care

Adopting a health-social partnership program to promote health and self-care management among older adults in the community

Traditional health and social sectors often operate in silos, creating barriers to effective collaboration. In response, the School of Nursing and the Hong Kong Lutheran Social Service Center have initiated a groundbreaking collaboration. Our project utilizes a robust hybrid effectiveness-implementation trial approach to develop, foster, assess, and maintain a community-based health-social partnership model that aimed at improving the well-being of the older person dwelling in the community. This initiative aligns with the government's 'ageing in place' strategy, which advocates for integrated health and social services within primary healthcare to enhance well-being of the community.

In this project, the nurse case managers, in collaboration with social workers and community healthcare workers, delivered a three-month health maintenance community-based program to older people dwelling in the community. This multidisciplinary approach not only enhances health outcomes but also strengthens psychosocial well-being among participants. We are currently making significant strides in the implementation phase, identifying health and social needs of the individuals and providing prompt help to address their needs with health-social intervention. We are able to expand the narrow focus of using only clinical perspective in viewing clients’ health and their needs. In addressing the social determinants of health, such as the available resources in health maintenance, the team is able to support the clients to reach optimal well-being. Our initial data analysis has suggested some promising and exciting results to support the health-social partnership model in the first level preventative primary health care in enhancing wellness of the older population.

mHealth mobile app enhances elderly health management

mHealth app for health worker partnership program

Primary healthcare is an integral part of the entire healthcare system. The Government put forward the Primary Healthcare Blueprint (the Blueprint) at the end of last year, which proposed prevention-oriented and community-based strategies to improve the overall health of the general public.

The School of Nursing of The Hong Kong Polytechnic University (PolyU) has launched a pilot mHealth health management mobile app with interactive nursing support. Research data shows the app empowers the elderly to monitor their chronic diseases and mental health conditions. An interdisciplinary team formed by healthcare professionals and social workers offer support to the elderly, such as providing timely medical referrals, thereby reducing the unplanned use of health services and enhancing elderly health management.

The mHealth app is jointly developed by The School of Nursing of PolyU and a local telecommunications company to help monitor the health condition of the elderly. When an abnormal vital sign (such as blood pressure, or blood glucose level) is detected, a registered nurse will be notified via the app and will contact the elderly person to understand their health condition. Another highlight of the mHealth app is the 24-hour nurse interaction function. By tapping one button in the app, the elderly can make a video call to a registered nurse to support and evaluate their health and mental condition.

The research team, led by Dr Arkers WONG, Assistant Professor of The School of Nursing of PolyU, recruited participants from five elderly service centres of the Hong Kong Lutheran Social Service. A total of 221 elderly aged 60 or above with at least one chronic condition(s) (including hypertension, pain or diabetes) participated in the study.

The study found that there was a significant increase in self-efficacy, a significant decrease in the level of depression, a reduction in the use of medical services, and an improvement in the quality of life* in physical aspects, after the elderly used the app for three to six months.

Hong Kong has one of the most rapidly ageing populations in the world. The number of Hospital Authority patients with chronic diseases is projected to reach three million in the coming decade by 2039, which will bring a heavy burden to the public healthcare system.

Dr Arkers WONG said, “There was a significant reduction in the unplanned use of health services and unplanned visits to general practitioners by 76% and 72% respectively, after the elderly used the mHealth app with nursing support for three months. This illustrates that the approach of combining nursing support and digital technology can relieve the pressure brought about by the rising demand for public medical services, helping to achieve the goals set out in the Blueprint to improve the overall health condition of the elderly.”

The research team recommends promoting the use of digital technology for health management among the elderly, and strengthening health-social collaboration on digital platforms. The research and development team will enhance the app, adding functions such as artificial intelligence, and incorporating content that is more suitable for the needs and preferences of the elderly so that they will continue to use the app, which will contribute to the goal of reducing public medical expenses.

*Physical component summary of quality of life includes four domains, which are general health, physical functioning (e.g., climbing several floors, moderate activities), role activities (limited kinds of activities), and bodily pain. Read More

Food Angel turns delivery female workers into community health workers

mHealth-based healthcare professional–lay health worker partnership program me (mHLPP) among community-dwelling impoverished older adults

Dr Arkers WONG (Assistant Professor) received a donation of over HK$11 million from the Li Ka Shing Foundation to carry out a project aimed at training female food delivery workers from Food Angel (惜食堂) to perform basic health checks for older adults living alone in the community.

After undergoing training, the female delivery workers will be equipped with basic health knowledge and the ability to measure physical vital signs, including blood oxygen levels, blood pressure, and pulse and pain indices, for around 100 older adults when they visit them to deliver meals. The health data collected by the delivery workers will be uploaded to the mHealth monitoring platform developed by Dr Arkers WONG’s research team. Registered nurses (RNs) will be given access to the platform to evaluate the health status of the older adults. When needed, an RN will give in-depth personal care and interventions via the mHealth app to the older adults. Referrals to allied health professionals or social workers can also be made by the RNs for early interventions.

The team hope that this first-of-its-kind grassroots community health model, undertaken in combination with the Health-Social Partnership, will provide scientific research evidence for the Hong Kong government to consider introducing the mHealth app and the service model to the community as a way to strengthen primary healthcare.

The mHealth app is a pilot health management mobile app with an interactive nurse support function. The app enables nurses to monitor the health status of users and allow users to communicate with nurses when they have health concerns. Research findings released by the team in March 2023 showed that older adults’ use of the app for 3 to 6 months resulted in a significant increase in self-efficacy, a significant decrease in depression levels, a reduction in the use of medical services, and an improvement in quality of life.

Institute of Medical Intelligence and XR

Technological innovations have led to new and promising ways to improve medical diagnoses, treatment, education, and healthcare services with ever-increasing rigour, subtlety, insight, and precision. Among advanced technologies, artificial intelligence (AI) and extended reality (XR) are growing rapidly and leading to huge transformations in medicine and healthcare. ‘XR’ refers to all real and virtual combined environments and human–machine interactions generated by computer technology and wearables. Integrating AI and XR research can open many new possibilities for achieving and delivering precision medicine for next-generation healthcare, but challenges remain in adopting AI and XR to medical image computing and computer-assisted interventions in real-world clinical applications.

The objective of this project is to build a world-class institute for medical intelligence and XR in Hong Kong by developing cutting-edge techniques aimed at overcoming these challenges and facilitating ‘one-stop’ medicine and healthcare services, covering screening, diagnosis, treatment, management, and prognosis. Specifically, we will address the following major challenges and important questions: (1) How do medical intelligence methodologies help to achieve precision medicine? (2) How can intelligent data analytics be delivered to clinicians/patients in a human-centred way by merging AI and XR developments? (3) How can intuitive and AI-enabled interactions be facilitated for clinicians with intelligent XR systems for optimising the delivery of precision medicine to patients? We will develop innovative solutions to these challenges, including (1) Intelligent Personalised Diagnosis (IPD) for diagnosis via advanced medical image analysis; (2) AI-XR Interaction & Virtual Surgery (IVS) for next-generation visualisation, assessment, treatment coordination, precise planning, and surgical training and education; (3) Intraoperative AI-AR Assisted Surgery (IAS) for dynamic medical interpretations, efficient execution of a surgical plan, and real-time fused intraoperative image guidance; and (4) an integrated multi-facet pipeline platform to demonstrate its usefulness for important applications for the diagnosis, treatment, prognosis, and medical training relating to liver cancer (hepatocellular carcinoma) and kidney cancer. Our research team has already collaborated fruitfully over a long period, and the backgrounds and strengths of the team members are complementary, enabling synergies to be achieved. Ultimately, our collective efforts will advance the frontier of AI and XR in medical and healthcare applications.

Peer support virtual reality-based intervention for AD/HD carers

In this project, a novel peer support virtual reality-based therapy will be developed for AD/HD carers to reduce their stress and increase their empathy in dealing with children with AD/HD. Under the impact of COVID-19, children with AD/HD and their parents felt lost and worried and experienced changes in mood and behaviour. During the closure of schools and childcare centres, parents became responsible for the daily personal care and education of their children with AD/HD. A peer support VR intervention can relieve stress and increase empathy by providing carers with a leisurely, memorable, and immersive experience. Furthermore, with better stress management, carers will experience an improvement in well-being and develop fewer chronic health conditions, leading to improved caregiver performance. Empathy contributes to helping behaviours that benefit interpersonal relationships. Therefore, the relationship between carers and children with AD/HD will also be enhanced by the therapy approach developed in the project. In addition, arrangements will be made for two participants to be in the same therapy session so that they can share their experiences of and feelings and knowledge about taking care of children with AD/HD. This can promote mutual assistance among peer carers. It is anticipated that the project will help families with children with AD/HD to become better able to adapt to a rapidly changing society.

Tai Chi for the prophylaxis of episodic migraine

Many studies have found that aerobic exercise can significantly reduce the frequency of migraine attacks and alleviate the intensity and duration of headaches. However, as exercise might also be a trigger, the type, frequency, intensity, and duration of exercise should be carefully determined for migraine prophylaxis. Tai Chi, a traditional Chinese martial art, can be easily and conveniently practised in daily life. Most prophylactic medications treat migraineurs merely through general biochemical mechanisms. As a traditional Chinese martial art and a complementary and alternative therapy, Tai Chi differs from conventional medication in that it can be considered a holistic approach to healthcare. We are interested in investigating the underlying mechanisms of how Tai Chi works to alleviate migraine attacks. The key issues that we want to address are whether Tai Chi is appropriate as a stand-alone preventive strategy that is comparable in treatment efficacy with standard prophylactic medications, or is at least not worse than these; and, if it is proven to be effective, what mechanism leads to such treatment efficacy.

Supported by the General Research Fund, Dr Grace XIE (Associate Professor) and her team are implementing a two-arm individual-level non-inferiority randomised controlled trial. A total of 220 local women aged from 18 to 65 who have been diagnosed with episodic migraine will be randomly assigned to one of two groups: (1) a Tai Chi training group receiving the 33-short form Yang-style of Tai Chi training; or (2) a standard prophylactic medication group receiving regular medication prescribed by a neurologist. The intervention period will be 24 weeks with another 24 weeks of follow-up. The frequency of migraine attacks, number of days with migraine, and intensity and duration of headaches will be recorded using a migraine diary at baseline, 24 weeks, and 48 weeks. MRI and a Transcranial Doppler will be used to measure white matter lesions and cerebral vasculature activity before and after the intervention, respectively. The clinical efficacy will be determined by comparing the differences in outcomes between the two groups from baseline to the end of the trial. The mechanism of the intervention effect will be explored by analysing the changes and associations of migraine features with the process of brain white matter and neurovascular changes after the Tai Chi training.