The Impact of a Health Empowerment Program on Self-Care Enablement and Mental Health among Low-Income Families: Evidence from a 5 Year Cohort Study in Hong Kong
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Subjects and Data Collection Procedure
2.2. Study Intervention—The HEP
2.3. Outcome Measures and Study Instruments
2.4. Data Analysis
2.5. Ethical Approval
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Date | Content | |
---|---|---|
2012–2013 | 26 May 2012 | Cough and common colds, common eye conditions |
4 August 2012 | Child development/ADHD | |
6 October 2012 | Psychosomatic illness in children, stress related to parenting | |
1 December 2012 | Chinese medicine and yangsheng | |
2013–2014 | 30 November 2013 | Oral health, oral hygiene practice and common oral/dental problems, weight management, healthy cooking techniques, and food selection |
2014–2015 | 2 March 2014 | Qigong |
24 May 2014 | Ergonomics, exercise, and fitness training help to protect from back pain | |
5 July 2014 | Liver disease management—liver disease | |
13 December 2014 | Body constitutional types in Chinese medicine | |
2015–2016 | 11 April 2015 | Common eating problems |
9 May 2015 | Introduce my plate | |
13 June 2015 | Fat facts: know more about oil | |
18 July 2015 | Summary and nutrition Q&A | |
5 December 2015 | Body constitutional types in Chinese medicine | |
5 December 2015 | Common female health problems | |
2016–2017 | 9 April 2016 | Knowing my plate |
16 April 2016 | Tasting event—try new foods | |
23 April 2016 | Supermarket field trip—label reading | |
30 April 2016 | Family cooking | |
17 December 2016 | Men’s body constitutional types in Chinese medicine | |
17 December 2016 | Men’s health problems | |
2017–2018 | 22 April 2017 | Knowing your nutrition needs |
29 April 2017 | How to value food | |
6 May 2017 | Recipe revamp | |
13 May 2017 | Be a smart eater | |
4 November 2017 | Sexual health of teenagers | |
4 November 2017 | Positive psychology | |
2018–2019 | 5 May 2018 | Knowing my signature dish |
15 May 2018 | Turning old to new | |
26 May 2018 | Adding color to your dish | |
2 June 2018 | Menu of the week | |
1 December 2018 | Understand the causes, screening for H. Pylori, other clinical assessments, management using Western medication—from the view of Western medicine | |
1 December 2018 | Understand the causes, management for different body constitutions—from the view of Chinese medicine | |
2019–2020 | 4 May 2019 | Healthy home cooking—foods for chronic disease prevention |
11 May 2019 | Healthy home cooking—recommendations for festive dishes | |
18 May 2019 | Healthy home cooking—food recommendations for children and older adults | |
25 May 2019 | Healthy home cooking —foods for skin care and improving immune system | |
30 August 2019 | Nutrition talk—understanding the concept of “fruits and vegetables 2 + 3 a day” and tips for practice | |
25 October 2019 | Dental talk—focus on understanding dental problems and methods of prevention | |
2020–2021 | 1 August 2020 | Healthy home cooking—introduction to the concept of the “three lows” |
8 August 2020 | Healthy home cooking —sodium in food/condiments and use of low-sodium alternatives in cooking | |
15 August 2020 | Healthy home cooking —identification of healthier cooking methods and ingredients | |
22 August 2020 | Healthy home cooking—Recognizing hidden sugar in food and knowing how to cut down on sugar intake or find alternatives when craving | |
9 January 2021 | Stress management talk | |
20 February 2021 | Visual health talk |
Appendix B
Date | Content | |
---|---|---|
2012–2013 | 9 November 2012–19 December 2012 (6 sessions) | Healthy living and healthy family |
2013–2014 | 10 April 2013–22 May 2013 (6 sessions) | Mental health enhancement |
2014–2015 | 26 April 2014–14 June 2014 (8 sessions) | Eight-section exercise 1 |
19 July 2014–13 September 2014 (8 sessions) | Eight-section exercise 2 | |
1 November 2014–20 December 2014 (6 sessions) | Tai chi | |
1 January 2014–31 July 2014 (15 sessions) | Family well-being enablement counseling | |
1 May 2014–30 August 2014 (2 sessions) | Family well-being workshops | |
2015–2016 | 30 May 2015–18 July 2015 (8 sessions) | Eight-section exercise |
28 March 2015–16 May 2015 (8 sessions) | Mawangdui daoyin exercises | |
10 October 2015–16 January 2016 (8 sessions) | Physiotherapy class | |
2016–2017 | 12 March 2016 (1 session) | Nutrition education for children |
9 April 2016–30 April 2016 (4 sessions) | Nutrition workshop | |
16 July 2016–6 August 2016 (4 sessions) | Kids and parents learn healthy recipes together | |
9 July 2016–30 July 2016 (4 sessions) | Boxing class for teenagers | |
4 August 2016–30 August 2016 (4 sessions) | Dancing class for teenagers | |
8 October 2016–3 December 2016 (8 sessions) | Parents exercise together with their children | |
2017–2018 | 22 April 2017–13 May 2017 (4 sessions) | Kids and parents learn healthy recipes together |
3 March 2017–24 March 2017 (4 sessions) | Rope skipping class 1 | |
3 August 2017–10 August 2017 (4 sessions) | Rope skipping class 2 | |
11 November 2017–23 December 2017 (4 sessions) | Rope skipping class 3 | |
14 September 2017–21 October 2017 (6 sessions) | Dancing gym | |
2018–2019 | 5 May 2018–2 June 2018 (4 sessions) | Kids and parents learn healthy recipes together |
25 April 2018–12 September 2018 (6 sessions) | Dancing gym | |
19 September 2018–23 October 2018 (6 sessions) | Dancing gym 2 | |
20 February 2018–27 March 2018 (6 sessions) | Dancing gym 3 | |
19 July 2018–16 August 2018 (5 sessions) | Rope skipping class 1 | |
10 November 2018–26 January 2019 (6 sessions) | Rope skipping class 2 | |
2019–2020 | 4 May 2019–25 May 2019 (4 sessions) | Kids and parents learn healthy recipes together |
29 May 2019–3 July 2019 (6 sessions) | Dancing gym 1 | |
11 September 2019–16 October 2019 (6 sessions) | Dancing gym 2 | |
30 July 2019 (1 session) | Summer sports | |
2 November 2019–30 November 2019 (4 sessions) | Walking group | |
2020–2021 | 1 August 2020–22 August 2020 (4 sessions) | Kids and parents learn healthy recipes together |
27 August 2020–31 August 2020 (6 sessions) | Dancing gym 1 | |
16 December 2020–3 March 2020 (8 sessions) | Dancing gym 2 | |
10 March 2021–31 March 2021 (5 sessions) | Dancing gym 3 |
Appendix C
B (95% CI) | p-Value for B | R2 | F | Significance for F Test | Post Hoc Power | |
---|---|---|---|---|---|---|
PEI-2 | ||||||
1. Able to cope with life | 1.12 (0.77, 1.47) | <0.001 * | 0.17 | 2.89 | <0.001 * | 1.00 |
2. Able to understand your illness | 0.66 (0.35, 0.96) | <0.001 * | 0.13 | 2.07 | 0.006 * | 0.99 |
3. Able to cope with your illness | 0.87 (0.54, 1.19) | <0.001 * | 0.13 | 2.18 | 0.004 * | 1.00 |
4. Able to keep yourself healthy | 0.68 (0.36, 0.99) | <0.001 * | 0.11 | 1.79 | 0.023 * | 1.00 |
5. Confident about your health | 0.65 (0.33, 0.98) | <0.001 * | 0.12 | 2.02 | 0.008 * | 1.00 |
6. Able to help yourself | 1.37 (1.04, 1.69) | <0.001 * | 0.25 | 4.68 | <0.001 * | 1.00 |
Total PEI-2 score | 5.35 (3.81, 6.89) | <0.001 * | 0.18 | 3.21 | <0.001 * | 1.00 |
DASS-21 | ||||||
Depression score | −2.01 (−3.68, −0.35) | 0.02 | 0.08 | 1.06 | 0.392 | 0.69 |
Anxiety score | −0.85 (−2.45, 0.76) | 0.300 | 0.06 | 0.82 | 0.684 | 0.23 |
Stress score | −1.50 (−3.56, 0.57) | 0.154 | 0.05 | 0.66 | 0.853 | 0.29 |
SF-12V2 | ||||||
PCS | −1.24 (−3.69, 1.21) | 0.321 | 0.05 | 0.75 | 0.767 | 0.07 |
MCS | 3.15 (0.28, 6.02) | 0.031 * | 0.08 | 1.21 | 0.246 | 0.35 |
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Before Weighting | After Weighting | |||||||
---|---|---|---|---|---|---|---|---|
Total (n = 289) | Intervention Group (n = 162) | Comparison Group (n = 127) | p-Value | Total | Intervention Group | Comparison Group | p-Value | |
Age (%), year | 41.63 ± 6.91 | 41.10 ± 7.01 | 42.31 ± 6.74 | 0.140 | 41.74 ± 7.57 | 41.03 ± 7.20 | 42.43 ± 0.68 | 0.114 |
<35 | 17.99% | 19.14% | 16.54% | 0.831 | 17.43% | 18.03% | 16.84% | 0.933 |
≥35 and <50 | 72.32% | 70.99% | 74.02% | 72.79% | 72.80% | 72.78% | ||
≥50 | 9.69% | 9.88% | 9.45% | 9.78% | 9.17% | 10.38% | ||
Gender (%, n) | 0.173 | 0.959 | ||||||
Female | 72.32% | 69.14% | 76.38% | 71.26% | 71.41% | 71.11% | ||
Male | 27.68% | 30.86% | 23.62% | 28.74% | 28.59% | 28.89% | ||
Educational level (%) | 0.271 | 0.923 | ||||||
No formal education/primary | 14.19 % | 16.67% | 11.02% | 12.95% | 13.75% | 12.16% | ||
Secondary | 79.58 % | 78.40% | 81.10% | 80.88% | 80.36% | 81.39% | ||
Tertiary/further education | 6.23 % | 4.94% | 7.87% | 6.17% | 5.89% | 6.45% | ||
Working status (%) | <0.001 * | 0.960 | ||||||
Working (employee or employer) | 73.36% | 81.48% | 62.99% | 73.84% | 73.98% | 73.70% | ||
Not working (homemaker, retired, unemployed) | 26.64% | 18.52% | 37.01% | 26.16% | 26.02% | 26.30% | ||
Marital status (%) | 0.020 * | 0.829 | ||||||
Married | 85.12% | 90.12% | 78.74% | 85.50% | 85.71% | 85.29% | ||
Divorced | 10.38% | 8.02% | 13.39% | 10.88% | 11.38% | 10.39% | ||
Unmarried (single/widower) | 4.50% | 1.85% | 7.87% | 3.62% | 2.92% | 4.32% | ||
Monthly family income # (%), HKD | 0.344 | 0.910 | ||||||
≤11,000 | 39.45% | 37.04% | 42.52% | 39.71% | 40.06% | 39.36% | ||
>11,000 | 60.55% | 62.96% | 57.48% | 60.29% | 59.94% | 60.64% | ||
Government assistance (%) | 0.076 | 0.769 | ||||||
Yes | 20.42% | 16.67% | 25.20% | 21.73% | 20.91% | 22.53% | ||
No | 79.58% | 83.33% | 74.80% | 78.27% | 79.09% | 77.47% | ||
Obesity status (%) | 0.996 | 0.980 | ||||||
Normal weight | 58.13% | 58.02% | 58.27% | 58.49% | 58.84% | 58.14% | ||
Overweight | 37.02% | 37.04% | 37.01% | 35.99% | 35.95% | 36.03% | ||
Obese | 4.84% | 4.94% | 4.72% | 5.52% | 5.21% | 5.83% | ||
Chronic morbidity (%) | 0.236 | 0.817 | ||||||
Yes | 42.56 % | 60.49% | 53.54% | 41.52% | 40.79% | 42.23% | ||
No | 57.44 % | 39.51% | 46.46% | 58.48% | 59.21% | 57.77% | ||
Smoking status (%) | 0.907 | 0.999 | ||||||
Never smoked | 77.85% | 77.16% | 78.74% | 75.52% | 75.66% | 75.38% | ||
Quit | 6.92% | 6.79% | 7.09% | 7.53% | 7.45% | 7.61% | ||
Current smoker | 15.22% | 16.05% | 14.17% | 16.95% | 16.88% | 17.02% | ||
Alcohol consumption (%) | 0.125 | 0.986 | ||||||
Never drank | 69.20% | 72.84% | 64.57% | 68.84% | 69.24% | 68.45% | ||
Quit | 3.46% | 4.32% | 2.36% | 3.93% | 3.73% | 4.13% | ||
Current drinker | 27.34% | 22.84% | 33.07% | 27.23% | 27.03% | 27.42% | ||
Use of a regular family doctor (%) | 0.694 | 0.746 | ||||||
Yes | 15.92% | 16.67% | 14.96% | 15.04% | 15.76% | 14.34% | ||
No | 84.08% | 83.33% | 85.04% | 84.96% | 84.24% | 85.66% |
Before Weighting | After Weighting | |||||||
---|---|---|---|---|---|---|---|---|
Baseline | Follow-Up | Baseline | Follow-Up | |||||
Intervention Group | Comparison Group | Intervention Group | Comparison Group | Intervention Group | Comparison Group | Intervention Group | Comparison Group | |
Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | |
PEI-2 | n = 162 | n = 127 | n = 162 | n = 127 | ||||
1. Able to cope with life | 2.84 ± 1.00 | 4.02 ± 0.89 | 3.79 ± 0.97 | 3.89 ± 1.02 | 2.83 ± 0.94 | 4.05 ± 0.93 | 3.79 ± 0.97 | 3.88 ± 1.08 |
2. Able to understand your illness | 2.96 ± 0.88 | 3.62 ± 0.92 | 3.55 ± 0.89 | 3.61 ± 0.90 | 2.94 ± 0.84 | 3.55 ± 1.00 | 3.56 ± 0.87 | 3.58 ± 0.96 |
3. Able to cope with your illness | 2.84 ± 1.01 | 3.72 ± 0.88 | 3.58 ± 0.89 | 3.65 ± 0.95 | 2.81 ± 0.98 | 3.65 ± 0.96 | 3.57 ± 0.88 | 3.58 ± 0.99 |
4. Able to keep yourself healthy | 2.87 ± 0.99 | 3.61 ± 0.80 | 3.49 ± 0.89 | 3.57 ± 0.87 | 2.83 ± 0.95 | 3.58 ± 0.86 | 3.47 ± 0.88 | 3.55 ± 0.87 |
5. Confident about your health | 2.78 ± 0.97 | 3.57 ± 0.82 | 3.46 ± 0.94 | 3.57 ± 0.81 | 2.76 ± 0.94 | 3.58 ± 0.83 | 3.42 ± 0.95 | 3.59 ± 0.80 |
6. Able to help yourself | 2.61 ± 0.97 | 4.11 ± 0.77 | 3.86 ± 0.93 | 3.98 ± 0.85 | 2.62 ± 0.93 | 4.11 ± 0.79 | 3.85 ± 0.93 | 4.00 ± 0.84 |
Total PEI-2 score | 16.90 ± 4.65 | 22.65 ± 3.63 | 21.73 ± 4.49 | 22.28 ± 4.13 | 16.78 ± 4.44 | 22.52 ± 3.81 | 21.66 ± 4.46 | 22.17 ± 4.23 |
DASS-21 | n = 151 | n = 130 | n = 151 | n = 130 | ||||
Depression score | 4.28 ± 5.72 | 4.32 ± 6.52 | 3.47 ± 5.22 | 5.43 ± 6.54 | 4.30 ± 5.72 | 4.07 ± 6.16 | 3.51 ± 5.23 | 5.26 ± 6.22 |
Anxiety score | 4.85 ± 6.00 | 4.71 ± 5.44 | 4.78 ± 5.80 | 5.54 ± 6.03 | 4.76 ± 5.98 | 4.54 ± 5.14 | 4.76 ± 5.81 | 5.51 ± 5.88 |
Stress score | 7.50 ± 7.84 | 7.93 ± 7.64 | 6.10 ± 7.02 | 7.87 ± 6.99 | 7.50 ± 7.94 | 7.63 ± 7.37 | 6.06 ± 7.00 | 7.63 ± 6.60 |
SF-12V2 | n = 175 | n = 149 | n = 175 | n = 149 | ||||
PCS | 48.80 ± 8.45 | 49.84 ± 7.55 | 48.08 ± 9.03 | 49.63 ± 8.24 | 48.76 ± 8.67 | 49.57 ± 7.79 | 47.72 ± 9.06 | 49.87 ± 8.20 |
MCS | 50.05 ± 11.43 | 51.64 ± 11.16 | 53.32 ± 10.23 | 52.77 ± 8.56 | 49.24 ± 11.62 | 52.04 ± 11.16 | 53.37 ± 10.29 | 53.18 ± 8.66 |
B (95% CI) | p-Value for B | R2 | F | Significance for F Test | Post Hoc Power | |
---|---|---|---|---|---|---|
PEI-2 | ||||||
1. Able to cope with life | 1.13 (0.79, 1.47) | <0.001 * | 0.15 | 43.11 | <0.001 * | 1.00 |
2. Able to understand your illness | 0.59 (0.27, 0.90) | <0.001 * | 0.05 | 13.45 | <0.001 * | 0.92 |
3. Able to cope with your illness | 0.83 (0.52, 1.15) | <0.001 * | 0.10 | 26.55 | <0.001 * | 1.00 |
4. Able to keep yourself healthy | 0.67 (0.37, 0.97) | <0.001 * | 0.07 | 19.81 | <0.001 * | 0.99 |
5. Confident about your health | 0.66 (0.35, 0.97) | <0.001 * | 0.06 | 17.51 | <0.001 * | 0.98 |
6. Able to help yourself | 1.34 (1.02, 1.66) | <0.001 * | 0.22 | 69.09 | <0.001 * | 1.00 |
Total PEI-2 Score | 5.22 (3.81, 6.63) | <0.001 * | 0.17 | 53.17 | <0.001 * | 1.00 |
DASS-21 | ||||||
Depression score | −1.98 (−3.48, −0.47) | 0.001 * | 0.03 | 6.72 | 0.010 * | 0.66 |
Anxiety score | −0.96 (−2.42, 0.49) | 0.193 | 0.01 | 1.70 | 0.193 | 0.23 |
Stress score | −1.44 (−3.31, 0.42) | 0.129 | 0.01 | 2.32 | 0.129 | 0.29 |
SF-12V2 | ||||||
PCS | −1.34 (−3.82, 1.14) | 0.290 | 0.00 | 1.12 | 0.290 | 0.16 |
MCS | 2.99 (0.34, 5.64) | 0.027 * | 0.02 | 4.94 | 0.027 * | 0.55 |
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Lu, F.; Wong, C.K.H.; Tse, E.T.Y.; Ng, A.P.P.; Li, L.; Lam, J.S.M.; Bedford, L.; Fong, D.Y.T.; Ip, P.; Lam, C.L.K. The Impact of a Health Empowerment Program on Self-Care Enablement and Mental Health among Low-Income Families: Evidence from a 5 Year Cohort Study in Hong Kong. Int. J. Environ. Res. Public Health 2023, 20, 5168. https://doi.org/10.3390/ijerph20065168
Lu F, Wong CKH, Tse ETY, Ng APP, Li L, Lam JSM, Bedford L, Fong DYT, Ip P, Lam CLK. The Impact of a Health Empowerment Program on Self-Care Enablement and Mental Health among Low-Income Families: Evidence from a 5 Year Cohort Study in Hong Kong. International Journal of Environmental Research and Public Health. 2023; 20(6):5168. https://doi.org/10.3390/ijerph20065168
Chicago/Turabian StyleLu, Fangcao, Carlos King Ho Wong, Emily Tsui Yee Tse, Amy Pui Pui Ng, Lanlan Li, Joyce Sau Mei Lam, Laura Bedford, Daniel Yee Tak Fong, Patrick Ip, and Cindy Lo Kuen Lam. 2023. "The Impact of a Health Empowerment Program on Self-Care Enablement and Mental Health among Low-Income Families: Evidence from a 5 Year Cohort Study in Hong Kong" International Journal of Environmental Research and Public Health 20, no. 6: 5168. https://doi.org/10.3390/ijerph20065168