Enhancing Quality of Life of Eczema Families by Psychosocial Intervention Program
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18th Interdisciplinary Conference
COMMUNICATION, MEDICINE & ETHICS (COMET 2020)
Enhancing Quality of Life of Eczema
Families by Psychosocial Intervention
Program
FUNG, YL; CHAN, Celia; HUI, Christy; LUK, Martha; SO,
Georgina; CHAU, Priscilla; CHAN, Cecilia
Department of Social Work and Social Administration
The University of Hong Kong
1
Agenda
Background of Research Study
Literature Review
Conceptual Framework
Design and Methodology
Findings
Conclusions and Limitations
2
General Pattern (infant,
preschooler)
Infant
Preschooler
From
3
DermNet NZGeneral Pattern (school age, adult)
School age
Adult
From
4
DermNet NZCauses of Eczema: A combination of
factors
Abnormal
Genetics function of the Environment
immune system
Activities that Defects in the
may cause skin skin barrier that
to be more allow moisture
sensitive out and germs in
5Statistics of Eczema at a glance
Affect 15%-30% of children, up to 10% of adult
45% begin from the first 6 months of life
70% affected before age of 5
60% grow out by adolescence
50% continue to exist in adult
(Archer, 2013)
31.3% of primary and secondary school students reported
one or more skin diseases. Eczema was the most common
problem (Fung & Lo, 2000).
60% of local children interviewed reported experiencing skin
problems, and eczema was top of the list (Hon, Leung, Wong,
Ma, & Fok, 2004).
6Impact on Quality of Life of Parents
• disruption of daily routines
• reduction of social activities
• poor physical health
• emotional health
(Carmen et al., 2018; Ho et al., 2010: Holt, Cohen, Mannarino, &
Jensen, 2014; Meyer et al., 2014)
Impact on Quality of Life of Children
• lack of sleep, Irritability
• Daytime tiredness, Appearance-related teasing
• Social stigmatization emotional distress
• Diminished self-esteem
• Psychological disturbance
(Archer, 2013; Lin, 2012; Eichenfield et al., 2014; Ferro & Boyle,
2015; Fortson et al., 2017; Maksim Vic et al., 2012;
7
Wang et al.,
2016)Parental Stress Inventory of Eczema Caregiving Process
8Vicious Cycle of Eczema Caregiving Process
9Results of Literature Review
• Parents of children with eczema have suffered from various
kinds of psychosocial distress from multidimensional
perspectives
• It is uncertain about what and how various qualitative
components (e.g. guilt, benefit-finding) interact and affect
one another in the caregiving meaning reconstruction process
• Parental trainings are found to be an effective adjunct to
conventional dermatological intervention, little focus on the
psychosocial impacts of the disease on parents
• Little empirical evidence can be found, and conclusive results
cannot be drawn on the effectiveness of the training
10Research Gap
Existing research studies scarcely focus on:
• Psychosocial care for parents and family support
• Psychological mechanism of reconstructing the meaning of the
disease
• Benefits that the parents may gain from the caregiving
experience
Existing intervention programs:
• No psychosocial intervention for parents
• No evidence-based and theory-based psychological and
educational intervention for parents
• Effectiveness of existing parental education programs is
limited
11Schematic Model of Initial Conceptual Framework
12Research Objectives
a) Conduct the psychosocial intervention program for parents
and children based on the customized IBMS protocol;
b) Identify the correlation of the variables defined in the
intervention program;
c) Provide empirical evidence on the effectiveness of the
intervention program in improving the holistic wellbeing of
the participants.
13Integrative Body-Mind-Spirit (IBMS) Approach
(Chan, C.L.W., 2001; Chan, Ho, & Chow, 2002; Lee et al., 2009)
Spiritual
Wellbeing
Emotional Wellbeing
& Interpersonal Physical
Relationship Wellbeing
14
EnvironmentFoundation of Integrative Body-Mind-Spirit (IBMS)
Daoism Yi-jing
Respect nature Five Elements Theory
Simple lifestyle Yin-Yang Theory
Holistic Perspective
u Trust in self restoration ability
u Believes that restoring the harmonious dynamic
equilibrium can help the organism to heal itself
u Facilitates self-healing
u Positive experiences
15IBMS in various Clinical Settings
Children with eczema and parent caregivers (Fung et al., 2020), (Xie at al., 2020), (Fung et al, 2019)
Patients with psoriasis (Chan, Yao, Fung, Ji, & Chan, 2017)
Family impacted by cancer (Leung & Chan, 2015)
Patients with depressive symptoms (Rentala et al., 2015), (Chan et al., 2014), (Sreevani et al.,
2013), (Hsiao et al., 2011), (Yang et al., 2009)
Patients with adjustment disorder and (Ji et al., 2018), (Hsiao et al., 2014)
depressive mood
Patients with depression and anxiety (Lo, Ng, Chan, Lam, & Lau, 2013)
Terminal cancer (Lau et al., 2018), (Chan & Ho, 2012)
Women undergoing in vitro fertilization (Chan, Lau, Tam, 2020), (Chan et al., 2019), (Lau et al.,
2019), (Lau at al., 2018), (Yao et al., 2018), (Chan et al.,
2012), (Chan, Ng, Chan, Ho, & Chan, 2006), (Chan, Chan, Ng,
Ng, & Ho, 2005)
Patients with breast cancer (Hsiao et al., 2013), (Hsiao et al., 2012), (Ho, Potash, Fu,
Wong, & Chan, 2010), (Liu et al., 2008), (Chan, Ho, Lee, et
al., 2006)
Trauma management (Chan & Ng, 2012), (Chan, Chan, et al., 2006), (Chan et al.,
2000)
Mental health (Yu at al., 2018), (Ng, Chan, Leung, Chan, & Yau, 2009)
Patients with colorectal cancer (Lee et al., 2007)
Stress management (Chan, so, et al., 2006)
Psychosocial oncology (Chan, Ho, Fu, & Chow, 2006)
Patients with chronic disease (Ng et al., 2006)
Divorced Chinese women (Chan et al., 2005), (Chan, Chan, & Lou, 2002), (Chan & Wong,
2000) 16IBMS Session Objectives
Session Objective
1 To introduce fundamentals of Integrative Body-Mind-Spirit
and holistic wellbeing
2 To understand the mind-body connection
3 To experience self-appreciation and to stay calm under
stressful condition
4 To realize the discrepancies between parents’ and
children’s thought in the caregiving experience and
appreciate the importance of parents’ wellbeing
5 To appreciate the importance of ‘letting-go’ in
maintaining mental health, and to identify a support
group
6 To practice the concept of reciprocity and initiate
transformation 17IBMS Intervention Goal (for Children)
1. To facilitate the expression of emotion
2. To enhance self-esteem
3. To augment psychological resilience
IBMS Session Objective (for Children)
Session Topic Objective
1 Day-dream To explore self-identity
2 Funny Monster To face eczema in a positive way
3 Emotion magician To understand different kinds of emotion
4 Invincible Me To enhance resilience capacity
5 Power from within To identify personal strength and resources
6 My support network To identify support network and strength
supportFrom Theories to Practices: Customization of Protocol
a. Simple bodily movement exercises (body techniques)
b. Traditional Chinese Medicine life style (concepts and dietary information)
c. Acupressure points massage (physical and emotional health)
d. Emotion management (theories and exercises)
e. Life review by autobiographical timeline (challenges and blessings in life
journey)
f. Self-portrait and self-talk (self-exploration and appreciation)
g. Pain and suffering (preparation on transformation)
h. Appreciation diary (appreciation on other people and the nature)
i. Letter writing (reflection and priority setting)
19Efficacy of Intervention
Ø 3 phases (2017, 2018, 2019)
Ø Randomized Waitlist-Controlled Trial
Ø 114 intervention, 105 control
Ø IBMS program (6 weeks, 3 hours per week)
Ø Children with eczema (age 6-11)
Depa men of Social Wo k and Social Admini
The Uni e i of Hong Kong
港大學 會工作及 會 政學
a ion
Ø Parallel group (Parents and Children group)
Ø Measurement: 2 time points (Before, After)
為濕疹兒 及其家 的 心 子健康工作坊
Ø Collaborators (over 50 trained social
workers):
• The Hong Kong Society for Rehabilitation
(HKSR)
日期 二 一九年七 十二月 於 六
地 港大學 或 塘基督教家庭服務中心
對 患有濕疹的六 十一歲學 及其一位家
用 低收入家庭 用全免 取 援或學校書 津 之家庭
• The Boys’ and Girls’ Clubs Association of Hong
低收入家庭 用為港幣六千元
形式 家 及兒 分別參加共六 每 三小時的工作坊
導師 已受培 並獲得「 心 健康全人模式」 書的 深 工
備 兒 參加 在 前後填寫問卷、
Kong (BGCA)
接受 液測 及 生 估。
家 則 在 前後填寫問卷。
• Christian Family Service Centre (CFSC)
• 20
The Neighbourhood Advice-Action Council
查 39175526 或 g k@hk .hk
h ://lea ning.hk .hk/ibm /ec ema- ha e3/
報名 h ://goo.gl/fo m /LaCYUeaBg iUOY C2
此 目已由 操守委員會批核 EA1803058 。
承 K enflo e Managemen Inc. 以
慷慨捐款予瑞 慈善基 以全數 助本
坤及
的低收入家庭
娟名
(NAAC)Schematic Model of Intervention
AFTER
completion of study
IBMS Holistic Well-being Scale (HWS) IBMS
Intervention Intervention
Program Perceived Stress Scale (PSS) Program
Dermatitis Family Impact (DFI)
Patient Health Questionnaire (PHQ-9)
Parents General Anxiety Disorder (GAD-7)
Parents
Children Children
Children’s Dermatology Life Quality
Index (CDLQI)
Intervention Disease Quality of Life Control
Questionnaire (PADQLQ)
Group Group
Patient-Oriented Eczema Measure
(POEM)
21Time Schedule of Measurement
Recruitment
Randomization
Intervention Group Control Group
Parents Group Children Group Parents Group Children Group
T0 Assessment
Six-Session Six-Session
intervention for intervention for 6 weeks
Parents Children
T1 Assessment 22CONSORT Workflow of Intervention
Enrollment Assessed for eligibility (n= 555)
Excluded (n= 174)
• Not meeting inclusion criteria (n= 56)
• Decline to participate (n= 118)
Randomized (n= 381)
Excluded (n= 122)
• Decline after randomization (n= 122)
Allocation
Allocated to intervention group (n=
Allocated to control group (n= 127)
132)
Follow Up
• Fail to complete follow up • Fail to complete follow up
assessment (n= 18) assessment (n= 22)
Analysis
23
Analyzed (n= 114) Analyzed (n= 105)Demographic Characteristics of Parents
Intervention Group Control Group
n Mean SD or % n Mean SD or %
Age 129 40.05 5.765 122 40.39 5.762
Gender
Male 10 7.60% 17 13.40%
Female 121 91.70% 107 84.30%
Employment
Full time 51 38.60% 52 40.90%
Part time 12 9.10% 13 10.20%
Retired 1 0.80% 1 0.80%
Homemaker 66 50.00% 58 45.70%
Unemployed 1 0.80% 0 0.00%
Education level
Primary 3 2.30% 4 3.10%
Secondary 64 48.50% 62 48.80%
Tertiary 51 38.60% 41 32.30%
Postgraudate 12 9.10% 17 13.40%
Marital status
Single 3 2.30% 1 0.80%
Married/Cohabited 114 86.40% 108 85.00%
Divorced/Separated 10 7.60% 13 10.20%
Widowed 3 2.30% 2 1.60%
Religion
No religion 73 55.30% 71 55.90%
Catholic 12 9.10% 11 8.70%
Christian 34 25.80% 28 22.00%
Buddhism 7 5.30% 11 8.70%
Others 4 3.20% 2 1.60%
Family income
80,000 3 2.30% 13 10.20%
No answer 10 7.60% 14 11.00%Outcome of Intervention Measurement
Outcome Variables Time (Main Effect) Partial Time * Group (Interaction Effect) Partial
Eta Sq Eta Sq
CDLQI_Symptoms_and_Feelings F (1,217) = 34.816, p = 0.000** 0.138 F (1,217) = 0.494, p = 0.483 0.002
CDLQI_Leisure F (1,217) = 37.765, p = 0.000** 0.148 F (1,217) = 2.946, p = 0.088 0.013
CDLQI_SchoolHolidays F (1,216) = 4.896, p = 0.028* 0.022 F (1,216) = 0.022, p = 0.882 0.000
CDLQI_Relationship F (1,217) = 9.028, p = 0.003** 0.040 F (1,216) = 0.83, p = 0.363 0.004
CDLQI_Sleep F (1,217) = 21.773, p = 0.000** 0.091 F (1,217) = 0.114, p = 0.736 0.001
CDLQI_Treatment F (1,217) = 16.839, p = 0.000** 0.072 F (1,217) = 0.507, p = 0.477 0.002
PADQLQ_Activities F (1,113) = 7.642, p = 0.007** 0.063 F (1,113) = 0.96, p = 0.329 0.008
PADQLQ_Symptoms F (1,109) = 7.874, p = 0.006** 0.067 F (1,109) = 0.562, p = 0.455 0.005
PADQLQ_Emotions F (1,114) = 5.031, p = 0.027* 0.042 F (1,114) = 0, p = 0.993 0.000
POEM F (1,112) = 15.549, p = 0.000** 0.122 F (1,112) = 0.235, p = 0.629 0.002
HWS_Nonattachment F (1,212) = 0.111, p = 0.74 0.001 F (1,212) = 3.942, p = 0.048* 0.018
HWS_Afflictiveemotion F (1,208) = 2.69, p = 0.102 0.013 F (1,208) = 0.346, p = 0.557 0.002
HWS_Afflictivesensation F (1,211) = 2.913, p = 0.089 0.014 F (1,211) = 8.85, p = 0.003** 0.040
HWS_Afflictiveideation F (1,210) = 1.06, p = 0.304 0.005 F (1,210) = 5.847, p = 0.016* 0.027
HWS_Mindfulawareness F (1,210) = 0.25, p = 0.617 0.001 F (1,210) = 1.565, p = 0.212 0.007
HWS_Generalvitality F (1,213) = 0.5, p = 0.48 0.002 F (1,213) = 8.666, p = 0.004** 0.039
HWS_Spiritualselfcare F (1,211) = 0.368, p = 0.545 0.002 F (1,211) = 0.517, p = 0.473 0.002
DFI F (1,212) = 82.211, p = 0.000** 0.279 F (1,212) = 10.972, p = 0.001** 0.049
PSS F (1,212) = 31.087, p = 0.000** 0.128 F (1,212) = 15.418, p = 0.000** 0.068
PHQ9 F (1,211) = 4.857, p = 0.029* 0.023 F (1,211) = 14.348, p = 0.000** 0.064
GAD7 F (1,214) = 4.285, p = 0.04* 0.020 F (1,214) = 12.142, p = 0.001** 0.054
** Significance in 0.01 level 25
* Significance in 0.05 levelOutcome of Intervention Measurement
Parents Score
Holistic Wellbeing Significantly Improved ✌
Family Functioning Significantly Improved ✌
Stress Level Significantly Reduced ✌
Depression Level Significantly Reduced ✌
Anxiety Level Significantly Reduced ✌
Children Score
Generally improving but no significant interaction effect
26Conclusions and
Theoretical Contributions
v The IBMS program could significantly improve the holistic wellbeing
of the parents. Their perceived stress and depression level have also
been significantly reduced.
v The IBMS protocol presented a theoretical framework and practical
guideline for the psychosocial intervention research studies and
community health program development in future.
v the IBMS program for the parent-child dyads, which identified a
theory-based and evidence-based psychosocial therapeutic direction
in addition to the conventional pharmacological approaches.
27Limitations
v Representativeness of data – dropout in RCT
v Only parents of children in primary school were included in the
quantitative study
v Running groups at different times (Phase 1, 2, 3)
v Running groups by different NGOs (Fidelity check)
28Thank You
Contact
Dr YL Fung yl.fung28@hku.hk
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