Publications

As rates of chronic illness have increased in recent decades there have been significant changes in national and international health systems. Emerging approaches have shifted the focus from hospital-based, acute and curative interventions to the management of chronic illness through primary health care programs in local communities. Integrated care has emerged as an increasingly prominent approach within primary health care programs that target chronically ill populations.

This empirical doctoral study of an integrated care program explores how global discourses, which position the problem of chronic illness as an issue of cost to health care systems and a burden to the community, are translated from national policies to everyday lives in domestic households. Through close analysis of six chronically ill clients of a state-run primary health care program, named HealthOne Camara, this study brings to the fore the alignments, relays and connections of integrated care in ways that contrast with the dominant linear views typically generated through policy analysis and program evaluation studies.

Using a governmentality perspective based on the later work of Michel Foucault and other writers on governmentality, the study identifies patterns and consistencies across policy texts and everyday practices of integrated care in HealthOne Camara. Innovatively, Foucault’s work on space and heterotopia is used in the study to identify the spaces of integrated care as heterotopias. In doing so, the focus shifts from what integrated care is to an analysis of how this care weaves through the lives of the HealthOne Camara clients.

By drawing on empirical and documentary data, this study offers a unique way of rethinking chronic illness and integrated care within primary health care programs. It highlights the tensions and complexities of integrated care for chronically ill clients in a local site. The analysis of these tensions opens up new ways of thinking about HealthOne’s integrated care as an attempt to direct the self-governing abilities of people in certain ways. Examining the localised practices of care through the analytics of space and heterotopia brings to the fore the tension and resistance that emerges as practices of ‘care’ attempt to align complex lives with the often linear logic of policy. As rates of chronic illness increase, levels of health inequalities continue to rise and governments remain focused on reducing costs of care, the knowledge generated through this study argues for careful consideration of what the localised and unintended effects of programs of integrated care may be.

This chapter explores emotion work and emotional reflexivity in online health communication research. The authors draw on their own experiences of conducting qualitative interviews during the COVID-19 health crisis to consider how emotions are modified and expressed in the absence of face-to-face contact with research participants. This experience highlighted the importance of emotional reflexivity in health communication research as well as the vital role of nonverbal and paralinguistic features in interviewing. The authors identify three strategies which can support emotional reflexivity in online interviewing and enhance the robustness of research whilst facilitating emotional connection with interviewees.

Health care is shaped by often complex communication between multiple people such as doctors, nurses, patients and carers. Research has repeatedly shown that effective communication is key to safe and high-quality care yet improving communication remains a challenge across health systems. In recent years, the field of natural language processing has developed analytic tools to supplement the study of verbal communication through visual representation of analysis. To date, these tools have primarily been used on English data. This study used the software tool Discursis to compare visual representations of Cantonese conversational data that were analysed before and after English translation. Results indicate that some linguistic features of Cantonese that carry meaning may be lost in translation into English. Specific concerns relate to the multidimensional issues of equivalence, ranging from cultural and social associations to semantic, lexical and conceptual differences. These results highlight the importance of developing visual analytic tools that can be used on Cantonese data. Generating visual representations of such data contributes to local and international understandings about communication in health care.

This article explores the unique contribution that Foucault’s work on genealogy and governmentality can make to the analysis of contemporary programs of government. The article uses an Australian study of the ‘problem’ of chronic illness to argue that this perspective offers valuable insights into how ‘problems’ such as chronic illness have become linked to advanced liberal discourses and practices of self-governing and self-responsibility. These insights are particularly valuable in fields such as primary health care that have a noted shortage of critical and reflective studies that explore the links between people and changing ideas of health and disease. This article details how taking up an analytics of governmentality and political genealogy informed by Foucault, facilitated the tracing of the dominant discourses and practices, and the connections to the day-to -day lives of the clients with chronic diseases. Importantly, this approach opened up a more critical consideration of the ways in which dispersed approaches to governing through programs, such as integrated care, shape and influence the lives of individuals. These dispersed ways of governing are not linear but rather unfold through ongoing relays, connections and the (re)production of discourses.

Background Empathy is essential for patient-centered nursing care, yet consensus on effective teaching methods remains limited.

Aim This article presents an overview of the design, implementation, and evaluation of a narrative medicine-based teaching intervention that aimed to enhance nursing students’ awareness of communication associated with expressions and perceptions of empathy as a multidimensional construct.

Methods Six nursing students enrolled at a public university in Hong Kong participated in a 4-week intervention that consisted of three sequential activities (reflective writing, point-of-view exercises, and simulation role play) aligned with Kolb’s experiential learning cycle, targeting affective, cognitive, and behavioral dimensions of empathy.

Results Findings indicated that the sequential narrative medicine-based activities developed participants’ awareness and understanding of empathy. Students reported that the structured reflective exercises encouraged deeper reflection and greater consideration of patients’ perspectives within communication practices.

Conclusion The findings of this exploratory study suggest that theoretically grounded, narrative-based interventions can support students’ awareness of empathy and integrate reflective and communication-focused activities into nursing education curricula.

Objectives This study explored how end-of-life (EOL) care practitioners in Hong Kong engaged in emotional labor while fulfilling their professional roles in a Chinese cultural context.

Methods A sequential explanatory mixed-methods design was employed. A quantitative survey (n = 32) using validated scales that measured emotional job demands and emotional labor strategies was followed by in-depth interviews (n = 11) with EOL care practitioners from diverse disciplines. Survey data were analyzed using descriptive statistics, while interview transcripts underwent thematic analysis.

Results EOL care practitioners reported high emotional job demands, with deep acting being their preferred emotional labor strategy over surface acting. Three key themes emerged related to: (1) balancing emotional involvement and professional boundaries; (2) employing strategic emotional engagement; and (3) navigating cultural beliefs and family dynamics. This multidisciplinary workforce developed sophisticated practices to manage their emotions authentically while establishing protective psychological boundaries. These practices integrated the provision of emotional support with the navigation of tensions between Chinese cultural values and professional responsibilities.

Significance of results This study used mixed-methods to explore how traditional values were integrated into the everyday care practices of EOL practitioners in Hong Kong. The findings contribute to an innovative and culturally sensitive framework for exploring emotional labor in EOL care contexts. This is useful in both Chinese and multicultural care contexts.

Background Uncertainty, when perceived as a danger, can severely undermine a cancer patient’s recovery, resilience, and quality of life. Managing this uncertainty is therefore vital to well-being. While research on uncertainty and coping is growing, little attention has been given to vulnerable groups, such as migrant domestic workers (MDWs). Therefore, this study explores how Indonesian MDWs in Hong Kong experience and navigate the uncertainties arising following cancer diagnosis.

Method This qualitative study is based on semi-structured interviews with 12 Indonesian MDWs diagnosed with cancer or being under observation due to suspicion of cancer (e.g., having cysts or lumps) in Hong Kong. The participants were selected by using a combination of purposive and snowball sampling. The interviews conducted in Bahasa Indonesia were audio-recorded, transcribed, translated into English, and analyzed employing reflexive thematic analysis.

Results Our analysis, focusing on personal uncertainty, showed two primary forms: psychosocial and existential. Our participants managed these through four strategies, particularly reducing threatening uncertainty, maintaining uncertainty perceived as comfortable, increasing uncertainty to avoid distressing certainty, and adapting to chronic uncertainty.

Conclusion Their narratives of experiencing and managing uncertainty reveal resilience and a quiet strength that restored hope and agency amid adversity. These findings highlight how structural inequities shape illness experiences and point to the need for equity-oriented cancer care for migrant workers.

Background Communication is crucial across all stages of cancer diagnosis, treatment, and recovery. However, engaging in consistently high levels of interpersonal communication can generate additional burdens for people with cancer. Despite increasing rates of diagnosis in Asia and the dominance of intraregional migration for employment, limited research has focused on the cancer experiences of migrant women. This article presents a unique study of communication ‘work’ done by female Migrant Domestic Workers (MDWs) diagnosed with cancer in Hong Kong.

Methods Qualitative data were collected between June and December 2023 through semi-structured interviews with 22 MDWs from the Philippines who were diagnosed with cancer in Hong Kong. Data were analyzed using the Integrative Theory of Communication (ITC). This framework examines communication in relation to: information and instruction work, emotion work, identity work, relational work, and articulation and coordination work.

Results Results indicated that MDWs engaged in all types of communication work described in the ITC. Each type of communication was uniquely shaped by their position as MDWs in Hong Kong with specific links to their relationship with their employer, the precarious nature of their employment, and comparisons of oncology services available in Hong Kong and the Philippines.

Conclusions Our study highlights how interpersonal communication is complicated by migrant status, the intersection of individuals’ multiple identities, and family financial vulnerability. These factors increased the complexity of MDWs’ efforts to manage relationships, financial responsibilities, and employment to maintain access to treatment, placing a greater physical and emotional burden on them during treatment and recovery.

This article presents the narrative analysis of interview data collected from 15 migrant domestic workers (MDWs) from the Philippines who were diagnosed with breast cancer in Hong Kong. The analysis draws on a social constructionist understanding of identity as multiple and performed through language, communication, and social interaction to explore how these MDWs narrated their cancer experiences and changing identities as they worked to incorporate serious illness into their lives as MDWs. The narratives of these MDWs highlight their multiple and changing identities as they move and communicate across places, systems of migration and networks of relationships.

Background COVID-19 vaccine hesitancy has been shaped by diverse sociocultural and political influences (SPIs), rendering it a multifaceted and context-specific issue. Various studies spanning different academic domains have endeavoured to dissect these diverse SPIs, revealing that the impact of a particular influencer can vary significantly depending on the context and disciplinary interpretation. However, prevailing review literature has predominantly focused on enumerating influential factors without providing in-depth contextual backgrounds or disciplinary interpretations. Additionally, a majority of these studies have been confined within specific disciplines, hindering the development of a holistic understanding of vaccine hesitancy. To broaden the scope of knowledge, this study aims to systematically review how SPIs on COVID-19 vaccine hesitancy have been approached and interpreted across disciplines.

Methods This systematic review adopted a qualitative comparative synthesis approach to explore how SPIs on COVID-19 vaccine hesitancy had been approached (including their selection and application) in each study across disciplines. Five databases (PubMed, PsycINFO, Web of Science, CINAHL, and Scopus) were searched to identify peer-reviewed studies that primarily focused on exploring SPIs on COVID-19 vaccine hesitancy among healthy adults. Out of 665 records initially retrieved, 28 studies met the eligibility criteria.

Results Studies that adopted theoretical frameworks explored SPIs from four approaches: 1) Social Cognitive, 2) Disposition-Environment Interaction, 3) Critical Medical anthropology/Medical Ecology, and 4) Social Structures. For studies without theoretical framework were synthesized into three main themes: 1) influences from political ideology, 2) interaction between political views and trust in science; and 3) contextual social cognitive determinants.

Conclusions This qualitative comparative synthesis facilitated the comparison of diverse studies from multiple disciplines. The integration of theoretical and empirical evidence illustrated how different disciplines interpreted SPIs on COVID-19 vaccine hesitancy, enhancing interdisciplinary understanding and underscoring theoretical and practical research opportunities and gaps. These findings highlighted the complexity of COVID-19 vaccine hesitancy and emphasised the necessity of an interdisciplinary approach in advancing future vaccine research and communication. Additionally, the findings outlined promising avenues for future interdisciplinary research.

Diagnoses of breast cancer are continuing to increase in the Philippines, but little is known about incidence rates among the significant number of Filipino women working abroad as migrant domestic workers (MDWs). These women are often the main income providers for their families, and their ability to work depends upon their physical health and strength. In this article, we use interpretive phenomenological analysis to explore the experiences of 10 MDWs from the Philippines who were diagnosed with breast cancer during a period of employment in Hong Kong. Analysis of these narratives revealed numerous points at which their status as temporary, transnational migrant workers intersected with their experiences of breast cancer detection, diagnosis, and treatment. We argue that these women’s experiences of breast cancer were shaped by the structures of migration that link the Philippines with host destinations like Hong Kong. These structures create a unique context in which these women had to constantly renegotiate their identities as migrants, financial providers, and breast cancer patients.

Periods of localised social unrest are increasing in frequency and are usually described in terms of crisis. Events that unfold during these periods are often recounted retrospectively once a sense of stability has emerged. In contrast, this article contributes an empirical analysis of identity work undertaken by a group of individuals amid an unfolding crisis by drawing on interview data collected in one Hong Kong University across December 2019 and January 2020. We frame our analysis with the concept of liminality which draws attention to the space or state of in-between-ness occupied by people as they navigate and work to transition from ‘before’ to ‘after’ a time of great change. We explore linguistic representations of liminality by analysing the use of metaphors in these interview narratives. Metaphors, in this context, are considered key markers of complex cognitive and psychological processing. Findings of this analysis indicate the dominance of (dis)orientation to time and uncertainty about the future which are associated with liminality and identity work.

Background The Asia Pacific Region’s middle-income countries (MICs) face unique challenges in the ongoing development of primary care (PC) systems. This development is complicated by systemic factors, including rapid policy changes and the introduction of private healthcare services, as well as the mounting challenges associated with ageing populations and increasing rates of chronic diseases. Despite the widespread acknowledgement of the importance of family doctors in the development of PC services, relatively little is known about how these roles have developed in Asian MICs. To address this gap, this systematic review presents a synthesis of recent research focused on the role of family doctors within the PC systems of MICs in the Asia Pacific Region.

Methods We searched six electronic databases (CINAHL Complete, Embase, PsycINFO, PubMed, Web of Science, and Index Medicus for the South-East Asia Region and Western Pacific) for peer-reviewed qualitative literature published between January 2010 and December 2020. The quality of the studies was evaluated using the Critical Appraisal Skills Programme tool. Eighteen articles were included in the analysis. Findings from these articles were extracted and synthesised using qualitative thematic synthesis. We used the Rainbow Framework to analyse the interconnections within health systems at the macro, meso and micro levels.

Results Our analysis of the included articles showed that family doctors play a crucial role in bridging the gap between hospitals and communities. They are essential in adopting holistic approaches to health and wellbeing and are in a unique position to try and address social, psychological, and biological aspects of health. Our findings also highlight the influence of policy changes at the macro level on the role and responsibilities of family doctors at the meso (organisational) and micro (interpersonal) levels.

Conclusions Limited research has explored the role of family doctors in the ongoing development of primary care systems in MICs in the Asia Pacific Region. The findings of this review have significant implications for policymakers and healthcare administrators involved in ongoing improvements to and strengthening of PC systems. Areas of particular concern relate to policy linked with training and workforce development, insurance systems and public awareness of what primary care services are.

Background The use of personal protective equipment (PPE) in emergency departments (EDs) is an important defense during infectious disease emergencies. However, what counts as appropriate PPE in EDs is contentious and inconsistently implemented in practice.

Methods An online scenario-based video survey was distributed through purposive sampling, and completed by 270 ED and infection prevention and control clinicians in Australia. A descriptive content analysis was performed on the data, and differences between groups were tested using Fisher exact test.

Results Participants agreed that most items were required in both scenarios. Eye protection, mask use, and hand hygiene frequency were more contentious. Physicians were more likely than nurses, and ED clinicians more likely than infection prevention and control clinicians, to regard items or actions as optional rather than essential. Many ED clinicians, particularly physicians, regarded sequences as too time-consuming to be practical in a busy ED.

Discussion Our findings likely reflect differences in professional roles, competing priorities, and risks, and highlight important contextual characteristics of EDs, such as diagnostic uncertainty, equipment inaccessibility, and resource constraints.

Conclusions To be feasible, practicable, and thereby effective, PPE guidance in the ED must be designed collaboratively with frontline ED staff, and reflects the complexities of their practice.

In this article, I present a Foucauldian analysis of the speeches made by the then Prime Minister of Australia (Mr. Scott Morrison) in March 2020. This analysis sets out to explore the political rationalities that assembled COVID-19 as a particular type of ‘problem’ that warranted unprecedented governmental intervention into the everyday lives of citizens. I believe that the insights provided by such an analysis are relevant to ongoing examination of governing in liberal democracies both during a crisis and afterwards.

Objective Communication at the end-of-life (EOL) is complex and multidimensional. Although culture is acknowledged as a key influence, there remains a gap in knowledge about intracultural aspects of EOL communication in the Chinese context. This review presents a synthesis of practitioners’ accounts of communication at the EOL in Hong Kong, Mainland China and Taiwan.

Methods This review was registered prospectively on PROSPERO (CRD42021297052). Five databases were systematically searched using the terms ‘communication’, ‘End-of-Life’, ‘Hong Kong’, ‘China’ and ‘Taiwan’. Empirical research published between 2015 and 2021 was downloaded and appraised. Fifteen articles were included in the review.

Results Findings highlight the influence of Chinese culture and philosophy, inadequate communication skills training and psychological support for practitioners and legislative and organisational factors.

Conclusion Education and training for practitioners and public education about the EOL needs strengthening. Enhanced understanding of how culture influences EOL communication will strengthen service delivery and enhance awareness in multicultural communities.

Practice implications EOL workers need practical and workplace-based support to engage in meaningful communication practices. The influence of culture and the readiness of patients and families to engage in communication are also important considerations.

Ageing populations and rising rates of chronic disease globally have shifted key elements of disease management to ideas of integrated care and self-management. The associated policies and programmes often focus on intervention and support beyond the sites of the hospital and clinic. These shifts have significantly impacted the delivery and practice of nursing for both nurses and the clients with whom they work. This article argues that Foucault's comments on space, place and heterotopia (1986) are useful in exploring these changes from a philosophical perspective, to draw out the complexity of these programmes and add texture to discussions on the ways these shifts to localisation and the dominant discourses of self-management and responsibility have reconfigured nursing practices. The theoretical discussion is augmented with illustrations from an Australian integrated health care programme.

Background The rate of international migration for the primary purpose of employment has increased exponentially in recent decades. A significant proportion of this global movement takes place across East and Southeast Asia as workers move on a temporary basis from lower-middle-income home countries such as Indonesia, the Philippines, Thailand and Vietnam to high-income host destinations including Hong Kong and Singapore. Relatively little is known about the unique and long-term health needs of this heterogeneous group of people. This systematic review presents an analysis of recent research into the experiences and perceptions of health of temporary migrant workers in the East and Southeast Asian regions.

Methods Five electronic databases CINAHL Complete (via EbscoHost), EMBASE (including Medline), PsycINFO (via ProQuest), PubMed and Web of Science, were systematically searched for qualitative or mixed methods, peer-reviewed literature published in print or online between January 2010 and December 2020. Quality of the studies was assessed using the Critical Appraisal Checklist for Qualitative Research published by the Joanna Briggs Institute. Findings from the included articles were extracted and synthesised using qualitative thematic analysis.

Results Eight articles were included in the review. Findings from this review indicate that multiple dimensions of workers’ health is impacted by the processes of temporary migration. In addition, the research reviewed indicated that migrant workers used various strategies and mechanisms to attempt to address their health-related issues and to take better care of themselves. Such agentic practices could help them manage and maintain their health and wellbeing across physical, psychological and spiritual dimensions within the structural constraints of their employment.

Conclusions Limited published research has focused on the health perceptions and needs of temporary migrant workers in East and Southeast Asia. The studies included in this review focused on female migrant domestic workers in Hong Kong, Singapore, and the Philippines. These studies provide valuable insights but do not reflect the heterogeneity of migrants moving within these regions. The findings of this systematic review highlight that temporary migrant workers experience high and sustained levels of stress and are exposed to certain health risks which may compromise long-term health outcomes. These workers demonstrate knowledge and skills in managing their own health. This suggests that strength-based approaches to health promotion interventions may be effective in optimising their health over time. These findings are relevant to policy makers and non-government organisations supporting migrant workers.

Previous research has identified that effective and high-quality communication between patients, families and professionals is a key contributing factor to end-of-life (EOL) care and recovery after bereavement. Increasingly, this communication work is being done by non-clinical staff in places such as homes and community settings. These additional care providers offer important pre- and post-bereavement support that can improve the quality of EOL care as well as promote healthy grieving for families, friends and communities. Despite this contribution, though, little is known about how these non-clinical workers use communication in their daily practices. This paper reports on the analysis of a set of nine in-depth interviews conducted in Hong Kong and in one region of Australia that examined in detail relational aspects of communication that shape interactions between non-clinical workers and service users. Data were collected during the COVID-19 health crisis, when the workers experienced exceptional restrictions on communication. The findings of this study highlight the fundamental importance of both verbal and non-verbal communication to the relationships established between non-clinical workers and service users. Specifically, greater support for the development of communication skills in non-clinical EOL workers will promote improvements in the quality of EOL care.

The COVID-19 outbreak in 2020 and localised government responses have led to fundamental changes in the conditions in which organisations operate. This article draws on a social constructionist understanding of identity as multiple and performed (Angouri 2016; Butler 1990) to explore the experiences of a group of six Australian Christian priests during this crisis period. Drawing on in-depth interview data, the article presents a narrative analysis of the storying of identities and power relations within church communities whose everyday activities were suddenly curtailed. In contrast to linguistic studies of narrative which often focus on structural features of canonical discourse ‘events’, this article takes up Bamberg and Georgakopoulou’s (2008) extension of narrative analysis to focus on ‘small stories’ which reflect the everyday, situated practices in which identities and power relations are negotiated and performed. This article contributes unique insights into the operation and practices of religious organisations in a crisis context.

The death of a family member or friend is a significant stressor in an individual’s life and adverse bereavement can lead to mental and/or physical consequences. The outbreak of the COVID-19 pandemic and the associated infection control regulations have been reported to disrupt people’s bereavement. However, the majority of the present literature has focused on Western contexts with no published studies on bereavement in Hong Kong. Given that grief and bereavement is a universal but culturally-specific experience, this article foregrounds the role of culture and ritual practices in Hong Kong Chinese’s bereavement. By focusing on the Chinese cultural identity, it highlights how their grieving process has been influenced by the pandemic and associated regulations. This article calls for more attention to this fundamental but under-investigated research area.

Background Hong Kong Special Administrative Region is one of the most technologically advanced and interconnected cities in the world in terms of ownership of internet-enabled mobile devices. mHealth programs that make use of mobile devices such as smart phones and tablets to maximise access to health information, have been identified as having great potential for ageing communities for the management of health and social care needs. This paper reports the findings of a two-stage exploratory research project which examined the experiences and perceptions of Hong Kong residents aged over 60 years in relation to mHealth technologies and health literacy.

Methods This study collected data from older Hong Kong residents at a community centre. Data were collected at two stages in July and August 2019. Stage one involved a one-on-one interview at Centre A with each research participant. The self-report surveys included seven questions about mobile phone ownership and a 16-item gerontechnology survey previously used in Hong Kong. Stage two of the data collection involved three discussion groups with the research participants that were run over a 3-week period.

Results (I) Providing health information via digital devices was considered promising and acceptable by most of our participants. (II) Major concerns that impeded the elders’ use of digital devices were their lack of the necessary skills to use these gadgets and their loss of memory. (III) Many participants stated their concern that they found it difficult to recall information immediately after being taught. (IV) Most participants had problems in reading because of low literacy levels or some age-related eye-diseases. (V) Video instructions were preferred by participants as audio and visual input is more useful than rather than static written information with heavy reading requirements.

Conclusions Participants were interested in using mHealth technologies. Education and ongoing support in their use is necessary.

This article explores the unique contribution that Foucault’s work on genealogy and governmentality can make to the analysis of contemporary programs of government. The article uses an Australian study of the ‘problem’ of chronic illness to argue that this perspective offers valuable insights into how ‘problems’ such as chronic illness have become linked to advanced liberal discourses and practices of self-governing and self-responsibility. These insights are particularly valuable in fields such as primary health care that have a noted shortage of critical and reflective studies that explore the links between people and changing ideas of health and disease. This article details how taking up an analytics of governmentality and political genealogy informed by Foucault, facilitated the tracing of the dominant discourses and practices, and the connections to the day-to -day lives of the clients with chronic diseases. Importantly, this approach opened up a more critical consideration of the ways in which dispersed approaches to governing through programs, such as integrated care, shape and influence the lives of individuals. These dispersed ways of governing are not linear but rather unfold through ongoing relays, connections and the (re)production of discourses.