Policy Research @ HKIAPS

Sociodemographic Change & Wellbeing

* Policy Research @ HKIAPS member

On Health

Policy research report on building a sustainable healthcare system in Hong Kong
Editors: Anothny Y. H. Fung, & Ben Y. F. Fong
Funding source: Policy Research @ HKIAPS
Completion date: July 2024

Last year, the Policy Forum on Building a Sustainable Healthcare System for Hong Kong was successfully held, gathering together local and international academics and politicians to discuss how to build a sustainable healthcare system for Hong Kong. This policy report aims to record the fruitful discussions that were held at the forum and to provide a summary of the issues that were raised by the experts and their shared views. It also aims to provide policy recommendations for the Hong Kong Government.

The report consists of six sections, namely: (1) Introduction, (2) Transcript, (3) Summary of Issues and Shared Views, (4) Policy Recommendations for Building a Sustainable Healthcare System for Hong Kong, (5), Editors’ Notes, and (6) References.

The transcript records the spirited discussions that took place at the forum, including three keynote speeches and four panel sessions. In addition, 24 policy statements, divided into six categories, are recommended for building a sustainable healthcare system for Hong Kong. First, it is suggested that talent and manpower be nurtured to build higher-level human capacities. Second, the provision of facilities, such as community facilities and public and private hospitals, should be reviewed. Third, a financing strategy, such as value-based funding, could be adopted. Fourth, a service delivery model, including a model of a system based on values, evidence, mutual trust, and public engagement, could be constructed. Fifth, primary healthcare should be promoted to improve people’s health. Last, disaster and crisis management could be improved, such as appointing a designated government spokesperson to release reliable information.

This policy report transcribes and studies the presentations and sessions of the Forum that was held last year and provides a summary of issues and shared views. Furthermore, salient recommendations have also been proposed to facilitate the construction of a sustainable healthcare system in Hong Kong.

Full report:

Personalised health coaching for family caregivers
Investigators: Helen Chan* (PI), Benny Zee, Sally Lo, & Fiona Chan
Funding source: Private Donation

The goal of this project is to promote wellbeing among family caregivers through primary prevention strategy. The objectives are to identify the cardio-metabolic risk and mental wellbeing of 1,000 family caregivers and to motivate those with identified risk for lifestyle modification and behavioural change through personalised health coaching. This project intends to shift the healthcare focus from cure- to prevention-oriented. This project will help to heighten the community awareness towards cardio-metabolic risks and preventive strategies.

Assessing and health coaching for cardiometabolic risk in middle-aged group
Investigators: Helen Chan* (PI), Benny Zee, Sally Lo, & Fiona Chan
Funding source: Knowledge Transfer Project Fund, The Chinese University of Hong Kong

The overall aim of this project is to raise public awareness towards cardiometabolic risk factors in middle adulthood. In this project, people with cardiometabolic risk will be motivated to behavioural change through a personalised health coaching intervention. The project experiences will shed light on the local development of primary healthcare policy and services.

On the road to combat the pandemic: Hong Kong citizens’ views on the impact of and responses to COVID-19
Investigators: Victor Zheng*, Hua Guo*, & Fanny M. Cheung*
Funding source: Policy Research @ HKIAPS
Completion date: January 2022

It has been one-and-a-half years since the first case of coronavirus infection was confirmed in Hong Kong in January 2020. There were four waves of outbreak during this period. Although hundreds of infected cases appeared daily at the peak of the third and fourth waves, the epidemic was eventually brought under control. Nonetheless, there is still a risk from imported cases, although the pandemic is less intense than before. At this important moment, it is necessary to conduct comprehensive research to analyse opinion polls and understand the attitudes of citizens towards various disease prevention measures and arrangements implemented by the government.

Since the start of the pandemic, studies have been conducted from different perspectives to determine how to combat the pandemic, for example, from the perspective of public health, technology, or medicine. However, studies are lacking on how to understand the emergency responses of people in this COVID-19 war. This research is based on data from long-term opinion polls. It includes an in-depth analysis of the COVID-19 pandemic from different aspects in Hong Kong. Directional policy recommendations are also provided to related policymakers and organizations.

The research team discovered that citizens demonstrated active and stable responses to the pandemic, but that their vigilance in applying disease protection measures would become less intense as the pandemic eases. Also, individuals hold different views and stances towards the various disease prevention measures and arrangements implemented by the government. However, opinions are more varied on the policies or measures that impose more restrictions on personal freedoms, and these disagreements are also magnified among those in certain age groups and of certain political orientations. In addition, citizens hold an overall negative view of the government’s emergency response to the pandemic. The view on economic prospects and household income is pessimistic as well, more so among those in the non-establishment camp than in the establishment camp.

Drawing on the research findings, the research team proposed directional policy recommendations. First, science should take the lead in disease prevention. The government should be sensitive in handling political factors and needs to be aware of the negative impact of announcing new emergency response measures. Second, the impact of the pandemic on different groups may differ. To resuscitate the economy, emergency response measures should focus on those groups that were the most affected by the pandemic. Lastly, promoting the value of “taking the big picture into consideration” and encouraging people to actively take protective measures could lead to more long-term and comprehensive results than hardline measures. These policy recommendations could help the government to understand public opinion and allow them to take it into consideration when implementing disease prevention policies in the future.

Full report:

Implementation of a family-based multimedia educational programme to promote the utilisation of colorectal cancer screening by older south Asian ethnic minorities in Hong Kong
Investigators: Winnie K. W. So* (PI), Dorothy N. S. Chan, Kai-chow Choi, & Carmen W. H. Chan
Funding source: Health Care and Promotion Scheme, Food and Health Bureau, HKSAR Government

Colorectal cancer (CRC) is currently the most prevalent type of cancer in Hong Kong. As CRC screening is recognised as an effective strategy for CRC prevention, its universal utilisation by residents of Hong Kong is crucial for reducing the prevalence of CRC in Hong Kong. Previous studies have reported that South Asian ethnic minorities do not tend to utilise cancer screening services, as they face multiple barriers to do so, such as language barriers, and a limited awareness of the need to undergo regular screening and how to access screening services. Older individuals in this population are more prone to face these barriers, as they are less able to comprehend the health information disseminated by the Hong Kong government. These individuals therefore require linguistically appropriate health educational programmes that increase their knowledge of CRC prevention and screening.

The aim of this project was to implement a family-based multimedia educational programme that increases the awareness of the importance of CRC screening and promotes the utilisation of CRC screening by South Asian older adults. We recruited South Asian older adults and one of their younger family members to the programme, which was delivered to participants by trained instructors at centres with which we have established collaborations and are operated by non-governmental organisations (NGOs) serving South Asians in the local community.

We found that the programme considerably enhanced CRC screening utilisation by older adults, and that a significant proportion of them were able to submit their stool samples for screening on their own, rather than relying on assistance from their younger family members. These observations indicate that the programme effectively increased both the willingness of the older adults to undergo CRC screening and their self-efficacy at submitting their samples for screening.

Our findings indicate that our family-based multimedia programme could effectively promote CRC screening utilisation to South Asian ethnic minorities throughout Hong Kong, and to increase their knowledge of CRC prevention and screening. We recommend that the Hong Kong government allocates further resources to enable the implementation of this family-based programme at all NGOs serving South Asians in Hong Kong, to enable this programme to be integrated as part of the support services provided by these NGOs. For example, the government may consider providing funding for the employment and training of programme instructors, to increase the competence and knowledge of these instructors in the delivery of the programme to their community peers. The building of such partnerships with these NGOs may be the key to enhancing the reach of the educational programme to local South Asian communities and the sustainability of its implementation, enabling more South Asians to become aware of the importance of CRC screening and be willing to voluntarily undergo screening. Ultimately, this could reduce both the prevalence of CRC in this underserved population and associated burdens on the health system.

A study on public attitudes towards improving the sanitation of public toilets
Investigators: Yuk-sik Chong (PI), Fanny M. Cheung*, Victor Zheng*, & Po-san Wan*
Funding source: Policy Research @ HKIAPS, CUHK
Completion date: November 2020

Public toilets are fundamental to the prevention of disease and the maintenance of public health; we may not visit clinics and hospitals every day, but addressing “nature’s call” is unavoidable. It is a blind spot, and little attention has so far been paid to the basic question of how toilet sanitation is maintained and how people use public toilets. The objectives of this research were:
1.	To provide an account of public preferences in the improvement of sanitation;
2.	To measure social acceptance of the use of norms and penalties to encourage hygienic behaviour in public toilets;
3.	To explore the mechanism for visualizing unhygienic behaviour in public toilets;
4.	To evaluate the desires that toilet users have with regard to maintaining toilet sanitation and the realities that they face in doing so; and
5.	To develop a new gender perspective to understanding toilet sanitation and the making of a social body.
A territory-wide probabilistic landline telephone survey was conducted to obtain representative information. Hong Kong residents who were at least 18 years of age were our target population.

Full report:

An ongoing follow-up study on the participation rate in cervical cancer screening among South Asian women
Investigators: Dorothy N. S. Chan (PI), Winnie K. W. So*, Kai-chow Choi, & Sharmila Gurung
Funding source: Health Care and Promotion Scheme, Food and Health Bureau, HKSAR Government

Cervical cancer screening, or the Pap test, is one of the most effective ways of preventing cervical cancer via the early detection of any signs of the development of tumours. Nevertheless, despite the availability of cervical cancer screening services for the Hong Kong public and efforts on the part of the government to promote their utilization, the research team’s previous survey conducted in 2012 showed that the rate of utilization of the Pap test among South Asian women in Hong Kong was as low as 36.9%. In view of this, culturally relevant multimedia education programmes were developed to increase South Asian women’s awareness and knowledge of cervical cancer and of the measures that can be taken to prevent it. Moreover, information on how to access cervical cancer screening services and interpretation services to overcome language barriers was also given during the implementation of the programmes.

The aim of this follow-up study was to assess whether efforts to implement health education programmes for South Asian women in Hong Kong on the topic of cervical cancer and its prevention had resulted in an increase in the utilization rate of cervical cancer screening. A follow-up survey was conducted in 2017, which revealed that 40.3% of the 776 interviewed South Asian women had previously undertaken a Pap test, suggesting a slight increase in the uptake of cervical cancer screening among local South Asian women. In this survey, the research team also found that the availability of the clinics known to the survey participants and the issue of language had a significant relationship with the barriers that South Asian women faced in utilizing cervical cancer screening services, and thus with the uptake of screening. Recently, the team conducted a second follow-up survey on this group of women, where 633 participants responded to the survey. This follow-up survey showed that an increasing number of South Asian women had attended cervical cancer screening. Overall, 53.1% of the South Asian women had previously undertaken at least a Pap test, indicating that the delivery of the education programmes had resulted in a considerable increase in cervical cancer screening uptake among the participants in the survey. These results suggest that the implementation of culturally relevant multimedia health education programmes among South Asian women in Hong Kong is an effective means of increasing their intention to undergo cancer screening, which will subsequently increase the uptake rate of cervical cancer screening among these individuals.

Moreover, to overcome these barriers to the utilization of Pap tests, which were identified in the first follow-up survey, the research team proposed a currently ongoing study that involves the development of a further education programme, delivered by community health workers of South Asian origin, in an attempt to more effectively raise the intention of South Asian women within the community to undergo cervical cancer screening.

Development of a community health worker-led multimedia intervention to increase cervical cancer screening utilization among South Asian women in Hong Kong
Investigators: Cho-lee Wong (PI), Winnie K. W. So*, & Dorothy N. S. Chan
Funding source: Health Care and Promotion Scheme, Food and Health Bureau, HKSAR Government

With cervical cancer being one of the most common forms of cancer among South Asian women, the dissemination of information on the benefits to these individuals of utilizing cancer screening services in preventing cervical cancer is of paramount importance. Nevertheless, South Asians may face language barriers to obtaining health-related information, which could result in their lacking awareness of the availability of cervical cancer screening services for the Hong Kong public. In light of this, it would be better if health programmes dedicated to South Asians could be delivered by community health workers (CHW), who are lay individuals within a community who are trained to deliver health-related programmes to peers in their community of the same ethnic origin. These CHWs can serve as a bridge by communicating health information between healthcare professionals and members of the community. Furthermore, these individuals would possess knowledge of the cultural practices that are detrimental to the health of their peers in the community, and would therefore provide more comprehensive and effective health education to their peers by targeting those practices. This train-the-trainer approach has previously been demonstrated to be useful in enhancing the effectiveness of health education programmes dedicated to ethnic minorities.

The aim of this project was to develop a CHW-led multimedia intervention for South Asian women in Hong Kong, which educates them on the risk factors for cervical cancer and on effective preventive measures, thereby enhancing their intention to undergo screening for cervical cancer. The recruited CHWs were first trained, by educating them on various aspects of cervical cancer and methods for its early detection. Through such training, these CHWs will become more competent in educating their community peers, and more effective at encouraging them to undergo cancer screening. Combining the use of a multimedia approach, which makes the programme more interesting and interactive, will be of greater benefit to the participants and lead to improved learning outcomes.

In this project, the research team collected quantitative data from the programme participants, assessing their readiness to undergo cervical cancer screening, in order to evaluate whether the programme was effective at increasing their intention to undergo screening. The findings of this study will provide further evidence of the effectiveness of combining CHWs and multimedia in delivering health education programmes to increase the intention of South Asian ethnic minorities to screen for cancer, thereby making a case for such programmes to be developed to promote the health of these individuals.

Development of a multimedia health education programme to promote cervical cancer prevention among South Asian women in Hong Kong
Investigators: Winnie K. W. So* (PI), Carmen W. H. Chan, Doris Y. P. Leung, Helen Y. L. Chan*, Sek-ying Chair, & Andrew Chan
Funding source: Knowledge Transfer Project Fund, CUHK

Cervical cancer is one of the most common forms of cancer found in South Asian women. Its prevention through early detection by screening is therefore of great importance. However, South Asians are known to face multiple barriers to the utilization of the available cervical cancer screening services in Hong Kong, including language difficulties and their lack of awareness and knowledge of effective strategies for preventing cancer. The research team’s previous survey also revealed a low rate of utilization by South Asian women in Hong Kong of those cervical cancer screening services that are available to the public. The dissemination of information on cervical cancer and the importance to these individuals of making use of cervical cancer screening services, via health education programmes, is therefore warranted. In view of this, the team proposed a study involving the development of a multimedia health education programme aimed at enhancing the knowledge of South Asian women in Hong Kong on cervical cancer, and at raising their awareness of the importance of undergoing cancer screening in preventing cervical cancer. Afterwards, the effectiveness of the programme in achieving these aims was evaluated.

Education programmes utilizing a multimedia approach have previously been shown to enhance the effectiveness of programmes aimed at disseminating health-related knowledge to ethnic minority groups. Such approach was adopted in this study on the presentation of health information to the participants, via health talks using a variety of multimedia approaches including a PowerPoint presentation, video clip presentation, and health information booklets. During the education programme, information on cervical cancer, its risk factors and preventive measures, as well as information on the importance of screening for cervical cancer and common misconceptions on the utilization of such services, was presented. To implement the programme, the team fostered collaborations with a number of South Asian community centres and organizations so that a venue would be provided for the health talks and distribution of booklets.

Overall, 51 health talks were delivered in South Asian organizations all over Hong Kong, with a total audience of 1,061 South Asian participants. A survey for evaluating the programme revealed that the majority (over 90%) of the participants agreed that the programme was effective at enhancing their knowledge of cervical cancer and increasing their intention to undergo cancer screening. This indicates that the delivery of a multimedia education programme can be useful in encouraging South Asian women to undergo screening for cervical cancer.

Health behaviour in school-aged children study in Hong Kong: Assessing the physical, emotional, and social well-being
Investigators: Esther S. C. Ho* (PI), Anthony Y. H. Fung*, & Annisa Lee Lai
Funding source: Public Policy Research Funding Scheme, Policy Innovation and Co-ordination Office, HKSAR Government

The aim of the “Health Behaviour in School-aged Children” (HBSC) Study in Hong Kong is to assess the physical, emotional, and social well-being and health behaviours of school-aged children and their association with demographic factors and social and environmental contexts, and to inform policies and practices on health promotions and interventions among children. It attempts to address the policy objectives of the Commission on Children formed by the HKSAR Government in 2018. Coordinated by the World Health Organization Regional Office for Europe, the HBSC is a quadrennial study in which over 40 countries and regions are currently participating. Taking part in this cross-national study will enable reliable health-related data on children in Hong Kong to be collected and compared with comparable data from other countries. This is essential for formulating evidence-based policies, setting strategies and priorities, and developing local frameworks and indicators for monitoring the health and well-being of Hong Kong’s children, all of which are the objectives of the Commission on Children. This study will also address the increasingly prevalent mental and physical health problems of Hong Kong children, as noted in the Mental Health Review (2017), as well as the recommendation of the Review that health-related data should be collected in a timely, regular, and systematic manner.

Health inequity matters to everyone: The vision and research focus of the newly established CUHK Institute of Health Equity
Co-Directors: Jean Woo*, Michael Marmot, & Eng-kiong Yeoh
Associate Directors: Hung Wong* & Roger Chung*

Hong Kong is the place with the longest life expectancy in the world, yet it also has huge income and wealth inequalities. These social inequalities are expected to drive health inequalities in Hong Kong, which are mostly unnecessary and avoidable. Given the social gradient of health, health inequities exist not only among those at the bottom of the social ladder but also among relatively advantaged groups. In other words, health equity matters to everyone in our society.

With the commitment and determination of CUHK to research, educate, and transfer knowledge to achieve health equity in Hong Kong and other parts of the world, the CUHK Institute of Health Equity (CUHK IHE) was established in 2020 with the vision of being a leading institution in promoting health equity studies in the Asian region. CUHK IHE aims to examine and understand issues of health equity in Hong Kong, inform government policies and intervention programmes to improve health equity in Hong Kong, and establish a network for the Asian region. In close collaboration with the Institute of Health Equity at University College London, CUHK IHE will conduct a comprehensive review on health equity in Hong Kong, which will focus on understanding the extent of health inequities and the underlying forces driving them from different perspectives. Specific topics will be identified and discussed in detail in an upcoming series of health equity reports.

As the Coronavirus Disease 2019 (COVID-19) spreads across the world, it is argued that a devastating feedback loop between the disease (and associated containment measures) and social inequality has been set off in many countries. In response, CUHK IHE is currently conducting a mixed-methods study to examine the multi-dimensional impacts of the COVID-19 outbreak, in terms of physical, psychological, social, and economic aspects, on vulnerable populations in Hong Kong. Specifically, this study consists of a quantitative telephone survey on the impact of COVID-19 on the general Hong Kong population and qualitative interviews with members of socially vulnerable groups including older adults, migrants, and the working poor. Our findings are expected to have significant implications for policymaking on targeted interventions, mitigation efforts, public health education, social and economic alleviation policies, and financial support, as well as for promotion campaigns. Apart from research on COVID-19, the aim in other on-going research work is to explore factors contributing to the long life expectancies in Hong Kong and to disparities in both the physical and psychosocial well-being of Hong Kong people.

Moreover, CUHK IHE and the Hong Kong Institute of Asia-Pacific Studies will co-organize a health equity webinar series in the coming months, with the aim of raising public awareness on health equity, building up a network of researchers and stakeholders in the field, and promoting health studies in the Asian region. Proposed topics include health equity and COVID-19, housing, health care, and mental health.