BACKGROUND: Immigrant caregivers support the aging population, yet their own needs are often neglected. Mobile technology-facilitated interventions can promote caregiver health by providing easy access to self-care materials.
OBJECTIVE: This study employed a design thinking framework to examine Chinese immigrant caregivers\' (CICs) unmet self-care needs and co-design an app for promoting self-care with CICs.
METHODS: Nineteen semi-structured interviews were conducted in conceptual design and prototype co-design phases.
RESULTS: Participants reported unmet self-care needs influenced by psychological and social barriers, immigrant status, and caregiving tasks. They expressed the need to learn to keep healthy boundaries with the care recipient and respond to emergencies. Gaining knowledge was the main benefit that drew CICs\' interest in using the self-care app. However, potential barriers to use included issues of curriculum design, technology anxiety, limited free time, and caregiving burdens.
CONCLUSIONS: The co-design process appears to be beneficial in having participants voice both barriers and preferences.

The majority of patients with perinatal depression (PND) in China do not receive adequate treatment. As forming a therapeutic alliance with patients is crucial for depression treatment, shared decision-making (SDM) shows promise in promoting patients\' uptake of evidence-based mental health services, but its impact on patient outcomes and implementation in real-world maternal care remain uncertain. Therefore, this study aims to develop and evaluate an interprofessional shared decision-making (IP-SDM) model for PND to enhance maternal mental health services.
This study contains four research phases: feasibility testing (Phase 1), toolkit development (Phase 2), usability evaluation (Phase 3), and effectiveness evaluation (Phase 4). During the development stage, focus group interviews will be conducted with expectant and new mothers, as well as maternal care providers for feasibility testing. A toolkit, including a patient decision aid along with its user guide and training materials, will be developed based on the findings of Phase 1 and syntheses of up-to-date evidence and appraised by the Delphi method. Additionally, a cognitive task analysis will be used for assessing the usability of the toolkit. During the evaluation stage, a prospective randomized controlled trial embedded in a mixed methods design will be used to evaluate the effectiveness and cost-effectiveness of the IP-SDM care model. The study targets to recruit 410 expectant and new mothers who screen positive for depression. They will be randomly assigned to either an intervention group or a control group in a 1:1 ratio. Participants in the intervention group will receive decision aid, decision coaching, and clinical consultation, in addition to usual services, while the control group will receive usual services. The primary outcome is the quality of decision-making process, and the secondary outcomes include SDM, mental health service utilization and costs, depressive symptoms, and health-related quality of life. In-depth interviews will be used to explore the facilitating and hindering factors of SDM.
This study will develop an IP-SDM care model for PND that can be implemented in maternal care settings in China. This study will contribute to the understanding of how SDM impacts mental health outcomes and facilitate the integration of mental health services into maternal care.
ChiCTR2300072559. Registered on 16 June 2023.

Antibiotic resistance rates remain high in China where antibiotics are widely used for common illnesses. This study aimed to investigate the influences on people\'s decisions on treatment and antibiotic use for common illnesses in eastern China.
Semi-structured interviews were conducted with 29 patients recruited through convenience sampling between July 2020 and January 2021 in one hospital in County A in Zhejiang Province, and one hospital and one village clinic in County B in Jiangsu Province, respectively. All interviews were audio-recorded, transcribed verbatim and thematically analysed. This study is nested in a larger interdisciplinary mixed method project and we also compared our qualitative findings with quantitative results from a household survey conducted as part of this wider project.
Participants\' decisions about treatment-seeking and antibiotic use for common illnesses were found to be influenced by four interactive domains. (i) Self-evaluation of illness severity: Participants tend to self-treat minor conditions with ordinary medicines first and do not resort to antibiotics unless the condition worsens or is considered inflammation- related. Visiting healthcare facilities is seen as the final option. (ii) Access to and trust in care: These treatment-seeking practices are also associated with the perception, in contrast with retail pharmacies, hospitals provide professional and trustworthy care but are difficult to access, and hence require visiting only for severe illness. (iii) Prior experience: previous medical treatment and experiences of self-medication also influence participants\' treatment decisions including the use of antibiotics. (iv) Medication characteristics: Participants view antibiotics as powerful medicines with harms and risks, requiring consumers to carefully trade off benefits and harms before use.
People\'s treatment decisions in relation to antibiotic use in eastern China are influenced by an interplay of lay conceptual models of illnesses and antibiotics and broader organisational, social, and contextual factors. Interventions focusing on individual education to incorporate biomedical knowledge into lay understandings, and reducing situational and social incentives for self-medicating with antibiotics by strengthening access to quality professional care, would be helpful in promoting antibiotic stewardship.

With the implementation of the 37 years one-child policy, many couples only have one child in China. Chinese parents whose only child died and did not give birth to or adopt another child are known as \"Shidu\" parents or \"Shiduer\". Characterised by elements of childlessness, bereavement, and ageing, Shiduer are at a higher risk of experiencing loneliness. However, little is known about their loneliness experience. Adopting a life course perspective, this research aims to investigate how loneliness was experienced and coped by older Chinese Shidu parents and identify the most vulnerable groups for policy intervention.
Qualitative method was adopted for this study. Semi-structured interviews were conducted with 27 participants from urban and rural Wuhan, the capital city of Hubei province in central China, to collect data on participants\' life course related resources and loneliness experience after bereavement. An abductive approach was used to analyse the data.
The results demonstrate that the social environment (urban/rural), timing of bereavement (midlife/older age), social network (strong/weak), and coping strategies (escape-avoidance/problem-solving) differentiate the experience of loneliness among the Shiduer. Those who lived in rural communities, those bereaved in older age, those who had a weak social network, and those who adopted the escape-avoidance strategy were found vulnerable and suffered from more chronic and intensive loneliness than their counterparts without these characteristics.
This study is among the first attempts to examine loneliness experience and coping among older Chinese bereaved parents from a qualitative, life course perspective. It provides insights into how loneliness has been perceived and experienced differently among the bereaved one-child parents in China. The results of the current study provide important implications for policymakers and practitioners/social workers for the intervention of loneliness.

UNASSIGNED: Research into expatriation has made a great contribution to the understanding of issues surrounding international human resource management. However, academic discussion around the subject of expatriate management remains Western-centred, neglecting the use of expatriate staffing in multinational corporations (MNCs) from Eastern countries. By adopting a multi-foci perspective of the psychological contract, the overall objective of this research is to explore the content of Chinese expatriates\' psychological contracts.
UNASSIGNED: This paper draws on the findings of an organisational case study and is based on semi-structured interviews with 14 expatriates.
UNASSIGNED: The findings provide evidence that individuals have multiple simultaneous psychological contracts, each with a different focus. The contracts held by the Chinese expatriates in this sample contain predominately balanced contract beliefs, which contrast sharply to what the other authors find to be salient beliefs (e.g., transactional contract beliefs) for expatriates based on Western samples. Importantly, the most frequently listed exchange partners by the pre-departure expatriates were line managers and department managers in headquarters; individuals appreciate the respective role of each party in shaping their aspects of work conditions whilst acknowledging the simultaneous existence of such influences.
UNASSIGNED: This paper has implications for expatriate management in the following ways. First, managers are encouraged to appreciate the role of multiple parties in shaping expatriates\' psychological contracts. This helps to enhance management\'s understanding on the motives and demands of those expatriates. Second, policies of support and contact would aid feelings of integration. Finally, more attention should be paid to planning expatriate career prospects.

To explore the characteristics of kindergarten teachers\' occupational beliefs in China, 24 public and private kindergarten teachers were interviewed, their teaching was observed, and teaching reflection notes and educational essays were collected. A structural model was subsequently developed. Based on grounded theory, the information was coded at three levels and tested for theoretical saturation. The results demonstrated that the occupational beliefs of kindergarten teachers consisted of occupational cognition, occupational endurance, occupational expectation, and occupational intention, and these four core elements were not independent. Although there were characteristics common to public and private kindergarten teachers\' occupational beliefs, they also had distinct characteristics. The occupational beliefs of public kindergarten teachers were relatively stable, yet those of private kindergarten teachers were not. Moreover, most public kindergarten teachers were willing to stay in their teaching jobs. These findings reveal the composition and characteristics of Chinese kindergarten teachers\' occupational beliefs and the relationship between kindergarten teachers\' turnover and occupational beliefs.

In an increasingly globalised and interconnected world, evidence to evaluate complex interventions may be generated in multiple languages. However, despite its influence in shaping the evidence base, there is little literature explicitly connecting the translation process to the goals and processes of implementation research. This study aims to explore the processes and experience of an international implementation research team conducting a process evaluation of a complex intervention in Tibet Autonomous Region, China.
This study uses a collaborative autoethnographic approach to explore the translation process from Chinese or Tibetan to English of key stakeholder interview transcripts. In this approach, multiple researchers and translators contributed their reflections, and conducted joint analysis through dialogue, reflection and with consideration of multiple perspectives. Seven researchers involved with the translation process contributed their perspectives through in-depth interviews or written reflections and jointly analysed the resulting data.
We describe the translation process, synthesise key challenges including developing a \'voice\' and tone as a translator, conveying the depth of idioms across languages, and distance from the study context. We further offer lessons learnt including the importance of word banks with unified translations of words and phrases created iteratively during the translation process, the need to collaborate between translators and the introspective work necessary for translators to explore their positionality and reflexivity during the work. We then offer a summary of these learnings for other implementation research teams.
Our findings emphasise that in order to ensure rigour in their work, implementation research teams using qualitative data should make concerted effort to consider both the translation process as well as its outcomes. Given the numerous multinational or multilingual implementation research studies using qualitative methods, there is a need for further consideration and reflection on the translation process.

BACKGROUND: There is limited evidence about the influence of human milk feeding on short-term outcomes in a large preterm infant population.
OBJECTIVE: To explore the influences of human milk feeding on the primary outcome of necrotizing enterocolitis and secondarily sepsis, bronchial pulmonary dysplasia, severe retinopathy of prematurity, death, and the time to achieve full enteral feeding at discharge in very/extremely low-birth-weight infants.
METHODS: This study was a retrospective, longitudinal, observational two-group comparison cohort study. A total of 4470 very/extremely low-birth-weight infants from 25 neonatal intensive care units in China, between April 2015 and May 2018, were enrolled in this study. Exclusive human milk-fed and formula-fed participants were matched using propensity scores. After matching, human milk-fed participants (n = 1379) and formula-fed participants (n = 1378) were included in the analyses. The likelihood of necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, severe retinopathy of prematurity, death, and the time to achieve full enteral feeding were compared between the two groups.
RESULTS: Exclusive human milk feeding was associated with lower odds of necrotizing enterocolitis (2.90% vs. 8.42%, OR 0.33, 95% CI [0.22, 0.47]), bronchopulmonary dysplasia (15.74% vs. 20.26%, OR 0.69, 95% CI [0.56, 0.86]), severe retinopathy of prematurity (1.45% vs. 2.39%, OR 0.50, 95% CI [0.27, 0.93]), and death (6.02% vs. 10.38%, OR 0.44, 95% CI [0.32, 0.61]) compared with formula feeding. No significant differences in the time to achieve full enteral feeding or the odds of sepsis were found between the two groups.
CONCLUSIONS: Exclusive human milk feeding is associated with a reduction in necrotizing enterocolitis, bronchopulmonary dysplasia, severe retinopathy of prematurity, and mortality among very/extremely low-birth-weight infants.
BACKGROUND: Clinicaltrials.gov on November 9, 2015 (NCT02600195).

UNASSIGNED: Quantification of viral antigens and viral loads in human milk samples from mothers infected with hepatitis B virus is largely unknown.
UNASSIGNED: The aim of the study was to quantitatively measure the levels of viral antigens and deoxyribonucleic acid of hepatitis B virus in human milk from mothers infected with hepatitis B virus.
UNASSIGNED: Fifty-five pairs of milk and serum samples from mothers with positive hepatitis B surface antigen, including 11 hepatitis B e antigen positive, were quantitatively tested to measure viral antigens by microparticle enzyme immunoassay and viral loads by real-time polymerase chain reaction assay.
UNASSIGNED: The median level of hepatitis B surface antigen in the human milk samples of mothers with positive or negative hepatitis B e antigen was each lower than that in the sera, respectively (1.10 vs. 4.32 log10 IU/ml, t = 10.693, p < .001; -0.77 vs. 2.53 log10 IU/ml, t = -25.135, p < .001). The titers of hepatitis B surface antigen or hepatitis B e antigen in the human milk samples were each correlated with that in maternal serum. The detectable level of deoxyribonucleic acid of hepatitis B virus in human milk ranged from 1.42-5.27 log10 IU/ml, whereas that in maternal sera was 1.44-8.66 log10 IU/ml. The viral level in human milk was not correlated with that in maternal circulation.
UNASSIGNED: The present study data illustrate the relatively low titers of viral markers in the milk of mothers with positive hepatitis B surface antigen.

A growing, global conversation, regarding realities and challenges that parents experience today is ever-present. To understand recent parent\'s attitudes, beliefs, and perceptions regarding infant feeding, we sought to systematically identify and synthesize original qualitative research findings. Following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) framework, electronic databases were searched with a priori terms applied to title/abstract fields and limited to studies published in English from 2015 to 2019, inclusive. Study quality assessment was conducted using the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed. Of 73 studies meeting inclusion criteria, four major themes emerged. (1) Breastfeeding is best for an infant; (2) Distinct attitudes, beliefs, and perceptions of mothers that breastfeed, and those that could not or chose not to breastfeed, are evident; (3) Infant feeding behaviors are influenced by the socio-cultural environment of the family, and (4) Parent\'s expectations of education and support addressing personal infant feeding choices from health care providers are not always met. This systematic review, guided by constructs within behavioral models and theories, provides updated findings to help inform the development of nutrition education curricula and public policy programs. Results can be applied within scale-up nutrition and behavioral education interventions that support parents during infant feeding.