Browsing by Person "Chan, Kit Yee"

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A systematic review and meta-analysis of the effectiveness of hypertension interventions in faith-based organisation settings
(International Society of Global Health, 2023-10-13) Chan, Kit Yee; Srivastava, Noori; Wang, Zhicheng; Xia, Xiaoqian; Huang, Zhangziyue; Poon, Adrienne N; Reidpath, Daniel
Abstract Background Hypertension is the global, leading cause of mortality and is the main risk factor for cardiovascular disease. Community-based partnerships can provide cost-saving ways of delivering effective blood pressure (BP) interventions to people in resource-poor settings. Faith-based organisations (FBOs) prove important potential health partners, given their reach and community standing. This potential is especially strong in hard-to-reach, socio-economically marginalised communities. This systematic review explores the state of the evidence of FBO-based interventions on BP management, with a focus on randomised controlled trials (RCTs) and cluster RCTs (C-RCTs). Methods Seven academic databases (English = 5, Chinese = 2) and grey literature were searched for C-/RCTs of community-based interventions in FBO settings. Only studies with pre- and post-intervention BP measures were kept for analysis. Random effects models were developed using restricted maximum likelihood estimation (REML) to estimate the population average mean change and 95% confidence interval (CI) of both systolic and diastolic blood pressure (SBP and DBP). The overall heterogeneity was assessed by successively adding studies and recording changes in heterogeneity. Prediction intervals were generated to capture the spread of the pooled effect across study settings. Results Of the 19 055 titles identified, only 11 studies of fair to good quality were kept for meta-analysis. Non-significant, average mean differences between baseline and follow-up for the intervention and control groups were found for both SBP (0.78 mm of mercury (mmHg) (95% CI = 2.11-0.55)) and DBP (-0.20 mm Hg (95% CI = -1.16 to 0.75)). Subgroup analysis revealed a significant reduction in SBP of -6.23 mm Hg (95% CI = -11.21 to -1.25) for populations with mean baseline SBP of ≥140 mm Hg. Conclusions The results support the potential of FBO-based interventions in lowering SBP in clinically hypertensive populations. However, the limited evidence was concentrated primarily in Christian communities in the US More research is needed to understand the implications of such interventions in producing clinically meaningful long-term effects in a variety of settings. Further research can illuminate factors that affect success and potential expansion to sites outside the US as well as non-Christian FBOs. Current evidence is inadequate to evaluate the potential of FBO-based interventions in preventing hypertension in non-hypertensive populations. Intervention effects in non-hypertensive population might be better reflected through intermediate outcomes.
AIDS and the stigma of sexual promiscuity: Thai nurses' risk perceptions of occupational exposure to HIV
(Taylor and Francis Group, 2009-04-14) Chan, Kit Yee; Rungpueng, Arattha; Reidpath, Daniel
This paper examines the culturally shaped meanings of AIDS and perceptions of accidental occupational exposure to HIV among a group of twenty nurses in Bangkok, Thailand. The findings are based on data collected as a part of a larger mixed‐methods study that examined how perceptions of risk behaviours (including sexual promiscuity) shape health workers' perceptions of patients living with HIV/AIDS. Nurses' narratives revealed that despite acknowledgement of the low probability of occupational exposure to HIV, the fear of HIV infection remained and was largely driven by the enormity of the anticipated social (rather than the health) consequences of being HIV‐positive. The perceived certainty of social ostracism was reinforced by participants' observations of the social rejection experienced by people living with HIV/AIDS both within and outside clinical settings. For female nurses, the dominant social perception that women living with HIV/AIDS were violators of gender norms, and thus ‘guilty’ victims, was an issue central to their self‐identities. Ways of improving care for people living with HIV in the light of the nurses concerns and future research are discussed.
A case study of the counterpart technical support policy to improve rural health services in Beijing
(BMC, 2012-12-29) Jian, Weiyat; Chan, Kit Yee; Tang, Shunv; Reidpath, Daniel
Background There is, globally, an often observed inequality in the health services available in urban and rural areas. One strategy to overcome the inequality is to require urban doctors to spend time in rural hospitals. This approach was adopted by the Beijing Municipality (population of 20.19 million) to improve rural health services, but the approach has never been systematically evaluated. Methods Drawing upon 1.6 million cases from 24 participating hospitals in Beijing (13 urban and 11 rural hospitals) from before and after the implementation of the policy, changes in the rural–urban hospital performance gap were examined. Hospital performance was assessed using changes in six indices over-time: Diagnosis Related Groups quantity, case-mix index (CMI), cost expenditure index (CEI), time expenditure index (TEI), and mortality rates of low- and high-risk diseases. Results Significant reductions in rural–urban gaps were observed in DRGs quantity and mortality rates for both high- and low-risk diseases. These results signify improvements of rural hospitals in terms of medical safety, and capacity to treat emergency cases and more diverse illnesses. No changes in the rural–urban gap in CMI were observed. Post-implementation, cost and time efficiencies worsened for the rural hospitals but improved for urban hospitals, leading to a widening rural–urban gap in hospital efficiency. Conclusions The strategy for reducing urban–rural gaps in health services adopted, by the Beijing Municipality shows some promise. Gains were not consistent, however, across all performance indicators, and further improvements will need to be tried and evaluated.
China’s Rural-Urban Care Gap Shrank For Chronic Disease Patients, But Inequities Persist
(Project HOPE, 2010-12) Jian, Weiyan; Chan, Kit Yee; Reidpath, Daniel; Xu, Ling
Reducing the gap in health outcomes between rural and urban areas in China has been a focus of the central government’s health reform efforts since 2002. Drawing on national survey data from 2003 and 2008, this paper analyzes changes in the rural-urban gap for patients with chronic diseases. Overall, there were substantial improvements at the national level in insurance coverage and the use of hospital services for both urban and rural residents with chronic diseases. There was also an overall reduction in the rural-urban gap in the use of inpatient services. But the gains were uneven. For example, although rural Chinese with chronic disease could more easily start inpatient treatment in 2008 than they could in 2003, because of the higher hospital copayments required under insurance coverage for rural citizens, they were more than twice as likely to drop out of treatment as were Chinese in urban areas. The strongest evidence of the narrowing of the rural-urban gap came from central China, while the evidence is mixed for western and eastern China. Our analysis suggests that different approaches will be required to narrow the rural-urban health service gap in different regions of China.
Chinese Rural-Urban Care Gap: The Authors Respond
(Project HOPE, 2011-03) Jian, Weiyan; Chan, Kit Yee; Reidpath, Daniel
Disentangling the stigma of HIV/AIDS from the stigmas of drugs use, commercial sex and commercial blood donation – a factorial survey of medical students in China
(BMC, 2007-10-05) Chan, Kit Yee; Yang, Yi; Zhang, Kong-Lai; Reidpath, Daniel
Background HIV/AIDS related stigma interferes with the provision of appropriate care and support for people living with HIV/AIDS. Currently, programs to address the stigma approach it as if it occurs in isolation, separate from the co-stigmas related to the various modes of disease transmission including injection drug use (IDU) and commercial sex (CS). In order to develop better programs to address HIV/AIDS related stigma, the inter-relationship (or 'layering') between HIV/AIDS stigma and the co-stigmas needs to be better understood. This paper describes an experimental study for disentangling the layering of HIV/AIDS related stigmas. Methods The study used a factorial survey design. 352 medical students from Guangzhou were presented with four random vignettes each describing a hypothetical male. The vignettes were identical except for the presence of a disease diagnosis (AIDS, leukaemia, or no disease) and a co-characteristic (IDU, CS, commercial blood donation (CBD), blood transfusion or no co-characteristic). After reading each vignette, participants completed a measure of social distance that assessed the level of stigmatising attitudes. Results Bivariate and multivariable analyses revealed statistically significant levels of stigma associated with AIDS, IDU, CS and CBD. The layering of stigma was explored using a recently developed technique. Strong interactions between the stigmas of AIDS and the co-characteristics were also found. AIDS was significantly less stigmatising than IDU or CS. Critically, the stigma of AIDS in combination with either the stigmas of IDU or CS was significantly less than the stigma of IDU alone or CS alone. Conclusion The findings pose several surprising challenges to conventional beliefs about HIV/AIDS related stigma and stigma interventions that have focused exclusively on the disease stigma. Contrary to the belief that having a co-stigma would add to the intensity of stigma attached to people with HIV/AIDS, the findings indicate the presence of an illness might have a moderating effect on the stigma of certain co-characteristics like IDU. The strong interdependence between the stigmas of HIV/AIDS and the co-stigmas of IDU and CS suggest that reducing the co-stigmas should be an integral part of HIV/AIDS stigma intervention within this context.
HIV, Stigma, and Rates of Infection: A Rumour without Evidence
(Public Library of Science, 2006-10-31) Reidpath, Daniel; Chan, Kit Yee
HIV, Stigma, and Rates of Infection: A Rumour without Evidence: Authors' Reply
(Public Library of Science, 2007-01-30) Reidpath, Daniel; Chan, Kit Yee
Interrelationships Between HIV/AIDS and Risk Behavior Prejudice Among Medical Students in Southern China
(Bentham Science, 2009) Chan, Kit Yee; Yang, Yi; Li, Ze-Rong; Stoove, Mark A; Reidpath, Daniel
Stigma within health care settings poses a considerable barrier to the provision of treatment and care for patients with HIV/AIDS (PLWHA). Southern China is located in a region with one of the worlds fastest growing HIV/AIDS epidemics. Attitudes towards PLWHA amongst health workers are currently under-researched in this region. This paper examines the inter-relationships between prejudicial attitudes among Chinese medical students towards HIV/AIDS and attitudes towards three risk behaviors: injecting drug use (IDU), commercial sex (CS) and commercial blood donation (CBD). Medical students (N = 352) in Guangzhou were presented with two random vignettes; each describing a hypothetical male that was identical, except for the disease diagnosis (AIDS/leukemia) and the cocharacteristic (IDU/CS/CBD/blood transfusion/no co-characteristic). After reading each vignette, participants completed a standard prejudicial scale. Univariate and multivariable analyses revealed significant levels of prejudice associated with AIDS, IDU and CS. Regardless of the disease, patients with IDU or CS were judged significantly worse than patients who had received a blood transfusion. No significant interactions were found between AIDS and the stigmatized cocharacteristics. The findings suggest that prejudice towards PLWHA needs to be understood within the larger context of the stigma towards risk behaviors. Although non-significant interactions were found between AIDS and the stigmatized risk behaviors, the overlap between the local HIV/AIDS, IDU and CS populations suggests that addressing risk behaviorrelated prejudices could be critical for improving care and treatment for PLWHA.
Stigma, social reciprocity and exclusion of HIV/AIDS patients with illicit drug histories: A study of Thai nurses' attitudes
(2008-08-23) Chan, Kit Yee; Stoové, Mark A; Reidpath, Daniel
Background Stigma is a key barrier for the delivery of care to patients living with HIV/AIDS (PLWHA). In the Asia region, the HIV/AIDS epidemic has disproportionately affected socially marginalised groups, in particular, injecting drug users. The effect of the stigmatising attitudes towards injecting drug users on perceptions of PLWHA within the health care contexts has not been thoroughly explored, and typically neglected in terms of stigma intervention. Methods Semi-structured interviews were conducted with a group of twenty Thai trainee and qualified nurses. Drawing upon the idea of 'social reciprocity', this paper examines the constructions of injecting drug users and PLWHA by a group of Thai nurses. Narratives were explored with a focus on how participants' views concerning the high-risk behaviour of injecting drug use might influence their attitudes towards PLWHA. Results The analysis shows that active efforts were made by participants to separate their views of patients living with HIV/AIDS from injecting drug users. While the former were depicted as patients worthy of social support and inclusion, the latter were excluded on the basis that they were perceived as irresponsible 'social cheaters' who pose severe social and economic harm to the community. Absent in the narratives were references to wider socio-political and epidemiological factors related to drug use and needle sharing that expose injecting drug users to risk; these behaviours were constructed as individual choices, allowing HIV positive drug users to be blamed for their seropositive status. These attitudes could potentially have indirect negative implications on the nurses' opinions of patients living with HIV/AIDS more generally. Conclusion Decreasing the stigma associated with illicit drugs might play crucial role in improving attitudes towards patients living with HIV/AIDS. Providing health workers with a broader understanding of risk behaviours and redirecting government injecting drug policy to harm reduction are discussed as some of the ways for stigma intervention to move forward.
Stigmatization of AIDS Patients: Disentangling Thai Nursing Students’ Attitudes Towards HIV/AIDS, Drug Use, and Commercial Sex
(Springer, 2007-03-16) Chan, Kit Yee; Stoové, Mark A; Sringernyuang, Luechai; Reidpath, Daniel
This paper analyzes the interrelationships between the stigma of HIV/AIDS stigma and the co-stigmas of commercial sex (CS) and injecting drug use (IDU). Students of a Bangkok nursing college (N = 144) were presented with vignettes describing a person varying in the disease diagnoses (AIDS, leukemia, no disease) and co-characteristics (IDU, CS, blood transfusion, no co-characteristic). For each vignette, participants completed a social distance measure assessing their attitudes towards the hypothetical person portrayed. Multivariate analyses showed strong interactions between the stigmas of AIDS and IDU but not between AIDS and CS. Although AIDS was shown to be stigmatizing in and of itself, it was significantly less stigmatizing than IDU. The findings highlight the need to consider the non-disease-related stigmas associated with HIV as well as the actual stigma of HIV/AIDS in treatment and care settings. Methodological strengths and limitations were evaluated and implications for future research discussed.
Stigmatization of Patients with AIDS: Understanding the Interrelationships between Thai Nurses' Attitudes toward HIV/AIDS, Drug Use, and Commercial Sex
(Mary Ann Liebert, 2007-10-20) Chan, Kit Yee; Reidpath, Daniel
There is currently a scarcity of research on the nature of HIV/AIDS stigma within the Thai health context. This is problematic given the negative role of stigma in hindering the provision of patient care and treatment. This study used a mixed-method approach to investigate the interrelationships between the stigma of HIV/AIDS and the stigmas relating to its various modes of disease transmission including injection drug use (IDU). Twenty interviews were conducted with trainees and qualified nurses from a Bangkok college. Participants were presented with vignettes describing a hypothetical person varying in disease diagnoses (AIDS, leukemia, no disease) and co-characteristics (IDU, commercial sex (CS), blood transfusion, no co-characteristic). Using a Q-sort task, participants arranged the vignettes along a bipolar scale according to their willingness to interact with the persons, and were asked to explain their decisions. Univariate and multivariate regression analyses showed that IDU, AIDS, and CS were all individually stigmatizing. Strong interactions were found between the stigmas of HIV/AIDS, IDU, and CS. Interview data also showed clear biases toward patients according to their IDU and CS habits. The findings suggest that addressing these co-stigmas could be vital to the success of efforts aimed at reducing the disease stigma of HIV/AIDS.
Tackling dementia globally: the Global Dementia Prevention Program (GloDePP) collaboration
(International Society of Global Health, 2019-12) Chan, Kit Yee; Adeloye, Davies; Asante, Kwaku Poku; Calia, Clara; Campbell, Harry; Danso, Samuel O; Juvekar, Sanjay; Luz, Saturnino; Mohan, Devi; Terrera, Graciela Muniz; Nitrini, Ricardo; Noroozian, Maryam; Nulkar, Amit; Nyame, Solomon; Paralikar, Vasudeo; Rodriguez, Mario A Parra; Poon, Adrienne N.; Reidpath, Daniel; Rudan, Igor; Stephan, Blossom CM; Su, Tin Tin; Wang, Huali; Watermeyer, Tam; Wilkinson, Heather; Yassuda, Monica Sanches; Yu, Xin; Ritchie, Craig
“Typhoid Mary” and “HIV Jane”: Responsibility, Agency and Disease Prevention
(Taylor and Francis Group, 2003-11-13) Chan, Kit Yee; Reidpath, Daniel
The construction of disease risks as knowable, calculable and preventable in dominant social science and public health discourses has fostered a certain kind of logic about individual risk and the responsibility for infection. Disease control measures that have developed out of this logic typically fail to recognise the socio-structural roots of many high-risk behaviours that are linked to the spread of infection. Instead, they hold the disease carrier responsible for managing his/her own risk of infection of others, and rely on constraining the agency of the carrier (e.g. by constraining movement, contact or occupation). In occupations associated with a high risk of infection, the idea of responsibility of the actor implicitly raises issues of “professional responsibility”. Using the case of “Typhoid Mary” and a hypothetical case of “HIV Jane”, this paper explores some of the problems with making sex workers responsible for the prevention of HIV transmission. It argues that for the notion of “responsibility” to make any sense, the HIV-positive person must be in a position to exercise responsibility, and for this they must have agency.