A team of researchers at the Chinese University of Hong Kong have recently completed the pilot study of a culturally-adapted Younger Women’s Wellness After Cancer Program for Women in Hong Kong (YWWACPHK).
We sat down with Assistant Professor Dorothy Chan from the Faculty of Medicine at the University to discuss the program pilot and plans to conduct a full-scale study in the coming months.
What was the driver for developing a culturally-appropriate program for younger women after cancer in Hong Kong?
Breast cancer is the most common cancer among Hong Kong Chinese women, and its incidence rate has continued to rise in recent years. In 2020, 4,956 new cases of breast cancer were reported in Hong Kong. Of these, 1,314 patients were aged below 50 years, representing 26.5% of the total breast cancer cases.
The number of breast cancer cases diagnosed at age 50 or below in Hong Kong is increasing. Around 70% of Chinese women in this age group are married and participate in the work force. Younger Chinese women with breast cancer are therefore expected to return to work after their cancer diagnoses and treatment. Current health promotion programmes for women with breast cancer in Hong Kong do not specifically target the younger age group. Most require the women to physically attend during office hours, and thus many working women may not be able to participate. The availability of a flexible and Internet-based programme that overcomes the problems of time constraint and geographical location can offer a new channel through which women can receive health information, advice and care from healthcare professionals. Nearly 99% of Hong Kong citizens use their smartphones to connect to the Internet, and approximately 71% use desktop computers. The Internet-based YWWACP, aimed at providing a whole-lifestyle intervention to help younger women managing their health, can therefore represent a suitable approach, which meets younger women’s needs and facilitates the delivery of information and support.
How has the program been adapted for Chinese women in Hong Kong?
The programme was culturally adapted, and modifications made where necessary. The text of the electronic original YWWACP programme book was translated into traditional Chinese. Then, to enhance the cultural relevance, some modifications were made, for example, in relation to the diet (types of food), the types of physical activities commonly performed by Hong Kong Chinese women and the places where relaxation activities took place. The body mass index was modified with reference to the recommendation made by World Health Organisation for Asian adults. Information about alcohol after cancer was removed as alcohol intake is not common among Hong Kong women. Furthermore, instead of presenting the content in the form of an electronic book, the contents were presented on the website and scheduled on a daily and weekly basis (over a 12-week period). In addition, some health information, such as local cancer statistics and screening measures, and the official websites of health departments providing information on healthy eating and physical activities, were added.
To illustrate the steps to perform stretching and muscle strengthening exercises, graphics of young Chinese women were used. A voice plugin function was added so that the participants could click and listen to the content. Consultations with a cancer nurse were conducted either using telephone or text messaging with a cancer nurse at Weeks 6 and 12 as per the preference of Hong Kong Chinese women made during the virtual consultation at the beginning of the programme. The discussion board was removed as suggested by previous WWACP studies as it was rarely used by participants.
What are you hoping to achieve from conducting a full-scale study later in the year?
In our pilot study which was conducted during the COVID-19 pandemic, at 12 weeks after intervention completion, the intervention group showed a significant increase in the pain subscale scores of sexual function, and more improvement in the level of physical activity than the control group. Nineteen intervention group participants reported that they were satisfied with the programme and suggestions for improvement were provided. We hope that in our future full-scale study, not only could we see the changes in their level of physical activity and sexual function, but also we hope to see changes in other aspects, such as sleep quality, dietary intake and quality of life.
What are your long-term ambitions for the YWWACPHK?
In the long term, we hope that this programme will be incorporated into the routine health services offered to breast cancer patients or have the website of the programme made available to all cancer patients who would like to search and obtain information.
For more information about the Younger Women’s Wellness after Cancer Program for Women in Hong Kong, you can visit ywwacp.nur.cuhk.edu.hk/
