Anni Wang

Background: Nursing interns (fourth-year undergraduate nursing students in their clinical practicum) often report low career intention, closely linked to transition shock during role transition. Purpose: To examine how transition shock affects career intention and the moderating role of professional identity using ecological momentary assessment. Methods: The study tracked 1162 nested observations of 83 nursing interns over 14 days. Data were analyzed using a 2-level Hierarchical Linear Modeling. Results: Transition shock was relatively high (69.22 ± 25.17) and varied significantly ( P < .01), while career intention remained moderate and stable (2.42 ± 0.82). Sociocultural and development shock negatively predicted career intention (β = .02, P < .01). Professional identity showed a direct protective effect (β = −.01, P < .01) but no moderating role. Conclusions: Nursing interns show fluctuating shock but stable career intention. Sociocultural challenges lower intention, while professional identity buffers it. Strengthening professional identity mitigates shock, and better adaptation supports internship success.

Internet hospital is an online medical platform where doctors can provide patients with convenient medical services. Facilitating conditions, perceived risk, and performance expectancy have been identified as factors associated with the intention to use new technologies. However, limited studies explore the effects of these three factors on doctors' intention to use internet hospitals. This study aims to investigate the relationship between facilitating conditions, perceived risk, performance expectancy, and behavioral intention of doctors in public hospitals to use internet hospitals. Furthermore, it seeks to comprehend the multiple mediation effects of perceived risk and performance expectancy on the relationship between facilitating conditions and behavioral intention. A multicenter cross-sectional web-based survey was conducted from November to December 2022, using a sample of 233 doctors from 8 public hospitals in Shanghai. Structural equation modeling (SEM) and multi-group analysis were applied to test the proposed model and examine differences across professional title subgroups. The findings revealed significant correlations between facilitating conditions, perceived risk, performance expectancy, and behavioral intention (β = 0.337, p < 0.001; β=-0.213, p < 0.001; β = 0.460, p < 0.001, respectively). Facilitating conditions was indirectly associated with intention to use internet hospitals through perceived risk (β = 0.044, p = 0.02) and performance expectancy (β = 0.210, p = 0.001), and these two variables formulated a sequential mediating pathway (β = 0.021, p = 0.02). The mediation effect accounted for 44.8% of the total effect of facilitating conditions. Among doctors with lower titles, the path coefficient from facilitating conditions to behavioral intention was significantly higher compared to doctors with higher titles (CR=-2.923, p = 0.003); the path coefficient from perceived risk to behavioral intention was significantly lower than doctors with higher titles (CR=-3.258, p = 0.001). The findings suggest policymakers augment the doctors' intention to utilize internet hospitals by optimizing the circumstances surrounding internet hospitals, establishing comprehensive support systems, enhancing the performance benefits, and alleviating the perception of risk.

Background: Most older adults with disabilities in China and across Eastern Asian prefer to age in place, relying on home‐ and community‐based care. Their family caregivers frequently encounter significant challenges, including a pronounced lack of knowledge and skills for providing daily living assistance, highlighting a critical need for accessible, practical training. Furthermore, existing community‐based support programmes for caregivers often fail to incorporate an integrated family perspective. This oversight neglects the crucial dynamics and internal interactions within the family unit, which are fundamental to the overall adaptation and resilience of the entire family system. Objective: This study aims to develop a nurse‐led, family‐oriented resilience intervention programme for caregivers of older adults with disabilities. The programme is designed to enhance caregivers' practical competencies and to strengthen overall family adaptation within the context of Chinese community settings. Method: We followed the Medical Research Council (MRC) framework for developing and evaluating complex interventions to guide the development process. This involved integrating empirical evidence from our prior studies, identifying relevant theories of family resilience, and validating the preliminary intervention content. We employed a two‐round Delphi method with an expert panel to validate the initial programme draft. For each proposed activity, we calculated the coefficient of variation (CV) and Kendall's coefficient of concordance (Kendall's W ) to assess expert consensus. Result: The two‐round Delphi consultation yielded high positive and authority coefficients. In the first round, the mean importance scores for items ranged from 4.19 to 4.96 (overall mean 4.77 ± 0.21), with a coefficient of variation (CV) between 0.04 and 0.16 and Kendall's W was statistically significant ( p < 0.01). In the second round, scores ranged from 4.16 to 4.96 (overall mean 4.82 ± 0.19), with a CV between 0.04 and 0.15, and a significant Kendall's W ( p < 0.01). Based on this expert feedback, we refined the intervention into an 8‐week programme, delivered via weekly home visits, integrating two core components: caregiving skill and family resilience. The weekly themes are (1) Getting to know each other; (2) I am not fighting alone (cleaning care and coping, social support for caregivers); (3) Thank you, embrace you (family resilience and internal support); (4) Love flows through communication (dietary care and coping, family communication and coping); (5) Riding the wind and waves together (excretion care and coping, social support for peers); (6) Community with me (mobile care and coping, social support for community); (7) Supplementing energy (safety protection and basic first aid, social support for external systems); and (8) Radiating the caregiver's radiance (individual self‐resilience and self‐support). Conclusion: Guided by the MRC framework, we developed a theory‐driven, culturally appropriate, nurse‐led and family‐oriented resilience intervention for caregivers of older adults with disabilities. The program's flexible delivery allows adaptation to local resources and caregiver needs, help caregivers overcome practical challenges and enhance family resilience. Future research should utilize a three‐arm randomized controlled trial to evaluate the feasibility, acceptability and preliminary effectiveness of this complex intervention. Implications for Practice: This nurse‐led, family‐oriented resilience intervention offers a practical, home‐based training programme that equips family caregivers of older adults with disabilities with essential caregiving skills and strategies to strengthen family adaptation, thereby supporting the implementation of community‐based aged care services in China and similar Eastern Asian contexts.

Background Social support influences psychological resilience, which in turn affects disabled elderly and caregivers’ psychological distress. Objective Based on the actor–partner interdependence model extended to mediation, we explore the interaction relationship between social support for disabled elderly and caregivers and the mediating role of psychological resilience in psychological pain. Methods A total of 214 disabled elderly individuals and their caregivers were surveyed using a general information questionnaire, Lubben Social Network Scale, Social Support Rating Scale, Connor–Davidson Resilience Scale, and distress thermometer (DT). Results Caregivers’ social support (t = −11.2, p < 0.001) and psychological resilience (t = −6.38, p < 0.001) were significantly higher than those of the disabled elderly, while the psychological pain of the disabled elderly was significantly higher than that of caregivers (t = 5.21, p < 0.001). In the actor–partner mediation model, the social support of disabled elderly and caregivers played a fully and partially mediating role in their psychological pain, respectively, through psychological resilience. Moreover, the social support of caregivers had a partner effect on the psychological resilience and pain of disabled elderly people. Conclusion Both disabled elderly individuals and caregivers have significant mediating effects of psychological resilience between social support and psychological distress. The level of social support provided by caregivers can have an objective mediating effect on the psychological pain of disabled elderly people through their psychological resilience. The results suggest that in clinical research, the establishment of community support networks and flexible psychological interventions can help improve the psychological pain of disabled elderly people and their caregivers. Meanwhile, from the perspective of the actor-partner interdependence, future efforts should emphasize caregiver empowerment, improve their social support and psychological resilience, which will in turn help reduce psychological distress in the disabled elderly.

Background: Parents of autistic children frequently experience elevated stress levels, depressive symptoms, and reduced well-being. Positive psychology interventions (PPIs) can strengthen resilience, and chatbots offer a scalable channel through which such skills can be delivered. However, evidence on the evaluation of large language model–guided PPI-based chatbots for this population is limited. Objective: This study evaluated the feasibility and acceptability of a GPT-powered chatbot (“Allie”). This study was designed to deliver culturally adapted PPIs to parents of autistic children and to explore their preliminary effects on well-being, depression, stress, and health-related quality of life. Methods: We conducted a single-arm mixed-methods pilot study with 19 parents with autistic children. These parents engaged with Allie for 2 weeks to complete 8 structured PPI exercises. The primary outcomes were feasibility (completion, ease of use, and practicality) and acceptability (multidimensional user ratings). Secondary outcomes were the World Health Organization–Five Well-Being Index (WHO-5), Patient Health Questionnaire-9, Perceived Stress Scale-10, and Short Form-12 Health Survey (version 2) Physical and Mental Component Summary scores. Outcomes were analyzed using paired t tests or Wilcoxon signed-rank tests. Optional postintervention interviews were analyzed using reflexive thematic analysis. Results: A total of 17 (89.5%) participants completed all the exercises, which indicated a high degree of procedural feasibility. There were also high ratings for ease of use and practicality (means 4.47/5, SD 0.70, and 4.32/5, SD 0.67, respectively). Acceptability was favorable (overall satisfaction mean=5.68/7, SD 0.70; prompt response time=6.37/7, SD 0.68). The WHO-5 score improved significantly from 32.84 to 46.11 (t18=2.48, P=.02; Cohen d=0.52). Changes in the Patient Health Questionnaire-9 (z=−0.49, P=.63; r=0.11), Perceived Stress Scale-10 (t18=−0.82, P=.43; Cohen d=0.12), and Short Form-12 Health Survey (version 2) Physical Component Summary (t18=−0.94, P=.36; Cohen d=0.18) and Mental Component Summary (t18=−0.89, P=.39; Cohen d=0.17) scores were not significant. Qualitative feedback (14/19) described benefits aligned with PPI mechanisms such as greater self-reflection, a more positive orientation, perspective-taking, emotional support, and coping skills. However, participants also suggested refinements, such as more natural conversation (colloquial Cantonese), shorter or less repetitive outputs, user-chosen sequencing with reminders and progress tracking, multimodal features, and autism spectrum disorder–specific resources. Conclusions: This pilot study revealed the feasibility, acceptability, and preliminary improvement in well-being (WHO-5) of a PPI-based GPT-powered chatbot, Allie, among parents of autistic children. Although there was no significant short-term change in other outcomes, the findings provide insights into design priorities, including personalization, conversational naturalness, multimodal content, and autism spectrum disorder–specific guidance. Larger, controlled trials with longer exposures and more diverse samples are needed to establish efficacy and durability. Trial Registration: ClinicalTrials.gov NCT06438120; https://clinicaltrials.gov/study/NCT06438120

The declining fertility rate posed significant risks to social sustainability and development. However, few studies have explored the psychological factors

Background: Psychological Distress Among Family Caregivers of Older People With Functional Impairment Are a Significant Concern. However, the Lack of Simple and Rapid Tools to Assess Psychological Distress in These Caregivers Delays Timely Intervention. Aim: The aim was to examine the convergent validity and retest reliability of the Chinese version of the Distress Thermometer (DT) and document the cut‐off score in family caregivers. Methods: This was a diagnostic accuracy study and descriptive cross‐sectional survey to examine the validity of the DT. The cut‐off score was determined by using receiver operating characteristic analysis with the Depression Anxiety Stress Scale (DASS‐21) as the reference standard in a sample of 248 family caregivers. Results: Good convergent validity with the DASS‐21 (0.72–0.75) and good retest reliability ( r = 0.93) were both illustrated for the DT. At a cut‐off score of five, the sensitivity, specificity, Youden index, positive predictive value and negative predictive value were most satisfactory, and area under the curve values demonstrated significantly excellent discrimination. 37.1% of participants scoring higher than the cut‐off score experienced a significant number of problems. Conclusions: DT is a reliable tool for measuring the distress of family caregivers of older people with functional impairment. It is advisable for nurses to routinely employ DT to assess the distress of family caregivers. Imlications for Practice: Healthcare professionals can use the DT as a routine screening tool to identify caregivers with psychological distress at an early stage, which facilitates the timely implementation of supportive interventions for caregivers.

BACKGROUND Parents of autistic children frequently experience elevated stress levels, depressive symptoms, and reduced well-being. Positive psychology interventions (PPIs) can strengthen resilience, and chatbots offer a scalable channel through which such skills can be delivered. However, evidence on the evaluation of large language model–guided PPI-based chatbots for this population is limited. OBJECTIVE This study evaluated the feasibility and acceptability of a GPT-powered chatbot (“Allie”). This study was designed to deliver culturally adapted PPIs to parents of autistic children and to explore their preliminary effects on well-being, depression, stress, and health-related quality of life. METHODS We conducted a single-arm mixed-methods pilot study with 19 parents with autistic children. These parents engaged with Allie for 2 weeks to complete 8 structured PPI exercises. The primary outcomes were feasibility (completion, ease of use, and practicality) and acceptability (multidimensional user ratings). Secondary outcomes were the World Health Organization–Five Well-Being Index (WHO-5), Patient Health Questionnaire-9, Perceived Stress Scale-10, and Short Form-12 Health Survey (version 2) Physical and Mental Component Summary scores. Outcomes were analyzed using paired t tests or Wilcoxon signed-rank tests. Optional postintervention interviews were analyzed using reflexive thematic analysis. RESULTS A total of 17 (89.5%) participants completed all the exercises, which indicated a high degree of procedural feasibility. There were also high ratings for ease of use and practicality (means 4.47/5, SD 0.70, and 4.32/5, SD 0.67, respectively). Acceptability was favorable (overall satisfaction mean=5.68/7, SD 0.70; prompt response time=6.37/7, SD 0.68). The WHO-5 score improved significantly from 32.84 to 46.11 (t18=2.48, P=.02; Cohen d=0.52). Changes in the Patient Health Questionnaire-9 (z=−0.49, P=.63; r=0.11), Perceived Stress Scale-10 (t18=−0.82, P=.43; Cohen d=0.12), and Short Form-12 Health Survey (version 2) Physical Component Summary (t18=−0.94, P=.36; Cohen d=0.18) and Mental Component Summary (t18=−0.89, P=.39; Cohen d=0.17) scores were not significant. Qualitative feedback (14/19) described benefits aligned with PPI mechanisms such as greater self-reflection, a more positive orientation, perspective-taking, emotional support, and coping skills. However, participants also suggested refinements, such as more natural conversation (colloquial Cantonese), shorter or less repetitive outputs, user-chosen sequencing with reminders and progress tracking, multimodal features, and autism spectrum disorder–specific resources. CONCLUSIONS This pilot study revealed the feasibility, acceptability, and preliminary improvement in well-being (WHO-5) of a PPI-based GPT-powered chatbot, Allie, among parents of autistic children. Although there was no significant short-term change in other outcomes, the findings provide insights into design priorities, including personalization, conversational naturalness, multimodal content, and autism spectrum disorder–specific guidance. Larger, controlled trials with longer exposures and more diverse samples are needed to establish efficacy and durability. CLINICALTRIAL ClinicalTrials.gov NCT06438120; https://clinicaltrials.gov/study/NCT06438120

Background: Electronic resources have become a predominant modality for health information dissemination in recent years. eHealth literacy (eHL) means individuals’ competencies to effectively acquire and use health information from electronic sources. Enhancing eHL is thus essential to facilitate individuals’ effective engagement with electronic resources and promote improved health management. Objective: This scoping review aimed to synthesize the characteristics of eHL interventions, thereby providing a reference for future intervention strategies. Methods: A comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, ProQuest, CINAHL, CNKI, VIP, Wan Fang Data, and Sino Med limited to Chinese and English-language studies published before August 2024 was conducted. The interventional studies included had the explicit primary objective of enhancing eHL. We also incorporated studies that assessed eHL as a secondary outcome or mediator influencing health behaviors or clinical outcomes. All publications were required to provide publicly accessible complete datasets. We excluded conference abstracts and protocols. Academic theses and dissertations were included if they underwent institutional quality assurance through rigorous academic review processes and met predefined eligibility criteria. Results: A total of 35 studies were included in this review. The most prevalent eHL interventions (12/35, 34%) were delivered via mobile apps and devices in various settings, including educational institutions, public spaces, health care facilities, and community centers. These interventions predominantly focused on enhancing information literacy, health literacy, and computer literacy across the 6 domains of eHL: traditional, health, information, scientific, media, and computer literacy. A majority of the interventions were conducted on a weekly basis (6/13, 46%) and had a duration of 24 weeks (6/35, 17%). However, 77% (27/35) of interventions did not assess long-term effects. The primary outcomes of eHL interventions encompassed perceived eHL, actual eHealth knowledge and skills, health literacy, health behavior, and clinical outcomes, with 86% (30/35) indicating positive effects. The eHealth Literacy Scale was the most frequently used assessment tool. Conclusions: This study synthesizes the characteristics of eHL interventions. Current eHL interventions exhibit limitations in theoretical grounding, longitudinal tracking, and traditional or media literacy components. Overreliance on self-reported metrics constrains validity assessment. Future work should strengthen theoretical frameworks, integrate objective metrics, and enhance longitudinal designs.