Mengqi Li

This qualitative study aimed to investigate the challenges, coping strategies, and mental health experiences of individuals living with ankylosing spondylitis in Hong Kong. Semi-structured interviews were conducted with a purposive sample of 15 diagnosed individuals from May to July 2024, and thematic analysis was used to interpret the data. The analysis revealed five main themes: physical and psychosocial challenges, cognitive assessment and personal perceptions, behavioral coping strategies, emotional responses to ankylosing spondylitis, and expectations for the future. Participants reported significant difficulties in daily life and mental health, and utilized a range of coping strategies that resulted in both positive and negative outcomes. This study provided new insights into the lived experiences of individuals with ankylosing spondylitis, highlighting the importance of effective coping mechanisms and raising societal awareness, and suggesting directions for future interventions to enhance mental well-being and support for this population.

Systematic review and meta-analysis. Despite a growing prevalence of cognitive impairment and depression after spinal cord injury (SCI), evidence of associations between specific cognitive domains and processes with depressive symptoms remains uncertain. This systematic review with meta-analysis aimed to evaluate the relationship between cognitive functions and depressive symptoms in adults with SCI. This review was pre-registered with PROSPERO (CRD42024523479). Seven databases were searched from inception to March 2025. Eligible studies assessed depression and cognitive function in adults with SCI and were published in English. Cognitive functions included self-reported subjective cognitive failures and objective cognitive functions assessed by neuropsychological tests. Study quality was assessed via the Newcastle-Ottawa Scale. Ten studies (three cohort, seven cross-sectional; N = 1683 participants) were included, with seven studies eligible for meta-analysis. The pooled results revealed that elevated depressive symptoms are significantly associated with global cognitive impairment, whereas there were no associations with subjective cognitive decline or deficits in specific domains (i.e., executive function, attention, and learning and memory). Adults with SCI who have impaired global cognitive function exhibit higher levels of depressive symptoms. Interventions targeting either depression or cognitive function may yield concomitant benefits on both outcomes, thereby enhancing health-related quality of life of the SCI population. More prospective studies are needed to investigate the relationship between depression severity and specific cognitive domains and to elucidate their potential causal mechanisms.

Background: Nurse turnover is a significant contributor to the global nursing shortage, and nurses’ turnover intentions are typically caused by a combination of factors. Nurses’ job embeddedness is an important factor influencing nurses’ turnover intentions. However, existing studies have examined only the net effects of the individual constructs on turnover intention, overlooking the combined effects of the job embeddedness dimensions. Aim: To explore how the dimensions of job embeddedness combine to form configurations that lead to nurses’ turnover intention or no turnover intention. Design: A cross‐sectional study using fuzzy‐set qualitative comparative analysis. Setting(s): Six medical institutions in the Hong Kong Special Administrative Region, China. Participants: From March to June 2023, a total of 232 employed nurses were included using a convenience sampling method. Methods: The fuzzy‐set qualitative comparative analysis was used to analyze the set relationships between the six dimensions of job embeddedness and turnover intention. Robustness checks and predictive validity analyses, based on set theory methods, were employed to verify the robustness of the condition configurations and their ability to predict the outcome variables. Finally, ordered logit regression was used to examine the associations between the configurations and turnover intention. Results: Fuzzy‐set qualitative comparative analysis indicated that multiple job embeddedness–related conditions combine to lead to nurses’ turnover intention. Necessity analysis shows that job embeddedness–related conditions are not necessary conditions for the presence or absence of nurses’ turnover intention. Sufficiency analysis identified five configurations contributing to nurses’ turnover intention (solution coverage = 0.525) and six configurations contributing to no turnover intention (solution coverage = 0.668), and these configurations were categorized into six groups. Significant associations were found between these configurations and turnover intention. Conclusion: The results suggest that the absence of organization fit and organization sacrifice is the core condition that contributes to nurses’ turnover intention. Mutual collaboration and competition between the dimensions of job embeddedness combined to create multiple configurations that prevented nurses’ turnover intention. This study provides new insights and ideas for managers to implement targeted interventions to reduce nurses’ turnover intention in response to these configurations.

Background: Attitude-targeted interventions are important approaches for promoting vaccination. Educational approaches alone cannot effectively cultivate positive vaccine attitudes. Artificial intelligence (AI)–driven chatbots and motivational interviewing (MI) techniques show high promise in improving vaccine attitudes and facilitating readiness for vaccination. Objective: This study aimed to evaluate the effectiveness of a theory and evidence-based, MI-oriented AI digital assistant in improving COVID-19 vaccine attitudes among adults in Hong Kong. Methods: This 2 parallel-armed randomized controlled trial was conducted from October 2022 to June 2024. Hong Kong adults (N=177) who were vaccine-hesitant were randomly assigned into 2 study groups. The intervention group (n=91) interacted with the AI digital assistant over 5 weeks, including receiving a web-based education program comprising 5 educational modules and communicating with an AI-driven chatbot equipped with MI techniques. The control group (n=86) received WhatsApp (Meta) messages directing them to government websites for COVID-19 vaccine information and knowledge, with the same dosage as the intervention group. Primary outcomes included vaccine hesitancy. Secondary outcomes included vaccine readiness, confidence, trust in government, and health literacy. Outcomes were measured at baseline, postintervention, 3-month, and 6-month follow-up. Focus group interviews were conducted postintervention. Intervention effects were analyzed using the generalized estimating equation model. Interview data were content analyzed. Results: Decreases in vaccine hesitancy were observed while no statistically significant time-by-group interaction effects were found. The intervention showed significant time-by-group interaction effects on vaccine readiness (P=.04), confidence (P=.02), and trust in government (P=.04). Significant between-group differences with medium effect sizes were identified for vaccine readiness (Cohen d=0.52) and trust in government (Cohen d=0.54) postintervention, respectively. Increases in vaccine-related health literacy were observed, and a significant time effect was found (P=.01). In total, three categories were summarized from interview data: (1) improved vaccine literacy, confidence, and trust in government; (2) hesitancy varied while readiness improved; and (3) facilitators, barriers, and recommendations of modifications on the intervention. Conclusions: The intervention indicated promising yet significant effects on vaccine readiness while the effects on vaccine hesitancy require further confirmation. The qualitative findings; however, further consolidate the significant effects on participants’ attitudes toward vaccines. The findings provide novel evidence to encourage the adoption and refinement of a MI-oriented AI digital assistant in vaccine promotion.

This study evaluated the effectiveness of an AI-driven digital assistant in reducing COVID-19 vaccine hesitancy and enhancing vaccine confidence among vaccine-hesitant adults in Hong Kong through a randomized controlled trial (N = 177). Participants in the intervention group (n = 91) received a web-based psychoeducation program with an AI chatbot utilizing motivational interviewing techniques, while the control group (n = 86) received standard learning materials. Results showed significant improvements in vaccine readiness (p = 0.027), confidence (p = 0.012), and trust in government (p = 0.032) in the intervention group, with moderate effect sizes. The study highlights the potential of AI and motivational interviewing to improve vaccine confidence and readiness, supporting the integration of AI-driven communication strategies in public health interventions.

Loneliness, prevalent in people with spinal cord injuries (SCI), is negatively associated with mental health and quality of life. Mindfulness is a potential moderator that may buffer the negative impact of loneliness. This study aimed to explore the moderation effects of mindfulness on the relationship between loneliness, depression, and quality of life among people with SCI. We conducted an explanatory sequential mixed-methods study on SCI survivors in Hong Kong. Survey data (n = 72) including socio-demographics, mindfulness, loneliness, depression, and quality of life were analyzed using moderated regression with the SPSS PROCESS macro. Focus group interviews (n = 15) were analyzed using thematic analysis. Mindfulness significantly moderated the positive association between loneliness and depression (B= -0.060, p = 0.006), and a cutoff value (>116.569) for moderation was identified. The mindfulness moderation on the relationship between loneliness and quality of life was insignificant. Three themes were generated: connectedness contributes to subjective well-being, mindful perceptions foster emotional resilience and happiness, and mindful perceptions enhance physical health and social connections. This study revealed the protective moderation mechanism of mindfulness in buffering the negative impacts of loneliness on depression, providing a strong theoretical foundation for the use of mindfulness-based interventions in improving mental well-being among SCI survivors.

Background: Rheumatic diseases are a group of inflammatory conditions that significantly impact physical and mental health. Ecological momentary interventions have shown promising effects among individuals with rheumatic diseases as they can deliver the most appropriate type and intensity of intervention tailored to their needs in real time, but their effectiveness has not been systematically reviewed and examined. Objective: To examine the effectiveness of ecological momentary interventions in reducing pain, improving mental health, and enhancing quality of life in individuals with rheumatic diseases. Design: Systematic review and meta‐analysis. Methods: A literature search was conducted in nine electronic databases from inception to April 2024. Randomized controlled trials (RCTs) examining the impact of ecological momentary interventions on pain, mental health, and/or quality of life in rheumatic disease populations were included. Two authors independently screened studies, extracted data, and assessed the risk of bias using Cochrane’s bias risk tool for randomized trials (ROB 2). The intervention effect was estimated by calculating the standardized mean difference (SMD) and 95% confidence interval (CI) with R 4.3.3 software. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: Sixteen RCTs with 1869 participants were included. Ecological momentary interventions significantly reduced pain (SMD = 0.18, 95% CI: 0.04–0.33) and marginally improved quality of life (SMD = 0.29, 95% CI: −0.01–0.60) versus controls. Subgroup analyses revealed greater effects for ecological momentary interventions with daily reminders on pain reduction (SMD = 0.21, 95% CI: 0.06–0.36) and quality‐of‐life improvement (SMD = 0.45, 95% CI: 0.02–0.88), as well as for ecological momentary interventions involving human contact on pain (SMD = 0.31, 95% CI: 0.10–0.52) and quality of life (SMD = 0.60, 95% CI: 0.25–0.95). However, both the primary analysis and subgroup analyses showed that ecological momentary interventions did not significantly improve anxiety and depression. Conclusion: Ecological momentary interventions could alleviate pain and enhance quality of life in rheumatic disease populations, but had no significant effect on improving mental health. Future research should explore optimizing ecological momentary intervention design and implementation and further examine its effects on mental health outcomes in this population.

Background: Depression is a growing concern among university students. Chatbots provide flexible, accessible, personalized psychosocial support. Delivering Mindfulness-Based Stress Reduction (MBSR) sessions via chatbots may reduce depressive symptoms in university students. Aim: This study aims to evaluate the feasibility, acceptability, safety, and preliminary efficacy of a chatbot-based MBSR intervention for university students with depressive symptoms. Methods: A rule-based MBSR chatbot was developed and evaluated with a single-group pretest–posttest study for university students in Hong Kong ( N = 30) reporting depressive symptoms, followed by the collection of their subjective feedback. The intervention lasted eight weeks. The primary clinical outcome was depression levels, with a range of secondary outcomes. Results: The chatbot-based MBSR program demonstrated satisfying recruitment, retention, and adherence rates. The safety of the program was confirmed by the absence of any adverse events directly related to the intervention, tracked from the onset of the intervention to the completion of data assessment. Significant improvements were observed in both primary and secondary outcomes. Participant feedback highlighted the benefits of the program and its effects on depressive symptoms. Conclusions: The program has shown feasibility, acceptability, safety, and preliminary efficacy in reducing depressive symptoms among 30 university students in Hong Kong. The intervention should now be evaluated in a randomized controlled trial with follow-up. This study highlights the potential role of chatbot-based interventions in mental health promotion, nursing, and clinical practice and will inform the subsequent development of innovative digital interventions to address mental health challenges faced by university students.