Primary outcomes
Loneliness will be measured using The Revised UCLA Loneliness Scale comprising of 20 items, which has been validated with the Chinese context.35 36 Responses are made on a 4-point Likert scale (1=never to 4=always). The scale reported an acceptable level of internal consistency, with a Cronbach’s alpha of 0.90.35 Higher summed scores would indicate higher levels of loneliness.
Secondary outcomes
The validated Chinese version of De Jong Gierveld 6-item Loneliness Scale will also be used to measure loneliness.37 38 Participants will be asked to indicate their level of agreement for each statement on a 3-point Likert scale (1=Yes, 2=More or Less and 3=No). The scale has demonstrated good psychometric properties, with a Cronbach’s alpha of 0.76.38 Responses will be compiled into an overall score, as well as subscale scores. A higher score indicates a greater perception of loneliness.
Stress level will be assessed by the validated Chinese version of the 14-item Perceived Stress Scale.39 40 The scale seeks to understand the feelings and thoughts in the past month. Participants will be asked to specify the frequency of each statement on a 5-point Likert scale, ranging from 0 (never) to 4 (very often). The scale has an acceptable internal consistency, with a Cronbach’s alpha of 0.85 among the Chinese population.40 Prior to summing the items, some items will need to be reverse-coded, and a higher overall score represents a greater level of perceived stress.
Sleep quality will be measured using the 19-item Chinese version of the Pittsburgh Sleep Quality Index,41 42 which assesses overall sleep quality, duration, latency, efficiency, disturbance, daytime dysfunction and usage of sleep medication within the past month. Each item will be rated from 0 to 3, with higher scores indicating a poorer level of sleep quality and greater level of sleep disturbance. A Cronbach’s alpha of 0.75 has been reported among the Hong Kong Chinese population, indicating good internal consistency.42
Depressive symptoms will be assessed using the 9-item Patient Health Questionnaire Chinese version.43 44 Participants will be asked to report the frequency of cognitive, somatic and affective symptoms of depression felt over the past 2 weeks on a 4-point Likert scale, ranging from 0 (not at all) to 3 (nearly every day). The scale has reported a satisfactory level of psychometric properties, with Cronbach’s alpha of 0.82 and test-retest reliability of 0.76 within the Hong Kong context.43 All items will be calculated cumulatively, with higher scores indicating higher symptom severities.
Anxiety disorder will be measured using the 7-item Chinese version of the Generalised Anxiety Disorder scale,45 46 which assesses the anxiety symptom severity in the past 2 weeks. Each statement is rated on a 4-point Likert scale, from 0 (not at all) to 3 (nearly every day), with higher scores indicating the severity of anxiety symptoms. A Cronbach’s alpha of 0.89 has been demonstrated in the Chinese population, which suggests an acceptable level of internal consistency.46
Participants will be asked to rate the frequency on a scale ranging from 1 (not at all) to 5 (daily) and indicate the duration (number of hours) where they engaged in positive and meaningful daily life activities in the past 2 weeks. Positive and meaningful activity is defined as ‘involving in various aspects of subjective well-being, such as deriving pleasure and enjoyment, engaging in activities and satisfying basic needs through a wide range of daily living tasks’.47–49
Engagement in activities will be assessed using the 10-item Social Engagement and Activities Questionnaire (SEAQ).50 Participants will be asked to report their activity level (ie, social-group, interpersonal interaction and solitary) in different settings in the past month, on a 6-point Likert scale, ranging from 0 (not at all) to 5 (everyday). All items will be summed, with higher scores indicating a high level of daily engagement in activities.
MF will be evaluated using the 20-item Chinese version of the Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF).51 52 The FFMQ-SF consists of items measuring the five facets of MF: observing, describing, acting with awareness, non-judging to inner experience and non-reacting to inner experience. Participants will rate the questions on a 5-point Likert scale, from 0 (never or very rarely true) to 5 (very often or always true). Questions on two facets (ie, awareness and non-judging to inner experience) will be reserve-coded. The total MF score is the average of all items, and each facet can be calculated by averaging the corresponding items, with a higher score indicating a higher level of MF. Among colorectal cancer patients in Hong Kong, a satisfactory omega coefficient (ω=0.77–0.85) for four of the five facets (except non-judging to inner experience) and test-retest reliability (Intraclass Correlation Coefficient = 0.75–0.87) was reported.53
Sociodemographic and other covariates
The following sociodemographic and other characteristics will be collected: (1) age, gender, marital status, living arrangements, education attainment, employment status, household income and financial status; (2) health-related indicators (ie, functional health—activities of daily living and instructional activities of daily living, physical symptoms inventory and the presence of chronic illnesses) and (3) the use of social and healthcare services within the past 4 weeks.
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