Nurse-led Primary Healthcare Intervention Model in Women's Health Management in Hong Kong

Defined as completion (with response 'Yes' or 'No') of any medical referral (to corresponding referral sites) for consultation, prescriptions, screening, therapy, etc targeting health condition of concerns. A binary result with either "Yes" or "No" will be recorded.

Defined as the detailed information on service goal (i.e. as preventive care or treatment), targeted health conditions, date and result of screenings, number of times of consultation or therapy session.

Self-reported health confidence will be measured using the Health Confidence Scale (HCS) consists of four items, each has four response options (score 3 as strongly agree, 2 as agree, 1 as neutral, 0 as disagree). Total score of the scale ranging from 0 to 12, higher score indicates better response. After transposing to a 0 to 100 scale, the score is categorized as very low (transposed score 0-39), low (transposed score 40-59), medium (transposed score 60-79), high (transposed score 80-100).

The self-reported health management will be assessed using the Self-Management Assessment Scale (SMASc) consists of 10 items each with a 6-point Likert scale ranging from score 1 as strongly disagree to score 6 as totally agree. The 10 items were divided into five aspects, each aspect contains 2 items. Total score of each aspect ranging from 2 to 12, higher score indicates better response. Mean score of each aspect is categorized immediate need for self-management support (mean score 1-4), no acute need for self-management support (mean score 5-8), no need for self-management support (mean score 9-12).

The quality of life will be asse ssed using the HK Chinese version of the EQ-5D-5L instrument (EQ-5D-5L HK) consists of self-reported health on a 5-dimension descriptive system, each with 5 level of severity ranging from score 1 as no problem to score 5 as experiencing extreme problems. For the EQ-5D-5L HK, the overall response ranges from 11111 as full health, to 55555 as the worst health.

As a generic health-related quality of life (HRQoL) measure, the EuroQol Visual Analogue Scale (EQ-VAS) will be used to assess patients global subjective well-being. For EQ-VAS, the overall score ranging from 0 as the worst health to 100 as the best health.

The vasomotor symptoms risk level will be assessed using the VMS 2Q scale consists of 2 items each with 5 response ranging from score 0 as none, score 1 as 1 to 5 days/2 weeks, score 2 as 6 to 8 days/2 weeks, score 3 as 9 to 13 days/2 weeks, to score 4 as everyday/2 weeks. The risk level is categorized as low risk (both items scored 0), medium (either item scored 1), high (either item scored 2 or more).

Urinary incontinence types will be assessed using the 3 Incontinence Questionnaire consisting of 3 items in differentiating the types of urinary incontinence (i.e. stress only or stress predominant, urge only or urge predominant, other cause only or other cause predominant, mixed).

Urinary incontinence severity will be assessed using the Incontinence Severity Index consisting of 2 items assessing the urinary incontinence frequency (ranging from score 0 as never; to score 4 as every day and/or night) and amount (ranging from score 0 as never; to score 4 as more). Total score equals to score of item 1 times item 2, ranging from 0 to 12. Total index score is defined as none (0), slight (1-2), moderate (3-6); severe (8-9); very severe (12). The risk level is categorized as low (scored 2 or lower), medium (scored 3-6), high (scored 8 or higher).

The depression levels will be assessed using the Patient Health Questionnaire-9 consists of 9 items each with 4 responses ranging from score 0 as not at all to 3 as nearly every day. Total score ranges from 0 to 27, defined as mild (cutoff score of 5), moderate (cutoff score of 10), moderately severe (cutoff score of 15), severe (cutoff score of 20). The risk level is categorized as low (scored 4 or less), medium (scored 5-9), and high (scored 10 or more).

The anxiety risk level will be assessed using the Generalized Anxiety Disorder 2-item consists of 2 items with responses ranging from score 0 as not at all to 3 as nearly every day. Total score ranges from 0 to 6, with a score greater or equal to 3 denotes a clinically significant anxiety. The risk level is categorized as low (scored 1 or less), medium (scored 2), and high (scored 3 or more).

The risk level of osteoporosis will be assessed via the Chinese Osteoporosis Screening Algorithm (with response of score ≤ 0 or score greater than 0) together with the BeeTLE devices (with T-score ≥ -1, -1 to -2.5, or ≤ -2.5 for post-menopausal women; or Z-score < 0 or equal to or greater than -2.0 for pre-menopausal women). Risk levels are categorized as low (COSA≤ 0 and T-score ≥ -1.0 / Z-score greater than or equal to 0; or anyone with normal DXA scores as defined by the The Osteoporosis Society of Hong Kong https://oshk.org.hk/osteoporosis-risk-factor/ and NIH https://www.niams.nih.gov/health-topics/bone-mineral-density-tests-what-numbers-mean), medium (T-score -2.5 to -1.0, or those with COSA less or equal to 0 but BeeTle Z-score<0), and high (COSA greater than 0, or T-score ≤ -2.5; or anyone with osteoporosis DXA score).

The breast cancer risk level will be assessed using the assessment questionnaires and online calculation tools (www.cancer.gov.hk/bctool). For those who are suitable to for tool risk assessments, the risk percentage will be calculated as ≤25%, 26-50%, 51-75%, 76-99%, or greater than 99%. Risk levels are categorized as low (tool assessed risk ≤25%; or anyone with valid negative mammography results as defined by CEWG), medium (tool assessed risk 26%-75%), high (tool assessed risk ≥ 76%, or those unsuitable for the tool who meet the Hong Kong Cancer Expert Working Group high or moderate risk factors as described in https://www.chp.gov.hk/files/pdf/breast_cancer_professional_hp.pdf; and with no valid negative mammography results as defined by CEWG).

The hypertension risk level will be defined as low-risk with SBP≤120 mmHg, and DBP ≤ 80 mmHg; medium-risk with SBP 120-139 mmHg, and/or DBP 80-89 mmHg; high risk with Systolic Blood Pressure (SBP) ≥ 140 mmHg, and/or Diastolic Blood Pressure (SBP) ≥ 90 mmHg. The classification is based on seated clinic blood pressure. If SBP and DBP fall into different categories, the higher category should be used to classify blood pressure risk level. Three seated clinic BP measurements will be recorded, 1-2 min apart, and additional measurements only if the first two readings differ by \&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10 mmHg. BP is recorded as the average of the last two BP readings.

The cervical cancer risk level will be assessed using the risk assessment questionnaire covering the HK CEWG risk factors (as described in https://www.chp.gov.hk/files/pdf/cervical_cancer_professional_hp.pdf). Risk levels are categorized as low (women never had any sexual experience, and are not vulnerable to HPV infection and with no risk factors; or those who have valid negative screening results as defined by CEWG), medium (women never had any sexual experience, and are not vulnerable to HPV infection, and with risk factors of tobacco use/long term use of oral contraceptives for non-medical indication), high ( women had sexual experience (e.g., non-penetrative, penetrative, vaginal, oral, anal sex), and/or are vulnerable to Human Papillomavirus (HPV) infection by meeting the risk factors (e.g. immunocompromised individuals, recipients of organ transplant, with STIs co-infection), and have no valid negative screening results as defined by CEWG).

The colorectal cancer risk level will be assessed using the risk assessment questionnaires covers the risk factors (as described in https://www.chp.gov.hk/files/pdf/cewg_crc_professional_hp.pdf and https://www.colonscreen.gov.hk). Risk levels are categorized as low (women aged below 50, and without disease-related risk factors and lifestyle modifiable risk factors; or anyone has valid negative cancer screening result), medium (women aged below 50, and without disease-related risk factors, and with any one of the modifiable risk factors), high (women aged ≥ 50 years old, or anyone meets HK CEWG increased risk definitions, or anyone has symptoms of colorectal cancer/ history of colorectal cancer/ history of chronic inflammation of the bowel (e.g. ulcerative colitis)/ diagnosis of hereditary bowel syndromes/ family history of first-degree relative having hereditary bowel syndromes/ history of colorectal polyps; and have no valid negative cancer screening results).