Pilot Evaluation of ReFrame-R: A Communication Training to Reframe Older Adults' Family Roles and Promote Active Aging
Phase: NA
Conditions: Intergenerational Relations
Sponsor: The University of Hong Kong

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Title of the Study: Lay-led Brief Cognitive Behavioural Therapy for Insomnia (CBT-I) Group for 
Older Adults in Hong Kong: A Pilot Study 
 
NCT Number: [To be assigned] 
 
Document Date: 13 Mar 2026 
 
Organization/Affiliation: Department of Social Work and Social Administration, The University of 
Hong Kong 
 
 
 

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Introduction 
Meaningful participation and late-life wellbeing 
Hong Kong is aging rapidly, with a third of its population projected to be aged 65 and over by 
2046 (Hong Kong Census and Statistics Department, 2023), raising concerns about mental health 
and service needs among older adults (The Samaritan Befrienders Hong Kong, 2023). Meaningful 
participation is essential for supporting older adults’ psychological well-being (AshaRani et al., 
2022; Boreham & Schutte, 2023; Irving et al., 2017), particularly through family involvement (Liu, 
2024). Although not focused on older adults, evidence from midlife adults shows that caring for 
family members is often considered highly meaningful and commonly performed in daily life 
(Caldwell-Harris et al., 2013; Hooker et al., 2020), highlighting family involvement as a lasting 
source of purpose. Prior work has mainly focused emphasized older adults’ instrumental roles, such 
as household help or grandchild care (Liu, 2024) , which could benefit well-being (Bordone & 
Arpino, 2019; Dong et al., 2023; Tsai, 2016). However, such role may become less sustainable as 
physical capacity declines and can lead to overinvolvement (Luk & Joe-Laidler, 2023). In contrast, 
the role of older adults in providing emotional support to family members has received relatively 
little attention. 
Reframing older adults’ family role 
Older adults’ greater psychological flexibility (Plys et al., 2023) may enable them well-suited to 
emotionally supportive roles that align with their changing capacities and sense of meaning (Tierney 
& Beattie, 2020). Family relationships offer a natural context for such engagement because 
affectionate communication is central to family dynamics (Marquez, 2019). Recent work indicates 
that older adults remain an important source of emotional support for their adult children (Marquez, 
2019; Pew Research Center, 2024, January 25), and intergenerational programs have produced 
biopsychosocial benefits for both generations (Campbell et al., 2023; Sánchez-Cazalla & Gutiérrez-
Domingo, 2025). Embracing expressive role that affirms older adults’ ongoing contribution could 
therefore enhance their sense of purpose and strengthen family relationships, while also potentially 

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reducing distress among younger members. Moreover, from 2016 to 2025, the JC JoyAge project 
trained 1,029 older adults to offer emotional support to community-dwelling peers with depression 
(Jockey Club Holistic Support Project for Elderly Mental Wellness, n.d.; Wang et al., 2025), further 
supporting the feasibility of mobilizing older adults to take on such contributory roles. 
Barriers to intergenerational communication and unmet needs 
However, effective intergenerational communication may be impeded by generational 
differences in life goals (e.g., materialist versus post-materialist concerns) and values (Youth 
Research Centre, 2019; Yu et al., 2025; Yu et al., 2024). In addition, older adults may lack the 
communication competence needed to engage effectively with younger family members. Cultural 
norms in Chinese families often favor indirect expressions of care (e.g., preparing meals or providing 
tangible help) (Caldwell-Harris et al., 2013), so verbal expressions of affection are uncommon (Li, 
2021) and conveying emotional support can be an unfamiliar interaction task. A needs analysis of 
two unpublished cross-sectional surveys with young adults (total N = 1048) found low satisfaction 
with parents’ active listening, calm problem discussion, emotional disclosure, and avoidance of 
negative reactions during disagreements. 
Moreover, many older adults blend care with parental control and view involvement itself as 
an act of care (Caldwell-Harris et al., 2013; Wu, 2023). Given differing criteria for defining 
adulthood between older adults and adult children (Nelson et al., 2013), the mix can blur role 
boundaries and clash with younger generations’ preferred forms of affection and support as they gain 
independence or marry (Wu, 2023). This divergence is illustrated in a small mixed sample of young 
and older adults (total N = 39), young adults, unlike their older counterparts, generally did not 
endorse parent control as an expression of love. The resulting push-pull between remaining involved 
and stepping back typically manifests as overfunctioning-underfunctioning patterns described in 
Family Systems Theory (Miller & Elder, 2025; Moon et al., 2024), in which one family member 
takes on excessive responsibilities beyond their role and prompts others to withdraw or avoid 
responsibility. These dynamics produce emotional tensions and discourage younger family members 

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from seeking parental support.  
The current study 
While past research has focused largely on older adults’ instrumental roles, this study reframes 
emotional support as a meaningful and underrecognized form of familial participation for them. It 
adopts a role-enhancement framework that presents emotional support as an enduring form of 
contribution within families and calls for practical communication training to help older adults take 
on emotionally supportive roles. We propose “ReFrame-R”, a communication training program that 
combines core Motivational Interviewing (MI) skills with Family Systems Theory insights to 
enhance older adults’ communication competence in an open, autonomy-respecting manner while 
maintaining clear role boundaries. 
The ReFrame-R 
ReFrame-R is a theoretically grounded training program for autonomy-respecting 
intergenerational communication while preventing role overinvolvement in everyday family 
interactions. Communication skills that enable respectful, emotionally supportive dialogues are 
important for supporting younger family members’ emotional needs. MI is a collaborative, client-
centered approach that facilitates empathetic, non-judgmental, autonomy-respecting communication. 
Its core skills include open-ended questions, affirmations, reflective listening, and seeking 
permission for advice (Miller & Rollnick, 2013). These skills are recommended for parents to 
provide emotional support to their school-aged children (American Psychiatric Association 
Foundation, 2025), and a recent randomized controlled trial (RCT) demonstrated the feasibility of 
brief MI training to help lay people support family members with psychosis (Kline et al., 2022). 
These skills are particularly relevant in Chinese family contexts, where adult children may suppress 
feelings for fear of judgment in families with hierarchical, indirect communication patterns (Xiao, 
2023). In a preliminary sample of JC JoyAge peer supporters (n = 21) with prior support training, 
participants rated brief MI training as highly acceptable and agreed that these skills would be useful 
for providing emotional support to others. Preliminary data from a small sample of young adults (n = 

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19) indicated that young adults would be highly willing to share emotional distress with parents who 
possess the specified communication competencies.  
Meanwhile, setting clear role boundaries help to build secure bonds and facilitate healthy 
dynamics in families. The training helps older adults differentiate their role from that of their adult 
children and encourages self-focus while acknowledging their children as fully functioning adults 
(Miller & Elder, 2025). Training also aims to develop insight into balancing love and control, helping 
participants avoid conflating two in expression (Lo Cricchio et al., 2019; Wu, 2023). 
Using a mixed-methods approach, this study aims to evaluate the feasibility, acceptability, and 
preliminary efficacy of ReFrame-R and collect feedback to refine the training protocol to match 
older adults’ communication needs and family roles (Figure 1). Results from this pilot will inform 
the design of a fully powered RCT to test ReFrame-R’s effects on older adults’ well-being and the 
potential benefit to family bonds. We hypothesize that participant who receive the training will 
demonstrate greater communication competence and sense of meaning than those in the control 
group at week 4 (end of training) and week 6 (follow-up). In addition, a follow-up interview study 
will be conducted to solicit insights to further refine training protocol in alignment with their 
communication needs. 
Methods 
Study 1 
Study design and participants. Study 1 is a parallel-group, assessor-blinded pilot RCT 
involving older adults in Hong Kong. Participants will be recruited from community settings via 
university emails, social media advertisements, and posters in partner centers (in collaboration with 
the JC JoyAge project). Eligible participants are Cantonese-speaking older adults (aged 60 or above) 
who have regular contact with adult children and can comprehend traditional Chinese. We will 
exclude individuals with a known mental health diagnosis, those with mild or higher depressive 
symptoms (scored ≥5 on the Patient Health Questionnaire [PHQ-9; Kroenke et al., 2001; Manea et 
al., 2015]), or those with communication difficulties. Participants will be randomized (1:1) to either 

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the training group or the booklet-control group using block randomization. Informed consent will be 
sought before any study procedures. All participants will receive HK$ 50 per follow-up visit as an 
incentive. The study design and reporting will follow the CONSORT recommendations (Hopewell et 
al., 2025). 
Treatment allocation.   
An independent researcher will generate the randomization 
sequence using block randomization with a block size of 4 to 6. Ciphered group labels will be used 
to blind assessors during data collection and analyst during data analysis. A blinding check will be 
conducted at week 6 to assess the adequacy of masking. After completion of baseline assessments, 
participants will be informed of their group allocation with sequentially numbered opaque sealed 
envelopes. 
Training group. 
The ReFrame-R comprises four weekly 90-minute group sessions (total 6 
hours), supplemented by brief weekly individual consultations to troubleshoot barriers and reinforce 
home practice. Adapted from an existing MI protocol for lay people (Kline et al., 2022), the program 
is grounded in Family Systems Theory to address over-/underfunctioning dynamics in older parent-
adult child relationships, while also emphasizing empathic listening and autonomy-supportive 
communication. The curriculum ins structured as follows: session 1 introduces intergenerational 
communication barriers (e.g., judgmental language, co-existence of care and control in love 
expression), distinguishes emotional support from problem-solving., and explores common dilemmas 
such as “involvement versus letting go” patterns; session 2 focuses on open-ended questions and 
affirmations, using role-play to teach validation and autonomy support; session 3 introduces 
reflective listening and emotion-focused summarizing, highlighting respectful communication 
strategies such as asking permission before offering advice; session 4 consolidates all skills using a 
structured dialogue framework, guiding participants to apply techniques to real-life scenarios and set 
personal communication goals. An MI skills booklet will be distributed to support and record home 
practice. 
 
Control Group. 
Participants in the control group will not receive active training during the 

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study period. They will be provided with the same MI skills booklet for reference and self-directed 
practice.  
 
Measures. 
All outcome measures are self-reported. Participants will be assessed at three time 
points: baseline, Week 4 (end of training), and Week 6 (2-week follow-up). 
 
Primary Outcome Measure.  
 
1. Perceived communication competence  
Participants’ self-perceived communication competence will be assessed using a 10-item scale 
adapted from the Family Communication Scale (FCS; Ho et al., 2017; Olson & Barnes, 2004). An 
addition item asks participants to rate their overall competence in intergenerational communication. 
2. Meaning in life 
We will use the 10-item Meaning in Life Questionnaire (MLQ; Steger et al., 2006) to measure 
participants’ sense of meaning in live. 
 
Secondary Outcome Measures. 
1. General Self-Efficacy Scale (GSE-6). 
Participants’ self-efficacy will be assessed using the General Self-Efficacy Scale (GSE-6; 
Romppel et al., 2013), with higher scores reflecting greater perceived self-efficacy. 
2. World Health Organization Well-Being Index (WHO-5) 
The 5-item WHO Well-Being Index will be adopted for measuring participants’ subjective well-
being (Bech, 1998; Kong et al., 2016), with a higher score indicating better wellbeing. 
3. Role boundaries 
Wu (2023) documents common scenarios in which older adults in Hong Kong over-involve 
themselves in their adult children’s lives and conflate love with control, such as taking over daily 
responsibilities, controlling lifestyle choices, intruding on intimate relationships. To assess 
participants’ awareness of role boundaries and their endorsement of control-as-love beliefs, we 
will use a 5-item scale adapted from the Control subscale of the Parent-Adult Child Relationship 
Questionnaire’s Relationship with Father component (PACQF; Peisah et al., 1999). Higher score 
indicates greater over-parenting tendency, which may reflect weaker role boundaries.  
4. Family APGAR 
Overall family well-being will be evaluated using the Family Adaption, Partnership, Growth, 
Affection, Resolve questionnaire (Family APGAR; Chan et al., 1988; Smilkstein, 1978), with 
higher scores indicating better family functioning. 

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Assessment of acceptability, appropriateness, and feasibility. 
The appropriateness and 
acceptability of the ReFrame-R training will be assessed at Week 4, and feasibility will be assessed at 
Week 6. Implementation outcome measures will be adopted from Weiner et al (2017). 
Study 2 
Study 2 is a focus group study involving only participants from the training group, conducted 
after Week 6. Each group will consist of 4-5 participants, lasting approximately 45-60 minutes via 
Zoom or in person, and will be audio-recorded and transcribed. Topics will include perceived 
alignment between training content and communication needs, training efficacy, barriers and 
facilitators to implementation, and suggested refinements.  
Sample size calculation 
For the pilot RCT (Study 1), we plan to recruit 40 participants in total, with 20 participants each 
group. Whitehead et al (2016) recommend at least 15 participants per group to obtain sufficient 
methodological information for planning a fully powered trial assuming a medium effect size. 
Allowing for an anticipated 25% attrition rate, we therefore aim to enrol 20 participants per group. 
For the focus-group study (Study 2), participants will be drawn from the training group (n = 20) to 
solicit feedback for refining the training protocol. 
Statistical analysis 
Study 1: Between-group differences in changes from baseline to Week 6 for the primary 
outcomes (communication competence and sense of meaning) and for other outcome measures will 
be examined using Generalized Estimating Equations (GEE), testing the group by time interaction. 
We will use an intention-to-treat approach. Multiple imputation will be used for handling missing 
data. All analyses will be conducted in R (version 4.0.5), with significance level set at 0.05. 
Study 2: Transcript of the focus group interviews will be analyzed using an inductive thematic 
analysis by two independent coders (Ahmed et al., 2025). Two coders will familiarize themselves 
with the data, generate initial codes, develop a codebook, code the transcripts independently, and 
then synthesize into themes. Disagreements will be resolved by consensus. 

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Reference 
Ahmed, S. K., Mohammed, R. A., Nashwan, A. J., Ibrahim, R. H., Abdalla, A. Q., Ameen, B. M. M., 
& Khdhir, R. M. (2025). Using thematic analysis in qualitative research. Journal of Medicine, 
Surgery, and Public Health, 6, 100198. https://doi.org/10.1016/j.glmedi.2025.100198  
American Psychiatric Association Foundation. (2025). OARS Brochure for Parents and Caregivers: 
Motivational Interviewing Technique. In American Psychiatric Association Foundation (Ed.). 
AshaRani, P. V., Lai, D., Koh, J., & Subramaniam, M. (2022). Purpose in Life in Older Adults: A 
Systematic Review on Conceptualization, Measures, and Determinants. International journal 
of environmental research and public health, 19(10), 5860. 
https://doi.org/10.3390/ijerph19105860  
Bech, P. (1998). Quality of life in the psychiatric patient. Mosby-Wolfe.  
Bordone, V., & Arpino, B. (2019). Grandparenthood, grandchild care and depression among older 
people in 18 countries. Journal of Family Research, 31(2/2019), 216–239. 
https://doi.org/10.3224/zff.v31i2.06  
Boreham, I. D., & Schutte, N. S. (2023). The relationship between purpose in life and depression and 
anxiety: A meta‐analysis. Journal of Clinical Psychology, 79, 2736–2767. 
https://doi.org/10.1002/jclp.23576  
Caldwell-Harris, C., Kronrod, A., & Yang, J. (2013). Do more, say less: Saying “I love you” in 
Chinese and American cultures. Intercultural Pragmatics, 10(1), 41–69. 
https://doi.org/10.1515/ip-2013-0002  
Campbell, F., Whear, R., Rogers, M., Sutton, A., Robinson-Carter, E., Barlow, J., Sharpe, R., Cohen, 
S., Wolstenholme, L., & Thompson-Coon, J. (2023). Non-familial intergenerational 
interventions and their impact on social and mental wellbeing of both younger and older 
people—A mapping review and evidence and gap map. Campbell Systematic Reviews, 19(1), 
e1306. https://doi.org/10.1002/cl2.1306  
Chan, D., Ho, S., & Donnan, S. (1988). A survey of family APGAR in Shatin private ownership 
homes. Hong Kong Practitioner, 10, 3295–3299.  
Dong, X. Y., Ling, H. X., Yang, T. Y., & Wang, K. (2023). Grandchild care and life satisfaction of 
older adults: Empirical evidence from China. Frontiers in Psychology, 14, 1081559. 
https://doi.org/10.3389/fpsyg.2023.1081559  
Ho, H. C., Mui, M., Wan, A., Stewart, S. M., Yew, C., Lam, T. H., & Chan, S. S. (2017). Happy 
Family Kitchen: Behavioral outcomes of a brief community-based family intervention in 
Hong Kong. Journal of Child and Family Studies, 26(10), 2852–2864.  
Hong Kong Census and Statistics Department. (2023). Hong Kong Population Projections for 2022 
to 2046 (Hong Kong Population Projections, Issue. HKSAR government. 
https://www.censtatd.gov.hk/en/EIndexbySubject.html?scode=190&pcode=FA100061 
Hooker, S. A., Masters, K. S., Vagnini, K. M., & Rush, C. L. (2020). Engaging in personally 
meaningful activities is associated with meaning salience and psychological well-being. The 

10 
 
Journal of Positive Psychology, 15(6), 821–831. 
https://doi.org/10.1080/17439760.2019.1651895  
Hopewell, S., Chan, A. W., Collins, G. S., Hróbjartsson, A., Moher, D., Schulz, K. F., Tunn, R., 
Aggarwal, R., Berkwits, M., Berlin, J. A., Bhandari, N., Butche, N. J., Campbell, M. K., 
Chidebe, R. C., Elbourne, D., Farmer, A., Fergusson, D. A., Golub, R. M., Goodman, S. 
N.,…Boutron, I. (2025). CONSORT 2025 statement: updated guideline for reporting 
randomized trials. Nature Medicine 31, 1776–1783. https://doi.org/10.1038/s41591-025-
03635-5  
Irving, J., Davis, S., & Collier, A. (2017). Aging With Purpose: Systematic Search and Review of 
Literature Pertaining to Older Adults and Purpose. The International Journal of Aging and 
Human Development, 85(4), 403–437. https://doi.org/10.1177/0091415017702908  
Jockey Club Holistic Support Project for Elderly Mental Wellness. (n.d.). About JC JoyAge Project. 
Retrieved Jan 8 from https://research.jcjoyage.hk/scope/scope-about-jc-joyage-project/ 
Kline, E. R., Thibeau, H., Davis, B. J., Fenley, A., Sanders, A. S., Ipekci, B., Oblath, R., Yen, S., & 
Keshavan, M. S. (2022). Motivational interviewing for loved ones: Randomized controlled 
trial of brief training for first episode psychosis caregivers. Schizophrenia research, 250, 43–
49. https://doi.org/10.1016/j.schres.2022.10.005  
Kong, C. L., Lee, C. C., Ip, Y. C., Chow, L. P., Leung, C. H., & Lam, Y. C. (2016). Validation of the 
Hong Kong Cantonese Version of World Health Organization Five Well-Being Index for 
People with Severe Mental Illness. East Asian Archives of Psychiatry, 26(1), 18–21.  
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a Brief Depression 
Severity Measure. Journal of General Internal Medicine, 16(9), 606–613.  
Li, X. (2021). How do Chinese fathers express love? Viewing paternal warmth through the eyes of 
Chinese fathers, mothers, and their children. Psychology of Men & Masculinities, 22(3), 500–
511. https://doi.org/10.1037/men0000312  
Liu, Y. (2024). The relationship and heterogeneity of family participation and social participation 
among older adults: from an intersectionality perspective. BMC Geriatrics, 24, 949. 
https://doi.org/10.1186/s12877-024-05545-6  
Lo Cricchio, M. G., Lo Coco, A., Cheah, C. S., & Liga, F. (2019). The good parent: Southern Italian 
mothers’ conceptualization of good parenting and parent–child relationships. Journal of 
Family Issues, 40(12), 1583–1603. https://doi.org/10.1177/0192513X19842598  
Luk, K. W., & Joe-Laidler, K. (2023). Care and Control Revisited: Parent–Youth Co-residence and 
the Negotiation of Adulthood in Hong Kong. Journal of Youth Studies, 26(10), 1273–1292. 
https://doi.org/10.1080/13676261.2022.2081494  
Manea, L., Gilbody, S., & McMillan, D. (2015). A diagnostic meta-analysis of the Patient Health 
Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. General 
hospital psychiatry, 37(1), 67–75. https://doi.org/10.1016/j.genhosppsych.2014.09.009  
Marquez, M. P. N. (2019). Family Support and Intergenerational Exchanges. In G. T. Cruz, C. J. P. 

11 
 
Cruz, & Y. Saito (Eds.), Ageing and Health in The Philippines. Economic Research Institute 
for ASEAN and East Asia.  
Miller, E. A., & Elder, C. R. (2025). Balanced parenting: Proposing a differentiation‐based parenting 
approach informed by Bowen family systems theory. Family Process, 64(1), e13092. 
https://doi.org/10.1111/famp.13092  
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Guilford 
Press.  
Moon, H., Park, T., Park, Y., Bae, Y., & Chi, C. (2024). Psychological Dynamics in the Development 
Process of Panic Disorder: A Qualitative Study on a Family Therapy Case. Journal of 
Contemporary Psychotherapy, 54(3), 225–233. https://doi.org/10.1007/s10879-024-09616-y  
Nelson, L. J., Duan, X. X., Padilla-Walker, L. M., & Luster, S. S. (2013). Facing adulthood: 
Comparing the criteria that Chinese emerging adults and their parents have for adulthood. 
Journal of Adolescent Research, 28(2), 189–208. https://doi.org/10.1177/0743558412467685  
Olson, D. H., & Barnes, H. L. (2004). “Family communication”. In D. H. Olson, D. M. Gorall, & J. 
W. Tiesel (Eds.), Faces IV package (pp. 1–9). Life Innovations.  
Peisah, C., Brodaty, H., Luscombe, G., Kruk, J., & Anstey, K. (1999). The Parent Adult-Child 
Relationship Questionnaire (PACQ): The assessment of the relationship of adult children to 
their parents. Aging & mental health, 3(1), 28–38. https://doi.org/10.1080/13607869956415  
Pew Research Center. (2024, January 25). Young adults’ relationship with their parents (Parents, 
Young Adult Children and the Transition to Adulthood, Issue. P. R. Center. 
https://www.pewresearch.org/social-trends/2024/01/25/young-adults-relationship-with-their-
parents/ 
Plys, E., Jacobs, M. L., Allen, R. S., & Arch, J. J. (2023). Psychological flexibility in older 
adulthood: a scoping review. Aging & mental health, 27(3), 453–465. 
https://doi.org/10.1080/13607863.2022.2036948  
Romppel, M., Herrmann-Lingen, C., Wachter, R., Edelmann, F., Düngen, H. D., Pieske, B., & 
Grande, G. (2013). A short form of the General Self-Efficacy Scale (GSE-6): Development, 
psychometric properties and validity in an intercultural non-clinical sample and a sample of 
patients at risk for heart failure. GMS Psycho-Social-Medicine, 10, Doc01. 
https://doi.org/10.3205/psm000091  
Sánchez-Cazalla, V., & Gutiérrez-Domingo, T. (2025). Impact of intergenerational programmes on 
older adults for active ageing. A systematic review. Archives of Gerontology and Geriatrics 
Plus, 2(3), 100176. https://doi.org/10.1016/j.aggp.2025.100176  
Smilkstein, G. (1978). The Family APGAR: A proposal for family function test and its use by 
physicians. The Journal of Family Practice, 6, 1231–1239.  
Steger, M. F., Frazier, P., Oishi, S., & Kaler, M. (2006). The meaning in life questionnaire: Assessing 
the presence of and search for meaning in life. Journal of Counseling Psychology, 53(1), 80–
93. https://doi.org/10.1037/0022-0167.53.1.80  

12 
 
The Samaritan Befrienders Hong Kong. (2023). Annual Report for 2023. https://sbhk.org.hk/wp-
content/uploads/2024/06/ESBHK2023_Annual-Report_low-res.pdf 
Tierney, L., & Beattie, E. (2020). Enjoyable, engaging and individualised: A concept analysis of 
meaningful activity for older adults with dementia. International journal of older people 
nursing, 15(2), e12306. https://doi.org/10.1111/opn.12306  
Tsai, F. J. (2016). The maintaining and improving effect of grandchild care provision on elders’ 
mental health—evidence from longitudinal study in Taiwan. Archives of Gerontology and 
Geriatrics, 64, 59–65. https://doi.org/10.1016/j.archger.2016.01.009.  
Wang, Y. L., Wang, Y. H., Leung, D. K. Y., Wong, S. M. Y., Ng, Z. L. Y., Chan, R. C. L., Chan, O. L. 
H., Chan, W. C., Wong, G. H. Y., & Lum, T. Y. S. (2025). Peer-supported mindfulness-based 
intervention for managing depressive symptoms in community-dwelling older adults: 
Protocol for a randomized controlled trial. Contemporary Clinical Trials, 155, 107991. 
https://doi.org/10.1016/j.cct.2025.107991  
Weiner, B. J., Lewis, C. C., Stanick, C., Powell, B. J., Dorsey, C. N., Clary, A. S., Boynton, M. H., & 
Halko, H. (2017). Psychometric assessment of three newly developed implementation 
outcome measures. Implementation science, 12(1), 108. https://doi.org/10.1186/s13012-017-
0635-3  
Whitehead, A. L., Julious, S. A., Cooper, C. L., & Campbell, M. J. (2016). Estimating the sample 
size for a pilot randomised trial to minimise the overall trial sample size for the external pilot 
and main trial for a continuous outcome variable. Statistical Methods in Medical Research, 
25(3), 1057–1073. https://doi.org/10.1177/0962280215588241  
Wu, M. Y. (2023). The concept of guan in the Chinese parent-child relationship. In C. C. Yi (Ed.), 
The psychological well-being of East Asian youth (pp. 29–49). Springer Netherlands. 
https://doi.org/10.1080/13676261.2022.2081494  
Xiao, C. (2023). A comparative review of communication differences between Chinese and 
American families in child upbringing. Journal of Linguistics and Communication Studies, 
2(3), 50–57. https://doi.org/10.56397/JLCS.2023.09.07  
Youth Research Centre. (2019). Strengthening Intergenerational Understanding (Society and 
Livelihood, Issue. The Hong Kong Federation of Youth Groups. 
https://yrc.hkfyg.org.hk/2019/12/09/yi048 
Yu, Y. M. B., Hildebrand, C., Hong, Y. Y., & Chan, C. S. (2025). Differing Moral Foundations 
Underlying Generational Differences in Political Attitudes The 16th Biennial Conference of 
the Asian Association of Social Psychology (AASP 2025), Subang Jaya, Malaysia.  
Yu, Y. M. B., Lam, C., & Chan, C. S. (2024). All We Need is Love? Irreconcilable Political 
Incongruence in Families after the 2019 Social Unrest in Hong Kong. Political Psychology, 
45, 643–665. https://doi.org/10.1111/pops.12941  
 
 
 

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Figure 1. Study Flowchart