This paper describes the development of culturally-appropriate family-based interventions to promote family health, happiness and harmony in Hong Kong. Programs were developed and implemented in the community, using a collaborative approach between a School of Public Health and several community partners. We describe the development of the interventions and their measures and the lessons learned, highlighting both the benefits and the challenges of designing locally relevant interventions in a nonwestern culture and of academic-community partnerships. We believe that information about the development of this unique project may be of interest to the international scientific community for the following reasons. First, community-based intervention studies from nonwestern cultures are relatively rare. The importance of developing interventions from "within" a culture has been recognized as important [1
], but there are few examples available that delineate the associated process and challenges. Second, academic-community partnerships are increasingly relevant, particularly in cultures where community practitioners are not trained in evidence-based approaches, and community agencies offer a route for access to the population. The difficulties of disseminating evidence-based interventions have been recognized [2
], and the community-based participatory approach has been lauded [3
] but is still underutilized. Finally, the development of preventive interventions that can be practically applied to large samples of the population is at the interface of public health and psychology [4
]. This partnership has promise for the future inasmuch as there has been a recent prioritization of prevention as a direction in research in mental illness [6
There is evidence from several indicators that the traditional primacy of family in Chinese life [7
] is under threat. Reports of domestic violence have increased threefold in the last decade [9
]. Divorce has become more common, with the number rising more than eightfold in the last 25 years [10
]. Cross-border marriages have increased [11
] so the family may be split between Hong Kong and Mainland China. Immigration from China has increased but recent Mainland immigrants frequently have difficulty integrating into Hong Kong society. The number of families living in three-generation households has fallen 27% in 10 years, from 11.1% to 8.1% [12
]. Suicide attempts per 100,000 increased from 29.5 in 1997 to 41.6 in 2003, and completed suicide rates have risen from 7.8 per 100,000 in 1982 to 13.8 in 2009 [13
In November 2007, a Hong Kong-based charitable foundation funded the University of Hong Kong's School of Public Health to develop and implement a program entitled: "FAMILY: a Jockey Club Initiative for a Harmonious Society" (referred to in the remainder of the paper as "The Family Project"). The Family Project's goal was to enhance three key outcomes salient to Hong Kong families, health, happiness, and harmony (3Hs), via three platforms: a cohort study to determine risk factors and causes of impairment in family function; the deployment of social marketing strategies to help enhance family relationships; and the development and testing of preventive interventions to promote family relationships. Funding was allocated to the School of Public Health for six years. This paper focuses only on the intervention component's development, and reports on the first phase that lasted approximately two years following initiation.
Guidelines provided by the granting agency for the interventions to be developed were that they should: a) focus on "wellness" and not on dysfunction, i.e., the interventions be at the primary rather than secondary or tertiary prevention levels; b) target inter-family relationships; c) be developed and grounded in local priorities; d) be conducted in partnership with community agencies with emphasis on capacity building; e) be efficient and sustainable for potential scale-up across the territory; and f) be evidence-based and/or evidence-generating using the best possible evaluation design to assess the impact of the interventions to be developed.