Current Projects

Current Research Projects

Slow Art Plus: Developing and Piloting a Single Session Art Gallery-based Intervention for Mental Health Promotion via a Mixed Method Waitlist Randomized Control Trial (RCT)

Project Duration: 2022-2023
Principal Investigators: Dr. Andy Hau Yan Ho
Grant Awarding Agency: Johnson & Johnson Foundation
Amount Awarded: S$ 45,000
Abstract of Research: In recognition of the mental health concerns that accompany COVID-19, the National Gallery Singapore (NGS) had developed her own Slow Art programme in 2020 with the aim to provide interested individuals with a meaningful platform for social connection, conversation, and art appreciation through an online visual art experience. While feedback surveys have shown an average satisfaction score of 86.5%, no formal evaluation has been conducted to examine the effectiveness of NGS Slow Art programme. The current study builds on the industrial expertise of the NGS and harnesses the clinical and empirical expertise of the Principal Investigator, in developing and piloting an enhanced version of the NGS Slow Art programme, namely “Slow Art Plus” for mental health promotion. Utilizing a Participatory Action Research (PAR) paradigm, this 12-month study will adopt a mixed method Waitlist Randomized Control Trial (RCT) with a built-in acceptability and feasibility study to test the efficacy of Slow Art Plus in reducing stress and empowering self-care among 200 participants. Slow Art Plus will be a first-of-its kind standardized intervention that integrates slow-looking, mindfulness and self-compassion practices, as well as reflective and creative expressions for addressing the mental health promotion needs of the general population, with the goal of relieving stress as well as building resilience and self-care capacity. Slow Art Plus has great potential to create a completely new paradigm of mental health self-care across the arts industry, fuelling hope and vitality into the lives of all people in Singapore and around the world.

The Table to Console: A Novel Psychotherapeutic Culinary Grief Intervention (CGI) for Bereaved Family Caregivers in Singapore

Project Duration: 2022-2024
Principal Investigators: Dr. Andy Hau Yan Ho
Grant Awarding Agency: Funded by the Palliative Centre for Excellence in Research and Education (PalC) Research Grant
Amount Awarded: S$ 49,670
Abstract of Research: Food and its myriad of psycho-socio-emotional experiences are integral to human existence throughout and even at the end-of-life. A person’s lifetime stories of and meaning with food can uniquely aid grief work for their loved ones following their deaths. However, food has not been studied as a medium of psychotherapeutic intervention for loss and bereavement. “The Table to Console” is a novel and innovative psychotherapeutic Culinary Grief Intervention (CGI)” conceived by the research team. It is empirically informed by the team’s signature investigation on the lived experiences of ‘living and dying with dignity’ among terminally ill patients and their family caregivers in Singapore, as well as a series of pioneering intervention studies designed to enhance holistic end-of-life care and bereavement support services in Asia. This 2 year study will test the effectiveness and efficacy of CGI in supporting bereaved individuals to experience enhanced quality of life, spiritual well-being, hope and perceived social support, as well as reduced levels of depressive symptoms and grief reactions. The expected findings from this first-of-its-kind study will serve as the foundation for a full-scale RCT for advancing holistic end-of-life care and meaning-centered culinary-based bereavement support locally and internationally.

Understanding and Strengthening University Students’ Psycho-Socio-Emotional Wellness and Preparedness for COVID-19 and Future Pandemics: A Cross-Sectional Mixed-Methods Study

Project Duration: 2021-2023
Principle Investigator: Dr Andy Hau Yan Ho
Grant Awarding Agency: Singapore Ministry of Education (MOE) Tier 1 Grant
Amount Awarded: S$ 82,618
Abstract of Research: Under the shadow of COVID-19, life as we know it is rapidly changing. One of the strongest measures put in place, globally, to protect people and curb the spread of COVID-19 is social distancing. While this has shown to be effective in slowing the rate of infections, social distancing also implies displacement of social and work life routines, prohibiting physical closeness and intimacy with loved ones, peers and colleagues. The progressive disintegration of our social relationships and connections is a threat to our sense of normalcy, safety, belonging and personhood – which can result in deleterious mental and emotional outcomes such as fear, anxiety, depression, and loneliness.

Youths, especially undergraduate university students, coping with the challenges identity formation, emerging adulthood and workforce entry are at a higher risk for mental health problems such as loneliness, depression and suicide ideation under normal circumstances. COVID-19 brings an additional layer of developmental difficulties to this population cohort, it is thus imperative to strengthen their psycho-socio-emotional wellness and preparedness for future infection waves of the new coronavirus and other pandemics. As such, there is an urgent need to examine the psychological impacts of COVID-19 on undergraduate students – to identify those who cope well (resilient group) and those who need more support (vulnerable group), to pinpoint the individual, relational and contextual factors that affect their mental health, and to develop a holistic understanding of their needs, struggles, and coping strategies.

The proposed research fills a critical knowledge gap by examining the challenges and coping strategies of university students in facing COVID-19 and related social distancing measures. This understanding will inform the development of a public health crisis preparedness and response framework on both public policy and higher education levels, one that provides evidence-based supportive initiatives and resilience-based psychoeducation programs that protect the psycho-socio-emotional well-being of youths in the midst of and in anticipation of current and future pandemics.

Effects of Participatory ‘A’rt-Based Activity On ‘Health’ of Older Community-Dwellers: The Singapore A-Health Randomized Controlled Trial Study

Project Duration: 2020-2022
Principle Investigator: Dr Andy Hau Yan Ho
Grant Awarding Agency: NTU Lee Kong Chian School of Medicine and Sir Mortimer B. Davis Jewish General Hospital
Amount Awarded: S$79,600
Abstract of Research: Aging is often associated with worsening health and withdrawal from social activities, both increasing the risk of poor quality of life. While it has been reported that participatory art activities can promote and elevate health and wellbeing among older adults, relevant research are mostly weak in intervention design with unclear methodology. In 2015, Dr Olivier Beauchet (Co-Investigator) and his colleagues at the McGill Centre of Excellence on Longevity and the Montreal Museum of Fine Arts successfully initiated a standardized museum-based participatory art programme known as “A-Health: Participatory Art-based Activity on Health of Older Community Dwellers”. Through a pilot single-arm study, A-Health was found to be effective in improving health condition, quality of life and wellbeing of Montreal older adults. Building on the success of the pilot A-Health Study, an international consortium comprising academic institutions, national museums and galleries has been established to systematically test the efficacy of the A-Health Intervention Framework in health and wellness promotion. Using the gold standard of Multi-site Randomized Control Trial, 6 major cities around the world including Canada (Montreal), France (Nice), England (London), Taiwan (Kaohsiung), Switzerland (Basel), and Singapore is part of this extraordinary effort to develop and test a series of empirically-driven and culturally-unique museum-based participatory art programmes that follow a unifying A-Health framework. The ultimate goal is to firmly authenticate the causal link between art, health and wellness, with the breakthrough of creating an efficient museum art programme for seniors of all ethnicities and cultural backgrounds. The Singapore A-Health RCT study (current study), is led by an interdisciplinary team including Dr Andy Ho (SSS Psychology), Dr Olivier Beauchet (LKCMedicine) and Dr Michael Tan (ADM), implemented in partnership with National Gallery Singapore. This significant collaboration will ensure programme sustainability in the local context.

Identifying Care Needs and Measuring Longitudinal Outcome Holistically for Acute and Chronic Stroke Patients

Project Duration: 2019-2023
Overall Technical Principle Investigator: Dr Andy Hau Yan Ho
Grant Awarding Agency: Rehabilitation Research Institute Singapore (RRIS) Rehabilitation Research Grant 3 – Complementary Grant
Amount Awarded: 296,700
Abstract of Research: Local studies on stroke outcomes have generally shown gain in global indicators after inpatient rehabilitation. However, knowledge gaps remain regarding chronic stroke survivors of beyond 5 years post-stroke, specific stroke subgroups such as young stroke or aphasic stroke, dynamic changes in outcomes within the first year after stroke, as well as the specific factors influencing global measures. Through this study, we aim to firstly, use a person-centred approach to identify the care needs of acute stroke versus chronic stroke; secondly, to use a holistic approach towards measuring and comparing outcomes of acute versus chronic stroke; and thirdly, to describe the longitudinal trajectory of changes in care needs and outcomes from up to 1 year post-stroke to at least 5 years post-stroke. With this data, we will be able to formulate value-added care services to current stroke care bundles, particularly the inclusion of psychosocial care as well as generate hypotheses for new approaches towards interventions for specific stroke subgroups and generate new indicators for measuring outcomes of health services.

A Longitudinal Mixed Method Study on Psychosocial Quality of Life Trajectories of First-Time Stroke Patients and Their Family Caregivers in Singapore

Project Duration: 2019-2023
Principle Investigator: Dr Andy Hau Yan Ho
Grant Awarding Agency: Rehabilitation Research Grant Institute of Singapore, Rehabilitation Research Grant 3 (RRG3)
Amount Awarded: S$299,988
Abstract of Research: Stroke affects patients as a whole and the effects go beyond physical/cognitive impairments, influencing their psychological wellbeing, social relationships and quality of life (QoL), as well as those of their family caregivers. Despite substantial research conducted in Western societies has identified the rehabilitation needs and recovery outcomes of stroke survivors and caregivers, most research adopt either a quantitative or qualitative investigative approach that focus solely on patients or caregivers alone, thus, a holistic and cultural-specific understanding of the lived experience of stroke rehabilitation and caregiving is greatly lacking in the local Singaporean context. This study adopts a longitudinal mixed method design with the aims to: (1) identify the psycho-socio-emotional-spiritual needs of a representative sample of first-time stroke patients and their caregivers through a series of quantitative assessments; (2) explore the lived experience a nest sample of first-time stroke patients and their caregivers through a series of qualitative meaning-oriented interviews. Sample for the quantitative study will comprise 166 families in Singapore, inclusive of one first-time stroke patient and one identified family-carer whom the patient considers to be his or her primary caregiver (N=332). 30 families will be purposively drawn from the quantitative sample to participate in the qualitative study concurrently. Assessments and interviews will conducted at four time points including 1 month post inpatient care discharge [T1], 3-month [T2], 6-month [T3] and 12-month [T4] follow-up. A holistic framework for understanding the Singaporean QOL trajectory of stroke rehabilitation and recovery will be established.

ARTISAN 2.0: Deconstructing the Integrative Efficacy of a Multimodal Art-based Intervention to Strengthen Understanding and Demystify Misconceptions on Arts, Heritage, and Health

Project Duration: 2019-2022
Principle Investigator: Dr Andy Hau Yan Ho
Grant Awarding Agency: National Arts Council (NAC) Research Grant
Amount Awarded: 123,000
Abstract of Research: To address the urgent problem of loneliness via citizen empowerment, ARTISAN (Aspiration and Resilience Through Intergenerational Storytelling and Art-based Narratives), a multimodal, intergenerational arts and heritage-based intervention was developed in partnership with the National Arts Council and the National Museum Singapore. Results from a 2018 pilot study revealed ARTISAN’s robust effectiveness in promoting resilience, social connectedness, personhood and nationhood among Singaporean youths and seniors. Despite these promising findings, questions and doubts remain to surface among biomedical researchers and medical clinicians about the multimodal nature of ARTISAN and its precision treatment impact. Objectives: To critically investigate and assess the independent and combined efficacy of each key intervention component of ARTISAN’s framework for promoting positive life changes, including participatory arts, art space, and storytelling within an intergenerational context. A five-arm, multicenter randomized controlled trial (RCT) with four treatment groups and one control group will be conducted. 70 youths and 70 seniors will be recruited from the 10 community collaborators and equally randomized into: (1) full ARTISAN condition, (2) intergenerational participatory arts condition, (3) intergenerational art space condition, (4) intergenerational storytelling condition, and (5) control condition of physical activity. Participants will be assessed at baseline, immediate post-intervention and 10-week follow-up with psychometric measures to assess intervention outcomes, while qualitative focus groups will be conducted to inform and enhance future intervention design. The findings from this study will add to the existing empirical foundation of ARTISAN for large-scale societal dissemination, while serving to demystify any doubts, misunderstanding and misconceptions about the efficacy of arts and heritage for health promotion and social empowerment.

Preventing Limb Losses in Singapore through Health Literacy and Healthcare Improvement

Project Duration: 2019-2022
Co-Principle Investigator: Dr Andy Hau Yan Ho
Grant Awarding Agency: Ministry of Health Singapore – Health Service Research Grant (HSRG)
Amount Awarded: 1,528,312
Abstract of Research: Diabetic foot ulcers (DFU) are the leading cause of amputations and mortality among patients with diabetes. Worryingly, Singaporean statistics indicate a faster rate of ulcer deterioration and higher rates of amputations compared to most other countries. The current applied care model in Singapore is acute-centric and does not sufficiently consider strategies for prevention and self-care. The aim is to support more efficient prevention and management of DFUs and thereby reduce the number of DFUs and its progression to limb loss. The hypothesis is that this can be achieved through (a) evidence-based prevention, (b) better care co-ordination, (c) improved understanding about the gaps in the provision and deviations from care guidelines, and (d) enhanced self-care of people with DFUs or at risk of developing a DFU through an app-based educational program targeting patients, informal caregivers and foreign domestic workers. The work by the national Diabetes Prevention and Care Taskforce to fight diabetes will be complemented by focusing on the prevention and management of DFUs. Current everyday care related to DFUs will be investigated to outline treatment pathways and identify possible gaps in the provision of care. Additionally, patients, informal caregivers and foreign domestic workers will be surveyed on their knowledge on preventing and caring for DFU and current care provision and monitoring. An app will be developed and evaluated supporting evidence-based practice through eLearning for the prevention and caring of DFUs directed towards patients, informal caregivers and foreign domestic workers. Health economic modelling will demonstrate potential gains through better healthcare coordination, evidence based prevention and more advanced self-care. Taken together, the proposed research activities will help to maximize the potential of available resources for preventing and caring of DFUs in Singapore, enable earlier identification of patients prone to develop microvascular complications, decrease the number of complications, and demonstrate savings in costs and improvements in quality-of-life.

The Cost of Care in Advanced Dementia: Blessing or Burden?

Project Duration: 2019-2023
Principal Investigators: Dr. Allyn Hum and Dr. Andy Hau Yan Ho
Grant Awarding Agency: Funded by the NTU Ageing Research Institute for Society and Education & Geriatric Education Research Institute (ARISE-GERI), Singapore
Amount Awarded: S$100,000
Abstract of Research: In Singapore, the cost of dementia care is estimated to be as great as for heart disease and cancer. Singapore will spend $1.4 billion annually for healthcare “direct (or ‘formal’) costs”, which will encompasses both medical and non-medical expenses. “Indirect (or ‘informal’) costs” relate to the financial burdens affecting the individual, which includes loss of income for family caregivers who care for them without any financial returns. In Singapore, non-reimbursable and unpaid labor costs range annually from S$15,750 for mild dementia to S$33,408 for moderate dementia. With increased debility and complications in the last stage of dementia, these costs will increase. Beyond the financial burdens, the intangible costs of caregiving for the advanced dementia (AD) sufferer are the psychosocial, emotional and spiritual burdens which are difficult to quantify. Caregivers suffer loss in quality of life and are more likely to suffer poor physical health and emotional distress than non-caregivers. Caregiver burden leading to burnout is a known factor for institutionalization. The main aim of this study is to measure the intangible costs of caregiving for AD patients and compare these costs between those living in the community (home based) and in institutions (i.e., nursing home or hospice). 180 principal family caregivers of advanced dementia patients will be identified and recruited from different healthcare sites (community and institutions) to participate in a longitudinal survey to identify their needs and mental health outcomes. Lived experiences of 30 AD family caregivers of community living (with and without palliative care support) and institution-based (i.e., nursing home) advanced dementia patients will be examined via a longitudinal qualitative approach with a concurrent nested design.

Mindful-Compassion Art Therapy for Dementia Care (MCAT-DC) – Empowering Resilience and Holistic Wellbeing for Sustainable Family Caregiving: A Waitlist Randomized Controlled Trial

Project Duration: 2019-2022
Principal Investigator: Dr. Andy Hau Yan Ho
Grant Awarding Agency: Funded by the NTU Ageing Research Institute for Society and Education (ARISE) Strategic Initiatives, Singapore
Amount Awarded: S$198,989
Abstract of Research: Dementia is a neurodegenerative disease that leads to irreversible decline in one’s cognitive and functional capacity, identity, and personhood. In Singapore, the number of persons with dementia is expected to soar to 187,000 by 2050. Hence, it is imperative to render comprehensive support to dementia sufferers, and especially their family caregivers. While local initiatives have raised public awareness and developed services for dementia care, they do not adequately address the psycho-socio-spiritual needs of family caregivers, as caregiving stress can greatly impede one’s mental and emotional health. International research for dementia family caregivers has thus focused on developing multicomponent interventions that accentuate holistic support to promote healthy and sustainable caregiving. This proposed 3-year study builds on the empirical foundation of Mindful-Compassion Art Therapy (MCAT) to test its efficacy as a multicomponent, holistic, psycho-socio-spiritual intervention for supporting dementia family caregivers. MCAT is a group-based intervention that integrates mindfulness meditation and art therapy, with reflective awareness complementing emotional expression, to foster self-compassion and inner-resilience among professional caregivers. Results from a randomized controlled trial (RCT) with end-of-life care workers revealed MCAT’s effectiveness for reducing burnout and promoting wellbeing to enrich caregiving.