India is undergoing a demographic transition characterized by population aging and is witnessing a high dementia rate. Although nearly 7 million people live with dementia in India, dementia awareness is poor, and current resources addressing dementia care are basic and often incomplete, duplicated, or conflicting. To address this gap, this study aims to use digital media, which has had a massive technological uptake in India, to improve dementia care in India.The objective of this paper is to describe an intervention study design that examines the feasibility and acceptability of Moving Pictures India, a digital media resource to improve dementia care in India.This study employs a mixed methods design and is divided into 4 phases: (1) video interviews with Indian caregivers and health professionals; (2) coproduction of resources; (3) pilot randomized controlled trial (RCT); and (4) dissemination and analytics. The pilot RCT will follow an experimental parallel group design with 2 arms aiming to assess the impact, feasibility, and acceptability of the developed resources. The primary outcome measures for the pilot RCT will be feasibility and acceptability, while the secondary outcome measures will be caregiver burden, mood, and quality of life.This study received funding from the Alzheimer’s Association in the United States in July 2021. In 2023, we will enroll 60 dementia caregivers (40 caregivers in the intervention arm and 20 in the control) for the pilot RCT. The study has been approved by the National Institute of Mental Health and Neuro Sciences Ethics Committee (26th IEC (BEH.SC.DIV.)/2020-21 dated November 11, 2020); the Health Ministry's Screening Committee, India ; the Curtin University Human Research Ethics Committee ; and the NARI Research Governance Office .This protocol is designed to deliver unique, coproduced, and evidence-based media resources to support caregivers of persons with dementia in India and other countries aiming to utilize digital media for dementia care. If the intervention is found feasible and acceptable, postpiloting analytics and qualitative feedback will be used to develop an implementation trial to evaluate the effectiveness of the potential low-risk high-benefit intervention in practice.Clinical Trials Registry-India CTRI/2021/01/030403; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=50794DERR1-10.2196/38456 India, like the rest of the world, is experiencing population aging, and this demographic transition will have a significant impact on age-related conditions such as dementia . With neDespite affecting millions in India, the symptoms of dementia are often viewed as a normal part of aging, and there is a lack of awareness about the symptoms, treatment, and challenges associated with caring for a person with dementia . Some faTo ameliorate these burdens, greater focus on imparting knowledge and skills to empower caregivers for persons with dementia is crucial . As manyTechnological innovations, especially digital media, can help improve dementia care. Digital media, particularly smartphones, can help caregivers access information online, monitor their own physiological and biometric data along with that of the person with dementia, and set reminders for medications and other therapies ,14. AccoIn Australia, an innovative multimedia project called Moving Pictures is producing short films on dementia care, which are coproduced with people from culturally and linguistically diverse backgrounds . The proThe methodological approach for the study follows the United Kingdom Medical Research Council guidelines for the development and evaluation of complex interventions . The proIn the first year of the study, video interviews with family caregivers and health professionals will be recorded to create the films for mobile devices targeting family caregivers and the Indian public. Family caregiver interviews will focus on initial perceptions of dementia symptoms, at what point medical intervention was sought and why, examples of successful collaboration between caregivers and services, and how the dementia care pathway unfolds for families. Health professional interviews will focus on working with doctors; going to the hospital; pain; eating, nutrition, and dental care; hygiene and incontinence; and later stages and palliative care. The topics for discussion in the interviews are based on patient and public involvement and clinician consultation. We will recruit family caregivers who are currently caring for a family member with dementia for at least 6 months. Health professionals include medical specialists , nurses, allied health care workers , or related professionals  involved in providing health and community services to people living with dementia. We will include participants who speak either English, Hindi, or Kannada, have the capacity to consent, and are willing to participate in a video interview, snippets of which will be included in the final Moving Pictures India films and resources.The aim is to purposively recruit 25 family caregivers speaking either of the 3 aforementioned languages and representing different genders and socioeconomic classes, along with 25 health professionals who satisfy the inclusion criteria. The sample size was determined based on the research team’s extensive experience of sampling to ensure sufficient diversity. Participants will be invited to participate in a 30- to 60-minute video interview conducted in English, Hindi, or Kannada. Purposive and snowball sampling will be employed for recruitment. Data will be collected in Bengaluru, India.Upon confirmation of interest, the researcher will forward a copy of the participant information and consent form (PICF) either by email or regular mail with a prepaid envelope. Contact will be made a few days later to gauge interest, answer any relevant questions, and arrange the interview. If the consent form is not received by the research team prior to the interview, it will be completed before starting the interview. All participants will be provided with a verbal overview of the study, time to read the PICF (if not done earlier), and an opportunity to seek clarification about any study-related matter from the researcher prior to the interview.Data will be translated, transcribed into English, and thematically analyzed -20 by thIn the second year, the data from the first phase will be storyboarded to form the basis of 9 films and animations. The themes for the storyboards are based on common issues in dementia care arrived at through the researchers’ prior work ,16 and wTo evaluate the appropriateness of the films and animations, they will be member-checked with the original interview participants as well as with community members to ensure believability and trustworthiness . InterviMembers of stakeholder groups and the community members must be 18 years of age or over, have a smartphone, have the capacity to provide consent, and be literate in either English, Hindi, or Kannada.Family caregivers and health professionals who participated in phase 1 of the study will be asked to provide feedback on resources once they are completed. Community members (n=~300) speaking either of the 3 aforementioned languages, representing different genders and socioeconomic classes, and satisfying the inclusion criteria will be recruited in Bengaluru to test the films and resources. Bengaluru is one of the most multicultural and ethnically diverse cities in India and has a large migrant population due to its status as the information technology hub of the country ,24. RecrTo evaluate the impact of the resources produced, a pilot RCT will be conducted in the second and third year of the study . The pilParticipant inclusion criteria are aged 18 years and up, proficient in English and/or Hindi/Kannada, self-reported family caregiver of a person with dementia who has been involved in the caregiving process for at least 6 months, capacity to consent, and own a smartphone. Participants involved in the development phase will be excluded.Participants will be recruited in Bengaluru, India. Purposive and snowball sampling will be employed for recruitment. Family caregivers who accompany people with dementia to the Geriatric Clinic and Services Unit at the National Institute of Mental Health and Neuro Sciences (NIMHANS) will be recruited. Furthermore, advertisements will be posted in public spaces in the NIMHANS facility and distributed in hard or soft copy by the research team to relevant clients, through relevant NIMHANS services and other support and social groups. The materials will contain contact details for the NIMHANS-based research team (email/phone). Potential participants will be able to contact the research team to express their interest in the study. The researcher will describe the study procedures, and if the participant agrees to the study, the researcher will confirm the participant’s eligibility. Alternatively, if potential participants learn about the study from a NIMHANS service provider, the latter will provide the contact details of the research team or, with verbal consent from the interested individual, forward their details to the research team, who will make the initial contact to provide the necessary study information. Upon confirmation of interest, the researcher will forward a copy of the PICF either by email or regular mail with a prepaid envelope, or it can be obtained from the research team located at NIMHANS upon request. Contact through phone or email will be made a few days later to confirm interest, answer any questions, and arrange for a brief meeting to sign the consent form. Signed consent can also be provided by mail or electronically.Following consent, participants will be randomized into either an intervention arm that comprises usual clinical care plus access and use of the digital resources or a control arm comprising usual clinical care and access to nondementia resources . Randomization will be done using computer-generated random number sequences, and the process will be overseen by a researcher not involved in the study. After allocation to groups, participants will be able to choose to receive specific instructions on how to access materials relevant to the condition  they have been allocated to either electronically, by regular mail, or in person. As a booster, participants in the intervention arm will also receive a monthly phone call from the research associate to help sustain intervention engagement over the long term, which is a risk to any digital trial . CaregivThe primary outcome measures for the pilot RCT will be feasibility and acceptability, while the secondary outcome measures for the pilot RCT will be (1) caregiver burden, as measured by the Zarit Burden Interview ; (2) carValidated, translated versions of the Zarit Burden Interview and World Health Organization Quality of Life Scale measures are already available in English, Hindi, and several other Indian languages. All the secondary outcome measures will be self-rated and measured at baseline, 3 months, and 6 months via regular mail, telephone, or online. Sociodemographic data  will also be collected. The schedule of enrolment, interventions, and assessments for the pilot RCT is presented in To estimate parameters of feasibility and acceptability with sufficient precision, which will help inform the future implementation trial, 40 participants from the intervention arm and 20 from the control arm are expected. The expected values for the proportion of family caregivers rating the intervention as “very acceptable” are 70% (95% CI 59%-87%) or 70% (95% CI 62%-85%) for participants for whom outcomes are completed at the 6-month follow-up. Achieving these expected values will be a priori criteria for progression to an implementation trial without modification of the intervention.Repeat measures ANOVA will examine changes over time. The proportions of eligible family caregivers approached who agreed to take part in the study will be reported with a 95% CI, and any reasons for refusal will be summarized. Characteristics of people with dementia and their family caregivers that are included in the study will be summarized using means (with SD), medians (with interquartile ranges), counts, and proportions, as appropriate. Scores measured pre- and postintervention will be summarized at each time point  and as differences between the randomization groups with 95% CI. Completeness of these scores will also be described. We will estimate parameters to help inform development of the implementation trial, particularly, the proportion of family caregivers using the intervention and for whom outcomes were completed at the 6-month follow-up.If required, specific changes based on the research team’s postpilot experience and participant feedback will be incorporated into the intervention before dissemination of the resources.Following postpilot minor revisions (if any), all the resources developed in the study will be disseminated via the mobile-optimized Moving Pictures website. Key stakeholders  and consumers  will receive a media release with links to the website. Social media campaigns will also be run at regular intervals on Facebook, YouTube, WhatsApp, and Twitter. To evaluate the reach and uptake of these digital resources, analytics data will examine website traffic and viewing trends over 6 months. The feedback in the comment sections will be reviewed and visits to the website will be counted. A flowchart of this phase is illustrated in The procedures outlined in this study are in accordance with the Declaration of Helsinki, and this study has been approved by the NIMHANS Ethics Committee (26th IEC (BEH.SC.DIV.)/2020-21 dated November 11, 2020); the Health Ministry's Screening Committee, India ; the Curtin University Human Research Ethics Committee ; and the NARI Research Governance Office .As the data are being collected in India, data will be stored securely onsite; specifically, hard copy data will be stored in a locked filing cabinet in the office of the investigators. Signed documents will be converted to electronic files, which will then be password protected and stored on the secured NIMHANS network. When in the field, data will be stored on the research staff member’s laptop, which is password protected and backed up to an external hard drive that will also be password protected if required. All data (hard and soft copies) will be stored securely stored and destroyed 7 years after publication. Electronic copies of all data will be securely shared with the Australian research team. During data analysis and write-up, the data will be stored on a secured server in the password-protected folder only accessible by the Moving Pictures research team. Upon completion, all data will be securely transferred and stored under secure conditions at Curtin University and NARI, Australia, for 7 years after the research is published and then securely destroyed.Data will be published in deidentified form in academic and other publications  under pseudonyms or participant IDs. For example, the participant might be described in the following manner: Asha Chand (pseudonym), female, age, caregiver for mother. Data used in films and resources may be identifiable, as we will be using the video data from the interviews in the resources. Caregivers will be assigned pseudonyms, and health providers will be using their own names and affiliations as specified in the PICFs. The films will be accessible via the Moving Pictures website to anyone in the community, and efforts will be made to disseminate the resources as broadly as possible. There are no plans to make the dataset publicly available after deidentification.This study was funded by the Alzheimer’s Association. It brings together complementary expertise across multiple disciplines such as anthropology, psychology, psychiatry, geriatrics, film and media studies, disability studies, and social work.Postdissemination analytics and qualitative feedback will be used to develop an implementation trial; explore how different strategies for dissemination and integrating the resources in local service provisions impact relevant caregiver variables like caregiver burden, mood, and quality of life; and evaluate the effects of the approaches to improve the uptake and utilization of the intervention. From July to December 2023, we will enroll 60 dementia caregivers (40 caregivers in the intervention group and 20 in the control) for the pilot RCT and follow them up for 6 months. This study is expected to conclude in June 2024.Although dementia has been recognized as a global public health priority, a huge gap between dementia care needs and resources still exists, especially in low- and middle-income countries. There is a clear need for the development of dementia literacy and care resources that emphasize identifying dementia through awareness, offer interventions to manage the symptoms of dementia, and promote well-being of both the caregiver and the person with dementia. In this paper, we have outlined the design of an intervention study that involves the development of a digital media resource to improve dementia care in India and determine the feasibility and acceptability of the developed resource using an RCT design. This study will be one of the first to deliver coproduced, evidence-based media resources to support caregivers of people with dementia in the Indian context.The flexible, nonlinear approach of the UK Medical Research Council framework that guides the methodology of this study has previously been used in the design processes for the development of new technology-based interventions across disciplines -31. ThisThrough the process of coproducing films, we will gain an understanding of how dementia is perceived cross-culturally. This is an important aspect for dementia literacy and care, as dementia in India is typically viewed as a natural part of aging with cultural explanations used to describe dementia such as “chinnan” (childishness) . The outAlthough there are no foreseeable risks associated with participation in this study, there are some factors that may hinder recruitment and participant retention. Digital media is not a common support intervention for caregivers of persons with dementia in India, and acceptance of the program, especially by older caregivers such as spouses, could hamper recruitment. Lack of time to take part in the study due to care responsibilities could also be a factor in retention and recruitment. Nonadherence in eHealth interventions has been reported to be high in earlier studies ,38. AnotThis research protocol directly addresses a looming public health crisis in India by promoting dementia awareness and developing resources to support caregivers in delivering high-quality care at home. It offers solutions that are culturally specific, scalable, and based on knowledge of local resources and burden of disease . Thus, i


However, unexpectedly the disease aggravated after 2 days of parturition, and she was unable to walk and forced to stay indoors due to complete extension of the stifle joint. As a result, she was unable to lay down and maintained a permanent standing position for 2 months of aggravation. Clinical findings showed difficult mobilization of the right hind leg, which was locked in extension at the stifle joint, and the hoof was dragging on the floor. Based on history and clinical findings, upper fixation of the patella was diagnosed, and it was treated with median patellar desmotomy under local anesthetic infiltration. Finally, after the complete severing of the medial ligament and skin closure, the animal was able to walk normally, and the wound was healed uneventfully.A 6-year-old multiparous Borana breed cow, which has been suffering from difficulty walking for 6 months, was presented to veterinary teaching hospital. As her previous history indicated, the lameness started during the second gestation, especially in the early morning, and subsides after a few hours of sunrise. She was completely cured after giving her second birth and a similar condition reappeared from the 5 Upper fixation of the patella is one of the main functional disorders of the stifle joint in cattle and horses. In young horses, this condition occurs mainly secondary to the beginning of training and is mainly related to their straight hind limb conformation . It can th month of the third gestation until she calved. Contrary to the situation on the second parity, the condition was aggravated after 2 days of parturition. Consequently, she was unable to walk distances and forced to stay indoors rather than grazing in the field. The owner also expressed that she was unable to lay down and spent all the time in a standing position for the last 2 months of disease aggravation. After a long wait for her recovery, the owner called a nearby veterinary professional to visit her. Accordingly, she received antibiotics for two days suspecting blackleg and was finally referred to the Veterinary Teaching Hospital, Addis Ababa University. Clinical findings revealed good body condition, defensive behavior since she has calved, difficult mobilization of the right hind limb as it was locked in extension at stifle joint, and the tip of the hoof was dragging on the floor  method and blind (closed) method , 5, 7–9.Even though it did not happen in the present case, the open method is suspected to have a higher risk of inducing surgical wound infection . In the From this, it was concluded that if the animal remain untreated for a relatively long time after complete upper fixation, median patellar desmotomy could not be the sole treatment, because the firmness of patellar adhesion at the displaced position can increase with duration. Additionally, undergoing desmotomy through stab incision without exteriorization of the tensed median ligament was found an effective technique in terms of saving time, reducing wound size, and postoperative complications. Therefore, the authors recommend this promising surgical management technique for similar cases.


People with disability following a serious injury require long-term care. The most common injuries resulting in long-term disability are spinal cord and acquired brain injuries. While the long-term effects are difficult to predict and will vary between individuals, the costs of care and recovery span well beyond the initial treatment phase and include long-term care. Long-term care is changing with the availability and advances in cost and function of technologies, such as home automation. “Home automation” refers to technology that automates or remotely controls household functions. Home automation costs vastly differ, but home automation has the potential to positively impact the lives of people with disabilities. However, there is a dearth of evidence relating to the impact of home automation for people with a disability and few rigorous evaluations about the costs and return on investment.The purpose of this study is to describe the impact of home automation for people with long-term disability following a serious injury (such as a motor vehicle accident) using case studies, and by conducting an evaluation of the costs and outcomes for individuals, families, and the wider community using a Social Return on Investment (SROI) approach.SROI is a form of economic evaluation that develops a theory of change to examine the relationship among inputs, outputs, and outcomes and, in recent years, has gained popularity internationally, including in Australia. SROI has six phases: (1) identify scope and stakeholders, (2) map outcomes, (3) evidence outcomes and give them value, (4) establish impact, (5) calculate the SROI, and (6) report findings. Individuals with a disability who use home automation and key stakeholders will be interviewed. Stakeholders will be individuals involved in home automation for people with disabilities, such as allied health professionals, medical practitioners, equipment suppliers, engineers, and maintenance professionals. Users of home automation will be people who have a disability following a serious injury, have the capacity to provide consent, and have 1 or more elements of home automation. The impact of home automation will be established with financial proxies and appropriate discounts applied to avoid overestimating the social return. The SROI ratio will be calculated, and findings will be reported.The project was funded in November 2021 by the Lifetime Support Authority. Recruitment is underway, and data collection is expected to be completed by October 2022. The final results of the study will be published in March 2023.To our knowledge, this study represents the first study in Australia and internationally to employ SROI to estimate the social, personal, and community outcomes of home automation for people with a disability following a serious injury. This research will provide valuable information for funders, consumers, researchers, and the public to guide and inform future decision-making.DERR1-10.2196/42493 People with a disability following a serious injury (such as a motor vehicle accident) require treatment, care, and support. The most common injuries resulting from an accident are spinal cord injuries and acquired brain injuries . While t“Home automation” refers to technology that automates or remotely controls household functions ,6. For eHome automation costs vastly differ, and the potential benefits of home automation can be wide ranging. These may include improved safety, improved comfort, greater independence and autonomy, improved social participation, improved quality of life, and the potential for the person with disability to be left alone for longer periods of time, leading to a reduced need for care attendants -13. For There have been an increasing number of studies evaluating smart homes and home automation in different populations. A recent scoping review examining the effectiveness of smart home technologies for older people with dementia identified 5 studies that provided evidence to support the use of smart home technologies in improving their health outcomes . A qualiIn Australia, funding for home automation for people with disabilities is provided by the National Disability Insurance Agency (NDIA), an Australian government organization that funds costs associated with disability, with individual state organizations such as the Lifetime Support Authority (LSA) in South Australia funding home automation for people who sustain serious injuries following a motor vehicle accident. Internationally, funding for home automation is available in high-income countries. For example, local government councils provide grants for home automation in the United Kingdom, and support is also available through registered disability charities . SimilaThe overarching aim of the study is to understand the impact of home automation on people with disabilities following a serious injury. The objectives of the study are as follows: (1) to describe the impact of home automation for people with long-term disability following a serious injury  using case studies, and (2) to evaluate the Social Return on Investment (SROI) of home automation for this population. The findings from this study will provide valuable and significant information for funders, consumers, researchers, and the public to guide future decision making about home automation.A steering group will be established at project commencement, involving the research project team, representatives from the funding body (LSA), a disability advocacy group, and an equipment supplier. The steering group will also include 2 consumer representatives who have experienced serious injury or care for someone with serious injury. The steering group will oversee the conduct of the study, provide accountability and transparency, inform the analysis, and support the dissemination of findings.The study will employ a SROI approach. The SROI methodology was developed in the United States in 2000 by the Roberts Enterprise Fund . The appSROI is a form of evaluation that commences with a theory of change to examine the relationship among inputs, outputs (activities), and outcomes. The approach is unique as it emphasizes the engagement of stakeholders to inform the analysis and for the valuation of personal, community, and societal outcomes that are not typically included in more traditional forms of economic evaluation . The method captures the overall social impact of an intervention in a simple ratio such as 4:1 . The SROI methodology has six distinct phases: (1) identify scope and stakeholders, (2) map outcomes, (3) evidence outcomes and give them value, (4) establish impact, (5) calculate the SROI, and (6) report findings .Key stakeholders in home automation will be identified and invited to participate in interviews (n=10) to determine inputs , and intended outcomes for the home automation user. Stakeholders will be individuals involved in home automation  for people with serious disabilities, such as allied health professionals, medical practitioners, equipment suppliers, rehabilitation engineers, installers, and service and maintenance professionals.Users of home automation will be interviewed (n=5) to determine the outcomes of home automation. The selected sample size considers the relatively small population size of people with disabilities following a serious injury requiring high levels of care and the small subgroup that uses home automation . ParticiInterviews will be semi-structured, and the interviewer will follow an interview schedule. The interviews will be conducted face to face, over the phone, or via videoconference (depending on the participant’s location and preference) at a time convenient to the participant. All interviews will be audio recorded and professionally transcribed. The interview schedule will consist of 4 sections: socio-demographic questions, inputs of home automation, outputs (activities) of home automation, and the outcomes experienced (capturing negative as well as positive outcomes). The participant will also have the opportunity at the end of the interview to discuss any impacts and outcomes of home automation that have not already been discussed.Purposive sampling will be adopted to recruit stakeholders and home automation users for the interviews. Recruitment for users of home automation will initially be done via LSA. In addition, local providers of home automation and disability organizations will be contacted to inform them about the research and to advertise the study to potential participants by sharing information, using the opt-in approach. Finally, social media (Facebook and Twitter advertisements for consumer groups) will be used to promote the research and recruit participants. Stakeholders will be recruited through the NDIA, professional networks, the LSA, organizations that provide home automation, and the steering group. An email will be sent to potential participants with information about the study, allowing them to opt in by replying to the research team. If necessary, social media (Facebook and Twitter) will be used to promote the research and advertise for potential stakeholder participants.The inputs, outputs (activities), and outcomes involved in the home automation process will be mapped (this is referred to as the “theory of change”), guided by the interview data from stage 1, existing literature, and with input from the steering group. Given the wide variety of home automation options, 4 scenarios will be developed based on LSA’s most common injury types relevant to requiring home automation  and the differing levels of severity of the injury and the type of home automation. The data from the existing literature and interviews will be used to develop the scenarios, and the inputs, outputs, and outcomes will be described in relation to these scenarios to provide context for the analysis and to support the interpretation of findings. Tables will be produced to illustrate the funder’s inputs , the calculations for each scenario, and the payback period for each scenario. A scenario-based approach was recently used successfully in a SROI analysis calculating the social impact of modified vehicles for people with disabilities, in which 5 scenarios were developed to illustrate the social return for low to high-cost modifications of vehicles . A signiEvidence of outcomes will be obtained from stage 1 interview data as well as relevant Australian and international data from published home automation studies. Values for outcomes will be obtained in two ways: (1) from extensive searches of existing SROI literature reporting the same or similar outcomes and how they were valued, and (2) from value games with participants and their families. Value games are a revealed preference approach in which participants rank an outcome without considering its market value among several items that can be purchased ,28. In tThe impact of home automation will be established with appropriate discounts applied to cumulated financial proxies to avoid possible overclaiming. Discounts are calculated based on what would have happened without the intervention (deadweight), what outcomes were displaced by the intervention (displacement), who else has contributed to the outcomes aside from the funder (attribution), and whether the experience of the outcomes declines over time (drop off). The “benefit period”  will be determined. Benefit periods need to be long enough to capture the most valuable outcomes for participants, and in this context, consider the life span of home automation products.The SROI ratio is calculated with costs incurred and benefits realized at different time periods made comparable using discounting to calculate the net present value to ensure the values of the outcomes are in today’s dollars. Sensitivity analysis will also be performed to determine how sensitive the SROI ratio is to changed assumptions in the calculation ,29,30. TThe results will be widely disseminated in different formats for different audiences. Findings will be presented in project reports and in peer-reviewed articles. Findings will also be disseminated at relevant conferences. It is also anticipated that the Flinders University media team will share the findings internally and externally to promote the research.Ethical approval (human subject research) was obtained by the Flinders University Social Human Research Ethics Committee in South Australia (project number 5039) in March 2022. Participants will give informed consent and can opt out of the research. Participant’s information will remain private and any identifying details will be omitted. It is acknowledged that this research is of a sensitive nature, and participants may become upset or distressed during the interview. Participants who become upset will be comforted by the interviewer, offered details on counseling services, and may withdraw from the research if they wish. The study will include people with significant disabilities, and therefore, the interviews will be accommodating to ensure the comfort of the participant, for example, by monitoring fatigue and shorter interviews. It is also the intention that interviews will be conducted with family members on behalf of the person with the disability if this is a preferred option. Participants will also be given the option of requesting another person to be present at the interview if they wish. Potential participants will be given a participant information sheet and a consent form. All participants will be provided with the researcher’s contact information and an opportunity to ask questions and discuss any aspect of the study. All study data will be stored confidentially, and any identifying data will be removed to ensure the data is deidentified. Any publications arising from the data will not identify any individual person. Informed written consent to participate in the interviews and for the use of this data for analysis will be sought from all participants. In recognition of the participant’s time and contribution, they will receive an honorarium (Aus $50 [US $35] voucher) on completion of the interview.The project was funded in November 2021 by LSA (Grant No. R21005). Recruitment of participants for the interviews commenced in June 2022, and we expect data collection to be completed by October 2022. As of September 2022, we have recruited 10 stakeholders and 6 users of home automation. Data analysis will be conducted during November and December 2022, with the results expected to be published in March 2023.The aim of the study is to understand the impact of home automation for people with disabilities following a serious injury, and this will be achieved by describing the impact using case studies and evaluating the SROI of home automation for this population.To our knowledge, this study represents the first study in Australia and internationally to employ a SROI methodology to estimate the social, personal, and community outcomes of home automation for people with a disability following a serious injury. SROI is advantageous because it involves both consumers and stakeholders in the analysis and valuation of personal, community, and societal outcomes, resulting in a simple ratio that demonstrates how much social value (in Aus $) is created for every Aus $1 [US $0.67] invested.Home automation is tailored depending on an individual’s needs and can range from inexpensive (Aus $200 [US $130]) to more costly  depending on the type of home automation . Given tHome automation has the potential to offer significant benefits to people with disabilities. The World Health Organization (WHO) states home automation enables people with a disability to experience increased independence, improved health, and well-being and can also lead to a reduction in caregiver hours, impacting the broader community . RecogniUpon completion of the study, the strengths and limitations will be summarized. The research builds on what is already known about home automation by considering the benefits of home automation reported by users in the research literature. Results will provide valuable information for funders, consumers, researchers, and the public to guide and inform future decision-making and practice about home automation. By providing a simple social return ratio, the payback period can be calculated, and comparisons between high-cost and low-cost home automation can be made to guide decisions. Furthermore, the study may be helpful to researchers who want to assess the social value of other types of interventions, and the model could be adapted for research in other fields.


IntroductionPreoperative assessment using widespread laboratory investigations and ancillary tests as preoperative screening may be unnecessary and lead to an economic burden. This study aimed to determine the routine preoperative investigations performed in a tertiary care teaching hospital in the Caribbean that could be categorized as unnecessary and the costs incurred for these tests.MethodsPatient and surgery-specific data were collected prospectively from adult elective surgery patients over a three-month period. Surgical intensity, American Society of Anesthesiologists (ASA) grade and the National Institute for Health and Care Excellence (NICE)  Clinical Guideline for Preoperative Investigations were used to determine which tests to deem unnecessary. The overall economic burden of unnecessary testing was assessed.ResultsData were prospectively collected from 636 patients during the study period. Sixty-four percent of the preoperative investigations performed were deemed unnecessary. The money spent on these unnecessary investigations amounted to $44,622. When extrapolated, this can amount to approximately $178,488 per annum. This represented 59% of the total money spent on the overall preoperative investigations performed. Relatively healthier patients (ASA I and II) had a significantly higher number of unnecessary investigations performed.ConclusionThis study found that the majority of preoperative investigations performed routinely may be deemed unnecessary. This results in a huge economic burden on the healthcare system. There is a need to update and strictly implement clinical guidelines for preoperative investigations. The preoperative assessment incorporates a detailed clinical history, physical examination, and laboratory and radiological investigations that precede anesthesia for surgical procedures. In most countries, preoperative clinical evaluation is the responsibility of the anesthetist. A vast majority of patients admitted for elective surgery undergo routine preoperative laboratory investigations and ancillary testing; however, the need for such testing is controversial . Over thPreoperative assessment has the following objectives: (a) to reduce associated risks by identifying existing medical conditions; (b) to improve safety by assessing and qualifying risk; (c) to allow planning of perioperative care; and (d) to provide the opportunity for explanation to allay patient anxiety and obtain informed consent. In essence, the assessment allows planning for appropriate perioperative care, while decreasing associated adverse outcomes and facilitating the patient’s timely return to the desired level of functioning. The use of laboratory tests as an adjunct during the preoperative assessment of patients has been facilitated by medical technology that allows for rapid screening of multiple chemical factors in the blood and for automated counting of blood cells . The purHowever, there has been enough evidence to show that the economic burden and time consumed by widespread ancillary testing have outweighed the value added by the results obtained. Unnecessary preoperative tests can be defined as the series of tests ordered for asymptomatic individuals, in the absence of any specific clinical indication, to identify conditions undetected by clinical history and examination . Such teWith this background, the current study aims to determine the cost of preoperative laboratory testing in a tertiary care teaching hospital in Trinidad and Tobago. By extension, the study will attempt to assess the economic burden of "unnecessary" testing on patients who present for elective surgical intervention at this institution.The study was designed as a prospective observational cross-sectional study of adult patients having elective surgical procedures at the operating theatres of a tertiary care hospital in Trinidad and Tobago. Data were collected on a daily basis for three months. At the time of the preoperative assessment, one would ordinarily attain all the information needed to complete this survey, as such, no additional clinical intervention or patient exposure was required. There were no inherent risks to patients or staff members associated with the conduct of this research. The Ethics Committee of the Regional Health Authority granted approval to conduct this research with permission to waive the need for individual patient consent.Data collected included basic demographic information (age and gender), along with parameters specific to the patient’s medical history, including a history of cigarette smoking and/or alcohol consumption, patient co-morbidities, an estimated or actual body mass index, and American Society of Anesthesiologists (ASA) grades. Other clinical data recorded included the patient’s diagnosis, the operation performed, the type of anesthetic performed, and specific laboratory or radiologic investigations conducted as part of the preoperative assessment. No specific patient identifiers were documented, and data were stored under password protection, accessible only to the primary researcher, and research supervisor.Information was analyzed based on the most recent Clinical Guidelines published in April of 2016, by the National Institute for Health and Care Excellence (NICE), United Kingdom, outlining the preoperative tests that should be performed in adult elective surgery patients.Patients were categorized according to the surgical intensity and then the ASA grade. Based on the NICE Clinical Guideline, the laboratory results were then categorized as necessary, to be considered, or not necessary. An additional category was included for tests that were omitted. This omitted category refers to the tests that were not conducted but should have been performed, as indicated by the NICE Clinical Guideline. The National Costing of Health Services published by the Health Economics Unit for the Ministry of Health was used to calculate the cost of preoperative tests that were performed on the patients. The cost of all investigations performed was calculated in order to highlight the cost of the preoperative investigations that were deemed "unnecessary."Five categories of tests were identified by the analysis of the preoperative investigations using the NICE Clinical Guidelines: (i) performed, necessary tests done, also deemed as mandatory based on the NICE Guidelines; (ii) performed, to be considered - tests done are described as to be considered by the NICE Guidelines based on the patient’s co-morbidities, recent symptoms, or evaluation of risk for specific complications; (iii) performed but unnecessary - tests that were done as part of the routine preoperative evaluation but deemed inappropriate based on the NICE guidelines; (iv) not performed, appropriately omitted - investigations that were not done, as consistent with the NICE Guidelines recommendations; (v) not performed, inappropriately omitted - investigations that were omitted from the hospital preoperative evaluation, that was deemed as mandatory by the NICE Guidelines.To evaluate the preoperative investigations that were actually performed during the three-month period, the tests were divided into categories of "appropriate" and "inappropriate."Inclusion criteria were patients undergoing elective surgical procedures that involved anesthesia intervention in the operating theaters in general surgery, urology, gynecology (including laparoscopic procedures), obstetrics, plastic surgery, orthopedics, otolaryngology, maxillo-facial surgery, and ophthalmology.Patients under the age of 18, patients presenting for cardiac, thoracic, neurological, and major vascular surgery, and any patient booked for an emergency operation or procedure under local anesthesia were not included in the study.Data were entered into Microsoft Excel™ software , and descriptive as well as inferential statistical analyses were done. Patient gender, ASA grade, age, surgical grade, and BMI were used as categories. Statistical analyses were performed using the Pearson chi-square, Student's t-tests, and analysis of variance (ANOVA). The Statistical Package for Social Sciences (SPSS), version 21 software , was used for analyses. The statistical significance was fixed at the level of p < 0.05.Six hundred and thirty-six (636) patients were enrolled during the three-month study period, and preoperative data were collected on all of them. Eighty-four (13%) patients had a minor surgical procedure performed, 325 (36%) had an intermediate-grade surgical intervention, and 227 (51%) patients underwent major or complex surgical procedures.Patients were categorized by ASA grade, and most cases belonged to the ASA II category. Specifically, 59% of patients belonged to ASA II and 23% to ASA I. Only 2% of patients were categorized as ASA IV. The ASA grades for each category of surgery are shown in Figure The NICE Clinical Guidelines, UK, were used to evaluate the preoperative tests performed, based on the patient's ASA grade and the surgical intensity of the proposed operation. The tests performed were identified as necessary, to be considered, or unnecessary. Further to this, tests that were not performed were also divided into two groups. These included tests that were not appropriately done and tests that should have been done but were not. The breakdown of these five categories is shown in Table The investigations that were actually performed preoperatively were evaluated in three basic subcategories: tests that were appropriately done, tests that could have been considered, and tests that were inappropriately done. The distribution of these tests is shown in Figure A detailed analysis of the cost for each test, based on the categories delineated by the NICE Clinical Guideline, is provided in Table A detailed breakdown of unnecessary tests performed, the proportion of each type of test done, and the incurred costs are summarized in Figures The comparison between the number of laboratory tests performed as well as the cost incurred did not have any statistically significant difference based on the patient’s gender and BMI. In accordance with the NICE guidelines, when the number of tests was compared between ASA grades as well as surgical intensity, there was a statistically significant difference between the categories (p < 0.001) Table .Individual comparisons were made between the two categories (appropriate versus inappropriate tests) based on the patients’ ASA grades. This analysis revealed statistical significance with respect to the appropriateness of the CBC, LFT, PT/PTT, RFT, and ECG performed, and the ASA grade of the patients (p < 0.001). The same was true with respect to the CXR done (p < 0.05).Similarly, with respect to the amount of money spent unnecessarily on CBC, LFT, RFT, ECG, and CXR, there was a statistically significant difference between the ASA grade and surgical intensity categories. Coagulation screening (PT/PTT) was the only investigation that did not reflect a significant change in the amount of money wasted based on the ASA grade.To evaluate whether age influenced the amount of money wasted on unnecessary investigations, the patients were divided into two categories, with 65 years old as the threshold. Five hundred and twelve (512) patients belonged to the category of non-elderly (<65 years), while 124 patients fit the category of elderly (≥65 years). This analysis revealed that age was a statistically significant factor for the money wasted on RFT, PT/PTT, and CXR. The analyses showed that a significantly larger percentage of the money was expended on the category of non-elderly patients.The major finding of the present study is that, despite existing hospital guidelines, there was unnecessary preoperative testing in surgical patients, especially in otherwise healthy and fit patients. Many of these patients belonged to the categories of intermediate surgical intensity and ASA grade II. When categorized in accordance with the NICE guidelines, almost two-thirds of these investigations 64%) were deemed unnecessary. A previous study conducted in the United States by Onouha et al. found that more than 70% of routine preoperative testing was unindicated, similar to the present study [4% were dThe high proportion of unnecessary investigations in the present study highlights the fact that voluminous information is being retrieved as part of the routine preoperative assessment for elective cases. The study hospital does not have a preoperative anesthetic assessment clinic, and as such, the laboratory investigations performed for most patients are routinely requested by junior members of the surgical team. Subsequent evaluation by the anesthesiologist usually occurs on the morning of the scheduled operation. As suggested by Korpman, some surgeons do offer a justification for routine preoperative testing with a gamut of investigations, but only because "anesthesia" wants to have them done.  In essenThe total expense incurred by the tests that were deemed unnecessary amounted to $44,622 in the present study. Chandra et al. conducted a retrospective evaluation of a relatively healthy population presenting for elective general surgery and concluded that none of the preoperative investigations performed led to any additional peri-operative intervention. The cost incurred for the requested investigations was quoted at $10.81 per patient . In compAlthough the number of unnecessary investigations accounted for 64% of the total number of tests performed, the money spent on these tests represented only 59% of the total money spent on preoperative investigations within the time period evaluated. This is similar to the finding reported from Brazil, which showed that though 55.8% of the tests done were deemed "not indicated," these tests accounted for 50.8% of the total cost of investigations performed . The ecoThe current clinical guidelines to guide preoperative evaluation available in the study hospital were formulated and published in 2002. Strides have been made throughout the world in these two decades as to the evidence available and subsequent clinical publications that advise on appropriate preoperative investigations . One sigFurthermore, the international guidelines and protocols for preoperative investigation describe tests that are performed for patients who have severe cardiovascular or pulmonary pathology. Many such investigations are not readily available at the study hospital and so cannot form part of the formal assessment for most patients. These investigations include, but are not limited to, exercise stress testing, cardiopulmonary exercise testing, coronary angiography, and lung function testing.The distribution of the money spent on each type of unnecessary investigation showed a fairly even spread. Specifically, the amount of money spent per investigation ranged from 13% to 23% of the total amount expended. Thirteen percent was spent on the electrocardiograms performed, whereas 23% could be attributed to liver function testing. The study by Chandra et al. did imply a much broader distribution of spread among the investigations deemed unnecessary. In their study, 50% of patients had a serum creatinine evaluation, whereas 100% of the patients received multiple biochemistry and hematological investigations.Evaluation of the full spread of investigations based on the patients’ ASA grade and surgical intensity showed statistically significant differences between categories. On the other hand, there were no statistically significant differences with respect to the investigations when the patients were categorized according to demographics. These results are consistent with the current clinical guidelines that are used in the US and UK to advise which preoperative investigations ought to be performed. Most recent clinical guidelines for preoperative investigations are based on the patient’s ASA grade and proposed surgical intervention. Gender and age are no longer seen as independent factors that determine which preoperative investigations ought to be performed.When preoperative tests were analyzed based on ASA grade, as expected, the lower the ASA grade, the higher the number of inappropriate investigations performed. Conversely, the higher the ASA grade, the lower was the number of inappropriate investigations. As a corollary, the money spent on unnecessary investigations such as CBC, LFT, RFT, ECG, and CXR in lower ASA grades was significantly higher compared to higher ASA grades.In this era of economic scarcity, this research serves to highlight the fact that more than half the money spent on preoperative investigations for elective surgery patients may be saved. To achieve this, there is a need to effectively upgrade the 2002 Clinical Guidelines implemented in the study hospital. As early as 2000, the American Association of Family Physicians published a list of "recommended" preoperative tests before elective surgery . In 2020One limitation of the study may be the use of the Ministry of Health publication to quantify the cost of preoperative investigations performed. The costs of healthcare have always been approximate, and this has been acknowledged in all cost estimation studies. The inter-observer difference in the initial ASA grade assessment can also be a source of error. The most recent update to the ASA Classification included examples of patients in each category. Two specific examples that are not always adhered to during patient assessment would be categorizing pregnant patients as ASA II and the differentiation of specific ASA grades based on body habitus. In addition to this, at the time of data collection, there was no note of duplicate investigations that were present in the patient’s record. It is not uncommon to see more than one of the same type of investigation performed on the same patient. One typical scenario is when a patient who was postponed has returned for their intended surgical procedure but has a repeat of the preoperative laboratory tests performed within a short period of time. This may lead to an error in the calculation of the actual money spent on preoperative evaluation for such patients.Nevertheless, in summary, this study did show that the use of pre-anesthesia evaluation as a comprehensive assessment using laboratory screening is ineffective in influencing peri-operative outcomes. The laboratory investigations and ancillary tests should be undertaken only on a value-added basis since two-thirds of these tests can be potentially eliminated. In conclusion, this study clearly found that greater attention needs to be paid to the investigations being performed for elective surgery patients preoperatively. This would greatly reduce the economic burden and improve the efficiency of the preoperative assessment being performed.


The rapid outbreak of COVID-19 wreaked havoc and brought a pause to the normal lives, and the labor market and human livelihoods were strongly negatively affected because of it. The emergence of groups that were unable to withstand various pressures has increased the appeal of donation behavior to a certain extent. Therefore, under the impetus of COVID-19 and digital background, online donation represented by Waterdrop financing has become popular. In the common difficult period, how to improve an individual’s willingness to donate online has become an urgent problem to be solved. To address this issue, on the basis of previous literature, we proposed a research hypothesis and a theoretical model of “nostalgia-relationship variables-donation”. After that, we determined the measurement scale, conducted a large sample survey, and finally conducted hypothesis testing through confirmatory factor analysis and structural equation modeling analysis. Through the above analyses, the study reached the following conclusions: the main influence factors of personal nostalgic proneness are insecurity, past experience, loneliness, and recovery from grief, among others. There is a positive causal link between nostalgia proneness and familial utility intensity and emotional utility intensity. The greater the degree of the nostalgia intensity of the donor, the more the trust placed in charitable organizations. The donors’ relationship commitment to charitable organizations significantly influences their online donation willingness. The main source of relationship commitment consists of emotional intensity, followed by trust, and finally, familial intensity. The rapid outbreak of COVID-19 in 2019 caused serious destructive consequences to the labor market and human livelihoods. In contrast, it accelerated the pace of social digital transformation and enhanced consumers’ sympathy and nostalgia.Foreign studies have shown that, on the background of COVID-19, donation activities have increased and that donations are mainly aimed at the unemployed and the poor . In the With the help of the research paradigm of consumer behavior, this article attempts to analyze the nostalgia from “customers” to “donors” from the micro perspective of charitable organizations and tries to prove that the nostalgia of donors can affect the donor’s willingness to donate through the relationship between donors and charitable organizations . Based on the psychological analysis of charity customers, this study designs nostalgic marketing operation strategies for charity managers to attract more new donors, stimulate existing donors to increase the number and frequency of charitable donations, improve repeated donations and donor loyalty, and improve the overall performance and competitiveness of charity organizations.Domestic and foreign scholars regard individual donation as an individual public consumption behavior and consider individual donors as consumers of nonprofit organizations. Its consumption behaviors are classified as consumer behavior research fields . FactorsConsumer nostalgia is often favored by young people . As for The donate model of Many existing bodies of literature have studied the relationship between demographic variables and donation behaviors, most of which deeply discussed donation motivation, but the psychological and emotional motivations of donors are rarely involved. Research studies based on marketing perspectives of customer relationships are even less. As for studies on how nostalgic feelings of donation affect the decision-making of donation (consumption), nostalgic feelings are horizontally divided into individual nostalgia and collective nostalgia in the existing literature, whereas discussion from a longitudinal perspective is unusual. Meanwhile, the generation mechanism of nostalgic feelings and influencing factors are often confused and lack hierarchical discussions. Therefore, it is widely accepted that nostalgic feelings are directly related to donation decision-making and that the tiny minority of discussions is related to specific conversion mechanism and intermediary utility in nostalgia.Antecedents of nostalgic feelings involve two aspects, indirect factors and direct trigger factors. The indirect factor refers to factors that affect individual nostalgia proneness, including both external factors, such as society and culture, and personal factors such as individual experience, personality, age, and so on; the direct trigger factor refers to the nostalgic stimulation developed by charitable organizations.via nostalgia, thereby helping to reduce the sense of insecurity.Sense of insecurity is related to nostalgia proneness to some extent. It means that consumers, driven by insecurity, would like to choose the products or brands they trust and know well and form affection or attachment to them, thereby providing an incentive for nostalgic consumers. During a period of crisis or social unrest, nostalgia allows people to seek comfort, gives people a comfortable and friendly emotion, and even becomes the hearted sanctuary . NostalgTherefore, we postulate hypothesis 1 (H1): Sense of insecurity in real life has a significant positive impact on personal nostalgia proneness.Nostalgia is affected by past experiences. The more intense the past experience, the deeper the memory of it . In addiThus, we postulate H2: Past experiences related to charitable organizations have a significant positive impact on personal nostalgia proneness.Nostalgia is affected by loneliness. In the past, people spent more time with their families and were closely related to social organizations. However, because of the rapid pace of life at present, people are prone to feeling less sense of belonging and sense of security than ever before. When people could not achieve their desire that is expected to enhance their relationship with family and social organizations in real life, people would feel frustrated, depressed, meaningless, and lonely. Naturally, nostalgia, as the sanctuary, could help individuals recall their past memory with family and friends and rebuild memories of happiness when people feel lonely.In conclusion, we postulate H3: Loneliness has a significant positive impact on personal nostalgia proneness.Recovery from the sadness of the death of friends and relatives is related to nostalgia. On the one hand, people become quite nostalgic because of past memories and things when their lost loved ones cross their mind. On the other hand, people who felt sad when nostalgic would tend to donate to charity in honor of relatives and in order to recover from their grief.To this end, we postulate H4: Recovery from grief has a significant positive impact on personal nostalgia proneness.Nostalgia proneness refers to individual views and attitudes toward the past, and is implicit and stable; nostalgia intensity represents the degree of nostalgia toward nostalgic objects (such as the past and remembrance of things of past times) under external stimulation and is explicit, mutable, and transient.The degree of nostalgia intensity in the donation scene is shown by emotional utility and friend and relative utility in donation motivation: nostalgic emotional intensity is performed by the size of emotional utility in donation motivation of donors; the intensity of memorizing relatives and friends is reflected through the size of relatives and familial utility.Influenced by environmental changes brought about by COVID-19 and annual growth, people would increasingly expect to return to the past  to cheriTherefore, we hypothesize H5: Individual nostalgia proneness has a significant positive impact on relative and friend intensity.Individual nostalgic experience is reflected not only by the memory of people and goods but also in the remembrance of the past. For example, universities stimulate the memory of school graduates through various ways to appeal to their senses of nostalgia, consequently donating to their universities . In termOverall, we hypothesize H6: Individual nostalgia proneness has a significant positive impact on emotional intensity.Trust is one of the important factors that decide the level of donation . The levCommitment is a continued desire to maintain a valuable relationship . The depIn China, the crisis of confidence is one of the major obstacles to the development of charitable donations. With the development of charities in China, trust problem has continuously emerged in the charitable field. Netease, one of most famous Internet companies, ended up with the Netease online donation platform of China Red Cross Society on 14 May 2008, while Netease began to cooperate with the Liao Bingxiong Humane Fund Management Committee. In addition, an increasing number of netizens give rise to questions about the amount and channels of donation of some celebrities such as Yu Qiuyu and Chen Guangbiao. What is worse, the development of charity career, which is particular in the development of individual charity level, has undergone its bottom because of Guo MeimeiEvent in 2011 and ten thousand-yuan catering invoice events in Shanghai Luwan District Red Cross. Based on the above, trust is a necessary condition for the public to donate to charitable organizations in China, since trust would affect the degree of relationship commitment between individual donors and charitable organizations, thereby affecting online donation willingness and donation level.Therefore, we postulate H11: The degree of trust of individual donations on nonprofit organizations has a significantly positive correlation with commitment level.The impact of commitment on purchase intention and brand loyalty had already been found in the marketing research field previously. To this end, we hypothesize H12: The commitment level of donors to charitable organizations has a significant positive correlation with online donation willingness.The donation model of The measurement scale is the basis of the empirical research because the credibility and validity of the measurement scale would directly affect the meaning and value of the entire study. The main part of the test item in this article includes ten parts. The online donation willingness adopts the scale designed by A large sample survey was conducted from February to April 2022. Since we studied the donation behavior of respondents, we considered the donors of online donation platforms as the survey object. To this end, we used the following methods to conduct a questionnaire survey: first, 750 individual donors were randomly selected to conduct a questionnaire survey through the donor information from nonprofit organizations such as Waterdrop financing, easy financing, and worry-free financing; therefore, 440 questionnaires were withdrawn within the specified time limit; after eliminating invalid questionnaires, there were 394 valid questionnaires, and the effective rate was 52%.The analysis of large sample survey included descriptive statistics, variable data description, CITC, reliability, one dimensionality, and validity. Project descriptive statistics is mainly conducted for preliminary testing of variable projects. CITC  and Cronbach’s α reliability coefficient are used for the reliability coefficient of purification measurement items and test measurement items, respectively. The factor analysis, at the structural level, was conducted to verify the single-dimensional variables. In addition, we tested the fitting of large sample data and theoretical hypothesis model with the AMOS26.0.First, the descriptive statistics were conducted to measure the measured values of variables and analysis results, which include the mean of each variable, standard deviation, and so on. As it can be seen from the By CITC, reliability, and validity analysis of the large sample, we found that C3 and C5 in relationship commitment, T4 in trust, PN8 and PN11 in nostalgia proneness, L5 and L6 in loneliness, R3 in recovery from grief, and IS2 in insecurity should be deleted. From the item analysis of both the large sample and the small sample, the measurement items of all variables were optimized, after which 39 optimized measurement items in total are shown in the table below. Then, a statistical analysis was conducted according to the optimized measurement items in the following text.The factor standardized loading, Cronbach’s α, and fitting index of measurement model are shown in Before the structural equation modeling test, a pairwise correlation analysis is conducted to each latent variable first, which is the preliminary test of the hypothesis. In general, the two variables in the assumptions should have a high correlation. Meanwhile, correlation coefficient is statistically significant. The correlation between each latent variable is analyzed with SPSS26.0, and the correlation coefficient between each latent variable is shown in The theoretical assumptions above are preliminarily demonstrated by a correlation analysis testing. In order to verify the causal relationship between self-variables and dependent variables, AMOS26.0 is used to study the hypothesis testing of the model.A summary of the hypothesis test is provided in H1: Realistic insecurity has a significant positive impact on personal nostalgia proneness. The path coefficient is 0.258 and the T value is equal to 5.967, which are significant at a confidence level of 0.001. Therefore, the hypothesis is supported. According to this hypothesis, when individuals feel insecurity in real life, they would be likely to be nostalgic and seek comfort. H2: Past experiences related to charitable organizations have a significant positive impact on personal nostalgia proneness. The path coefficient is 0.167 and the T value is equal to 3.4227, which are significant at a confidence level of 0.001. Therefore, the hypothesis is supported. According to this hypothesis, the more important the past experience of donors is, the deeply they remember. Memories of past experiences in real life have a more remarkable impact. H3: Loneliness has a significant positive impact on personal nostalgia proneness. The path coefficient is 0.158 and the T value is equal to 3.31, which are significant at a confidence level of 0.001. Therefore, the hypothesis is supported. It means that individuals would become nostalgic and always remember past good times when they feel lonely in real life. H4: Recovery from grief has a significant positive impact on personal nostalgia proneness. The path coefficient is 0.199 and the T value is equal to 3.739, which are significant at a confidence level of 0.001. Therefore, the hypothesis is supported. Accordingly, individuals would think of old times spent with their relatives and friends when they recalled them. Nostalgia is considered an important means to overcome grief. The relationship above was rarely mentioned in the previous literature, except H5: Personal nostalgia proneness has a significant positive impact on relative and friend intensity. The path coefficient is 0.227 and the T value is equal to 3.827, which are significant at a confidence level of 0.001. Therefore, the hypothesis is supported. According to the hypothesis, when someone thinks of relatives and spouse, individuals often feel a very close relationship with the people they miss. This intimate relationship would lead to his or her donation  and getsH6: Personal nostalgia proneness has a significant positive impact on emotional intensity. The path coefficient is 0.189 and the T value is equal to 3.609, which are significant at a confidence level of 0.001. Therefore, the hypothesis is supported. Under the hypothesis, the nostalgic proneness of donors would produce a sense of “yesterday once more,” thereby appreciating pleasantness, happiness, and warmth . SargeanH7: Relative and friend intensity of individual donations has a significant positive impact on the level of trust on charitable organizations.H8: The emotional intensity of individual donors has a significant positive impact on the trust level for charitable organizations. The path coefficient of “relative and friend intensity to trust” is 0.194 and the T value is equal to 3.74, which are significant at a confidence level of 0.001. The path coefficient “emotional intensity to trust” is 0.247 and the T value is equal to 4.584, which are significant at a confidence level of 0.001. Therefore, the two hypotheses are supported. According to the two hypotheses, individuals would have more confidence in charitable organizations when a certain nostalgia intensity is aroused and produced by the organizations. It is unusual to find literature on the relationship between nostalgia intensity and trust at present, but the relationship above provides a way for charitable organizations to improve their trust.H9: Relative and friend intensity has a significant positive impact on the relationship commitment of individual donors to charitable organizations.H10: Emotional intensity has a significant positive impact on the relationship commitment of individual donors to charitable organizations. The path coefficient between relative and friend intensity and relationship commitment is 0.302 and the T value is equal to 5.007, which are significant at a confidence level of 0.001. The path coefficient between emotional intensity and relationship commitment is 0.591 and the T value is equal to 10.22, which are significant at a confidence level of 0.001. Therefore, the two hypotheses are supported. Under the two hypotheses, donors would have a greater relationship commitment to charitable organizations when nostalgic intensity is aroused and produced by the organizations. H11: The trust level of individual donors on nonprofit organizations presents a significant positive correlation on donation commitment level. The path coefficient is 0.434 and the T value is equal to 7.247, which are significant at a confidence level of 0.001. Therefore, the hypothesis is supported. According to the hypothesis, donors would produce a greater relationship commitment to charitable organizations because of their increasing trust to the organizations. This relationship had been studied by H12: The level of commitment of donors to charitable organizations presents a significant positive correlation with online donation willingness. The path coefficient is 0.894 and the T value is equal to 14.709, which are significant at a confidence level of 0.001. Therefore, the assumption is supported. According to this hypothesis, the online donation willingness of donors would improve as donors produce a growing relationship commitment to charitable organizations. Based on the context of donation above, we demonstrated the relationship between the commitment and the purchase intention again, which has been researched by many marketing researchers such as .As shown in (1) Insecurity, past experience, loneliness, and recovery from grief have a certain impact on individual nostalgia proneness. Influenced by the outbreak of COVID-19, these factors are the most representative, but there are other factors that are yet to be excavated.As it can be seen in (2) In donation scenarios, given nostalgia intensity includes two dimensions, relative and friend intensity and emotional intensity, which have a positive impact on nostalgia proneness. On the one hand, there may be other dimensions of nostalgia intensity; on the other hand, there may be other regulatory variables besides the influencing factors of nostalgia proneness.As shown in However, because the research on nostalgia intensity in the nostalgia study field is still at the exploratory stage, this article tends to separate nostalgia proneness from nostalgia intensity. It is considered an innovation itself to measure the nostalgia intensity with the intensity of relatives and friends and emotional intensity. In future research, first, there may also be other dimensions in the structure of nostalgia intensity besides relative and friend intensity and emotional intensity. Second, the two variables, relative and friend intensity and emotional intensity, are more complex, and they may also be influenced by many other psychological variables.Based on the background of COVID-19, we found that, in addition to improving the performance of charity organizations, timely feedback, and effective communication, the donor’s individual psychological variables mentioned in this article are important factors in the source of trust of charitable organization donors . The morAs can been seen in (3) The change of donation channels highlights the role of relationship commitment. From the perspective of relationship marketing, relationship commitment is the most critical variable in determining consumer purchasing behavior. In the scene of the charitable donations, the relationship commitment of donors on charitable organizations has a remarkable impact on online donation willingness and donation behaviors of donors. The source of relationship commitment in donation context involves emotional intensity, followed by trust, and comes up with relative and friend intensity. Although trust has a great influence on relationship commitment and online donation willingness, the stimulation of nostalgic feelings (including other feelings that have not been researched) of the donors should be subject to the attention of managers of charitable organizations, especially in the COVID-19 era with nostalgia.As shown in In the context of relationship marketing, the relationship between consumers and companies determines purchase intention and even brand loyalty. It means that the commitment of consumers to brand is considered an important channel promise such that enterprises launch brand management and enhance brand equity. In terms of this study, relationship commitment is a decisive factor in online donation willingness of donors. The relationship commitment level directly determines whether donors would like to donate money (goods) to charitable organizations and even to be willing to do long-term and ongoing donation. Therefore, the relationship commitment level directly determines the development of charitable organizations. Therefore, charitable organizations during the process of management should attach great importance to this variable.Where is the source of relationship commitment? This study has demonstrated that nostalgia intensity has explained 34.04% of the variance of relationship commitment and that trust has explained 18.84% of the variance of commitment relationship. According to the data above, two conclusions can be inferred as follows:First, trust has a great impact on relationship commitment. The level of trust directly affects the relationship commitment level of “donors to organization”. In the current donation environment in China, the public has shown the decreasing trust on charitable organizations because of their opaque information and corruption of their managers. Since the event of Guo Meimei, the number of donations that the Red Cross has received has witnessed a drastic reduction, which showed that the level of trust of donors on charitable organizations has a significant impact on the development of philanthropy in China.Second, the nostalgic feelings of donors make greater contribution to relationship commitment. If charitable organizations feel like improving the level of donation, they should focus more on mental communication with donors and inspire their nostalgic feelings (including other feelings that have not been researched). In research on donation motivation, donation behaviors of donors are dominated by many psychological factors , and studies on these emotional factors have an important influence on improving the level of charitable organizations as a whole.Charitable organizations can develop various strategies to provide a platform for making donors experience nostalgia, which will allow institutions and existing donors to establish stronger links and attract new donors, thereby benefiting the whole organization. Concretely speaking, charitable organizations, such as charity organizations of medical care and education, should take the nostalgic feelings of donors into consideration and effectively use them in marketing communication strategy development, market segmentation, target market selection, and positioning.(1) Marketing managers of charitable organizations could design nostalgic communication demands, develop nostalgic platform, and evoke the nostalgic feelings of donors to increase online donation levels and willingness.Marketing managers of charitable organizations must identify the important personal experiences of online donors and create a reasonable design in marketing communications (such as public service advertising), which develops a platform for online donors to allow them to re-experience the past and appeal to their personal nostalgic feelings. This kind of nostalgic communication strategy design is extremely effective in university alumni associations, hospitals, schools, poverty alleviation educational foundations, and any health-related charitable organizations.Take the University Celebration Committee for example, in order to improve the online donation willingness and donation levels of schoolfellows, if the celebration preparatory groups mail the same paper and audio and video products to the schoolfellows that span decades or even centuries, it is impossible to produce a communication effect and make the school fellows produce nostalgic feelings or era resonance. For universities, they must segment schoolfellows according to the standard of admission age to raise the number of donations, since schoolfellows experienced different events during their school lives. Alumni associations should design different communication elements in various media , tell about dramatic events during their school age, give an account of their campus anecdotes, and record the characters and trivia of the faculty of donors and photos of canteens, dormitories, school buildings, libraries and campus, and other important landmark attractions. Although alumni associations cannot guarantee that each schoolfellow would receive a different media package , the alumni associations at least should be in accordance with the enrollment year and use 4 years as a unit so that the schoolfellows of different times could receive the unique materials related to their college lives and (cannot make it can be relaxed to 10 years). On the one hand, schoolfellows would feel valued; on the other hand, precisely because these materials (such as photos and audio and video products) are closely related to their college campus lives, they can effectively recall their college life and produce nostalgic feelings, which are accompanied by pleasantness and warmth, thereby enhancing the trust of schoolfellows, the relationship commitment degree, increasing online donation willingness, and even extending the loyalty on long-term donation.(2) Managers of online charitable organizations should carry out effective market segmentation and positioning through nostalgic feelings.Different people have different nostalgia proneness. Would nostalgic appeal have a negative impact on online donors who have low nostalgic feelings? Therefore, if nostalgic appeal could stimulate nostalgic feelings of online donors, managers of charitable organizations must assess the nostalgia proneness of donors. This study has shown that online donors who are lonely and experiencing more significant past time, insecurity, and recovery from grief tend to easily become nostalgic. Managers of charitable organizations need to comprehensively assess these factors, which would enable to help them select the target market and identify real relevant online donors more easily by producing nostalgic feelings. However, in the management practice of charitable organizations, there is a difficult problem: how do charitable organizations obtain the personality of online donors, scenes of past life, and other factors? (3) Managers of charitable organization should expand their impact on marketing and enhance online donation willingness and levels by nostalgia clubs (brand clubs). The greater the nostalgia intensity of online donors, the greater their relationship commitment to charitable organizations. Online donors with similar commitment gather in a virtual or real community in many ways, such as Wechat groups, forums, and so on, and could share past experiences with each other. Managers of charitable organizations need to build such community, organize recurrent activities or initiate discussions and communication, form a social organization, and inspire the nostalgic feelings of online donors, which would enhance the emotional contract and relationship commitment of the entire community to the charitable organizations. In the management practice of charitable organization, there are many small charitable organizations through the network platform, such as websites, forums, micro blogs, Wechat groups, and full discussions and communication, that stimulate nostalgic feelings of whole community, thereby improving the online donation willingness and donation levels of the entire organization.(1) The variance that explained the degree of nostalgic proneness and nostalgia intensity is limited. In the empirical model, exogenous variables  together only explain 15.9% of the individual nostalgia proneness variance. Nostalgia proneness only explains 5.15% of the variance of friend and relative intensity and 3.57% of emotional intensity. According to the standard of (2) It is possible that there exist other variables between nostalgia intensity and relationship commitment. Charitable organizations may take some actions, including writing response cards and letters of thanks to increase the emotional contract and relationship commitment of donors on charitable organizations, which requires further research to explore.(3) It is possible that there exists other structure dimensions in nostalgia intensity. It is difficult to distinguish emotional intensity from relative and friend intensity in nostalgia intensity. However, emotional intensity is only related to positive emotions, so future studies may also need to focus on other dimensions of nostalgia intensity as well as negative nostalgic feelings.(4) Limitations of the data and scales. Although some of the scales meet the requirements, their reliability is not high, such as insecurity in nostalgia proneness, relative and friend intensity, and emotional intensity in nostalgia intensity, which indicates that there is room for improvement in the scales themselves. The process of the small sample investigation and formal investigation and the geographical scope of sample survey is relatively narrow, which may affect the universality of the data. The number of valid questionnaires is also limited. Although they meet the statistical requirements, the proportion of valid questionnaires in the course of the investigation is not high, which has some impact on this study.(1) Further exploration on influencing factors of nostalgic proneness is needed. Since the exogenous variables only explain 15.9% of the variance of individual nostalgia proneness, it can be inferred that more influencing factors of individual nostalgia should be explored in future studies. Moreover, further exploration of collective (substitution) nostalgia should be discussed on donation behavior.(2) Further exploration on dimensionalities and influencing factors of nostalgia intensity is needed. The variance that explained the degree of nostalgia intensity is lower. For future research, first, the structure of nostalgia intensity may also show other dimensions that need to be explored besides the intensity of relatives and friends and emotional intensity. Second, because the two variables, relative and friend intensity and emotional intensity, are more complex, they may also be influenced by many other psychological variables.(3) Improvements of the empirical survey data on quantity and quality is required. First of all, due to insecurity in nostalgia proneness and relative and friend intensity and the emotional intensity in nostalgia intensity, there are problems on the scales themselves and that they need further improvements. Second, the number of the survey questionnaires and the proportion of valid questionnaires are limited. Under the conditions of human, material, and financial resources in the future, improvement of survey data could be enhanced from quantity and quality. In the empirical study, cross-sectional data are used, and there would be great differences between different charitable organizations, so it is not appropriate to study and infer that nostalgic feelings have a significant effect on all donation behaviors. In future studies, we can demonstrate the relationship between nostalgic feelings and donation behavior of different organizations .(4) There exist many other influencing factors that need to be developed about online donation willingness. For example, what roles do response cards and letters of thanks that donors receive play in the model of donation decision-making? Does receiving letters of thanks have a significant impact on future donations? Is there any difference in the attitude on letters of thanks between donors with low frequency and high frequency? In addition, is it possible that donation behaviors stem from religious beliefs or donation habits? Would they last? Would the habit be interrupted by indifferent attitudes charity organizations hold? Would the relationship commitment of donors be improved if charitable organizations promise them in advance? Further research is needed to demonstrate the abovementioned issues.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.YZ was responsible for determining the theme and completed most of the writing. WT was responsible for issuing and collecting the data and completed data analysis. Both authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. 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