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Article History

Received: 6 December 2024

Accepted: 13 November 2025

First Online: 3 December 2025

Competing interests

: The authors declare no competing interests.

: The study was conducted in accordance with the Declaration of Helsinki and followed the Measures for Ethical Review of Biomedical Research Involving Human Beings issued by the National Health Commission of the People’s Republic of China. In fulfillment of the requirements for international collaborative research as stipulated in the Declaration of Helsinki (Article 23), the research protocol was reviewed and approved by research ethics committees in both the host country (China) and the sponsoring institution’s country (Malaysia). Approval was granted by the Ethics Committee of the Fifth Hospital of Yulin City (Shaanxi Province, China) on December 25, 2023 (Approval No: 20231225E2) and the Human Research Ethics Committee of Universiti Sains Malaysia on November 15, 2024 (Approval No: USM/JEPeM/PP/24080647). The scope of the approval covered all procedures involving human participants, including participant recruitment, the informed consent process, and the administration of questionnaires as described in this study.

: Written informed consent was obtained from all participants by trained research assistants (postgraduate students in social work and psychology) prior to their participation in the study. The signing of the informed consent forms took place on-site in private consultation rooms at the Fifth Hospital of Yulin City between late November and early December 2024. Prior to consenting, participants received an information sheet and a verbal explanation of the study’s purpose, procedures, and risks. They were also assured of their right to withdraw and that their data would be kept confidential and used only for anonymized analysis and publication. The signed consent form explicitly covered permission for participation, the use of anonymized data for research purposes, and the publication of aggregated findings.