Abstract
The global nursing shortage poses challenges to healthcare accessibility, clinical outcomes, and patient safety. Researchers have explored factors that influence nursing attrition, and the Nurses’ Perceived Professional Benefits (NPPB) is one such factor that has gained attention. This cross-sectional study aims to assess the NPPB among registered nurses in Macao, a multicultural city with a unique healthcare system. A 33-item online questionnaire was used to collect data from 279 nurses. The questionnaire measured NPPB across 5 dimensions: positive occupational perception, personal enhancement, recognition from family and friends, decent nurse-patient relationships, and team belongingness. This study indicated that Macao nurses had a moderate level of NPPB. Nurse-patient relationships, income, and job stability received the most positive responses, while team belongingness received the lowest scores. These findings suggest that improvements are needed in team building, providing more opportunities for specialized training, and offering more career advancement opportunities.
Keywords
Introduction
Nurse shortages pose a significant challenge globally, 1 prompting governments in various countries to implement strategies such as recruiting nurses from abroad, increasing nursing training programs, and redistributing certain responsibilities to other healthcare professionals. 2 Another crucial approach to addressing this issue is to prevent the loss of the nursing workforce. 3 Research studies have considered positive and negative psychology to investigate the challenges faced by nurses, aiming to improve their well-being, enhance nursing care, and reduce attrition rates.4 -6 These studies have explored various aspects, including job satisfaction, work-family stress, and professional status, among others. Within these aspects, nurses’ perceived professional benefits (NPPB) have received considerable attention.7 -9
NPPB refers to the rewards and advantages associated with the nursing profession that are recognized and valued by nurses. These benefits play an important role in retaining nurses within the profession.7 -9
Review of the Literature
Numerous studies have examined the factors influencing NPPB in different regions and countries, revealing that these factors may have varying effects depending on the cultural backgrounds and healthcare systems.7 -9 One of the earliest studies conducted in Canada in 1995 suggested that nurses who were working as clinical instructors for nursing students or junior staff could enhance professional competence and improve NPPB. 10 A study conducted in Tianjin, China identified organizational support and support from family and friends as the most significant factors influencing NPPB. 11 Another recent nationwide study in China indicated that organizational policies, salary, and career development were significant factors influencing NPPB. 12
In general, NPPB is influenced by various factors, including sociodemographic characteristics, workplace environment, and individual experiences.7,13,14 Sociodemographic characteristics such as gender, age, marital status, and educational level have been consistently associated with NPPB.7,13,14 Nurses working in critical care units, occupying higher-level working positions, and engaging in clinical teaching activities tend to exhibit higher levels of NPPB.10,13 Moreover, nurses who actively participated in anti-epidemic efforts during the COVID-19 pandemic and those involved in scientific research activities also reported higher levels of NPPB. 15 However, it is important to note that these findings may not apply to all cultural backgrounds, particularly in regions with unique healthcare systems. 16
Although studies related to NPPB can be found in various cities in mainland China, no such study has been conducted in the unique multicultural city of Macao, which was a former Portuguese colony and is now under Chinese rule. The healthcare system in Macao is also distinct, combining elements from Portugal, China, and even Australia, as the major governmental hospital in Macao is accredited by an Australian healthcare organization. 17 Research has shown that healthcare research outcomes in Macao may differ from those in mainland China and Portugal. 18
Macao’s healthcare system is characterized by a mix of public and private services, ensuring access to medical care for its residents. The public healthcare sector, managed by the Macao Health Bureau, offers a range of services, including hospitals, health centers, and outpatient clinics, all staffed by trained nursing professionals. 19 Nurses play a crucial role in patient care, health education, and community outreach, serving as the primary point of contact for patients in both hospital and community settings. In recent years, there has been a growing emphasis on enhancing nursing education and professional development, aiming to improve the quality of care and meet the evolving health needs of the population. 19 Despite these advancements, challenges remain, including increasing demand for services, the need for better integration between the public and private sectors, and a shortage of nurses in Macao. 19 The Macao Health Bureau has been planning to expand the number of students at the only 2 nursing institutes to address the shortage in the nursing workforce. 20
Macao has a total population of 682 500 in 2021, 20 and there are only 2742 registered nurses, resulting in a nurse-to-population ratio of 40 per 10 000 people. 20 This ratio is lower than that of many developed countries, such as Finland, Sweden, and Belgium, which have around 200 nurses per 10 000 population, and Canada, the United Kingdom, and Denmark, which have a nurse-to-population ratio of around 100 per 10 000 people. 21 The shortage of nurses in Macao leads to increased workloads in clinical settings, which can result in various physiological and psychological problems under pressure. Ultimately, these issues may impact the quality of nursing care.
This study aimed to investigate the level of NPPB in Macao and explore the factors that influence it through a questionnaire survey. By understanding these factors, healthcare organizations can develop strategies to enhance NPPB, which may improve job satisfaction, retention rates, and the overall quality of nursing care.
Methods
This is a cross-sectional study using an online platform to distribute questionnaires and collect responses from participants. The participants of this study were nurses registered in Macao. The number of registered nurses in Macao was 2742 at the time of performing this study. 20 Participants were recruited through a nursing professional online group, the WeChat Macao Nursing Group. This study employed convenience sampling and the questionnaires were distributed to participants via Google Forms from 1st December 2022 to 20th January 2023. The inclusion criteria were Macao registered nurses who were willing to participate in this study and could read Chinese.
One method for estimating the required number of participants in a cross-sectional study is to multiply the number of questions in a questionnaire by 5 to 10. 22 There were 33 questions in this questionnaire, so the required sample size was between 165 and 330. The final number of completed questionnaires obtained in this study was 279.
Nurses’ Perceived Professional Benefits Scale
The questionnaire used in this study consists of 2 parts: general information (Supplemental Material 1) and the Nurses’ Perceived Professional Benefits Scale (NPPBS; Supplemental Material 2). The General Information Questionnaire is designed to gather essential demographic data from participants in the study. It includes questions regarding gender, age, marital status, educational attainment, and employment-related information, such as job category and workplace setting. Furthermore, it assesses work experience, shift patterns, participation in epidemic prevention efforts, involvement in scientific research, and monthly income. Collecting this information is crucial for understanding the diverse backgrounds of participants, as these factors may influence their experiences and perspectives related to nursing professions.
The NPPBS was developed by Hu and Liu, 23 and it is a 33-item scale divided into 5 dimensions. These dimensions include positive occupational perception (7 items), personal enhancement (8 items), recognition from family and friends (6 items), decent nurse-patient relationships (6 items), and team belongingness (6 items). Supplemental Material 3 provides an overview of the questions corresponding to each dimension. The NPPBS employs a 5-point Likert scoring method, ranging from “strongly disagree” to “strongly agree” (scored from 1 to 5). Higher scores indicate a stronger sense of occupational benefits, with a total score range of 33 to 165. The scale demonstrates good reliability and validity, with Cronbach’s α reliability coefficient of .958 for the overall scale and Cronbach’s α coefficients ranging from .821 to .893 for each dimension. 23 The split-half reliability coefficients range from 0.813 to 0.938. The content validity index (CVI) is 0.970, and the 5 dimensions explain 65.031% of the total variance. The I-CVI ranges from 0.83 to 1.00. 23 The NPPBS is widely used in different regions of China to assess nurses’ occupational benefits.24 -27
In this study, the stability of the NPPBS was evaluated using a test-retest reliability test. Thirty Macao registered nurses were asked to complete the questionnaire twice, with a 14-day interval between completions. The answers from the 2 administrations of the questionnaire were compared and analyzed. The results showed that the test-retest reliability coefficient for nurses’ perceived professional benefits was r = .887, P < .001, indicating that the questionnaire has acceptable stability.
The internal consistency of the NPPBS was tested among the 279 participants using Cronbach’s α analysis. The results reflected acceptable reliability of the data measured by the scale, as indicated by the overall Cronbach’s α value of .943. The range of Cronbach’s α values for the different dimensions was .735 to .823.
The original questionnaires were in Chinese and participants answered in Chinese. We have included translated versions of the questionnaires in the Supplemental Materials 1 and 2, which are solely for the readers of this article.
Ethical Consideration
Informed consents were obtained from all participants after a detailed explanation of the research. The questionnaires were anonymous, and all questions were required to be answered for successful submission through the Google Form. The questionnaires were designed for self-administration, and the authors’ contact details were provided for all participants. This study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies, as specified in the EQUATOR Checklist.
Statistical Analysis
SPSS 22.0 software was used to conduct data analysis, with P < .05 set as the significance level. Inferential statistical analyses were performed using independent-sample t-tests and one-way analysis of variance (ANOVA) to examine whether there were significant differences in overall perceived professional benefits and their dimensions among nurses with different demographic backgrounds who participated in the survey. Multiple regression analysis was used to examine the influencing factors of perceived professional benefits and their dimensions among the nurses surveyed. We employed forward stepwise modeling to develop multiple regression models. We began with the outcome variable, the total score of the NPFPS, and incorporated additional variables one at a time. Each variable was retained in the model only if its inclusion improved the statistical power; if not, it was excluded. This systematic approach allowed us to identify the key predictors that significantly influence the total score of the NPFPS.
Results
The majority of participants in this study were female (82.2%), had siblings (85.7%), and were required to work night shifts (71%; Table 1). They had work experience ranging from 6 to 10 years (38.7%) and were working in clinical practice settings (95%; Table 2). The age distribution of participants fell between 30 and 39 years old (53.8%). The average age of all participants was 34.9 years. Approximately half of the participants were either married or single, only 4% were divorced. Seventy-seven percent of participants reported monthly earnings ranging from MOP 40 000 to 60 000 (approximately USD 4963-7445; Table 2). Most participants worked in internal medicine, followed by surgery and outpatient department (Table 2).
Perceived Professional Benefits Scale Scores by Dimensions: Nurses’ Responses to Dichotomous Variables (N = 279).
Note. 1 = positive occupational perception, 2 = personal enhancement, 3 = recognition from family and friends, 4 = decent nurse-patient relationships, and 5 = team belongingness. The P-value of less than .05 is italicized.
Perceived Professional Benefits Scale Scores by Dimensions: Nurses’ Responses to Polytomous Variables (N = 279).
Note. 1 = positive occupational perception, 2 = personal enhancement, 3 = recognition from family and friends, 4 = decent nurse-patient relationships, and 5 = team belongingness.
1 USD is approximately equivalent to 8 MOP (Macao Patacas).
P < .05. **P < .01. ***P < .001.
The overall mean NPPBS score for all the participants was 3.84. Among the dimensions, decent nurse-patient relationships received the highest score of 3.93, while the team belongingness dimension obtained the lowest score of 3.68. The other 3 dimensions, namely personal enhancement, positive occupational perception, and recognition from family and friends, had mean scores of 3.88, 3.87, and 3.81, respectively.
Among the 33 questions comprising the NPPBS, the item assessing the stability and security of income in the nursing profession received the highest score of 4.12 (Figure 1, question 19). Conversely, the question regarding receiving guidance and recognition from superiors obtained the lowest score of 3.44 (Figure 1, question 22). The mean scores for each of the 33 NPPBS questions can be found in Supplemental Material 3.
Mean scores for the 33 questions on the Nurses’ Perceived Professional Benefits Scale (NPPBS). The y-axis represents the score, while the x-axis corresponds to the question number as indicated in Supplemental Material 2.
Dichotomous Variables
The participants engaged in scientific research demonstrated higher scores across all 5 dimensions, although statistical significance was observed solely in the personal enhancement dimension (Table 1). The involvement of clinical instruction was found to have a positive impact on the NPPBS scores (Table 1). Participants who were clinical instructors obtained higher scores in all 5 dimensions, specifically in the personal enhancement, decent nurse-patient relationships, and team belongingness dimensions.
Concerning gender differences, the male participants exhibited lower average scores across all 5 dimensions compared to their female counterparts (Table 1). However, statistical significance (P < .05) was observed only in the decent nurse-patient relationships dimension.
In terms of other participant characteristics, such as having siblings, working night shifts, and engaging in epidemic prevention efforts, no statistically significant differences were observed in their NPPBS scores. These characteristics were found to have similar scores on the NPPBS (Table 1).
Polytomous Variables
Regarding the different age groups, older participants exhibited enhanced self-reported nurse-patient relationships and team belongingness (Table 2). Interestingly, participants with the level of education as a specialized diploma obtained the highest scores across all 5 dimensions, followed by those with a Master’s degree or above, while participants with a Bachelor’s degree attained the lowest scores (Table 2). Among the 5 dimensions, 4 of them showed statistically significant differences. Furthermore, as older participants generally possess more years of working experience, the scores demonstrated an increasing trend from shorter to longer years of experience. Married participants obtained higher scores in all 5 dimensions compared to their single counterparts.
Among the various workplace settings, participants in the operating room achieved the highest overall scores, while psychiatry, intensive care, and the emergency department obtained the lowest overall scores. It is worth noting that participants working in obstetrics and gynecology or pediatrics obtained high scores in 4 dimensions, but relatively lower scores in the recognition from family and friends dimension. Participants in psychiatry demonstrated relatively high scores in terms of nurse-patient relationships. The scores for internal medicine and surgery were relatively stable across all 5 dimensions.
There were no significant differences observed in perceived professional benefits among participants with different income levels and job categories.
Stepwise Multiple Regression Analysis
The final multiple regression analysis model contains 6 variables (Table 3) and obtained a joint explanatory variance of 0.172. This indicates that 17.2% perceived professional benefits can be influenced by the participants’ workplace, marital status and whether they were clinical instructors or not. The F-value for the R2 change is 10.60, P < .001, indicating that the regression model explains a significant amount of variance. In terms of the individual variables’ explanatory power, the variable “workplace (internal medicine)” has the highest predictive power, with an explanatory power of 5.4% (β = .319, t = 5.31, P < .001). The next is “marital status (unmarried),” with an explanatory power of 4.2% (β = −.203, t = −3.68, P < .001). The explanatory powers of clinical teaching (yes), workplace (surgery), workplace (obstetrics and gynecology/pediatrics), and workplace (operating room) are 2.9%, 2.3%, 2.1%, and 2.1% respectively.
Multiple Regression Analysis of Scores on the Nurses’ Perceived Professional Benefits Scale.
Note. Joint explanatory variance = 0.172, F = 10.60, P < .001.
Discussion
The total score of the NPPBS for all the participants in this study was 126.63, with a standardized score of 76.7%, indicating a moderate level of perceived professional benefits for Macao nurses. 28 Our statistical analysis reveals several demographic and professional factors associated with higher NPPB. Particularly, female nurses tend to report higher NPPB, which aligns with existing research indicating that they often engage more in collaborative practices and patient-centered care, thereby enhancing their perceived benefits from the profession. 8 Additionally, nurses who have conducted scientific research demonstrate higher NPPB. Engaging in research enhances their skills and knowledge, leading to improved confidence and a greater sense of professional growth. 29 Furthermore, the role of clinical instructor is linked to higher NPPB, as this role involves mentoring and teaching, which reinforces a nurse’s sense of professional value and commitment to high standards of care. 29
Marital status also appears to influence NPPB positively, being married is associated with higher perceived benefits, suggesting that the support systems provided by marriage contribute to greater job satisfaction and professional engagement. 29 Moreover, nurses with more years of work experience report higher NPPB, as increased experience is often correlated with greater confidence and familiarity with best practices, thus enhancing their perceived benefits. 30
These personal and professional factors positively affected the overall NPPB and varied across its different dimensions
Decent Nurse-Patient Relationships
Among the 5 dimensions of the NPPB assessed, the dimension of decent nurse-patient relationships obtained the highest mean score, which aligns with the findings reported by Xin et al. 31 In particular, question 13 (Supplemental Material 3) within this dimension obtained the highest score (Figure 1), suggesting that nurses experience a sense of professional worth when they can save patients’ lives and receive gratitude from both the patients and their families. A previous study has found a positive association between nurses’ perceived professional benefits and their job satisfaction. 32 When patients and their families understand the work and responsibilities of nurses, it encourages a stronger professional identity, which in turn leads to a higher sense of job satisfaction.
This study revealed that female nurses had a higher score in the decent nurse-patient relationships dimension, which is consistent with the findings of a study conducted in mainland China. 33 This could be attributed to the fact that female nurses in China may possess better communication skills and relationship-building abilities compared to their male counterparts. 34 Additionally, older nurses also tended to have higher scores in this dimension, which aligns with previous research. 33 This may be due to the accumulation of experience and enhanced communication skills over time, enabling older nurses to establish stronger relationships with patients compared to younger nurses.
Personal Enhancement
The dimension with the second-highest score was personal enhancement. Within this dimension, question 17 (Figure 1) received the highest score, indicating that nurses value and appreciate life when they witness patients suffering from illnesses (Supplemental Material 3). On the other hand, question 6 obtained the lowest score, suggesting that nurses experience personal growth, broaden their horizons, and enhance their ability to be tolerant of others (Supplemental Material 3). These findings align with the theory of existential meaning, which posits that individuals can find meaning in life through creative work, experiencing values related to their work or culture, and finding meaning in suffering. 35 Additionally, the Social Exchange Theory suggests that helping others brings various benefits, including an improved sense of self-worth and increased happiness. 36
The scores in the personal enhancement dimension were particularly higher among participants who held the role of clinical instructors and researchers. This finding is consistent with a previous study, 10 which indicated that nursing clinical instructors and researchers often require additional study and continuous knowledge updates. Consequently, their sense of personal enhancement may also be heightened due to these professional demands.
In Macao, nurses not only perform professional procedures but also provide comprehensive nursing care to patients. However, the ongoing issue of nursing shortages, coupled with an increase in infectious diseases, has resulted in a significant rise in nurses’ workload. Consequently, this has led to higher levels of work pressure and occupational fatigue among nurses. Studies conducted by Li and Zhang 37 have found a negative correlation between nurses’ perceived professional benefits and occupational fatigue. Furthermore, research has demonstrated that occupational fatigue has detrimental effects on the physical, behavioral, and emotional well-being of nurses. 38 Therefore, it is crucial to address the workload of nurses to promote their holistic well-being and, consequently, enhance their perceived professional benefits.
Positive Occupational Perception
The dimension of positive occupational perception obtained a similar mean score as the other dimension of personal enhancement. The high score of question 19 indicates that nurses in Macao agreed that their job provided them with a stable and secure income. However, they were less agreeable with the statement that their job gives them a sense of pride in being a “white angel” and helping the sick and injured (Supplemental Material 3).
The median monthly per capita income in Macau was 17 000 Macau patacas in general and 25 000 Macau patacas for healthcare employees. 20 In our study, 77.1% of the participants reported a monthly income in the range of 40 001 to 60 000 Macau patacas. This suggests that nurses in Macau enjoyed higher salaries compared to many other industries, making the nursing profession a stable and secure source of income.
Recognition From Family and Friends
Within this dimension, question 12 received the highest score (Supplemental Material 3), indicating that participants are confident in their ability to provide their families with professional guidance on medical treatment and medication. Conversely, question 14 received the lowest score, suggesting that being a nurse may not allow them to provide convenient medical resources for their families.
Nurses in Macau are required to complete a 4-year Bachelor’s degree program, which includes education in pharmacology, surgery, and other relevant courses. This comprehensive education equips nurses with the necessary knowledge and skills to offer professional guidance in symptom recognition, medication usage, and nursing care. It is worth noting that Macau has a relatively well-established healthcare system, ensuring that individuals can promptly receive treatment when they fall ill. As a result, the importance of nurses providing convenient medical resources for their families may be minimized.
Team Belongingness
This dimension obtained the lowest score among the 5 dimensions. Within this dimension, question 16 received the highest score, indicating that a majority of participants agreed that interacting and communicating with colleagues enhanced their confidence and strength. However, the questions with the lowest scores suggested that participants may have felt a lack of sufficient guidance and recognition from their superiors in their work. Previous research has highlighted that the quantity of communication between nurses and their supervisors can be influenced by factors such as cultural backgrounds, psychological aspects, and perceptual factors. 39 It is important for supervisors to actively listen to nurses and consistently provide guidance and affirmation. This may subsequently enhance nurses’ perceived professional benefits.
It is noteworthy that participants with specialized diplomas exhibited a stronger sense of team belongingness compared to those possessing Master’s degrees or higher. This observation deviates from the findings of a study conducted in mainland China. 39 This discrepancy may be attributed to the unique promotion requirements in Macao, where clinical nurses seeking advancement to higher ranks are typically required to hold specialized diplomas rather than Master’s degrees. Additionally, the limited availability of clinical diploma programs in Macao contributes to this trend, as nurses with specialized diplomas often assume supervisory or managerial roles, encouraging a greater sense of team belongingness. This situation differs from mainland China, where pursuing postgraduate Master’s or PhD degrees is generally considered more challenging than obtaining a clinical diploma. Moreover, these clinical diplomas may not necessarily enhance their prospects for promotion to the higher management rank.
Recommendation
In Macao, registered nurses do not have the authority to diagnose patients’ illnesses, unlike in America, where nurses are entrusted with certain responsibilities akin to those of junior physicians. Currently, the general public in Macao may still perceive nurses as mere assistants to physicians, thereby potentially leading to an untrusting attitude toward them. We propose that promoting nurses’ professionalism through social media channels could enhance public trust in their capabilities.
Another recommendation is to align the nursing workforce with that of most developed countries, such as the United Kingdom, which has around 100 nurses per 10 000 population. 21 The current challenges posed by population aging and the rise in infectious diseases have significantly increased nurses’ workload, resulting in elevated levels of stress among them. By increasing the nursing workforce, we may alleviate this burden and potentially enhance their perceived professional benefits.
At present, Macao has 3 higher education institutions offering nursing-related Master’s degree programs. However, the availability of specialized training diplomas is severely limited. Therefore, we propose that expanding the provision of clinical training courses in Macao would enhance nurses’ personal growth and development, thereby contributing to their perceived professional benefits.
The low score in the team belongingness dimension found in this study indicates a need for improvement in collaboration and integration within the healthcare team. Hospital managers and the multidisciplinary team should promote a supportive environment for nurses. Hospital leadership should create a culture that values the contributions of nursing professionals and encourages open communication among all team members, including doctors and allied health professionals. This may be achieved by implementing regular forums for nurses to express their concerns and suggestions, which will facilitate a more inclusive decision-making process.
Limitation
Due to the limited research resources, we employed convenience sampling in this study. As a result, there are differences in the number of questionnaires on different age groups and job categories, and among different departments and institutions in Macao. The polytomous variables, including age, educational levels, and marital status, were categorized into groups, potentially introducing between-group inequality. Recoding these variables as binary variables could have addressed this issue and enhanced the validity of our findings. Another limitation of this study is the absence of a formal sample size calculation or power analysis before data collection. While we estimated the required sample size based on the number of questions in the questionnaire, a more rigorous approach would have strengthened the study’s validity. These limitations may have introduced sampling bias, limited diversity and reduced the generalizability of our results.
Conclusion
The findings of this study suggest that nurses in Macao have a moderate perception of their professional benefits. Among the 5 dimensions, the decent nurse-patient relationships received the highest score, while the team belongingness dimension obtained the lowest score. To enhance the current state, it is important to raise public awareness, provide channels for nurses to express their concerns and suggestions, establish a comprehensive promotion system, and offer diverse continuing education opportunities. These measures can improve nurses’ perceived professional benefits and contribute to overall improvements in nursing care.
Supplemental Material
sj-docx-1-inq-10.1177_00469580251316966 – Supplemental material for Cross-sectional Study Reveals Moderate Professional Benefits Among Nurses in a Multicultural Healthcare System
Supplemental material, sj-docx-1-inq-10.1177_00469580251316966 for Cross-sectional Study Reveals Moderate Professional Benefits Among Nurses in a Multicultural Healthcare System by Ka Ieng Lai, Pedro Fong and Lirong Meng in INQUIRY: The Journal of Health Care Organization, Provision, and Financing
Supplemental Material
sj-docx-2-inq-10.1177_00469580251316966 – Supplemental material for Cross-sectional Study Reveals Moderate Professional Benefits Among Nurses in a Multicultural Healthcare System
Supplemental material, sj-docx-2-inq-10.1177_00469580251316966 for Cross-sectional Study Reveals Moderate Professional Benefits Among Nurses in a Multicultural Healthcare System by Ka Ieng Lai, Pedro Fong and Lirong Meng in INQUIRY: The Journal of Health Care Organization, Provision, and Financing
Footnotes
Acknowledgements
We acknowledge the invaluable contributions of all the participants and nursing colleagues involved in this study.
Authorship Statement
MIL: Conceptualization, Investigation, Formal analysis, Writing-Original Draft. PF: Conceptualization, Methodology, Writing-Original Draft, Writing-Review and Editing. LM: Conceptualization, Methodology, Writing-Review and Editing, Project administration. All authors read and approved the final manuscript.
Data Availability Statement
Data generated or analyzed during this study may be available from the corresponding author upon reasonable request.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Ethical Approval and Informed Consent Statements
This study was ethically approved by the Research Ethics Committee of Macao Polytechnic University, Faculty of Health Sciences and Sports (ESCSD/ MSN-024/2021) on 20th September 2021. Written consent was obtained from all participants before taking part in this study. The collected data were kept confidential and used only for the purpose of this study. This research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki.
Supplemental Material
Supplemental material for this article is available online.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
