Pusat Pengajian Sains Kesihatan - Tesis

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Factors associated with hiv infection among sexually transmitted infection- clinic attendees in Kelantan, 2016- 2022
(2023-06)
Aminuddin, Abdul Mukmin M.
Background: The changing landscape of Human immunodeficiency virus (HIV) infection shifting from drug abuse to sexual contact as the primary of HIV transmission brought about new challenges in combating the spread of HIV worldwide and Malaysia is no exception. In response, Malaysia initiated state- based sexual health clinics in 2016 to reach out to those at risk, which was found to be effective in delivering HIV services that include early detection and prevention of HIV transmission among high-risk individuals as well as providing treatment for HIV positive patients. For Kelantan state, the Sexually Transmitted Infection (STI) clinics as they are known, was first established in Klinik Kesihatan Bandar Kota Bharu in 2016 expanded to include all the 10 districts 3 years later. Objective: This study aimed to determine the proportion of HIV positivity and factors influencing HIV infection among patients with STI who attended STI clinics in Kelantan from 2016 to 2022. Methodology: This study utilized a cross-sectional design whereby data were collected by extracting information from the records of patients who visited STI clinics in Kota Bharu, Pasir Puteh and Tumpat from the year 2016 to 2022. Logistic regression analyses and model were performed to identify factors related to HIV positivity among patients who attended STI clinics in Kelantan. Results: Out of 247 patients who attended the STI clinics involved in the study, 228 cases (93.3%) had documented HIV test results, of which 75 cases (32.9%) were HIV-positive. Significant factors associated with HIV infection among STI patients included age ≥30 years (AOR: 1.857, 95% CI 1.010, 3.416, p<0.046), male gender (AOR: 5.807, 95% CI 1.324, 25.466, p=0.020), divorced status (AOR: 9.407, 95% CI 1.074, 82.398, p= 0.043), working in private sector (AOR: 3.844, 95% CI 1.744, 8.473, p=0.001), and had syphilis (AOR: 6.612, 95% CI: 3.567, 12.259, p<0.001). Conclusion: About one third of the respondents were HIV positive and based on the final model, were associated with 3 factors- male gender, divorced and confirm STI diagnosis of syphilis. Strategies needed to prevent HIV positivity among the STI clinic attendees should address and focus on these 3 factors first.
Development, validation of competency questionnaire, analysis of its predictors and mediators for the adoption of health information system amongst nurses in Hospital Universiti Sains Malaysia
(2023-12)
Aziz, Naveen Azizen
Introduction: This study builds upon the importance of robust health systems in the wake of a pandemic and the need for increased organisational readiness for change, particularly in the Malaysian healthcare sector. The effectiveness and suitability of instruments employed to gauge organisational readiness have been the subject of considerable discussion and contention. Despite efforts to assess organisational readiness, over 70% of organisational change management initiatives fail to achieve their intended goals because of employee resistance and insufficient support from the management. This study focuses on the competency component of organisational readiness and its significance in facilitating digital health adoption. Digital health adoption failure has been widely documented in developed and developing economies. This study examined staff competencies, the predictors and mediators that influence employees’ competencies necessary for health information systems. The first objective was to develop and validate a competency questionnaire that forms a component of organizational readiness for health information system adoption among nurses in Hospital University Sains Malaysia (USM) in Kelantan, Malaysia. Followed by which the second objective determined the current competency level utilising the developed and validated questionnaire. The third objective was to identify the predictors while the final objective was to identify the mediating factors associated with the current competencies amongst nurses. Methods: After generating the items, a cross sectional study was conducted with 180 nurses, and an exploratory factor analysis was conducted to reduce the number of items and identify the latent constructs, followed by the recruitment of 305 nurses for confirmatory factor analysis (CFA) and evaluation of construct validity. The study continued with the recruitment of 420 nurses from hospital USM to assess the current staff competency for health information system adoption. Linear regression was conducted to identify the potential predictors that influenced competencies. Two mediation models were analysed to identify the mediators that influenced nurses’ competencies in the adoption of health information systems. Results: The final model for competency comprised of 18 items, which demonstrated a good model fit, as suggested by the CFA. The questionnaire displayed excellent convergent and discriminant validity, with all constructs having a correlation coefficient greater than 0.7 for domains with three or more items. The mean values for the Individual domains of Knowledge, Skill, and Attitude are 16.8, 11.0, and 31.0 respectively, with corresponding standard deviations of 3.04, 2.06, and 5.64. Similarly, the mean values for the Team domains of Knowledge, Skill, and Attitude are 15.6, 9.6, and 8.5 respectively, with corresponding standard deviations of 3.01, 2.08, and 2.44. The results for the Individual, Team, and Staff competencies were found to have mean scores of 58.6, 33.8, and 92.4 respectively, with corresponding standard deviations of 9.50, 6.21, and 13.9. In the regression analysis, no predictors were found to explain current staff competency. However, mediation analysis revealed that positional grade served as a mediating factor in the relationship between age and years of experience, mediating the effects of the two variables on staff, individual, and team competencies through competitive mediation classified under partial mediation. Conclusion: The competency questionnaire demonstrated exceptional psychometric properties with adequate validity and reliability and is thus suitable for use in any study pertaining to the adoption of health information systems among nurses. Additionally, the study identified grade as a potential mediator that exhibits competitive mediation effects through age and years of experience, respectively, to influence competencies related to the adoption of health information systems.
Confirmatory factor analysis of the Malaysia medication adherence assessment tool (MYMAAT) among patients with chronic medications
(2024-03)
Tian, Ong Gaik
The MyMAAT was developed using Exploratory Factor Analysis and the current study intends to confirm the measurement model, dimensionality and ensure the factor structure by Confirmatory Factor Analysis (CFA). A cross-sectional study was conducted using a self-report questionnaire at six health facilities in the Federal Territories Kuala Lumpur and Putrajaya Health Department between May to November 2023. Participants with age≥18 years old, prescribed with one or more chronic medications for at least six months and understand English or Malay language were selected using quota sampling. There were two constructs in the MyMAAT, namely the Specific Medication-Taking Behaviour (Factor 1) with eight items and the Social-Cognitive Theory of Self-Efficacy and Social Support (Factor 2) with four items. There were 470 participants which comprised of Malay (62.7%), Chinese (24.0%) dan Indian (12.2%). Most participants had five drugs or less (81.3%). The final model for the Malay version of the MyMAAT retained the two constructs and 12 items with good fit: CFI=0.978, TLI=0.973, RMSEA=0.036(90%CI 0.001,0.067) and with good composite reliability CR=0.790 for Factor 1 and CR=0.787 for Factor 2. The factor loadings ranged from 0.413 to 0.832 with p-value<0.001 The AVE for Factor 1 was 0.664 and for Factor 2 was 0.491. There was a strong correlation (ρ=0.507, p < 0.001) between the Malay version of the MyMAAT with the Malay version of the MMAS-8 by adherence category from the data of 191 participants. The final measurement model of the English version did not achieve the minimum level of good fit to the data: CFI=0.933, TLI=0.917, RMSEA=0.073(90%CI 0.052,0.094) but had good composite reliability CR=0.802 for Factor 1 and CR=0.852 for Factor 2. The factor loadings ranged from 0.347 to 0.845. The AVE was 0.630 for Factor 1 and 0.392 for Factor 2. Fifty-two participants completed the test-retest after five to ten days from the first administration. The Malay version had moderate to excellent reliability based on ICC=0.932(95%CI:0.661,0.986) for Factor 1 whereas Factor 2 had poor to excellent reliability based on ICC=0.956(95%CI:0.325,0.997) by using the Two-Way Mixed Model and Consistency type. The English version had moderate to excellent reliability based on ICC=0.911(95%CI:0.554,0.982) for Factor 1 whereas Factor 2 had poor to excellent reliability based on ICC=0.941(95%CI:0.092,0.996). It can be concluded that the Malay version of the MyMAAT is valid and reliable in measuring medication adherence among participants with chronic medication(s), but the English version needs to be improved and then re-tested
Development and validation of knowledge and attitude questionnaire on intellectually disabled adolescents' health issues and accessibility to primary healthcare services among primary healthcare providers
(2024-02)
Ismail, Nur Akmal
Background: Adolescents who have intellectual disabilities face distinct health challenges that necessitate specialized care and understanding. Accessing primary healthcare services poses further challenges for this population. The objectives of this study were to explore intellectually disabled adolescents’ health issues and their accessibility to primary healthcare services and subsequently develop a new questionnaire to assess primary healthcare providers' knowledge and attitudes regarding those concerns. Methodology: The study was conducted in two phases using a mixed-method approach. The first phase involved a questionnaire development based on an extensive literature review, in-depth interviews, content validation, face validation, and pretesting. In-depth interviews were conducted among 26 respondents including 12 caregivers, 10 primary healthcare providers who had experience in managing intellectually disabled adolescents, and four health and medical experts in the management of intellectual disabilities. They were selected using purposive sampling method. Data were analyzed using thematic analysis. The qualitative study findings informed item generation. The content validation was performed among seven experts and face validation was conducted among 10 primary healthcare providers in Kelantan. The second phase involved item response theory (IRT), exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to measure the questionnaire’s internal structure validity and reliability. A cross-sectional study was conducted among 444 primary healthcare providers to assess IRT, EFA and CFA. A multistage sampling was used to select the healthcare providers from 20 government primary health clinics in Kelantan. Result: The qualitative findings identified intellectually disabled adolescents’ health issues such as medical conditions, mental health conditions, developmental disabilities, high-risk behaviours, nutrition-related problems, as well as sexual and reproductive health issues. The findings also identified their challenges in accessing primary healthcare services according to Levesque’s model namely, approachability, acceptability, availability, affordability and appropriateness. The findings from qualitative study and literature reviews were integrated into the development of new knowledge and attitude questionnaire. An initial questionnaire was developed with 59 knowledge items and 61 attitude items within nine domains. Following the content validation, face validation, IRT for knowledge section and EFA as well as CFA for attitude section, the final questionnaire has resulted in 14 general information items, 38 knowledge items, and 28 attitude items within the same nine domains. Conclusion: A new Malay-validated questionnaire demonstrated strong reliability and valid psychometrics for assessing primary healthcare providers’ knowledge on health issues of intellectually disabled adolescents and their attitudes towards these adolescents’ accessibility to primary healthcare services.
Mental health help-seeking intention among health workforce in pahang: validation of mbace, barriers, associated factors, and the development of psyhelp pocket guide
(2024-02)
Kunyahamu, Muhammad Syafiq
Introduction: The health workforce’s mental well-being is crucial for healthcare systems’ sustainability. While it is recognised that the health workforce are exposed to high-stress and demanding situations due to the nature of their roles, some of them do not seek professional help when facing mental health challenges. Although the importance of ensuring that these individuals receive adequate mental health support is evident, numerous factors influence their decisions in seeking professional help. This intricate interplay requires a comprehensive examination, not just to inform effective strategies and interventions but also to foster a deeper understanding of the underlying complexities. Objectives: The primary aims were to: (1) translate, adapt, and validate the Barriers to Access to Care Evaluation (BACE-3) questionnaire for the Malay-speaking population, (2) determine the mental health help-seeking intention score, barriers, and associated factors among the health workforce in Pahang, and (3) develop the PsyHELP pocket guide to encourage the health workforce to seek help from mental health professionals. Methodology: The research was conducted in three phases. Phase 1 involved a detailed process of translating and adapting the BACE-3 questionnaire into the Malay version (MBACE). This version was then validated using Confirmatory Factor Analysis (CFA) in a cross-sectional study with 188 participants from diverse health workforce categories. The second phase employed a cross-sectional study design, utilising a set of self-administered questionnaires with 470 participants to gauge mental health help-seeking intentions, perceived barriers, and their associated factors. In the third phase, the PsyHELP pocket guide was developed, grounded in the Health Belief Model. This guide serves as an educational tool tailored specifically for the health workforce, aimed at bolstering mental health help-seeking behaviours. Results: The 28-item MBACE questionnaire was proven as a reliable and valid tool for the Malay-speaking health workforce, with Cronbach’s alpha values between 0.92 and 0.94. In Phase 2, the mean mental health help-seeking intention score was noted at 4.9 (SD=1.2). Significant factors associated with this intention were ‘perceived need for help’ (B = 0.532, p < 0.001) and ‘perceived stigma barriers’ (B = -0.588, p < 0.001). In the final phase, the PsyHELP pocket guide was introduced, incorporating insights from the earlier phases and presenting a practical resource for the health workforce. This guide integrates comprehensive mental health concepts and strategies tailored to the health workforce, highlights the importance of professional help, aims to mitigate stigma, and offers actionable steps towards achieving mental well-being. Conclusion: This comprehensive study underscores the complexities of mental health help-seeking behaviours among the health workforce in Pahang. It gives more insights into the mental health help-seeking intention score, as well as the barriers and associated factors within the Malaysian health workforce, highlighting the roles of perceived need for help and perceived stigma-related barriers that are significantly associated with professional mental health help-seeking intention. The validated MBACE questionnaire offers an effective tool to assess barriers, while the PsyHELP pocket guide emerges as a beacon for the health workforce to navigate their mental well-being. While PsyHELP looks like a promising intervention, its full potential and impact require further validation and research.

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