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Background Zoonoses among household pets are recognized as disease and infections transmitted between animals and humans. World Health Organization‐estimated zoonotic diseases have contributed about one billion cases of illness and millions of mortalities every year. Despite the emerging and re‐emerging zoonotic disease, most pet owners are unaware of the risks posed by their pets. As there are a lack of studies assessing infections at home, this study aimed to develop and validate a cognitive, affective and behaviour questionnaire (CAB‐ZDQ) to assess household pets’ zoonotic diseases. Methods This paper covers detailed explanation on the various developmental and validation process stages of the CAB zoonotic disease questionnaire development. The development phase comprised thorough literature search, focus group discussion, expert panel assessment and review. The validation process included pre‐test and pilot testing, data analysis of results, analysis of internal consistency and the development of the final version of the questionnaire. Participants selected represented main ethnicities, gender, levels of education and population type (urban/rural) in the Klang Valley area. Results The items in the questionnaire has undergone various changes in structurally and linguistically. The final refined CAB questionnaire consists of 14 items cognitive (no items removed at pilot phase), nine items affective (one item removed at pilot phase) and five items behaviour (no items removed from pre‐test phase), respectively. Reliability analysis revealed Cronbach's alpha values were 0.700 (cognitive) and 0.606 (affective) which indicated good internal consistency after item reduction. Conclusions The developed questionnaire has proved its feasibility in assessing the Malaysian general population cognitive, affective and behavior regarding the household pets’ zoonotic diseases., This article detailed the process of development and validation of a questionnaire used to assess Cognitive, Affective and Behaviour for humans in relation to zoonotic diseases for pets at home.

BACKGROUND Overweight and obesity among adults is a growing global public health threat and an essential risk factor for various non-communicable diseases. Although intermittent fasting is a generally new dietary approach to weight management that has been increasingly practised worldwide, the effectiveness of two-days per week dry fasting is still unclear. OBJECTIVE This study aimed to determine the cardiometabolic, anthropometric, dietary intake and quality of life changes among overweight and obese civil servants following combined Intermittent Fasting and Healthy Plate (IFHP) and Healthy Plate (HP), and to explore the participants’ experience. METHODS We designed a mixed-method quasi-experimental study that evaluates the effectiveness of IFHP and HP methods among overweight and obese adults. A total of 177 participants were recruited in this study, of which 91 were allocated in the IFHP group and 86 in the HP group. The intervention comprised two phases; supervised (12 weeks) and unsupervised (12 weeks). The data collection was conducted during baseline, after the supervised phase (at week 12), and after the unsupervised phase (at week 24). For each participant, serum and whole blood were collected for analysis. Data on socio-demographic, quality of life, physical activity and dietary intake were also obtained using questionnaires during data collection. RESULTS The majority of the participants were females (n=147, 83.7%) and Malays (n=141, 79.6%). The expected outcomes of this study are changes in body weight, body compositions, quality of life, physical activity, dietary intake and cardiometabolic parameters such as fasting blood glucose, 2-hour post prandial blood glucose, HbA1C, fasting insulin and lipid profile. CONCLUSIONS The CAIFA study is a mixed-method study to evaluate the effectiveness of intermittent fasting on cardiometabolic and anthropometric parameters and to explore participants’ experience throughout the study. CLINICALTRIAL ClinicalTrials.gov NCT05034653

One of the first critical recommendations made by the Malaysian government as part of the COVID-19 prevention measures was social distancing, also known as physical distancing. It has thus become necessary to determine to what extent this measure has successfully prevented the spread of the virus. However, the public has mixed feelings about this topic, so a study is required to understand the present situation. This study aims to assess the public's understanding, attitude, and practice regarding social distancing, particularly during the early stages of the Movement Control Order (MCO). An online survey was conducted from 19 June to 19 July 2020. The study also applied non-probability sampling, an unrestricted, self-selected survey, and the adopted snowballing method. The study concluded that the general public has a high knowledge, practice, and a positive attitude toward physical distancing. In conclusion, human nature is influenced by their understanding, attitudes, perceptions, and intentions to comply with the new practice.

Background Overweight and obesity among adults are a growing global public health threat and an essential risk factor for various noncommunicable diseases. Although intermittent fasting is a generally new dietary approach to weight management that has been increasingly practiced worldwide, the effectiveness of 2 days per week dry fasting remains unclear. Objective The Cardiometabolic and Anthropometric Outcomes of Intermittent Fasting study aims to determine the cardiometabolic, anthropometric, dietary intake, and quality of life changes among civil servants with overweight and obesity, following combined intermittent fasting and healthy plate (IFHP) and healthy plate (HP) and explore the participants’ experiences. Methods We designed a mixed methods quasi-experimental study to evaluate the effectiveness of the IFHP and HP methods among adults with overweight and obesity. A total of 177 participants were recruited for this study, of which 91 (51.4%) were allocated to the IFHP group and 86 (48.6%) to the HP group. The intervention comprised 2 phases: supervised (12 weeks) and unsupervised (12 weeks). Data collection was conducted at baseline, after the supervised phase (week 12), and after the unsupervised phase (week 24). Serum and whole blood samples were collected from each participant for analysis. Data on sociodemographic factors, quality of life, physical activity, and dietary intake were also obtained using questionnaires during data collection. Results Most of the participants were female (147/177, 83.1%) and Malay (141/177, 79.7%). The expected outcomes of this study are changes in body weight, body composition, quality of life, physical activity, dietary intake, and cardiometabolic parameters such as fasting blood glucose, 2-hour postprandial blood glucose, hemoglobin A1c, fasting insulin, and lipid profile. Conclusions The Cardiometabolic and Anthropometric Outcomes of Intermittent Fasting study is a mixed methods study to evaluate the effectiveness of combined IFHP and HP interventions on cardiometabolic and anthropometric parameters and explore participants’ experiences throughout the study. Trial Registration ClinicalTrials.gov NCT05034653; https://clinicaltrials.gov/ct2/show/NCT05034653 International Registered Report Identifier (IRRID) RR1-10.2196/33801

Purpose: This study aimed to assess and explore perceived sustainability and challenges of the intervention among Health Care Providers (HCPs) who were involved. Methods: The study applied mixed-method embedded design to analyze both quantitative and qualitative data. Quantitative approach was used to evaluate sustainability perception from 20 intervention clinics via self-reported assessment form whereas qualitative data were obtained through in-depth interview (IDI) and focus group discussions (FGDs) 14 health care professionals participated in IDI session and were either care coordinators, liaison officers (LOs)/clinic managers, or medical officers-in-charge for the clinic’s intervention. Nine FGDs conducted comprised 58 HCPs from various categories. Results: HCPs from all the 20 clinics involved responded to each listed Enhanced Primary Healthcare (EnPHC) intervention components as being implemented but the perceived sustainability of these implementation varies between them. Quantitative feedback showed sustainable interventions included risk stratification, non-communicable disease (NCD) screening form, referral within clinics and hospitals, family health team (FHT), MTAC services and mechanisms and medical adherence status. Qualitative feedback highlighted implementation of each intervention components comes with its challenges, and most of it are related to inadequate resources and facilities in clinic. HCPs made initiatives to adapt based on clinical setting to implement the interventions at best level possible, whereby this seems to be one of the core values for sustainability. Conclusion: Overall perceptions among HCPs on sustainability of EnPHC interventions are highly influenced by current experiences with existing resources. Components perceived to have inadequate resources are seen as a challenge to sustain. It’s crucial for stakeholders to understand implications affecting implementation process if concerns raised are not addressed and allocation of needed resources to ensure overall successfulness and long term sustainability.

BACKGROUND Home is a vulnerable place for accidental child injuries. Unintentional injuries are a leading cause of death, hospitalization, and disabilities. These injuries are considered preventable and if not tackled, they will continue to be a persisting problem. Smartphones have become increasingly important in our everyday life and is an important tool not only for communication but also for other purposes—they have apps that can be used for various purposes. Therefore, an app-based intervention (ChildSafe) was developed to assess and reduce child injury at home. OBJECTIVE This study aimed to evaluate the acceptance of the ChildSafe smartphone app intervention by parents/guardians. METHODS This study was conducted using a qualitative exploratory approach on selected participants of the ChildSafe intervention app study. A total of 27 semistructured in-depth interviews were carried out among parents or guardians who have at least one child between the age of 0 and 59 months in the area of Sungai Buloh, Selangor, between November 2017 and March 2018. Interview questions were developed from the consolidated framework for implementation research (CFIR). Interviews were recorded, transcribed verbatim, and data were thematically analyzed guided by CFIR. RESULTS The study revealed users’ perception on usability, feasibility, and acceptability toward the ChildSafe app. Three CFIR domains were identified: intervention characteristics, inner setting, and characteristics of individuals. A total of 5 constructs were revealed under intervention characteristics: evidence strength and quality, relative advantage, adaptability, trialability, and design quality and packaging; 2 under inner setting: implementation climate and readiness for implementation; and 4 under characteristics of individuals: knowledge and beliefs about the intervention, self-efficacy, individual stage of change, and other personal attributes. In general, participants felt the app is extremely useful and effective, easy to use, and purposeful in achieving home safety assessment via reminders. The app replaces the need for participants to search for information on home safety and dangers, as the app itself was designed as a tool to assess for this specific purpose. Even at the nascent stage and despite its limitations, the app has prompted users to consider and make changes around their own home. However, future versions of the app should be expanded to make it more attractive to users as it lacks interactive feedback and additional features. CONCLUSIONS Parents/guardians are accepting the use of the ChildSafe app to prevent child injury at home. However, further expansion and improvements are needed to increase the acceptability of this app by parents/guardians.

Background Implementation of the new Enhanced Primary Health Care (EnPHC) intervention aims to improve service quality and experience at primary healthcare clinics; especially to newly diagnosed patients. This was achieved by restructuring and improving existing services to better manage non-communicable diseases amongst patients. Objectives of this study are to explore patients’ experiences of the EnPHC intervention, to document their feedback and to determine effects of EnPHC intervention on patients. Methods This phenomenological qualitative study focussed on patients’ experiences in relation to EnPHC interventions. Participants were purposely selected from a group of patients who attended the eight intervention primary healthcare clinics in Johor and Selangor regularly for treatment. Data collection was conducted between April to July 2018. Semi-structured interviews were conducted at average an hour per interview for four to five patients per clinic. Interviews were audio recorded, transcribed verbatim, coded and analysed using a thematic analysis approach. Results A total of 35 patients participated. Analysis revealed five main themes about patient experiences receiving the EnPHC intervention. These are: (1) health assessment in disease progress monitoring, (2) patient-doctor relationship and continuity of care, (3) professionalism in service delivery, (4) ensuring compliance in achieving health targets and (5) communication skills. Each theme represents an important aspect of the service, how it should be delivered within the patient expectations and how it can improve patient’s health through their lens. Conclusion Even though patients were not able to exactly identify the EnPHC intervention components implemented, they are able to describe the process changes that occurred; enabling them to improve their healthcare status. Engagement is necessary to better inform patients of the EnPHC intervention, its purpose, mechanisms, changes and importance for healthcare. It would reduce resistance and increase awareness amongst patients at the clinic.

Background Malaysia has committed to the global call to achieve universal health coverage, and with the adoption of Sustainable Development Goals, is further strengthening the health system through the primary health care services, particularly the family doctor concept. The Enhanced Primary Health Care (EnPHC) initiative was implemented to address the worrying upward trend of non-communicable disease prevalence, and incorporates the Family Health Team (FHT) concept. The aim of this paper is to describe the implementation of the FHT as part of the EnPHC intervention. Methods In-depth interviews and focus group discussions were conducted with the intervention design team, healthcare providers and patients in two rounds during the implementation period. A total of 121 individuals in the two rounds, split into different groups, where some of the participants of the FGD were also interviewed individually. Data were analysed using a thematic analysis, with codes being organised into larger themes. Results Themes that emerged from the data were around the process of FHT implementation and the advantages of the FHT, which included continuity of health care and improved quality of care. Patients and health care providers were receptive to the FHT concept, and took the effort to adapt the concept in the local settings. Conclusions The FHT concept implemented at 20 public primary health clinics has benefits appreciated by health care providers and patients. Addressing the viable shortcomings would better prepare the current primary healthcare system to scale up the FHT concept nationwide and enhance its feasibility and sustainability. Trial registration The study is registered with the National Medical Research Register, Ministry of Health Malaysia (NMRR-17-295-34711).

Background Home is a vulnerable place for accidental child injuries. Unintentional injuries are a leading cause of death, hospitalization, and disabilities. These injuries are considered preventable and if not tackled, they will continue to be a persisting problem. Smartphones have become increasingly important in our everyday life and is an important tool not only for communication but also for other purposes—they have apps that can be used for various purposes. Therefore, an app-based intervention (ChildSafe) was developed to assess and reduce child injury at home. Objective This study aimed to evaluate the acceptance of the ChildSafe smartphone app intervention by parents/guardians. Methods This study was conducted using a qualitative exploratory approach on selected participants of the ChildSafe intervention app study. A total of 27 semistructured in-depth interviews were carried out among parents or guardians who have at least one child between the age of 0 and 59 months in the area of Sungai Buloh, Selangor, between November 2017 and March 2018. Interview questions were developed from the consolidated framework for implementation research (CFIR). Interviews were recorded, transcribed verbatim, and data were thematically analyzed guided by CFIR. Results The study revealed users’ perception on usability, feasibility, and acceptability toward the ChildSafe app. Three CFIR domains were identified: intervention characteristics, inner setting, and characteristics of individuals. A total of 5 constructs were revealed under intervention characteristics: evidence strength and quality, relative advantage, adaptability, trialability, and design quality and packaging; 2 under inner setting: implementation climate and readiness for implementation; and 4 under characteristics of individuals: knowledge and beliefs about the intervention, self-efficacy, individual stage of change, and other personal attributes. In general, participants felt the app is extremely useful and effective, easy to use, and purposeful in achieving home safety assessment via reminders. The app replaces the need for participants to search for information on home safety and dangers, as the app itself was designed as a tool to assess for this specific purpose. Even at the nascent stage and despite its limitations, the app has prompted users to consider and make changes around their own home. However, future versions of the app should be expanded to make it more attractive to users as it lacks interactive feedback and additional features. Conclusions Parents/guardians are accepting the use of the ChildSafe app to prevent child injury at home. However, further expansion and improvements are needed to increase the acceptability of this app by parents/guardians.

Health literacy is an indicator of a society’s ability to make better health judgements for themselves and the people around them. This study investigated the prevalence of health literacy among Malaysian adults and provided an overall picture of the society’s current health literacy status, which has not been previously assessed. The study also highlighted socio-demographic markers of communities with limited health literacy that may warrant future intervention. A population-based self-administered survey using the Health Literacy Survey Malaysian Questionnaire18 (HLS-M-Q18) instrument was conducted as part of the National Health Morbidity Survey 2019 in Malaysia. The nationwide survey utilized a two-staged stratified random sampling method. A sample of 9478 individuals aged 18 and above, drawn from the living quarter list, participated in the study. The health literacy score was divided into three levels, limited, sufficient, and excellent. Findings showed a majority of the Malaysian population had a sufficient health literacy level in all three domains—healthcare, diseases prevention and health promotion (49.1%, 44.2%, and 47.5%, respectively)—albeit leaning towards the lower end of the category with an average score of 35.5. The limited health literacy groups were prevalent among respondents with older age (68%), lower education level (64.8%), and lower household income (49.5%). The overall health literacy status for Malaysia was categorized at a lower sufficiency level. Future health literacy improvements should focus on communities with a limited health literacy level to improve the overall score.

BACKGROUND: Referrals are a two-way communication between healthcare facilities to enable information transfer for the continuity of patient care. The Enhanced Primary Healthcare (EnPHC) initiative, a complex intervention package to improve non-communicable disease (NCD) management, introduced improvements to the NCD’s referral mechanism from primary healthcare clinics to the hospital. This study explores the communication process between the Malaysian public primary healthcare and hospital for chronic care management. METHOD: A qualitative exploratory study using purposive sampling was done in all twenty EnPHC intervention clinics. In-depth interviews and focus group discussions were carried out among all healthcare providers working in EnPHC clinics. The 47 interview sessions were audio-recorded, transcribed verbatim, and analyzed thematically. RESULTS: A total of 97 healthcare providers participated. Three main themes of the communication process between the primary health care and hospital during the implementation of EnPHC intervention emerged from the analysis. These are; (1) structured information relay, (2) no show appointment tracking via various communication devices has strengthened the mechanism to monitor the referred patient appointment scheduling and their adherence to the appointment, and (3) inter-facility networking facilitated the implementation of EnPHC’s referral mechanism. CONCLUSION: The EnPHC referral mechanism created a platform for PHC clinics and hospitals to communicate and build rapport to help ensure care continuity for NCD patients. The traditional method of communication between healthcare facilities should change and instead start using the newest or most current, advanced technology.

PURPOSE: The main objective was to study health risk behaviours, knowledge and perception amongst Malaysian adolescents aged between 13-17 years of age. METHODS: Modified version of Youth Behaviour Risk Factor Surveillance System (YBRFSS) was used in this nationwide cross-sectional study involving 5,000 students enrolled from 50 selected schools, by adopting multi-stage sampling with randomization of schools and classes from all states in Malaysia. Descriptive data for behaviours, knowledge and perception were also compared between genders. RESULTS: Overall, 72.6% and 21.1% adolescents were found to not perform adequate exercise or did not perform any exercise, respectively. Majority of them also (81.8%) spent time watching TV beyond one hour per day. Although overall compliance to meal timings showed better result for girls (89.2%) than boys (84.8%); non-compliance to breakfast timing was the most frequent (74.7%) compared to other meal timings. Signs of continuous sadness ranked highest (21.3%), followed by signs of depression (9.4%) and suicidal ideation (7.8%). Girls suffered worse than boys for signs of continuous sadness (25.4% vs. 16.2%) and suicidal ideation (10.4% vs. 4.5%). In terms of perception, only 50.1% responded favourably to managing their anger. Boys were more satisfied with their own body weight and body shapes compared with the girls (43.3% vs. 34.7%; 45.3% vs. 37.9%, respectively). CONCLUSION: Although adolescents in Malaysia had good overall knowledge and perception on the healthy habits, they still practiced risky behaviours which may lead to early morbidity and mortality among adolescence.

Background Amid the current burden of non-communicable (NCD) diseases in Malaysia, there is a growing demand for more efficient service delivery of primary healthcare. A complex intervention is proposed to improve NCD management in Malaysia. This exploratory study aimed to assess primary healthcare providers’ receptiveness towards change prior to implementation of the proposed complex intervention. Method This study was conducted using an exploratory qualitative approach on purposely selected healthcare providers at primary healthcare clinics. Twenty focus group discussions and three in-depth interviews were conducted using a semi-structured interview guide. Consent was obtained prior to interviews and for audio-recordings. Interviews were transcribed verbatim and thematically analysed, guided by the Consolidated Framework for Implementation Research (CFIR), a framework comprised of five major domains promoting implementation theory development and verification across multiple contexts. Results The study revealed via CFIR that most primary healthcare providers were receptive towards any proposed changes or intervention for the betterment of NCD care management. However, many challenges were outlined across four CFIR domains—intervention characteristics, outer setting, inner setting, and individual characteristics—that included perceived barriers to implementation. Perception of issues that triggered proposed changes reflected the current situation, including existing facilitating aspects that can support the implementation of any future intervention. The importance of strengthening the primary healthcare delivery system was also expressed. Conclusion Understanding existing situations faced at the primary healthcare setting is imperative prior to implementation of any intervention. Healthcare providers’ receptiveness to change was explored, and using CFIR framework, challenges or perceived barriers among healthcare providers were identified. CFIR was able to outline the clinics’ setting, individual behaviour and external agency factors that have direct impact to the organisation. These are important indicators in ensuring feasibility, effectiveness and sustainability of any intervention, as well as future scalability considerations. Electronic supplementary material The online version of this article (10.1186/s12913-019-4312-x) contains supplementary material, which is available to authorized users.

INTRODUCTION: Cervical cancer is estimated to affect 500 000 women each year globally, whereby 80% of the cases are in developing nations. Almost all cervical cancer cases were attributed to Human Papilloma Virus (HPV) infection. AIM: To identify factors influencing the decision-making of HPV vaccination uptake as prevention for cervical cancer among female youth in the Klang Valley METHODS: This study used in-depth interview; purposive sampling and snowball sampling method. The questionnaire was based on the Health Belief Model, which consist of perceived susceptibility, severity, benefit, barrier and cues to action. NVivo 7 software was used to process, transcribe and analyse the data from interview sessions. RESULT: This study found that the key driving factors that encouraged female youth to get vaccinated were due to the role of family members and friends, concerns on contracting HPV related illness, free/discounted priced vaccination, recommendation from health care personnel, government’s policy, and benefit (believe in the effectiveness of vaccination). Meanwhile, deterring factors which prevented the uptake of HPV vaccination were lack of knowledge and awareness, costs, healthcare provider and services, time constraint and perceived not at risk. CONCLUSION: Factors leading to the uptake of the HPV vaccine should be seen in a transparent manner to ensure the success of the HPV vaccination program in this country.

Psychiatric screening and diagnostic assessments in Malaysia are generally translated versions of existing tools from the West due to the lack of research on indigenous mental health concepts for diagnostic and treatment purposes. This study examined the syndromes of psychotic disorder based on Western constructs within the local context to see its applicability in Malaysia. Knowledge of this investigation would help in determining the extent of adapted tools in Malaysia with regards to validity of use. Concurrently, this study aimed to develop a Malaysian Psychotic Symptoms Screening Inventory as a primary-care-level psychiatric screener. A total of 344 respondents (174 psychotic and 170 non-psychotic respondents) were recruited. Items in the instrument were derived from commonly used Western-based inventories. The generated inventory was self-administered and data collected from the respondents were factor analysed using Principle Component Analysis. Results revealed four factors, of which three indicat...