Chin Hai Teo

Barriers and facilitators to starting insulin in patients with type 2 diabetes: a systematic review

To identify the barriers and facilitators to start insulin in patients with type 2 diabetes.

The status of men's health in Asia

OBJECTIVES This study aims to compare health status and its risk factors between men and women who are from countries of different income status in Asia. METHOD We have included 47 Asian countries and 2 regions in this study. Life expectancy, mortality rate from communicable disease, non-communicable disease and injuries, the prevalence of non-communicable diseases risk factors and their trends were extracted from the WHO and respective governmental database. Subgroup analysis was performed based on country income groups. RESULTS Overall, men have shorter life expectancy and higher mortality rates compared to women. Men from higher-income countries lived longer compared to men from lower-income countries. There is a wide variation of male life expectancy in upper and lower middle income countries. The mean systolic blood pressure, fasting blood glucose and body mass index in Asia have also increased over the years. CONCLUSION This study confirms that Asian men have poorer health compared to women besides the growing concerns on NCD risk factors. The findings from this study calls for a concerted effort to find solutions in addressing mens health problems in Asia.

Relationships between cancer pattern, country income and geographical region in Asia

BackgroundCancer incidence and mortality varies across region, sex and country’s economic status. While most studies focused on global trends, this study aimed to describe and analyse cancer incidence and mortality in Asia, focusing on cancer site, sex, region and income status.MethodsAge-standardised incidence and mortality rates of cancer were extracted from the GLOBOCAN 2012 database. Cancer mortality to incidence ratios (MIRs) were calculated to represent cancer survival. The data were analysed based on the four regions in Asia and income.ResultsCancer incidence rate is lower in Asia compared to the West but for MIR, it is the reverse. In Asia, the most common cancers in men are lung, stomach, liver, colorectal and oesophageal cancers while the most common cancers in women are breast, lung, cervical, colorectal and stomach cancers. The MIRs are the highest in lung, liver and stomach cancers and the lowest in colorectal, breast and prostate cancers. Eastern and Western Asia have a higher incidence of cancer compared to South-Eastern and South-Central Asia but this pattern is the reverse for MIR. Cancer incidence rate increases with country income particularly in colorectal and breast cancers but the pattern is the opposite for MIR.ConclusionThis study confirms that there is a wide variation in cancer incidence and mortality across Asia. This study is the first step towards documenting and explaining the changing cancer pattern in Asia in comparison to the rest of the world.

Improving Health Screening Uptake in Men: A Systematic Review and Meta-analysis

CONTEXT Globally, uptake of health screening in men remains low and the effectiveness of interventions to promote screening uptake in men is not well established. This review aimed to determine the effectiveness of interventions in improving mens uptake of and intention to undergo screening, including interventions using information and communication technology and a male-sensitive approach. EVIDENCE ACQUISITION Studies were sourced from five electronic databases (October 2015), experts, and references of included studies. This study included RCTs or cluster RCTs that recruited men and reported uptake of or intention to undergo screening. Two researchers independently performed study selection, appraisal, and data extraction. The interventions were grouped into those that increase uptake and those that promote informed decision making. They were further sub-analyzed according to types of intervention, male-sensitive, and web- and video-based interventions. The analysis was completed in December 2016. EVIDENCE SYNTHESIS This review included 58 studies. Most studies were on prostate cancer (k=31) and HIV (k=11) screening. Most of the studies had low methodologic quality (79.3%) and after excluding them from the analysis, one study found that educational intervention (which was also male-sensitive) was effective in improving mens intention to screen (risk ratio=1.36, 95% CI=1.23, 1.50, k=1) and partner educational intervention increased mens screening uptake (risk ratio=1.77, 95% CI=1.48, 2.12, k=1). Video-based educational interventions reduced prostate cancer screening uptake (risk ratio=0.89, 95%CI=0.80, 0.99, k=1) but web-based interventions did not change mens screening intention or uptake. CONCLUSIONS This review highlights the need to conduct more robust studies to provide conclusive evidence on the effectiveness of different interventions to improve mens screening behavior.

What Do Men Want from a Health Screening Mobile App? A Qualitative Study.

There is a lack of mobile app which aims to improve health screening uptake developed for men. As part of the study to develop an effective mobile app to increase health screening uptake in men, we conducted a needs assessment to find out what do men want from a health screening mobile app. In-depth interviews and focus group discussions were conducted with 31 men from a banking institution in Kuala Lumpur. The participants were purposely sampled according to their job position, age, ethnicity and screening status. The recruitment was stopped once data saturation was achieved. The audio-recorded interviews were transcribed verbatim and analyzed using thematic approach. Three themes emerged from the analysis and they were: content, feature and dissemination. In terms of the content, men wanted the app to provide information regarding health screening and functions that can assess their health; which must be personalized to them and are trustable. The app must have user-friendly features in terms of information delivery, ease of use, attention allocation and social connectivity. For dissemination, men proposed that advertisements, recommendations by health professionals, providing incentive and integrating the app as into existing systems may help to increase the dissemination of the app. This study identified important factors that need to be considered when developing a mobile app to improve health screening uptake. Future studies on mobile app development should elicit users’ preference and need in terms of its content, features and dissemination strategies to improve the acceptability and the chance of successful implementation.

Usability and utility evaluation of the web-based "Should I Start Insulin?" patient decision aid for patients with type 2 diabetes among older people.

ABSTRACT This study aimed to evaluate the usability (ease of use) and utility (impact on user’s decision-making process) of a web-based patient decision aid (PDA) among older-age users. A pragmatic, qualitative research design was used. We recruited patients with type 2 diabetes who were at the point of making a decision about starting insulin from a tertiary teaching hospital in Malaysia in 2014. Computer screen recording software was used to record the website browsing session and in-depth interviews were conducted while playing back the website recording. The interviews were analyzed using the framework approach to identify usability and utility issues. Three cycles of iteration were conducted until no more major issues emerged. Thirteen patients participated: median age 65 years old, 10 men, and nine had secondary education/diploma, four were graduates/had postgraduate degree. Four usability issues were identified (navigation between pages and sections, a layout with open display, simple language, and equipment preferences). For utility, participants commented that the website influenced their decision about insulin in three ways: it had provided information about insulin, it helped them deliberate choices using the option-attribute matrix, and it allowed them to involve others in their decision making by sharing the PDA summary printout.

A consensus on men's health status and policy in Asia: a Delphi survey

OBJECTIVE There is currently no documentation on the availability and implementation of policies related to mens health in Asia. This Delphi study aimed to achieve an Asian consensus on mens health policy based on the opinions and recommendations from mens health key opinion leaders. STUDY DESIGN A two-phase Delphi online survey was used to gather information from mens health stakeholders across Asian countries. METHODS All stakeholders were invited to participate in the survey through mens health conferences, personal contacts, recommendations from international mens health organizations and snowballing method. Stakeholders were asked about their concerns on 17 mens health key issues as well as their opinion on the availability and recommendations on mens health policies and programmes in their countries. RESULTS There were a total of 128 stakeholders (policy makers, clinicians, researchers and consumers), from 28 Asian countries, who responded in the survey. Up to 85% of stakeholders were concerned about various mens health issues in Asia and in their respective country, particularly in smoking, ischaemic heart disease and high blood pressure. There is a lack of mens health policies and programmes in Asia (availability = 11.6-43.5%) and up to 92.9% of stakeholders recommended that these should be developed. CONCLUSIONS These findings call for policy change and development, and more importantly a concerted effort to elevate mens health status in Asia.

Men's Health Index: A Pragmatic Approach to Stratifying and Optimizing Men's Health

Purpose The proposed Mens Health Index (MHI) aims to provide a practical and systematic framework for comprehensively assessing and stratifying older men with the intention of optimising their health and functional status. Materials and Methods A literature search was conducted using PubMed from 1980 to 2012. We specifically looked for instruments which: assess mens health, frailty and fitness; predict life expectancy, mortality and morbidities. The instruments were assessed by the researchers who then agreed on the tools to be included in the MHI. When there was disagreements, the researchers discussed and reached a consensus guided by the principle that the MHI could be used in the primary care setting targetting men aged 55-65 years. Results The instruments chosen include the Charlsons Combined Comorbidity-Age Index; the International Index of Erectile Function-5; the International Prostate Symptom Score; the Androgen Deficiency in Aging Male; the Survey of Health, Ageing and Retirement in Europe Frailty Instrument; the Sitting-Rising Test; the Senior Fitness Test; the Fitness Assessment Score; and the Depression Anxiety Stress Scale-21. A pilot test on eight men was carried out and showed that the mens health index is viable. Conclusions The concept of assessing, stratifying, and optimizing mens health should be incorporated into routine health care, and this can be implemented by using the MHI. This index is particularly useful to primary care physicians who are in a strategic position to engage men at the peri-retirement age in a conversation about their life goals based on their current and predicted health status.

Development and pilot testing of a National Men’s Health Index

Recent men’s health reports from Asia, Australia, Canada and Europe have consistently shown that men have higher morbidity and mortality compared to women in most health conditions. There are numerous factors that may contribute to this and they range from men’s behaviour, socio-economic to health system factor. To date, there is no systematic way to document and compare men’s health determining factors and their impacts on men’s health. Policy makers do not have proper guidelines to accurately identify and prioritize on the key factors that affect men’s health status in individual country. To overcome this problem, we propose the concept of the National Men’s Health Index (NMHI), which aims to assess men’s health status and its social health determinants of a country. Men’s health status consists of several categories including survivability, physical and mental health, which is divided further into indicators such as life expectancy, communicable, non-communicable diseases, injuries and suicide rate. The overall NMHI score indicates the wellbeing of men in the country while the sub-score will provide an indication of physical and mental wellbeing. The social health determinants are factors that influence the NMHI score and they are made up of lifestyle risk factors, socio-economy status, safety, environmental and health system, which are measured by parameters such as literacy rate, smoking prevalence, pollution index and health expenditure. The NMHI will be developed systematically in 4 steps. Firstly, two systematic reviews will be carried out to review the existing composite health and non-health indices as well as to identify established indicators of men’s health. Secondly, NMHI model will be developed based on the systematic reviews and the expert opinions. Thirdly, a Delphi survey will be conducted with men’s health key opinion leaders in the world to prioritize the men’s health indicators. Fourthly, the NMHI model will be revised and weighted accordingly before pilot testing. The NMHI scores of each country will be ranked and this will be correlated with the various social health determinants to explain the score. We believe that NMHI can serve as a guide for policy makers to identify gaps in men’s health and help them to prioritize health policy for men in their country. The NMHI will also allow countries to share experiences and effective strategies with one another and to monitor men’s health progress.

Development of a web-based insulin decision aid for the elderly: usability barriers and guidelines

In recent years, researchers have attempted to shift patient decision aids (PDAs) from paper-based to web-based to increase its accessibility. Insulin decision aids help diabetes patients, most of whom are elderly to make an informed decision to start insulin. However, the lack of usability guidelines applicable for such target group causes developers to struggle to answer the challenging question ‘How can such web service be made usable, and, ultimately, acceptable and accessible for elderly patients?’. Hence, the purpose of this study is to identify the common usability requirements that may facilitate good practices to empower elderly diabetes patients in utilizing a web-based insulin decision aid for their benefit. We set out an approach to use prototyping and retrospective think-aloud techniques to explore web usability barriers that elderly patients may encounter when using an insulin decision aid web site and use the feedback for improving the prototype. Usability requirements were captured iteratively through scoping, brainstorming, prototype, testing and evaluating. The study suggests that the insights from experts and users are equally important to assure the validity of the identified usability guidelines; they reflect the accessibility needs of the aging community while complementing the key requirements of an insulin decision aid. The study contributes to recommend web usability guidelines backed by a series of expert and user evaluations which could be a proactive resource to improve usability, acceptability and accessibility of online insulin decision aids for elderly with diabetes.