Wan Nor Arifin

Development and validation of a new knowledge, attitude, belief and practice questionnaire on leptospirosis in Malaysia

BackgroundIn Malaysia, leptospirosis is considered an endemic disease, with sporadic outbreaks following rainy or flood seasons. The objective of this study was to develop and validate a new knowledge, attitude, belief and practice (KABP) questionnaire on leptospirosis for use in urban and rural populations in Malaysia.MethodsThe questionnaire comprised development and validation stages. The development phase encompassed a literature review, expert panel review, focus-group testing, and evaluation. The validation phase consisted of exploratory and confirmatory parts to verify the psychometric properties of the questionnaire. A total of 214 and 759 participants were recruited from two Malaysian states, Kelantan and Selangor respectively, for the validation phase. The participants comprised urban and rural communities with a high reported incidence of leptospirosis. The knowledge section of the validation phase utilized item response theory (IRT) analysis. The attitude and belief sections utilized exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).ResultsThe development phase resulted in a questionnaire that included four main sections: knowledge, attitude, belief, and practice. In the exploratory phase, as shown by the IRT analysis of knowledge about leptospirosis, the difficulty and discrimination values of the items were acceptable, with the exception of two items. Based on the EFA, the psychometric properties of the attitude, belief, and practice sections were poor. Thus, these sections were revised, and no further factor analysis of the practice section was conducted. In the confirmatory stage, the difficulty and discrimination values of the items in the knowledge section remained within the acceptable range. The CFA of the attitude section resulted in a good-fitting two-factor model. The CFA of the belief section retained low number of items, although the analysis resulted in a good fit in the final three-factor model.ConclusionsBased on the IRT analysis and factor analytic evidence, the knowledge and attitude sections of the KABP questionnaire on leptospirosis were psychometrically valid. However, the psychometric properties of the belief section were unsatisfactory, despite being revised after the initial validation study. Further development of this section is warranted in future studies.

Confirmatory Factor Analysis of the Universiti Sains Malaysia Emotional Quotient Inventory Among Medical Students in Malaysia

The Universiti Sains Malaysia Emotional Quotient Inventory (USMEQ-i) is a Malay-language emotional intelligence (EI) inventory that was based on a mixed-model approach of EI. It was specifically developed and validated for use among medical course applicants. However, evidence to support its use among medical students is inadequate. This study aims to provide further construct validity evidence for the USMEQ-i among medical students through confirmatory factor analysis (CFA). A cross-sectional study was carried out on a sample of 479 medical students in Universiti Sains Malaysia (USM). After a preliminary analysis, data from only 317 respondents were found suitable for inclusion in CFA. CFA was performed using the maximum likelihood estimation method with bootstrapping due to the nonnormality of items at the multivariate level. The results of the analysis support the two-factor model of the EI component and the one-factor model of the faking component. However, the USMEQ-i should be administered with caution until further cross-validation studies are conducted among students in other medical schools in Malaysia.

Understanding Dieting and Previous Weight Loss Attempts among Overweight and Obese Participants: Insights into My Body Is Fit and Fabulous at Work Program

Background A qualitative study providing an in-depth exploration of peoples view and the increasing burden of overweight and obesity is required. This study aimed to explore the understanding of dieting and previous experiences on weight loss attempts among overweight and obese government employees in Kelantan, Malaysia, prior to recruitment into the intervention program. Methods Thirteen focus group discussions involving 129 participants from a weight-loss intervention program were conducted within the first 1 month of recruitment. These discussions were moderated by two trained researchers in the Malay language and assisted by an interview guide. They were audio-recorded and transcribed verbatim. A thematic analysis was performed, and codes and themes from each discussion were constructed. Results The participants understood dieting with various meanings, including skipping meals and removing rice from daily diets. They applied numerous methods to lose weight and achieved various outcomes. Health and appearance, social support, and compliance with current trends were the factors motivating these participants to lose weight. Their determination to lose weight was limited by lack of self-control and motivation, experiences of unpleasant effects, influence on weight, and environmental and health factors. Conclusion Real-life weight loss experiences and perceptions provided relevant insights into current weight loss management strategies. Some of these issues and misunderstandings should be emphasized in weight loss strategies during health promotion.

Low Levels of Knowledge, Attitudes and Preventive Practices on Leptospirosis among a Rural Community in Hulu Langat District, Selangor, Malaysia

Little is known on the knowledge, attitudes and preventive practices (KAP) of leptospirosis worldwide. This study embarked on assessing the KAP of leptospirosis among rural communities in Malaysia. A total of 444 participants (223 male; 221 female) aged between 18 and 81 years old were surveyed by using a self-administered questionnaire. A majority of participants had poor knowledge level (57.0%), unacceptable attitudes (90.3%) and unacceptable preventive practices (69.1%) on leptospirosis, and only 29.7% knew “rat-urine disease” as leptospirosis. Only 34.2% of the participants knew the bacteria could enter via wound lesions. Ethnicity and income were strongly associated with knowledge level and preventive practices, respectively (p-values < 0.05). As for attitudes, ethnicity, income and education type were significantly associated (p-values < 0.05). Only 36.5% of the participants were willing to see a doctor and did not mind if their house or surrounding area is dirty (59.7%). Surprisingly, only 32.9% had used rubber boots during floods. By logistic regression analysis, ethnicity was the only significant predictor for both knowledge level (an odds ratio (AOR) = 0.39, 95% confidence interval (CI) = 0.222–0.680) and preventive practices (AOR = 1.81, 95% CI = 1.204–2.734). Ethnicity (AOR = 0.40, 95% CI = 0.239–0.665), income (AOR = 1.58, 95% CI = 1.041–2.385) and education type (AOR = 3.69, 95% CI = 1.237–10.986) were strong predictors for attitudes. Among the KAP variables, attitude (AOR = 4.357, 95% CI = 2.613–7.264) was the only predictor for the preventive practices by logistic regression analysis. The KAP elements on leptospirosis are still lacking and poor health seeking behavior and attitudes are of our utmost concern. Thus, effective strategies should be planned to impart knowledge, and develop proactive approaches and good preventive modules on leptospirosis to this leptospirosis-prone community.

Effect of combined psycho-physiological stretching and breathing therapy on sexual satisfaction

BackgroundDuring the last few decades, marital tensions and stresses have influenced various dimensions of life. The objective of the current study was to examine the effects of combined psycho-physiological therapy (stretching therapy combined with breathing exercise) on sexual satisfaction among heterosexual men.MethodsFor this research, we used “convenience sampling” to select 80 males, who were then split equally into two groups, the intervention group and the control group, both groups containing men who had voiced a desire to be in the experimental group. For collection of data, we used an identical quasi-experimental design called the “nonequivalent control group.” Therapy sessions, each lasting 90 to 120 min, were carried out on the same 3 days of the week (Sunday, Tuesday, and Thursday) for a total of 20 sessions. The volunteers were selected from heterosexual men with stable relationships, who had been married a minimum of 6 months and were ages 20 to 55 years of age. Pre-tests, post-tests, and follow-up tests were conducted in a clinic at the Hospital Universiti Sains Malaysia (HUSM [1] ). For assessment, we used the sexual satisfaction subscale of the ENRICH [2] questionnaire.ResultsThe intervention group had better post-test scores than the control group. Also, follow-up test scores for the intervention group were marginally better than those for the control group, but the difference did not reach statistical significance.ConclusionsCombined psycho-physiological therapy including stretching and breathing exercise leads to improved sexual satisfaction.

Adaptation and Validation of the Malay Version of the Index of Dental Anxiety and Fear (IDAF-4C+) for Malaysian Secondary School Children

Background Many questionnaires have been developed to measure dental anxiety and fear. Among them is the Index of Dental Anxiety and Fear Scale (IDAF-4C+), which consists of a dental anxiety and fear module (IDAF-4C), a phobia module (IDAF-P) and a stimulus module (IDAF-S). The objective of this research was to report the adaptation and validation of the IDAF-4C+ for Malaysian secondary school children. Methods This was a cross-sectional validation study. The original English version of the IDAF-4C+ was translated into Malay, back-translated, and then sent for content validation via an expert validation and face validation by the target student population. Three hundred and seventy questionnaires were then distributed among 16-year-old school children. Confirmatory factor analysis (CFA) was conducted for the IDAF-4C module using a bootstrapped maximum likelihood estimator. Spearman’s rank correlation was used to assess the relationship between the IDAF-S and IDAF-4C modules. Intraclass correlation (ICC) was used to determine the stability of the IDAF-S and IDAF-4C modules, while kappa values were used for the IDAF-P module. Results The response rate was 86.5% for CFA and 76.9% for stability. CFA showed the existence of only one factor with a reliability estimate of 0.921, obtained via Raykov’s procedure. All items in the IDAF-S module were significantly correlated with the IDAF-4C module (P < 0.001). The IDAF-S and IDAF-4C modules were stable, as determined via a two-way mixed model with absolute agreement, a single measure and a Case 3 ICC (A, 1). The IDAF-P module showed satisfactory stability, as assessed via kappa values. Conclusion The Malay version of the IDAF-4C+ is valid and reliable in measuring dental anxiety and fear among Malaysian secondary school children.

Psychometric Properties of the Heart Disease Knowledge Scale: Evidence from Item and Confirmatory Factor Analyses.

BACKGROUND Heart disease knowledge is an important concept for health education, yet there is lack of evidence on proper validated instruments used to measure levels of heart disease knowledge in the Malaysian context. METHODS A cross-sectional, survey design was conducted to examine the psychometric properties of the adapted English version of the Heart Disease Knowledge Questionnaire (HDKQ). Using proportionate cluster sampling, 788 undergraduate students at Universiti Sains Malaysia, Malaysia, were recruited and completed the HDKQ. Item analysis and confirmatory factor analysis (CFA) were used for the psychometric evaluation. Construct validity of the measurement model was included. RESULTS Most of the students were Malay (48%), female (71%), and from the field of science (51%). An acceptable range was obtained with respect to both the difficulty and discrimination indices in the item analysis results. The difficulty index ranged from 0.12-0.91 and a discrimination index of ≥ 0.20 were reported for the final retained 23 items. The final CFA model showed an adequate fit to the data, yielding a 23-item, one-factor model [weighted least squares mean and variance adjusted scaled chi-square difference = 1.22, degrees of freedom = 2, P-value = 0.544, the root mean square error of approximation = 0.03 (90% confidence interval = 0.03, 0.04); close-fit P-value = > 0.950]. CONCLUSION Adequate psychometric values were obtained for Malaysian undergraduate university students using the 23-item, one-factor model of the adapted HDKQ.