1.Study Protocol of a Mixed-Methods Study to Develop and Validate the Malaysian Anti-Hypertensive Agents Non-Adherence Scale in Hypertensive Patients
Sheng-Qian Yew ; Ahmad Iqmer Nashriq Bin Mohd Nazan ; Kit-Aun Tan
Malaysian Journal of Medicine and Health Sciences 2022;18(No.6):332-339
Introduction: Domains of adherence and non-adherence to hypertensive medications have not been extensively
documented in Malaysia due to the absence of theoretically driven and culturally appropriate measurement tools,
leading to a poor understanding of the adherence and underlying factors. We aim to identify these domains in Malaysian hypertensive patients and subsequently apply the findings to develop and validate the Malaysian Anti-Hypertensive Agents Non-Adherence Scale (MAANS). Methods: This study has an exploratory mixed-methods design.
In Phase 1, we will recruit hypertensive patients from two health clinics to participate in a semi-structured interview.
Recruitment of participants will terminate once thematic saturation is achieved. Coding and thematic analyses will
be performed to identify the domains of adherence and non-adherence to anti-hypertensive medications. In Phase
2, based on the domains generated from Phase 1, we will develop the Malaysian Anti-Hypertensive Agents Non-Adherence Scale (MAANS). Four hundred hypertensive patients will be randomly selected. Data from 200 participants
(serving as the calibration sample) will be subjected to exploratory factor analysis while data from additional 200
participants (serving as the validation sample) will be subjected to confirmatory factor analysis. Factor structure,
predictive validity, and reliability of the MAANS will be statistically tested. Discussion: With the presence of the
MAANS, health care providers can gather crucial information regarding barriers and facilitators to hypertensive
treatment adherence and design effective health promotion programmes to reduce complications of uncontrolled
hypertension. Trial registration: Ethical approval is granted by the Medical Research Ethics Committee, Ministry of
Health, Malaysia (NMRR-18-3251-44694).
2.Domains of Adherence and Non-Adherence to Anti-Hypertensive Medications in Hypertensive Patients from Kuala Lumpur: A Qualitative Study
Sheng-Qian Yew ; Kit-Aun Tan ; Ahmad Iqmer Nashriq Mohd Nazan ; Rosliza Abdul Manaf
Malaysian Journal of Medicine and Health Sciences 2023;19(No.5):70-81
Introduction: Previous medication adherence studies primarily focused on the domains of non-adherence in hypertension treatment and less attention has been given on domains that encourage adherence to anti-hypertensive medications. The current study is aimed to identify the domains of adherence and non-adherence to anti-hypertensive
medications among hypertensive patients in Kuala Lumpur, Malaysia. Methods: Hypertensive patients from two public health clinics in Kuala Lumpur were invited for in-depth interviews until thematic saturation. Audio recordings
from these interviews were transcribed verbatim. Transcripts were then analysed deductively with the guidance of
the World Health Organization Medication Adherence Framework to extract the domains of adherence and non-adherence to anti-hypertensive medications. Results: Ten patients who were predominantly Malays and aged 34-73
years old participated the study. Patient-related (encompassing knowledge, attitude, belief and culture, lifestyle,
personal barriers, self-efficacy, and cue to action), socioeconomic (encompassing social support), condition-related
(encompassing nature of illness and presence of multiple co-morbidities), therapy-related (encompassing experience
of receiving treatment, barrier in treatment, and side effects of treatment), and healthcare system (encompassing
access to healthcare and healthcare center experience) domains were identified as central to the medication-taking
behaviour of hypertensive patients. Conclusion: Sixteen codes of adherence and 22 codes of non-adherence to
anti-hypertensive medications were identified, which were distributed across five domains (patient-related, socioeconomic, condition-related, therapy related, and healthcare system domains). These findings can help to inform future development of medication adherence questionnaires, individualised interventions for patients with adherence
problems, and targeted health promotion programmes to reduce uncontrolled hypertension.
3.Effectiveness of an integrated-Weight Management Programme (i-WMP) in Reducing Body Weight among Noncommunicable Disease Patients in Malaysian Government Primary Care Clinics: A Randomised Controlled Trial
Siew-Tin Tan ; Sherina Mohd-Sidik ; Lekhraj Rampal ; Kit-Aun Tan ; Zuriati Ibrahim ; Norliza Binti Ahmad ; Ummu Kalsum Mustapha ; Fuziah Paimin ; Nor Hazlin Talib ; Naemah Sharifuddin ; Normala Ibrahim
Malaysian Journal of Medicine and Health Sciences 2022;18(No.6):54-64
Introduction: Obesity is a global issue called as “globesity”. Overweight and obesity may lead to many noncommunicable diseases (NCDs). Primary care is the first centre to monitor and follow-up the progress of NCD patients.
Therefore, the objective of this study was to determine the effectiveness of an integrated-Weight Management Programme (i-WMP) to reduce body weight among NCD patients from two Government primary care clinics from
Hulu Langat District. Methods: This study was single-blinded randomised controlled trial by design. There were 244
eligible patients were randomised into intervention (n = 122) or wait-list control group (n = 122). The i-WMP was
developed based on the behaviour change wheel through the operationalization of behaviour change techniques.
The duration of this intervention programme was four weeks. Data collected at week 0, week 4, and week 12. The
software IBM SPSS was used to analyse the data. Generalized linear mixed model analysis with intention-to-treat
principle was applied. Results: The retention rate was 74.2%. Findings showed that the i-WMP was significantly
effective in reducing not only body weight as primary outcome but also secondary outcomes such as waist-to-height
ratio, waist circumference, body mass index, and total sitting time. It also improved effectively other secondary outcomes such as participants’ knowledge, attitude, and practice towards dietary and towards physical activity. However, no significant changes were reported for body fat percentage and total physical activity metabolic equivalent of
task-minutes/week. Conclusion: Implications surrounding the implementation of i-WMP in the primary care clinics
are recommended.
4.Factors Correlated With Internet Gaming Disorder Among Malaysian University Students
Nik Ruzyanei Nik Jaafar ; Azlin Baharudin ; Izzat Tajjudin ; Ling Shiao Ling ; Muhammad Amirul Safarudin ; Don Shakir Sufia ; Tan Ying Hui ; Nur Hasya Zulkifle ; Kit-Aun Tan
Malaysian Journal of Medicine and Health Sciences 2021;17(No.2):54-62
Introduction: Internet gaming disorder (IGD) has recently been incorporated into the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) as a disorder for future research. The primary objectives of the present
study are to describe the level of IGD and to examine its correlations with sociodemographic factors and psychological comorbidities among undergraduate students in a Malaysian university. Methods: A total of 411 undergraduate
students completed an online questionnaire. They were selected from a random sample of participating university
faculties. The online questionnaire contained the Internet Gaming Disorder Scale-Short-Form and the Depression,
Anxiety, Stress Scale. Results: The presents study reported that 52.8% of the participants had high IGH. Using hierarchical multiple regression, age (β = -0.09, p < 0.05), gender (β = -0.40, p < 0.001) and stress (β = 0.23, p < 0.05)
were statistically significant predictors of IGD. Academic performance, depression and anxiety did not emerge as
significant predictors. Conclusion: These findings highlight the risk factors (in particular, stress) of IGD. Further studies on interventions, particular that of preventative strategies, will be needed to combat this emerging public health
problem.