1.Translation and Validation of Malay Version of the Simplified Diabetes Knowledge Test (DKT)
Mohd Aznan Md Aris ; Hafizah Pasi ; Mohd Shaiful Ehsan Shalihin ; Umair Othman ; Nur-Hidayah Abdul Rahim
Malaysian Journal of Medicine and Health Sciences 2022;18(No.3):76-84
Introduction: Type 2 diabetes mellitus is a chronic disease which is highly prevalent in Malaysia. In managing diabetes, the American Diabetes Association (ADA) and the International Diabetes Federation (IDF) have advocated
self-management to be the basic component of diabetes care. However, an ongoing discussion, education and assessment of the patient’s diabetic knowledge should be implemented in the patient’s empowerment process. There
are various assessment tools available worldwide but very few are available in the Malay language. This study is
aimed to perform the Malay translation of the Simplified Diabetes Knowledge Test (DKT) questionnaire and validate
it. Methods: Forward-backward translation procedure was used to translate the simplified version of the DKT questionnaire. A total of 120 respondents with type 2 diabetes mellitus from a selected government health clinic were
recruited to answer the questionnaire which consists of socio-demographic, diabetes characteristics and the 20-item
Malay version of simplified DKT questionnaire. Reliability and construct validity were tested with Cronbach’s alpha
coefficient and Exploratory Factor Analysis. Results: Factor analysis with Varimax rotation identified five meaningful
domains for the final 18 items. The Cronbach’s alpha for the overall scale of the translated questionnaire was 0.573
with values of each five significant domain’s Cronbach’s alpha ranged from 0.370 to 0.564. Conclusion: The Malay version of simplified DKT is valid and reliable to be used as a brief assessment of knowledge among Malaysian
diabetic patients.
2.Content identification for the development of a nutrition resource kit for malnourished and at-risk elderly: A review
Iman Nabihah Noor Azam ; Aliza Haslinda Hamirudin ; Sakinah Harith ; Mohd Aznan Md Aris ; Karimah Hanim Abd Aziz ; Siti Nur Amirah Sheikh Hishamuddin ;
Malaysian Journal of Nutrition 2021;27(No.3):373-396
Introduction: Elderly population is more likely to suffer from malnutrition, thereby
requiring appropriate nutrition education as part of nutrition intervention to
overcome this issue. This review aims to identify content suitable for developing a
nutrition resource kit that provides nutritional guidance to combat malnutrition
among malnourished and at-risk elderly in health clinics setting, particularly in
Malaysia. Methods: A literature search was conducted up to 15th December 2019
in four databases: PubMed, Scopus, COCHRANE, and ProQuest Health & Medical
Collection. Potential literature on nutrition education, suitable dietary guidelines
and existing educational materials for elderly in the community, in English and
Malay languages, were searched to identify suitable content for the nutrition
resource kit. All relevant documents were included based on inclusion and exclusion
criteria. Data were extracted and analysed according to the PRISMA-ScR guidelines.
Results: A total of 27 documents consisting of articles, printed materials and
guidelines were included for analysis. Suitable content included information related
to malnutrition such as definition, signs and symptoms, cause-consequences, and
nutrition management, which included food plate, serving size, menu suggestion,
examples of recipes, tips to increase energy and protein intakes through food or
drink, texture modification, a guide to using oral nutritional supplements, tips for
maintaining nutrient content in food and drink, tips to encourage to eat, and oral
health. Conclusion: A nutrition resource kit tailored for malnourished and at-risk
elderly would be a beneficial nutrition intervention. There is a need to incorporate
these information in the development of a nutrition resource kit to improve their
dietary intake.
3.Types of Nutrition Resource Kit Needed by Community Living Elderly in Malaysian Health Clinic Setting: A Qualitative Study
Iman Nabihah Noor Azam ; Aliza Haslinda Hamirudin ; Sakinah Harith ; Mohd Aznan Md Aris ; Karimah Hanim Abd Aziz ; Nurul Syaireen A Rashid
Malaysian Journal of Medicine and Health Sciences 2021;17(No.2):217-224
Introduction: Elderly population is at high-risk to suffer from malnutrition and nutritional inadequacy. The use of
nutrition resource kit which provides nutritional guidance could be helpful to improve their dietary intake. There is
no study performed previously on the type of nutrition resource kit that can be used to overcome and prevent malnutrition among Malaysian elderly. Therefore, this study aimed to identify the types of nutrition resource kit needed
by community living elderly in Malaysian health clinic setting. Methods: Qualitative study was conducted to explore
the types of nutrition resource kit needed by community living elderly in health clinics. Recruitment for in-depth
individual interview targeted elderly aged ≥60 years old who met the inclusion and exclusion criteria and received
primary healthcare services in four health clinics in Kuantan, Pahang. Interview questions addressed the knowledge
on existing nutrition educational materials, preference for types of nutrition resource kit and opinion on technology-based materials. Data were audiotaped, transcribed verbatim and thematically analyzed using NVivo software
version 12. Results: 21 participants involved in this study (mean age=67.24 ±6.98 years). Five key themes identified
from the data: provision of nutrition resource kit; preference for printed version; eye-friendly; facilitate understanding
with diagram; and support for technology-based materials. This study also found that majority of elderly preferred for
A5-sized booklet for nutrition resource kit. Conclusion: Future development of nutrition resource kit tailored to the
need of elderly is needed to deliver nutritional guidance effectively and served as an important reference for them to
overcome malnutrition.
4.Barriers and Opportunities of Nutrition Screening in Elderly Patients in Health Clinic Settings in Kuantan, Pahang: A Qualitative Study
Siti Nur Amirah Sheikh Hishamuddin ; Aliza Haslinda Hamirudin ; Sakinah Harith ; Mohd Aznan Md Aris ; Karimah Hanim Abd Aziz ; Nurul Syaireen A Rashid
Malaysian Journal of Medicine and Health Sciences 2021;17(No.4):21-29
Introduction: The elderly population are susceptible to malnutrition due to many factors. Hence, timely malnutrition
identification through nutrition screening needs to be performed routinely in health clinics. However, the
nutrition screening practice in health clinics need to be improvised for malnutrition identification among the elderly
population. This study identifies barriers and opportunities for nutrition screening in elderly patients in health clinic
settings. Method: A qualitative study was conducted among healthcare staff from urban and rural health clinics in
Kuantan, Pahang, Malaysia. In-depth individual interviews were performed, audio-recorded and transcribed verbatim.
Non-participant observations that act as triangulation were conducted among elderly patients (aged ≥60 years)
attending the sampled health clinics. Both data from the interviews and observations were analysed thematically
using NVivo software. Results: Twenty healthcare staff participated in the interviews were medical officers (n=6),
medical assistants (n=8), staff nurses (n=4), and community nurses (n=2) with a mean age of 33.7±6.3 years. Twenty-
one elderly patients were involved in non-participant observations. The four themes that emerged as barriers and
opportunities were: time, patient factors, organisation factors and nutrition screening knowledge. Time constituted
the main barrier, whilst incorporating a validated nutrition screening tool into current health screening practices was
identified as the most practical approach to performing nutrition screening. Staff also highlighted the need for appropriate
guidelines for implementing nutrition screening. Conclusion: This study identified appropriate approaches to
implementing nutrition screening among elderly patients in health clinics. Developing a comprehensive nutrition
screening guideline may facilitate healthcare staff in performing nutrition screening.
5.Development and Feasibility Assessment of a Nutrition Screening Guideline in Older Patients for Use by Healthcare Staff in Health Clinic Setting: An Action Research Study
Siti Nur Amirah Sheikh Hishamuddin ; Aliza Haslinda Hamirudin ; Sakinah Harith ; Mohd Aznan Md Aris ; Karimah Hanim Abd Aziz ; Nurul Syaireen A Rashid
Malaysian Journal of Medicine and Health Sciences 2023;19(No.1):46-56
Introduction: Older persons are more susceptible to malnutrition. However, malnutrition identification through
nutrition screening is not routinely performed in Malaysia’s health clinics due to no specific nutrition screening
guideline and validated tool in this setting. This study aimed to develop a nutrition screening guideline for older patients and assess its feasibility for use by healthcare staff in health clinic setting. Methods: This study was conducted
in three phases. In Phase I, needs assessment was conducted amongst healthcare staff. Development of nutrition
screening guideline in Phase II involved scoping review and validation amongst six experts and twelve healthcare
staff. In Phase III, twenty-two healthcare staff participated in feasibility assessment using in-depth interviews after
completing nutrition screening in older patients. Interview data was analysed thematically using NVivo Software
12.0. Results: A Malay language version of nutrition screening guideline in A4-sized with 31 pages was developed
and validated. Items with a content validity index ≥0.83 from experts review were retained, while <0.83 were revised
accordingly. Validation amongst healthcare staff showed positive responses. The guideline was then assessed for
feasibility, where 110 older patients (mean age= 68.7±6.1 years) were screened by healthcare staff using the newly
developed nutrition screening guideline. Four themes emerged from in-depth interviews: 1) Ease of use; 2) Identification and management of malnutrition; 3) Acceptability; and 4) Implementation of nutrition screening. Conclusion:
The newly developed and validated nutrition screening guideline is well-accepted and feasible for healthcare staff to
screen older patients in health clinic setting for timely malnutrition identification and management.
6.Development, Validation and Acceptability of a Newly Developed Nutrition Resource Kit for At-Risk and Malnourished Elderly in Health Clinics Setting
Iman Nabihah Noor Azam ; Aliza Haslinda Hamirudin ; Sakinah Harith ; Mohd Aznan Md Aris ; Karimah Hanim Abd Aziz ; Nurul Syaireen A Rashid
Malaysian Journal of Medicine and Health Sciences 2022;18(No.5):93-103
Introduction: The elderly population is highly vulnerable to malnutrition, including those in the community. The use
of nutrition education as part of nutrition intervention is able to improve their nutritional status. Hence, provision of a
nutrition resource kit addressing the needs of at-risk and malnourished elderly would be advantageous. This research
aimed to develop, validate and evaluate the acceptance of a newly developed nutrition resource kit, which served
as an educational material among at-risk and malnourished elderly in Malaysian health clinics. Methods: This study
was conducted in three phases: Phase I comprised of qualitative needs assessment to identify the types of nutrition
resource kit needed; Phase II was the development and validation of the nutrition resource kit; while Phase III was
acceptance evaluation, which involved individual in-depth interview and triangulation. Results: An A5-sized booklet with incorporation of an educational video in a QR code was developed. Both printed material and educational
video had excellent content and face validity. Suggestions by experts and elderly from validation were considered
and revision was done accordingly. Acceptance evaluation revealed four themes: 1) positive acceptance, 2) elderly-friendly, 3) valuable, and 4) individual preference. Triangulation data revealed that all elderly positively evaluated
both resources. Additional suggestions given by elderly were considered for improvement. Conclusion: This newly
developed nutrition resource kit, both in the printed and electronic format, was well-accepted among the at-risk and
malnourished elderly. It could be used as an important reference for the elderly, especially those attending health
clinics, in treating and preventing malnutrition.
7.Development of nutrition screening guideline content for use by healthcare staffs in older adults in health clinic setting: A scoping review
Siti Nur Amirah Sheikh Hishamuddin ; Aliza Haslinda Hamirudin ; Sakinah Harith ; Mohd Aznan Md Aris ; Karimah Hanim Abd Aziz ; Iman Nabihah Noor Azam ; Nurul Syaireen A Rashid
Malaysian Journal of Nutrition 2022;28(No.1):119-148
Introduction: Malnutrition, specifically undernutrition, in community-dwelling
older adults reduces their well-being and predisposes to diseases. Therefore, timely
malnutrition identification through nutrition screening is needed to identify at risk
and malnourished patients. This study aimed to develop the content of nutrition
screening guideline to facilitate healthcare staffs in health clinics to administer a
validated nutrition screening tool specifically for older adults. Methods: A scoping
review was conducted electronically using SCOPUS, PubMed, ProQuest Health &
Medical Complete, and Cochrane databases. The systematic search was performed
up to 31st December 2021. Search terms were created for identification of eligible
and related articles. Inclusion and exclusion criteria were determined for the
systematic search. The search was limited to English and Malay languages, and
full text articles with no limitation of years. All data were extracted and analysed,
guided by the PRISMA extension for scoping reviews (PRISMA-ScR). Results:
From 728 identified articles, 18 articles were included in the analysis. Identified
information for the guideline content were: introduction, aims and objectives,
definition of malnutrition, prevalence of malnutrition, implementation of nutrition
screening, guidance on administering items in validated tools, and guidance on
anthropometric measurements. Meanwhile, format and flow charts from established
guidelines served as references for the guideline development process. Conclusion:
Appropriate content to develop a nutrition screening guideline has been identified
based on this review. Development of a guideline based on this content can facilitate
healthcare staffs to perform timely nutrition screening in older adults.