With the highest prevalence of diabetes in the region, Malaysia faces a massive task ahead to care for its people afflicted with the disorder. For a successful Diabetes Care model to work, it requires a well-established functioning multidisciplinary team comprising Endocrinologists/Physicians/Family Medicine Specialist Physicians, Diabetes Nurse Educators, Dietitians, Pharmacists, and others such as Podiatrists are needed to provide broad ranging services. Although we have many such individuals trained and working independently, these services are fragmented. What is required is coordination and integration of these services to enable patients’ access in a timely manner. The Disease Control Division, Ministry of Health continues to play a central role – coordinating and funding these initiatives. What is desperately needed are more certified Diabetes Nurse Educators to manage the overall care of the patients as well as to provide key diabetes education that enable patient-empowerment to improve self-care, compliance, and ultimately result in better lives.
Patient Participation

BACKGROUND: The purpose of this exploratory study is to explain where, when and how the introduction of user fee system works in low and middle income countries using context, mechanism, and outcome configuration. METHODS: Considering advanced research in realist review approach, we made a review process including those following 4 steps. They are identifying the review question, initial theory and mechanism, searching and selecting primary studies, and extracting, analyzing, and synthesizing relevant data. RESULTS: User fee had a detrimental effect on medical utilization in low and middle income countries. Also previous and current interventions and community participation were critical context in user fee system. Those contexts were associated with intervention initiation and recognition and coping strategies. Such contexts and mechanisms were critical explanatory factors in medical utilization. CONCLUSION: User fee is a series of interventions that are fragile and dynamic. So the introduction of user fee system needs a comprehensive understanding of previous and new intervention, policy infrastructure, and other factors that can influence on medical utilization.
Consumer Participation ; Fees and Charges*

Objectives: Majority of the existing patient safety culture tools are designed for healthcare workers. Despite the claims that this patient safety tools are patient-centered, limited attention was given to the patients’ perspectives and cultural considerations in the development. Local studies are not available in extant literature that capture patient perspectives on being safe during hospitalization. The goal of the study was to develop and provide preliminary psychometric analysis on a tool that measures patients’ perception of safety culture in a hospital setting. Methods: The study was a quantitative methodological study. The instrument was developed in three phases, conceptualization and item generation through literature review, clinical observation, and focus group discussion, two rounds of expert panel review, and pilot testing. The tool was tested on 122 eligible patients admitted in a tertiary hospital. Factor analysis of the items was done to determine the underlying factor under each item. Cronbach’s alpha was used to test the degree of internal consistency of the scale. Results: The Patient Perceptions on Safety Culture in Hospital Setting Scale consists of 25 items. The analysis yielded four factors explaining a total of 69.23% of the variance in the data. Items were grouped in four dimensions: Hospital workforce (4 items), Hospital Environment (5 items), Heath Management and Care Delivery (7 items), and Information Exchange (9 items). Each factor registered a Cronbach’s alpha of 0.81, 0.78, 0.91, 0.94, respectively. The overall Cronbach’s alpha of the scale is 0.95. Conclusion The study offers preliminary evidence on the psychometric properties of a newly developed tool that measures patient perceptions on hospital safety culture. Subsequent studies on larger samples need to be conducted to determine the reliability and validity of the tool when applied to different population and contexts as well as determining valid cut-off points in scoring and interpretation.
Patient Safety ; Patient Participation

OBJECTIVES: Stakeholders and stakeholder engagement in agenda setting are not well documented despite its increased recognition. This paper aimed to describe stakeholder engagement in the agenda setting. Specifically, it aimed to (1) describe the process of stakeholder engagement in the development of the NUHRA 2017-2022; (2) describe characteristics of stakeholders involved; and (3) identify lessons learned during the engagement.

METHODS: Documents pertinent to the agenda setting process, which included profile of participants and feedback on the consultation process were reviewed and analyzed. Key informant interviews were also conducted among selected PCHRD officials and members of the Philippine National Health Research System - Research Agenda Committee. Stakeholder mapping was conducted prior to the engagement to identify potential stakeholders. Consultations were conducted in each region involving different stakeholders. Stakeholders in the consultation process were national government agencies, local government units, academe, public and private health facilities, and non-government organizations (NGOs).

RESULTS: The stakeholder with the highest representation was the national government (n=110), while the lowest were public and private health facilities (n=14 each). Interactive discussion of stakeholders with diverse background, is the top item that went well during the consultation and should be retained in the future, and; brainstorming session and presentation were identified item that needs improvement.

CONCLUSION: A diverse and well-represented set of stakeholders is important in an agenda setting to appropriately identify priorities and to improve uptake of the agenda. Stakeholder engagement, however, should not be limited to agenda setting, collaborative work must be sustained in all aspects of the research cycle.

In April, 2006, we made and distributed the pamphlet entitled “Declaration for safety measures in medical services.” Because we thought that sharing with patients in the safty target could lead to create a safe environment in the hospital.To make certain whether inpatients and nurses understood and practiced the declaration, we took a questionnaire survey. The results showed that about 90% of the medical staff and inpatients understood the declaration and thought it worked out well. However some of the medical staff answered that they thought it did not work out. We felt the necessity to educate the medical staff thoroughly. Moreover, we found out differences in the recognition between medical staff and patients. For example, medical staff wonders if they mistake the contents of injections. But most of patients worry about pain.The medical staff is always working nervously and anxiously. However, there arequite a few cases in which complaints or disputes result from insufficient understanding by patients although medical staff thought that it was checked and explained.We are now working on safety measures reflecting patient's opinions.
Safety ; seconds ; Work ; Patients ; participation

BACKGROUND: Community-managed health programs (CMHPs) were designed to promote community self-determination in addressing health needs, but there is a need to evaluate how CMHPs can lead to better outcomes while accommodating changes in the national health system, which requires analysis of current CMHP interventions, institutional and community readiness, and points of interface with other health facilities.

OBJECTIVE AND METHODS: This preliminary study aimed to guide an eventual effort to develop a framework to ensure CMHPs sustainably improve health outcomes. A preliminary analysis of results from a community participatory research was done in which baseline health characteristics, related social determinants, level of involvement of CMHPs with the local government health system, and quality of life were documented through surveys, focus group discussions and key informant interviews, both in a community with an established CMHP (Murcia, Negros Occidental, Philippines), and a control area without a similar NGO sector (Isabela, Negros Occidental).

RESULTS: There was higher NGO and local government involvement among respondents in Murcia, use of traditional medicine, and sense of awareness of the need to improve the water quality in Murcia, with noted persistence of sanitation concerns, pinpointing the need to assess community participation and the efficiency of CMHPs.

CONCLUSION: Further study is needed in measuring community participation while considering its underlying cultural and socioeconomic contexts, in order to facilitate planning and implementation of strategies that intend to address community-recognized health needs while sustainably improving health outcomes.

To identify life−related factors causing increased mortality, 2, 769 rural residents aged 29−77 were investigated through a self−administered questionnaire in 1990. Death certificates and migration information were inspected during the 4.5−year follow−up period. Age, obesity, life attitude, job, marital status, drinking and smoking habits, previous or current illness, and frequency of participation in health examinations were checked during the baseline survey. The person−year mortality rate was higher among irregular participants in health examinations than among regular participants both among males and females. From Cox’s multiple regression analysis, factors with a significantly high hazard ratio (HR) for mortality were irregular participation (HR=2.05), increase of age (HR=1.54, for 10 years), previous or current illness (HR=2.44), unemployment (HR=1.95), and living without a spouse (HR=2.61) for males; and for females they were having previous or current illness (HR=15.21) and living without a spouse (HR=2.94). Thus, irregular participation in health examinations, unemployment and aging showed a relationship with a higher mortality only in males. A previous or current illness and living without a spouse were related in both sexes.
participation ; Health ; Illness, NOS ; livin ; g <3>

In China, there are three basic clinical decision-making modes for patients, namely patients' autonomous decision-making mode, family decision-making mode and patient and family codetermination. They were produced under the unique background of Chinese medicine, Confucian philosophy and law in China. In this paper, the concepts, advantages and disadvantages of these three decision-making modes were analyzed. In addition, some suggestions were put forward for the improvement. The first is that we suggest to establish standards for choosing decision-making modes; the second is to further learn and publicize relevant laws; thirdly, the legal system needs to be further refined; and the last one is to carry out ethical ward round.
China ; Decision Making ; Humans ; Patient Participation

Pulmonary tuberculosis is the major infectious diseases that cause death in Indonesia. Indonesian government’s efforts to cope with this disease are to follow the WHO recommendation to use the DOTs strategy. The weakness of this strategy is DOTs socialization has not reached all health centers, government and private hospitals so that the finding of new cases is still very low. Introduced an alternative model is the partnership of educational institutions, health services and communities, through community empowerment in the early detection of TB cases. This model was named “Corong Segitiga sehat Model.” The purpose of this study was to see community participation in trials that proved the model of the household contact person coverage checked him into the clinic. Quantitative and qualitative research methods with experimental research design that uses one-group pre-post test. The results showed the formation of partnerships with the model PPTB group after 1 month of training provided by educational institutions and health centers, patients with detectable BTA (+) as many as 9 people, as many as 14 people with suspected tuberculosis. These data supported the statement that the results of the training cadre will strengthen our selves for the more daring cadres advised people to check their household contact him to health center. Involve partnerships with community participation is one key to effective implementation of the model to detect new cases of tuberculosis. It is recommended for local governments actively participate as one component of a healthy funnel triangle, because of the influence of local government to increase community larger.
Tuberculosis ; Tuberculosis, Pulmonary ; Social Participation ; Indonesia

Informed consent right is not just for basic ethical consideration, but is important for protecting patient's right by law, which is expressed through informed consent contract. The appraised individuals of forensic clinical examination have the similar legal status as the patients in medical system. However, the law does not require informed consent right for the appraised individuals. I recommend giving certain informed consent right to the appraised individuals in the forensic clinical examination. Under the contracted relationship with the institution, the appraised individuals could participate in the examination process, know the necessary information, and make a selected consent on the examination results, which can assure the justice and fairness of judicial examination procedure.
Forensic Medicine ; Humans ; Informed Consent ; Patient Participation