The views and experiences of Malaysian primary care doctors in managing patients with chronic low back pain: a qualitative study

Background: Chronic low back pain (CLBP) is a common and often difficult to treat condition in the primary care setting. Research involving in-depth exploration on the views and experiences faced by primary care doctors in managing patients with CLBP in Malaysia is limited. Objective: To explore the primary care practitioners’ views and experiences in managing patients with CLBP. Study design: A qualitative approach was employed using focus group discussions (FGD) at an academic primary care clinic in Kuala Lumpur, Malaysia. Twenty-three primary care doctors were purposively selected. Data were collected through audio-recorded interviews, which were transcribed verbatim and checked for accuracy. Data saturation was reached by the third FGD. An additional FGD was included to ensure completeness. A thematic approach using the one sheet of paper (OSOP) method was used to analyse the data. Results: Participants view managing patients with CLBP as challenging. This is mainly due to the difficulty in balancing the doctors’ expectations with the patients’ perceived expectations during consultation. Barriers identified include lack of awareness and conflicting views regarding the usefulness of the local clinical practice guideline (CPG) in clinical practice. Other barriers include time constraints and perceived lack of support from multidisciplinary teams in managing these patients. Conclusion: Managing patients with CLBP is still a challenge for Malaysian primary care doctors. Any intervention should target identified barriers to improve the management of patients with CLBP

Health literacy research in Malaysia: a systematic review

Introduction: Health literacy has emerged as an important determinant of health and a key component of self-care and patient centered medicine. In Malaysia, the recent National Health Morbidity Survey found that the adult l health literacy level was worryingly low. Local research in health literacy is urgently needed. The aim of this systematic review is to identify and synthesize research publications on health literacy carried out in Malaysia. Methods: The search was conducted up to February 2017 using the MEDLINE, Scopus and Malaysian Medical Repository databases. The free text search terms used were “health literacy” (all fields) and Malaysia (all fields). Inclusion criteria were that the study population was Malaysian and the study reported on health literacy. There was no restriction on study designs in order to maximize the scope of the review. Two reviewers independently selected the articles based on the titles and abstracts, followed by full-text screening. Study quality was not assessed. The following data were extracted from the full-text articles independently by two reviewers: year of publication, name of authors, geographical location, research focus, and key findings. Any disagreement was resolved by consensus. Results: In total, 10 articles were eligible for inclusion in the review with the earliest article published in 1985. Six were on general health literacy, two on medication literacy and two on mental health. Most were quantitative studies (n=9) with only one qualitative study eligible for inclusion. The number of studies increased over time with most studies being published in 2016 (n=3). Validated health literacy tools, such as the Newest Vital Signs (NVS) and HLS-EU-Q47 were used in studies published after 2015. Three studies used NVS to measure health literacy levels and the prevalence of limited health literacy levels ranged from 79.4 to 94.2%. HLS-EU-Q47 was used in two studies: a validation study of its’ Malay version and as an outcome measure in a study protocol. The majority of the studies (n=7) were conducted in central urban regions namely Kuala Lumpur, Selangor and Negeri Sembilan. The qualitative study explored the mental illness literacy among caregivers and found care givers have some understanding on mental illness and consider doctors as the primary source of health information. Conclusions: Even though the first paper was published nearly 32 years ago, much work remains to be done for health literacy research in Malaysia. The use of locally validated tools for the assessment of health literacy is recommended for future research

Psychological distress and internet addiction among medical students from a Malaysian public university: a comparison between gender

Introduction: Widespread use of the internet is a relatively recent phenomenon that is affecting different cultures worldwide in both positive and negative ways. This study aimed to determine the gender differences in the inter-net addiction among medical students in public university. Methods: 426 medical students from year one to four were invited to participate in the study. For data collection, we used a self-administered questionnaire consisting of socio-demographic and internet usage questions, the Internet Addiction Test (IAT) and the Depression Anxiety and Stress Scales 21 (DASS-21). Results: There were a total of 426 (270 female and 156 male) medical students included in this study. IA was high in both male and female students. There was a higher proportion of male students (44.9%) found to be addicted compared to female students (32.2%). There were positive correlations between the DASS-21 and IAT scores for both male and female students. For female students, longer hours spent online daily (p-value = 0.02), as well as high anxiety (p-value < 0.001) and depression scores (p-value = 0.037) were found to be most strongly associated with IA. Among male students, factors associated with IA were the availability of internet access at home (p-value=0.02) and high anxiety scores (p<0.001). Conclusion: IA was high in both male and female medical students, with higher anxiety raising the risk in both groups. In female students, a higher depression score was also found to be associated with IA

Health literacy research in Malaysia: a scoping review

Research on health literacy is expanding worldwide. Health literacy has been recognised as a critical determinant of health at the 2016 Shanghai Declaration. Little is known about health literacy research in Malaysia. This scoping review aims to identify and summarise published studies on health literacy in Malaysia. PubMed, Scopus and the Malaysian Medical Repository (MyMedR) databases were searched for published work by Malaysian researchers. Searches were conducted up to November 2019. The search terms used are related to ‘health literacy’ and ‘Malaysia’. Studies included were those involving Malaysian citizens and reporting on various aspects of health literacy. Studies were reviewed by two independent reviewers to determine their eligibility. Data extraction for the year of publication, name of authors, geographical location, research focus, and summary of findings from the full-text articles was carried out independently and any disagreement was resolved by consensus. A total of 29 articles were included with the earliest article published in 1985. Fifteen of the articles are on general health literacy, four on medication literacy, five on mental health literacy, three on media and e-health literacy and four on oral health literacy. Four articles are qualitative studies and the rest are quantitative studies. A few of the studies used validated health literacy tools such as Newest Vital Signs and HLS-EU-Q47. Therefore, we can conclude that there are only a limited number of articles published in the field of health literacy in Malaysia. Future work using validated international tools to allow comparison of the findings should be considered

The proportion of undiagnosed diabetic peripheral neuropathy and its associated factors among patients with T2DM attending urban health clinics in Selangor

Introduction: Diabetic Peripheral Neuropathy (DPN), the most common complication of Diabetes Mellitus (DM), is often under-diagnosed and inadequately treated. This study identified the proportion of undiagnosed DPN and its associated risk factors among patients with established type 2 DM (T2DM) in community health clinics in the Gombak district. Methods: A cross-sectional study was conducted in 2 community health clinics within the Gombak district between September and December 2017. Adults with T2DM were selected via systematic random sampling and screened using the Neuropathy Symptoms Score (NSS). Clinical records of participants’ foot examinations were reviewed to identify positive findings of DPN and compared with the NSS. Results: The study’s sample comprised 425 patients. Most had co-morbidities, including hypertension, dyslipidaemia and pre-existing DM-related complications. About two-thirds of them performed no daily foot inspection and had no proper footwear. The proportion of patients with positive NSS was 49.4%. However, only 0.2% were diagnosed with positive DPN in their clinical foot examination record. Conclusion: Although a positive NSS was identified in 1 out of 2 patients with established DM, only 0.2% of patients had DPN on their examination records. Most patients had never done daily foot inspections and lacked proper footwear. A positive NSS was associated with uncontrolled diabetes and lower BMI. Proper screening and examination for patients, especially those with uncontrolled diabetes and low BMI, is crucial in identifying DPN to ensure that these diabetic patients receive better preventative care, especially proper foot care and strict diabetic control, to prevent DPN-related complications

Do Malaysian asthma patients use asthma action plan? a cross sectional study in Malaysian primary care setting

Background: Supported self-management, including provision of an asthma action plan (AAP) improves asthma control. However, the concept of self-management and use of AAP among Asian population is relatively new. Aims: To determine the prevalence of AAP ownership among asthma patients and their characteristics in Malaysia primary care. Methods: We randomly sampled 550 asthma patients from five primary care practices between Oct 2017-Jan 2018. The patients were interviewed with pre-tested questionnaires to assess their AAP ownership, socio-demographic and the Asthma Control Test (ACT). Descriptive statistics were used to analyse the data. Results: Asthma control was poor in 143(26%) patients, partially controlled in 137(24.9%) and well-controlled in 270(29.1%). Only 160(29.1%) owned an AAP. These AAP were primarily given by the doctors (95%, n=152) and 5% were given by the allied health (nurses and pharmacists). Among those who owned an AAP, 106(66.2%) were confident to use it. For those using AAP, the mean age was 45.6 years old, predominantly female (67%), of Malay ethnicity (48%), had at least secondary educational level (40%) and had well-controlled asthma (46%). Conclusion: Education, usage and confidence in using an AAP for asthma self-management is sub-optimal among asthma patients in Malaysian primary care. Supported asthma self-management in this population must be strengthened

Prevalence, awareness and control of hypertension in Malaysia from 1980-2018: a systematic review and meta-analysis

Background: Hypertension is a common public health problem worldwide and is a well-known risk factor for increased risk of cardiovascular diseases, contributing to high morbidity and mortality. However, there has been no systematic review and meta-analysis of a multiethnic population such as that of Malaysia. Aim: To determine the trend in prevalence, awareness and control rate of hypertension in Malaysia. Methods: Systematic searches were conducted in six databases (PubMed, Scopus, Ovid, CINAHL, Malaysian Medical Repository and Malaysia Citation Index) for articles published between 1980 and 2018. Two authors reviewed the studies and performed quality assessment and data extraction independently. Pooled estimates of hypertension prevalence, awareness and control rate were calculated using the DerSimonian-Laird random-effects model. Subgroup and sensitivity analyses were performed. Results: We included 56 studies involving a total of 241796 participants. The overall pooled prevalence of hypertension aged ≥ 18 years was 29.7%. The prevalence of hypertension was the lowest in the 1980s (16.2%, 95% confidence interval (CI): 13.4, 19.0), increasing up to 36.8% (95%CI: 6.1, 67.5) in the 1990s, then decreasing to 28.7% (95%CI: 21.7, 35.8) in the 2000s and 26.8% (95%CI: 21.3, 32.3) in the 2010s. The prevalence of awareness was 51.4% (95%CI: 46.6, 56.3), while 33.3% (95%CI: 28.4, 38.2) of those on treatment had achieved control of their blood pressure. Conclusion: In Malaysia, three in ten adults aged ≥ 18 years have hypertension, while four in ten adults aged ≥ 30 years have hypertension. Five out of ten people are aware of their hypertension status and only one-third of those under treatment achieved control of their hypertension. Concerted efforts by policymakers and healthcare professionals to improve awareness and control of hypertension should be of high priority

Developing an asthma self-management intervention through a web-based design workshop for people with limited health literacy: User-centered design approach

Background: Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). Objective: The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. Methods: We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. Results: The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. Conclusions: This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing

A prevalence study of pharyngitis and its associated factors among adults with a sore throat in three primary clinics in Selangor, Malaysia

Introduction: Since pharyngitis in adults is one of the most common infectious diseases seen in general practitioner consultations in Malaysia, data on pharyngitis among adults concerning to its prevalence, socio-demographic, risk factors and clinical manifestations is very much lacking. This study aims to determine the prevalence of pharyngitis among adults in Sepang, Selangor, Malaysia from 2016 to 2017 and its associated demographic and risk factors. Methods: We conducted a cross-sectional study on 215 adult patients with a sore throat as the main symptom and who did not receive any antibiotic treatment within two weeks at three Malaysian primary care clinics. The researchers assessed the participants’ clinical manifestations and collected throat swabs for culture to determine the presence of group A streptococcus (GAS). Data on demographic characteristics, clinical manifestation and throat swab culture results were analyzed using chi-square test and multivariate logistic regression. Results: Pharyngitis was diagnosed in 130/215 (65%) adults with a sore throat. Only six isolates (2.8%) were identified as GAS. The overall mean age ± S.D was 36.43 ± 15.7. The majority of the participants were in the age group of 18-28 years. There were 42.3% males and 57.7% females; most participants were Malay 62.8%, followed by 30.2% Indian, 5.1% Chinese, and 1.9% other ethnicities. The most common symptom among the participants was cough 196 (91.2%), followed by rhinorrhea 161 (74.8%), tonsillar swelling or exudates 68 (31.6%), inflamed or reddish of pharynx 62 (28.8%), swollen anterior cervical lymph nodes 50 (23.3%), and fever ≥37.5°C 28 (13.0%). Conclusion: Besides, there was no significant association between pharyngitis and the demographic variables; the current findings emphasized that inflamed or reddish pharynx, tonsillar swelling or exudates were among the factors associated with pharyngitis