Emotional and behavioural problems among children: issues and trends in Malaysia

Emotional and behavioural problems among children have been increasing in many western as well as the eastern countries. Although the problem has been given attention and priority in terms of early detection, many children with early symptoms of emotional and behavioural problems has still not been detected at the early stages. This phenomenon is worrying as mental health problems were shown to be stable in the long run and if left undetected it may manifest into various problems in adulthood. This paper explores the issues on emotional and behavioural problems in terms of its definition, prevalence, aetiology, long term consequences and treatment. It also explores on mental health problems in a non-western country, i.e. Malaysia including its prevalence and intervention strategies which has been carried out in overcoming this worrying issue. Finally this review paper stresses the importance of providing a well-designed epidemiological study in Malaysia in assessing the current prevalence of emotional and behavioural problems in young children and adolescent

A Longitudinal Study of Emotional and Behavioral Problems among Malaysian School Children

Background: Emotional and behavioral problems (EBD) or mental health problems in children and adolescents are an important public health issue, but there has been no evaluation to date of the extent of such problems in near-developed countries. This study evaluated the prevalence and stability of EBD among children in Malaysia. Methods: This research comprises a longitudinal population-based study that measured the prevalence and 6-month stability of EBD in children aged seven to eight years and thirteen to fourteen years attending public schools in Malaysia based on parents, teachers and children’s (aged 13 to 14 years) report of the Strengths and Difficulties Questionnaire (SDQ) at baseline and 6 months later. Findings: The prevalence of EBD in Malaysian school children was 9.3% for teacher-report, 8.5% for parent-report and 3.9% for child-report. There was no significance difference in the prevalence of emotional and behavioral problems over six-months for all informants, except for teacher-report Emotional and Conduct problems scores which increased significantly and child-report Total Difficulties and Emotional problems scores which decreased significantly ('p' < 0.05). Conclusions: This study shows that the prevalence of EBD among Malaysian children is almost similar to the Western countries and stable over a 6-month period. These findings suggest the need for policy makers in near-developed countries to provide services aimed at preventing EBD and treating children identified as having such problems

Health-related Quality of Life of Cancer Caregivers in Klang Valley, Malaysia

Cancer caregiving has an impact on the quality of life (QOL) of the caregivers. This cross-sectional study determined the health-related QOL (HRQOL) of gastrointestinal cancer caregivers and associated factors across gender. A total of 323 respondents from major hospitals in Klang Valley completed HRQOL questionnaire from October 2017 to April 2018. Males had a better quality of life compared to females, mean HRQOL score 85.52 (SD=21.16) vs 77.66 (SD=21.36). The significant factors were: relationship between the caregiver and the patient; education level; employment status, marital status, household income and presence of disease. The gender role is vital for targeted intervention. Keywords: health-related quality of life; gastrointestinal cancer; caregivers; gender eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning &amp; Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v5i15.245

Clinicians’ perception of virtual reality therapy in treating patients with obsessive compulsive disorder: a preliminary study

In the Western context, virtual reality (VR)-based treatments had been suggested as an intervention for anxiety disorder. Despite its potential efficacy, there is a lack of study which using VR as an intervention, especially for obsessive-compulsive disorder (OCD) in Asian countries. Therefore, the present study aimed to examine what elements are required to design VR and the suitability of VR as an intervention in OCD for the local context. To address this, six clinicians, consisting of three clinical psychologists and three psychiatrists, were interviewed. They were interviewed using a semi-structured interview protocol related to their perception on VR as an intervention for OCD patients, as well as the cognitive behaviour therapy (CBT) elements that can be incorporated in VR. The findings showed that all clinicians anonymously supported CBT to be augmented into VR as part of intervention for OCD to overcome logistics issues, the interactive nature of the virtual environment and the sense of presence similar to a real-life situation. The side effects of VR also need to be studied before employing these new interventions. In conclusion, VR can be used as an intervention for OCD. CBT-VR intervention can be applied in the Asian context by using similar CBT modules which should be modified according to cultural context

Exploring the determinant of pre-pregnancy care services usage among reproductive ages women in Kedah, Malaysia

Introduction In Malaysia although mortality rate among women of reproductive ages has reduced over the years, the reduction has been stagnant for the past ten years. In order to achieve the 5th Millennium Development Goal, several measures need to be taken including a proper implementation of pre-pregnancy services in this country. This study explores the awareness, intention and usage of pre-pregnancy care (PPC) services and its determinant among women of reproductive ages in Kedah, Malaysia. Methods This is a qualitative study, which consisted of a focus group discussion (FGD) among women in the ages of 18 to 45 years old from all ethnic groups who attended four government clinics in the state of Kedah. The mothers were chosen through purposive sampling from twelve districts that were selected through a multistage random sampling. A semi-structured questionnaire was utilized during the FGD. The results from the FGD were recorded verbatim and thematic analysis was finalized once saturation of information from respondents was achieved. Results These are two themes was identified, namely personal reasons and reasons of service and there are several subthemes under two main themes. Under the Personal reason themes, the subthemes including awareness and intention to used the services, knowledge, perception, social support and history of medical illness. While under pre-pregnancy care services themes, the subthemes including the promotion of the services, the communication relationship with the health staff, the waiting time and also the accessibility of the service. Conclusions As a conclusion, there is still part of society who was unaware of prepregnancy services and its importance in reducing maternal mortality rate as well as producing good pregnancy outcome. Information and knowledge on pre-pregnancy care services should be disseminated among community members through various means including roadshows and pre wedding workshops

The Malay version of patient activation measure: an instrument for measuring patient engagement in healthcare

Effective diabetes management depends on both pharmacological treatment and patients’ engagement in their own care. PAM is an instrument that measures patients’ ability to self-manage their chronic illnesses and determines patients’ level of activation. The purpose of this study was to develop a translated Malay version of the PAM instrument and subsequently, to conduct a reliability and validity assessment. A cross-sectional study among patients with type 2 diabetes was performed in a teaching public primary care clinic. Forward and backward translation was conducted, followed by pre-testing and cognitive interviewing. Data from 130 patients were analysed using SPSS software to assess the internal consistency and the psychometric properties of the Malay version of PAM instrument. Cronbach’s alpha for all items was 0.87, indicating good internal consistency. Exploratory Factor Analysis (EFA) showed a possibility of a three-factor model, which were labelled as a) confidence in performing preventive behaviors b) feel responsible and in charge of own health, and c) knowledge, ability to communicate and adherence to treatment. All items have a factor loading of higher than 0.4. The Cronbach’s alpha value was 0.85, 0.7 and 0.58 for the first, second and third subscales, respectively. The Malay version of PAM instrument showed a good reliability index and might have multiple subscales. Assessing these subscales are useful for the healthcare team in the evaluation of ‘patient activation’ among patients with diabetes. Efforts will thus be easier when responding to the patients’ needs and facilitating them to become active health managers

Development and validation of a questionnaire to predict intention to comply to iron supplement during pregnancy

The World Health Organisation (WHO) has recommended iron supplementation to overcomeanaemia in pregnancy. In Malaysia, about half of pregnant women with anaemia do notcomply to iron supplement. The purpose of this study is to develop and validate aquestionnaire that assesses the attitude towards iron supplementation and later to predictintention to comply with daily iron supplement among pregnant women. Based on theguidelines for construction of the Theory of Planned Behaviour questionnaire, 18 items werecreated initially by using the findings from an open-ended questionnaire survey, literaturereviews and experts’ opinion. From content validity by 3 experts, 15 items with contentvalidity ratio (CVR) of ≥0.99 were retained. From a pilot test for exploratory factor analysis(EFA), total of 12 items were retained, and classified into 3 components and termed as“Attitudes”, “Subjective Norms” and “Perceived Behaviour Control”. Cronbach Alpha for the12 items was 0.814, and for each component were 0.844, 0.813 and 0.901 respectively, whichindicates acceptable internal consistency. During the Confirmatory Factor Analysis (CFA), afinal 10 items were retained. The construct validity was good where the Fitness Index haveachieved the threshold i.e. p-value &gt;0.05, RMSEA &lt;0.08, CFI &gt;0.90 and the ChiSq/df ratio&lt;3.00. The convergent validity and composite reliability were good i.e. Average VarianceExtracted (AVE) ≥0.50, and Composite Reliability (CR) ≥0.60 respectively. As a conclusion,the validation of this newly developed questionnaire has shown promising result andpotentially reliable in predicting compliance to iron supplement among pregnant womenspecifically in Malaysia

Initiating activation in diabetes self-management from patients’ perspective

Patients’ active role is crucial in managing chronic illnesses like type 2 diabetes. Current evidence demonstrated patients who were activated had better clinical outcomes. Some factors influencing patient activation have been identified but there is little knowledge on how patients successfully start to take their role in managing diabetes. This study aimed to explore how patients begin to activate themselves in self-management. The narrative inquiry was taken as the qualitative methodological approach. Ten participants with type 2 diabetes were purposively sampled from a public primary care clinic in Malaysia. In-depth interviews were conducted and recorded. The data were analysed with thematic analysis. Three themes and four subthemes were generated. The first theme, “Learning what to do” describes the learning process from social networks and healthcare professionals that helped to define their role. The second theme highlighted that patients wished for a gradual approach in initiating activation, i.e. “Taking one step at a time”. They started with a more straightforward self-management task and needed more time to take up their role. The third theme pointed out that when patients could not perform certain self-management tasks, they would engage with someone else to help: “Engaging with someone for challenging tasks.” In conclusion, diabetes self-management education is substantial in developing ‘patient activation,’ i.e. patient’s ability to self-manage. The self-management plan should also be realistic and suit patients’ circumstances. Having a health partner or buddy among family members or peers is helpful when trying to adopt good dietary habits and perform regular exercise

Factors influencing physical activity in pregnancy : a systematic review

Lack of physical activity in pregnancy may lead to poor maternal and perinatal outcomes including gestational diabetes, hypertensive disorders and postpartum depression. Given these risks, identifying factors that influence physical activity in pregnancy is crucial to planning and implementing appropriate interventional programmes and managing this vulnerable group. Peer reviewed articles on factors influencing physical activity in pregnancy were searched using the Pub-Med and Ovid databases, from 2014 to 2019. The selected articles were reviewed by two authors and critically appraised using the Mixed Methods Assessment Tool 2018. A total of 16 articles were included. Factors that positively influenced physical activity in pregnancy were fun, higher economic status, early trimester, and higher body weight. Factors that negatively influenced physical activity in pregnancy were lack of knowledge, lack of social support, multiparity, physical pain and discomfort, ethnic minority status, and concern for the safety of the baby. Fun was one of the most reported motivators of physical activity in pregnancy, and the most reported reason for reduced physical activity was lack of knowledge. Additionally, social support from friends and family played an important role in encouraging pregnant women to be active. This systematic review highlights the need to improve current health education programmes for physical activity in pregnancy, which should ideally be extended and targeted to the whole community, beyond pregnant women themselves for better uptake and acceptance

A mini-review on the determinants and risk factors of adolescent pregnancy in developing countries

Pregnant adolescents have been shown to have a higher incidence of health and non-health-related complications that affect both mothers and infants. These include increased risk of pregnancy-related diseases such as anemia and pre-eclampsia, preterm and low-birth-weight babies, as well as other social consequences such as educational and financial difficulties. This mini review evaluates selected articles which explain the attitudes, knowledge, behavior and other risk factors associated with pregnancy among adolescents in developing countries. It also revealed that inadequate knowledge among adolescents about reproductive and sexual health, other social, cultural and peer influences, parenting values, and poor financial and educational status were factors that contribute to adolescent pregnancy. Likewise, a lack of support from parents, educators and healthcare workers had negative impacts on healthy sexual behavior among adolescents, which may ultimately lead to adolescent pregnancy. We conclude that the factors discussed in this review need to be evaluated and taken into consideration by policymakers and healthcare workers when formulating strategies to prevent pregnancies among adolescents