Effectiveness of the EMPOWER-PAR Intervention on Primary Care Providers’ Adherence to Clinical Practice Guideline on the Management of Type 2 Diabetes Mellitus: A Pragmatic Cluster Randomised Controlled Trial

AIM: The objective of this study was to evaluate the effectiveness of the EMPOWER- participatory action research (PAR) intervention, a multifaceted strategy based on the chronic care model (CCM) on primary care providers (PCP)’ adherence to type 2 diabetes mellitus (T2DM) clinical practice guideline (CPG) in the Malaysian primary care setting. METHODS: This was a pragmatic cluster randomized controlled trial –PAR conducted in ten public primary care clinics in Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. The outcome measure was the absolute change in the proportion of PCP’s adherence to T2DM CPG captured using the “Indicators of Care Pro forma,” based on the recommendation by the Malaysian CPG on the Management of T2DM. Data were collected from the patients’ medical records, at baseline and at 1-year follow-up; and were analyzed using mixed method model. RESULTS: A total of 888 patients were recruited at baseline; 471 were in the intervention and 417 were in the control group. There was no significant demographic difference between the two groups at baseline except for ethnicity. At 1-year, 455 (96.6%) and 406 (97.3%) patients in the intervention and control groups completed the study, respectively. There were significant improvements in the absolute change in the proportion of PCPs’ adherence to T2DM CPG in the intervention group compared to the control group at 1-year follow-up in several indicators of care. These included the recording of BMI (0.6% vs. −1.8%, p<0.001); performing foot examination (2.4% vs. 0.6%, p<0.001); performing funduscopy/fundus photography (1.5% vs. 0.3%, p<0.001); monitoring renal profile (0.9% vs. −0.6%, p=0.001); measuring urine protein (1.2% vs. 0.6%, p<0.001), and giving lifestyle modification and self-management advice (1.2% vs. −0.3%, p<0.001) in the intervention versus control groups, respectively. CONCLUSION: The EMPOWER-PAR intervention has been proven to be effective in improving the PCPs’ adherence to T2DM CPG in several indicators of care. Findings from this study provided objective evidence of the effectiveness of multifaceted intervention based on the CCM in the Malaysian public primary care setting. TRIAL REGISTRATION: Registered with: ClinicalTrials.gov: NCT01545401. Date of registration: 1st March 2012

Knowledge, attitude and practices among mothers regarding childhood obesity at Kuantan, Malaysia

Background: The prevalence of childhood obesity has been increasing alongside rapid global economic development including Malaysia. The aims of this study were to assess the knowledge, attitude and practices (KAP) of mothers regarding childhood obesity and to determine the factors associated with the KAP as well as to map the correlation between KAP. Methods: A cross sectional study was conducted on 100 mothers aged above 18 years attending a Mother and Child Clinic in Kuantan, Malaysia. They had to fill up the consent form and questionnaires. Results: The survey revealed that mothers had moderate KAP on childhood obesity. Twenty three to 87 mothers answered correctly on knowledge part, 4 to 54 mothers and 17 to 76 mothers answered correctly on attitude and practices respectively. The knowledge was associated with educational level (t = -4.411, p < 0.001), age (r = +0.222, p = 0.026) and income (r = +0.337, p = 0.013). While attitude was associated with educational level (t = -4.384, p < 0.001), occupation (t = +2. 082, p = 0. 040) and income (r = +0.326, p = 0.016). It indicates that as educational level and income increased, the knowledge and attitude also increased. While as age increased, knowledge also increased. Different type of mother's occupation showed a different attitude on childhood obesity. There was a correlation between attitude with knowledge (r = +0.414, p < 0.001) and practices (r = +0.261,p = 0.009) but there was no correlation between knowledge and practices (r = +0.158, p = 0.116). Conclusions: It showed that a good attitude is related to higher knowledge and best practices, but high knowledge does not mean it had good practices. These findings may be useful in targeting programs and strategies for preventing and intervention of childhood obesity

A Revised Version of Diabetes Quality of Life Instrument Maintaining Domains for Satisfaction, Impact, and Worry

Background. Diabetes quality of life (DQoL) instrument has been widely used to measure quality of life among diabetes patients. This study aimed to develop a revised version of DQoL instrument that incorporated issues of redundancies in the items and strengthen the basis of validity of the instrument. Methods. This was a cross-sectional study where diabetes patients were recruited from December 1, 2014, until end of March 2015 at a public health clinic in Peninsular Malaysia. A questionnaire that included patients’ information and DQoL instrument was distributed to patients. Item selection of DQoL instrument was conducted to screen and finalize the items based on issues of missing values and redundancy. Validity testing was conducted for the revised DQoL instrument based on exploratory factor analysis, confirmatory factor analysis, and Rasch analysis. Results. The pattern structure matrix yielded three domains similar to the original version with 18 items. The minimum factor loading from the structure matrix was 0.358. The item’s and person’s reliability was excellent with 0.92 and 0.84 for “satisfaction” domain, 0.98 and 0.60 for “impact” domain, and 0.99 and 0.57 for “worry” domain, respectively. Confirmatory factor analysis has dropped 5 items and the revised version of DQoL contained 13 items. Composite reliability of the revised version was computed for “satisfaction” domain (0.922; 95% CI: 0.909–0.936), “impact” domain (0.781; 95% CI: 0.745–0.818), and “worry” domain (0.794; 95% CI: 0.755–0.832). Conclusion. A revised version of DQoL that maintains the conceptualization of “satisfaction,” “impact,” and “worry” with 13 items was successfully developed