Structural equation modeling of self-esteem, motives of participating in physical activity and duration of physical activity among adolescents in Kota Bharu, Kelantan

Introduction: Physical activity (PA) is an important daily routine that can maintain our health, whereas engaging in sedentary lifestyle can cause lifestyle-related diseases. There is no age limit of being active, but it is important to start from early age. Motivation of participating in PA is important to motivate people to sustain their PA regularly. Selfesteem could be a trigger factor to motivate people to increase the duration of PA. This study attempted to uncover how much self-esteem, motives of participating in any PA, and the duration of PA are related among adolescents, specifically in secondary school students in Kota Bharu, Kelantan. Objective: The study aimed to assess the level of self-esteem and motives of participating in PA and to ensure that both constructs are reliable and valid measures. Then, the inter-relationships between self-esteem, motives of participating in PA and duration of PA were examined using structural equation modeling (SEM). Method: A cross-sectional study was conducted among secondary schools‟ students in Kota Bharu, Kelantan using self-administered questionnaire. Participants were selected using cluster sampling method. Three schools were randomly selected from a total of 48 schools in Kota Bharu, Kelantan. The classes that involved in the study, within the selected schools were determined by the schools‟ principal. Self-esteem was measured using State Self-esteem Scale (SSES) and motives of participating in PA were measured using Physical Activity Leisure Motivation Scale (PALMS-Y). The scales were translated into Malay language using the standard procedure and there were named as SSES-M and PALMS-Y-M. Descriptive, confirmatory factor analysis (CFA), and SEM were used in statistical analysis. Results: Participants were 783 secondary school students (female= 57.3%, male= 42.7%) from Kota Bharu, Kelantan. Majority of the students were Malay (57.3%). Overall, theaverage of self-esteem and motives of participating in PA were 2.92 (SD=0.64) and 3.75 (SD=0.71) respectively. For measurement model assessment, SSES-M scale showed good fit to the data after some improvement were made (CFI=0.966, TLI=0.949, SRMR=0.030, RMSEA=0.040 (0.026, 0.055), Clfit p-value=0.861) with nine items remained. For PALMS-Y-M, the majority of the fit indices were within the acceptable threshold values (CFI=0.928, TLI=0.917, SRMR=0.048, RMSEA= 0.045 (0.042, 0.049), Clfit p-value= 0.982) with all items remained. The composite reliability for SSES-M and PALMS-Y-M were ranged from 0.582-0.632 and 0.622-0.823 respectively. Overall, the final SEM model showed a good fit to the data based on several fit indices (CFI=0.919, TLI=0.908, SRMR=0.048, RMSEA=0.044 (0.040, 0.047), Clfit p-value=0.998) with five hypotheses supported. The final SEM model explained 25% of the total variance in duration of PA, which was statistically significant. Conclusion: The SEM model tested in the present study provided useful insight in regard to the direct and indirect relationships among the study variables. The finding from the present study could provide valuable information that could help the teachers, health educators, health policy makers, and parents in promoting exercise and physical activity among secondary school students

Structural equation modeling of health belief, intention, health promoting behaviour, social support, symptom severity and quality of life among people with abdominal bloating in Kelantan

Abdominal bloating (AB) is regarded as one of the common bothersome symptoms by people of diverse backgrounds and all ages worldwide. However, there were still limited validated measures to explore the psychological behaviour of people with AB and its relationship with the outcome measures, such as psychological well-being, symptom severity and quality of life (QoL). This research aimed to develop validated measures for Bloating Health Belief, Intention, Bloating Health Promoting Behaviour, Bloating Social Support, Pictogram AB, Bloating Severity Questionnaire, Bloating Quality of Life and to examine the relationship between health belief, intention, health promoting behaviour, social support, symptom severity and QoL among people with AB in Kelantan. The study consisted of three phases, Phase I: Questionnaires development and translation; Phase II: Exploratory study by validating questionnaires through the exploratory factor analysis (EFA); and Phase III: Confirmatory study consisting of the validity of the measurement model with confirmatory factor analysis (CFA) and structural equation modeling (SEM) model development. The purposive sampling method was used in recruiting the participants for Phase II and Phase III. A cross-sectional study design was employed in all three phases. In Phase I, four new Malay language questionnaires were developed through literature search, experts‘ input and in-depth interviews. Besides, the English version of the Pictogram AB, Bloating Severity Questionnaire and Bloating Quality of Life were translated into Malay version. All of the questionnaires were examined for content validity based on experts‘ opinion and then pre-tested by the participants. In Phase II, all newly developed and translated questionnaires (except for intention as it consisted of one item and Pictogram AB) were tested for construct validity through exploratory factor analysis (EFA) and the reliability of internal consistency based on Cronbach alpha was reported. In Phase III, validity of the measurement models with CFA were confirmed for all the measures tested in Phase II, which were then used in a SEM analysis to determine the inter-relationships among the study variables. The validated Hospital Anxiety and Depression Scale was used to measure the anxiety and depression of the participants. Statistical analysis for Phase II and Phase III were performed by using SPSS 26 and Mplus 8, respectively. The newly developed and translated questionnaires were content validated based on seven experts‘ opinion and were comprehended by 30 participants during the pre-testing process. There were 152 participants with a mean age of 31.27 years old (standard deviation, (SD) = 14.36) and 323 participants with a mean age of 27.69 years old (SD = 11.50) participated in Phase II and Phase III studies. In Phase II of the exploratory study, the final models were established with all factor loading and Cronbach alpha showing evidence of validity and reliability for the questionnaires tested. Next, final measurement models of CFA with acceptable fit indices were obtained in Phase III of the confirmatory analysis. The final CFA measurement models were included in the SEM model, which explained the connections between the study variables. The final SEM model indicated good fit based on several fit indices and 15 significant path relationships were established. The final SEM model explained the variance of the social support by 16%, intention by 39%, and QoL by 53.8%. Significant relationships were found between severity general towards QoL, social support and intention towards severity general, health belief towards social support, depression and health belief towards severity 24 hours, health belief towards intention and health promoting behaviour, intention and health promoting behaviour towards depression and intention towards health promoting behaviour. The newly developed and translated questionnaires were considered to be valid and reliable in the assessment of health belief, intention, health promoting behaviour, social support, symptom severity and QoL among people with AB in Kelantan. The SEM model indicated that there were some inter-relationships between the study variables and there were significant contributing factors influencing the symptom severity and QoL of people with AB. The present study provides valuable insight to the health care providers in reducing the symptom severity and improving QoL among people with AB

Validity and Reliability of the Malay Versions of Bloating Severity (BSQ-M) and Quality of Life (BLQoL-M) Questionnaires

Abdominal bloating (AB) is a prevalent and bothersome symptom, but there are no specific measures for severity and quality of life (QoL) other than the Bloating Severity Questionnaire (BSQ) and Bloating Quality of Life (BLQoL). We aimed to translate the BSQ and BLQoL into the Malay language and to validate them using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) approaches. The 12-item BSQ has two components, seven-item severity in general (SevGen) and five-item severity in the past 24 h (Sev24), and BLQOL has five items. Translation to the Malay language (BSQ-M and BLQoL-M) was performed using standard forward and backward processes. EFA followed by CFA were performed in participants with AB due to functional bowel disorders, with the purpose of examining the validity and reliability of the questionnaires translated into Malay. After EFA with 152 participants, all the items of BSQ-M remained in the model. Total variance extracted was 53.26% for BSQ-M and 58.79% for BLQoL-M. The internal consistency based on Cronbach’s alpha values was 0.52 for SevGen, 0.86 for Sev24, and 0.81 for BLQoL-M. After performing CFA with another 323 participants, the final measurement model for BSQ-M and BLQoL-M fit the data well in terms of several fit indices (BSQ-M: root mean square error of approximation (RMSEA) = 0.050, Comparative Fit Index (CFI) = 0.966, Tucker–Lewis Fit Index (TLI) = 0.956, and standardized root mean squared residual (SRMR) = 0.051; BLQoL-M: RMSEA = 0.071, CFI = 0.985, TLI = 0.962, SRMR = 0.021). The composite reliability for BSQ-M and BLQoL-M were satisfactory (SevGen = 0.83, Sev24 = 0.89, BLQoL = 0.80). The intraclass correlation (ICC) results showed excellent stability for BSQ-M and BLQoL-M, ranging from 0.74 to 0.93. The Malay language versions of BSQ-M and BLQoL-M are valid and reliable instruments for measuring the severity and QoL of AB for the Asian population with functional bowel disorders