The Decision-Making Process Of Primary Care Doctors In Undertaking Health Check-Ups For Male Patients In Malaysia

Background: Many major causes of disease burden and health risk factors in men are lifestyle-related and amenable to early interventions. Male-specific morbidities such as sexual dysfunction are common but often under-reported by male patients during consultations. These health risk factors and male morbidities are prevalent in primary care settings, but they are rarely discussed. Yet, primary care doctors (PCDs) are well positioned to offer health check-ups during consultations. Therefore, there should be an effort to develop or improve the uptake of men’s health check-ups in primary care settings. An understanding of how PCDs negotiate this is crucial to this process as health care provider factors are implicated as one of the reasons for men’s poor engagement with preventive health care. Objectives: The objective of this study was to explore the determinants and process of decision making by PCDs in undertaking health check-ups for male patients in Malaysia. This study also aimed to quantify the average impact of each determinant and rank its significance on the doctors’ decision-making processes in men’s health check-ups. Methodology and methods: A mixed-method approach was adopted in this study. Phase I, an exploratory phase of the study, has utilised grounded theory methods to construct a theoretical framework in explaining the determinants and the decision-making process for initiating check-ups in men. This framework informed the conceptualisation of phase II, which has utilised a quantitative approach to identify the significant determinants from a representative sample of PCDs. In this phase, a cross-sectional survey with multiple regression analyses was undertaken to examine and quantify the relationship between the determinants and outcome variables – the doctors’ intention to undertake health check-ups for male patients. Fifteen regression models were constructed based on five topics concerning men’s health and three contexts (acute minor complaint, follow-up and health check-up visits) for each of the topics. Results: Fifty-two PCDs from the private and public settings were interviewed in phase I and 198 doctors (a response rate of 70.4%) completed the questionnaire in phase II. The concept of men’s health was new to many PCDs, and yet many PCDs were already managing many illness concerns related to men. The concept was best depicted as an unresolved jigsaw puzzle, in which an understanding of the concept was fragmented. PCDs balanced the weight of perceived male patients’ receptivity versus medical importance before engaging male patients in health check-ups. If the patients were perceived to be receptive to health check-ups, PCDs would engage them. However, if PCDs felt a particular men’s health issue to be important, they placed less emphasis on their perceived patients’ receptivity to discuss that health issue in their decision making. However, the perception of receptivity relied mainly on assumptive and subjective assessments of the taboos surrounding the topics of men’s health and men’s help-seeking behaviour. From the overall results of regression analyses, the perception of receptivity was noted to be the most frequent significant determinant in the decision-making process among the 15 models, and it often has the highest regression coefficient in the models. The attitude towards the medical importance of men’s health check-ups ranked second in the list of frequent significant determinants. Other important determinants included perceived external barriers and personal competency in offering men’s health check-ups. However, these played a lesser role in the doctors’ decision making to engage male patients in undertaking health check-up. Conclusions: The concept of men’s health is relatively new among Malaysian PCDs. The doctors’ decision making to engage male patients in health check-ups is a complex process. It is influenced by both their personal experience and societal perceptions about men’s help-seeking behaviour, and in particular their perception of male patients’ receptivity to health check-ups, which can be unfounded. This potentially creates miscommunication between PCDs and male patients in the clinics. Therefore, in addition to addressing knowledge deficiency and external barriers to men’s health check-ups, efforts should also be made to bridge this communication gap

Cross-cultural adaptation and linguistic validation of the Hypoglycaemia Symptom Rating Scale (HypoSRQ) among Malaysian patients with diabetes mellitus

The Hypoglycaemia Symptom Rating Questionnaire (HypoSRQ) is potentially useful for local research on hypoglycaemia. However, it requires adaptation and validation in local settings. This study reports the process and results of cross-cultural adaptation and linguistic validation of HypoSRQ for Malay and English versions in our local setting. The HypoSRQ underwent forward and backward translation and adaptation with support from professional translators and a clinical psychologist. Cognitive debriefing was done among patients with Type 1 and Type 2 diabetes mellitus from varying sociodemographic backgrounds. Discussion was done together with the original developers of the HypoSRQ to decide on the best version for local use. The finalised versions were proofread and formatted with the help of Health Psychology Research. Cognitive debriefing for Malay version involved 7 patients and for the English version5 patients. Direct literal translation into Malay language was unsuitable due to technical terms which were difficult for laypersons to understand. Amendments were made based on findings from the cognitive debriefing process. Participants found the questionnaire fairly easy to understand. The HypoSRQ-My (Malay) and HypoSRQ-EMy (English) is easily understood by local participants. These tools may undergo psychometric evaluation for future use in local settings

Risk Perception for Developing Erectile Dysfunction among Malaysian Men with Type 2 Diabetes Mellitus

Risk perception for developing erectile dysfunction (ED) is an appreciation of the susceptibility to having ED and its severity. This study examined this risk perception and its associated factors among 180 men with type 2 diabetes mellitus (T2DM), who claimed not to have ED. This cross sectional study was conducted at a public health clinic using a validated self-administered questionnaire, which assessed participant characteristics, perceived susceptibility to developing ED, perceived severity of ED, and knowledge on risk factors for ED. About 71.1% had an inaccurate perception of susceptibility to developing ED and their perception on its severity was moderate (median (IQR) score: 10.0 (6.0); range score: 3–15; midpoint: 9). In multiple linear regression, having ED symptoms (p-value < 0.001) and secondary (p-value = 0.045) or tertiary education (p-value: 0.022) significantly contributed to a higher perception of susceptibility. A higher perception of severity was significantly found in Malays (p-value < 0.001), the employed (p-value = 0.026), and those with better knowledge on risk factors for ED (p-value < 0.001). Risk perception for developing ED among men with T2DM appears poor and it was significantly influenced by sociocultural factors, educational attainment, ED symptoms, and knowledge on risk factors for ED. Thus, to improve their risk perception, they should be provided appropriate counseling and education

Modified team-based learning: a new delivery method for concept lectures in family medicine module

Traditional didactic lectures have the disadvantage of being non-interactive and less effective to stimulate the learning process among students. A modified team-based learning method was designed to replace the didactic method of delivery four concept lectures in family medicine module. This paper describes the implementation and student feedback regarding the new method used. The four lectures are ‘Concepts of family medicine’, ‘Communication and consultation skills’, ‘Primary care approach to chronic disease’ and ‘Introduction to palliative care’. The new method incorporated pre-learning from online materials, individual and team-based concept application tests (iCAT and tCAT) and feedback. Each session catered for groups of 50 to 55 students. Pre-learning materials were accessible to students via Schoology® learning management system. Students were required to attempt iCAT prior to the formal session. During the formal session, the students discussed the answers as a team (tCAT) and defended their answers. The other groups were allowed to challenge the answers with their own justification. The facilitator for the session would provide feedback and conclusion for the session. Students’ feedback has been very encouraging. The interactivity of the sessions was useful to facilitate better understanding of the core concepts. Discussions for each group were unique based on the students’ prior experiences and ideas, making the sessions less monotonous than didactic lectures. Only one to two facilitators were required to deliver the session to a large group of students compared to similar small group discussions. In conclusion, the modified team-based learning focusing on concept application is a more interactive and engaging teaching method. It is a sustainable and practical approach to maximise benefits of the allocated time for teaching

Helicobacter pylori related dyspepsia: prevalence and treatment outcomes at University Kebangsaan Malaysia-Primary Care Centre

<p>Abstract</p> <p>Background</p> <p>Optimum management of dyspepsia in primary care is a debatable subject. Testing for Helicobacter pylori (HP) has been recommended in primary care as this strategy will cure most underlying peptic ulcer disease and prevent future gastro duodenal disease.</p> <p>Methods</p> <p>A total of 98 patients completed Modified Glasgow Dyspepsia Severity Score Questionnaire (MGDSSQ) at initial presentation before undergoing the ¹³Carbon Urea Breath Test (UBT) for HP. Those with positive UBT received Eradication Therapy with oral Omeprazole 20 mg twice daily, Clarithromycin 500 mg daily and Amoxycillin 500 mg twice daily for one week followed by Omeprazole to be completed for another 4 to 6 weeks. Those with negative UBT received empirical treatment with oral Omeprazole 20 mg twice daily for 4 to 6 weeks. Patients were assessed again using the MGDSSQ at the completion of treatment and one month after stopping treatment.</p> <p>Results</p> <p>The prevalence of dyspepsia at Universiti Kebangsaan Malaysia-Primary Care Centre was 1.12% (124/11037), out of which 23.5% (23/98) was due to HP. Post treatment assessment in both HP (95.7%, 22/23) and non HP-related dyspepsia (86.7%, 65/75) groups showed complete or almost complete resolution of dyspepsia. Only about 4.3% (1/23) in the HP related dyspepsia and 13.3% (10/75) in the non HP group required endoscopy.</p> <p>Conclusion</p> <p>The prevalence of dyspepsia due to HP in this primary care centre was 23.5%. Detection of HP related dyspepsia yielded good treatment outcomes (95.7%).</p

Gender differences in factors influencing intention to undergo cardiovascular disease health checks: a cross-sectional survey

Background: Undergo a health check for cardiovascular disease (CVD) is an important strategy to improve cardiovascular (CV) health. Men are reported to be less likely to undergo cardiovascular disease (CVD) health check than women. Gender difference could be one of the factors influencing health seeking behaviour of men and women. We aimed to identify gender differences in factors influencing the intention to undergo CVD health checks. Methods: This was a cross-sectional survey using mall intercept interviews. Malaysians aged ≥30 years without known CVD were recruited. They were asked for their intention to undergo CVD health checks and associated factors. The factors included seven internal factors that were related to individuals’ attitude, perception and preparedness for CVD health checks and two external factors that were related to external resources. Hierarchical ordinal regression analysis was used to evaluate the importance of the factors on intention to undergo CVD health checks, for men and women separately. Results: 397 participants were recruited, 60% were women. For men, internal factors explained 31.6% of the variances in likeliness and 9.6% of the timeline to undergo CVD health checks, with 1.2% and 1.8% added respectively when external factors were sequentially included. For women, internal factors explained 18.9% and 22.1% of the variances, with 3.1% and 4.2% added with inclusion of the external factors. In men, perceived drawbacks of health checks was a significant negative factor associated with likeliness to undergo CVD health checks (coefficient = -1.093; 95%CI:-1.592 to -0.594), and timeline for checks (coefficient = -0.533; 95%CI:-0.975 to -0.091). In women, readiness to handle outcomes following health checks was significantly associated with likeliness to undergo the checks (coefficient = 0.575; 95%CI: 0.063 to 1.087), and timeline for checks (coefficient = 0.645; 95%CI: 0.162 to 1.128). Both external factors 1) influence by significant others (coefficient = 0.406; 95%CI: 0.013 to 0.800) and 2) external barriers (coefficient = -0.440; 95%CI:-0.869 to -0.011) were also significantly associated with likeliness to undergo CVD health checks in women. Conclusions: Both men and women were influenced by internal factors in their intention to undergo CVD health checks, and women were also influenced by external factors. Interventions to encourage CVD health checks need to focus on internal factors and be gender sensitive

Poor blood pressure control and its associated factors among older people with hypertension: a cross-sectional study in six public primary care clinics in Malaysia

Introduction: Hypertension is highly prevalent in the older people. Chronic disease care is a major burden in the public primary care clinics in Malaysia. Good blood pressure (BP) control is needed to reduce the morbidity and mortality of cardiovascular disease (CVD). This study aimed to determine the status of BP control and its associated factors among older people with hypertension in public primary care clinics. Materials and methods: A cross-sectional study on hypertensive patients aged 18 years and above was conducted in six public primary care clinics in Federal Territory, Malaysia. A total of 1107 patients were selected via systematic random sampling. Data from 441 (39.8%) patients aged 60 years and more were used in this analysis. BP control was determined from the average of two BP readings measured twice at an interval of 5 min. For patients without diabetes, poor BP control was defined as BP of ≥140/90 mm Hg and ≥150/90 for the patients aged 80 years and more. For patients with diabetes, poor control was defined as BP of ≥140/80 mm Hg. Results: A total of 51.7% (n = 228) of older patients had poor BP control. The factors associated with BP control were education level (p = 0.003), presence of comorbidities (p = 0.015), number of antihypertensive agents (p = 0.001) and number of total medications used (p = 0.002). Patients with lower education (less than secondary education) (OR = 1.7, p = 0.008) and the use of three or more antihypertensive agents (OR = 2.0, p = 0.020) were associated with poor BP control. Conclusion: Among older people with hypertension, those having lower education level, or using three or more antihypertensive agents would require more attention on their BP control

Blood pressure control among hypertensive patients with and without diabetes mellitus in six public primary health care clinics in Malaysia

Hypertension is a common comorbidity among diabetic patients. This study aimed to determine blood pressure (BP) control among hypertensive patients with and without diabetes. This was a cross-sectional study in 6 public primary care clinics in Wilayah Persekutuan, Malaysia. Hypertensive patients aged ≥18 years and attending the clinics were selected via systematic random sampling. The BP control target was defined as <130/80 mm Hg for diabetic patients and <140/90 mm Hg for nondiabetic patients. A total of 1107 hypertensive patients participated in this study and 540 (48.7%) had diabetes. About one fourth (24.3%) of the hypertensive patients with diabetes achieved BP control target, compared with 60.1% patients without diabetes (P < .001). Being diabetic and on ≥2 antihypertensive treatments were associated with poor BP control. Attention needs to be given to these groups of patients when managing patients with hypertension

An overview of patient involvement in healthcare decision-making: a situational analysis of the Malaysian context

Background: Involving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients’ desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia. Methods: In this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation. Results: There are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient’ programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan. Conclusion: In summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia

Aging male symptoms scale (AMS) for health-related quality of life in aging men: translation and adaptation in Malay

The Aging Male Symptoms Scale (AMS) measures health-related quality of life in aging men. The objective of this paper is to describe the translation and validation of the AMS into Bahasa Melayu (BM). The original English version of the AMS was translated into BM by 2 translators to produce BM1 and BM2, and subsequently harmonized to produce BM3. Two other independent translators, blinded to the English version, back-translated BM3 to yield E2 and E3. All versions (BM1, BM2, BM3, E2, E3) were compared with the English version. The BM pre-final version was produced, and pre-tested in 8 participants. Proportion Agreement, Weighted Kappa, Spearman Rank Correlation Coefficient, and verbatim responses were used. The English and the BM versions showed excellent equivalence (weighted Kappa and Spearman Rank Coefficients, ranged from 0.72 to 1.00, and Proportion Agreement values ranged from 75.0% to 100%). In conclusion, the BM version of the AMS was successfully translated and adapted