The Development and Testing of Consensus Recommendations for Collaborative Practice in the Malaysian Mental Health System

This project used participatory action research to develop and test a model of collaborative practice for the Malaysian mental health system. A hospital committee and a Delphi committee were formed to create a set of collaborative practice guidelines. Some of these recommendations were implemented in a psychiatric hospital, including staff training and systems changes. A realist evaluation, using both qualitative and quantitative methods, showed that some of these changes were effective in improving collaboration

The interpretation of depressive symptoms in urban and rural areas in Sabah, Malaysia

Objective: The treatment gap for mental health disorders in Sabah, Malaysia is estimated to be over 90%. Probable reasons include how the depressive symptoms are interpreted. The aim of this study was to explore the interpretation of depressive symptoms in Sabah in rural and urban areas in order to find ways of reducing the treatment gap. Methods: Subjects were given an instrument which consisted of a vignette identification exercise and a set of statements about causes and treatment of depression, which the subjects were asked to rate. Results: One hundred and ninety eight subjects from an urban area and 180 subjects from a rural area were sampled. The most common cause given for the vignette identification was “Stress”, with “Counseling” the preferred treatment option. Principal component analysis (PCA) of the causes of depression revealed five factors: “Lifestyle” (11 items), “Stress and Pressure” (10 items), “Supernatural” (9 items), “Environmental” (6 items) and “Biological” (5 items), with the “Environmental” and “Stress and Pressure” items the most heavily endorsed. PCA of the treatment options showed seven factors, of which five were retained for further analysis: “Psychological treatment and lifestyle,” “Traditional” and “Lifestyle”, “Religion”, “Psychology” with “Religion” and “Psychological treatment and lifestyle” the most heavily endorsed and “Supernatural” the least heavily endorsed. Conclusion: Improving the treatment gap in mental health in Sabah will require educating people on the differences between stress and depression, making services more acceptable by increasing the provision for psychological therapies and working with religious leaders

Development of parallel scales to measure HIV related stigma in Sabah

In this study parallel scales were constructed to use to measure the levels of HIV-related stigma towards people living with HIV (PLHIV) in populations with different backgrounds in Sabah. The study also explored the components of stigma within the population. We found that there were three principle components of HIV related stigma: “Interpersonal distancing,” “Shame and blame,” and “Positive opinions about PLHIV”. The scales constructed showed adequate internal consistency (Cronbach’s Alpha of 0.69 to 0.85) in all samples. The medical students and people with more knowledge about HIV had significantly lower levels of all three factors of personal stigma. Regarding HIV-related knowledge, the non-medical university students and the rural community group were found to have poor knowledge of HIV transmission and prevention. This scale can be used by researchers or public health officials who wish to study HIV related stigma or to evaluate the impact of stigma interventions in the local context

Study to measure alcohol related attitudes and drinking behaviours in rural Sabah

Alcohol related problems are the biggest cause of life years lost to disability in Malaysian men· Alcohol use is an important part of the culture of many of the ethnic groups of Sabah. It is widely believed that the alcohol consumption in rural Sabah is high, since a large amount of alcohol related harm is seen in the health system there. Objectives of this study are to estimate the prevalence of alcohol consumption in the study area.to determine the magnitude of harmful drinking, to explore into the factors associated with alcohol consumption.to determine the knowledge and attitude towards alcohol among different ethnic groups.to develop recommendation for future health intervention to combat against alcohol problem in the study areas. A Community-based Cross sectional study was conducted from 2009 Oct -2011 Oct for 2 years in 4 areas of rural Sabah in northern Borneo; Kudat, Kota Marudu, Pitas and Kotabelud. FGDs( Qualitative ) and questionnaires survey with face to face interview( Quantitative ) methods were used by trained local Research Assistants. Survey questionnaire was developed after qualitative survey and designed to detect alcohol consumption and other informations together with the AUDIT screening instrument .This study can find out find out which factors put people at risk of alcohol abuse and dependence.the knowledge and attitudes towards drinking, in particular how much alcohol subjects perceive to be an unhealthy amount, moral perceptions of alcohol use, perceptions about the importance of alcohol to their culture in northern rural community , Sabah

Geographic accessibility of healthcare services and health seeking behaviours of rural communities in Kudat and Pitas areas of Sabah

Introduction: One of the aims outlined in Malaysia’s Health Vision 2020 is to be a nation of healthy individuals, families, and communities through an equitable, affordable, efficient, environmentally adaptable, and consumer friendly healthcare system. Sabah faces tremendous challenges to provide the best care for patients. For example, Sabah's unique geographical location and landscape, such as steep hills and rivers, is one of the challenges that health staff faces. Objectives of this study aimed to examine the prevalence of geographical accessibility, types of healthcare services, and the types of health seeking behaviour in 2 northern rural areas of Sabah to assess the geographic accessibility and availability of healthcare services. Materials and Methods: A community-based cross-sectional study was conducted in two rural areas in Sabah—Kudat and Pitas. Data collection was done by using questionnaire and face–to-face interviews. Results: It was found that 48% of the study population sought healthcare and they mainly chose healthcare services from hospitals and health clinics. Conclusion: Half of the population in the areas studied used healthcare in the last year. The choice of using a public hospital or community health clinics was determined by distance from residence

Using the diamond dialogue to explore community ambivalence towards changing alcohol use and strengthen community action

Statement of the Problem: Alcohol related harm is considered significant in many areas in Sabah. This project aimed to provide community members with information and approaches to addressing this problem in their own area. This paper shows a unique approach to health promotion and community engagement in rural communities. Method: This project used action research methodology. A workshop for alcohol misuse was held in a rural village. At the start of the workshop four groups were formed and focus group discussions were held using the diamond dialogue technique. Responses were analysed for themes, using grounded theory methods. The position on the diamond shape was analysed by overlaying a 11 point grid, with 10 corresponding to the highest level of happiness and 0 corresponding to the lowest level of happiness. Results & Findings: The diamond dialogue was originally created as a research tool to measure the effectiveness of community level interventions on wellbeing. This tool was initially used as a way of evaluating our alcohol intervention. While being used in this way it was noted that the tool itself provided an avenue for change. It has not previously been used specifically as an intervention in itself. The respondents appeared to understand the exercise well. Five main themes were found: Family and relationships, security, health, expanding horizons, religion. Alcohol was a topic that pervaded all of these themes, with positive and negative effects. Results suggest that using the diamond dialogue created a collective motivation to change. Exploring community ambivalence towards alcohol, acceptance of both the positive and negative effects and validation of the community’s views provided a platform for engagement. This leads to “change talk” and ownership of possible solutions. Conclusion & Significance: This research suggests the diamond dialogue tool is useful both as an explorative tool and a standalone community level intervention tool. Further research is underway to further explore this conclusion and develop the tool for wider use in communities

Alcohol-stress interaction: possible stress alleviating prpoerties of ethanol

Stress is an inevitable part of daily life to every individual. Stress may be eustress or distress. It depends on stress exposure and individual's perception to experience the extent to which one is vulnerable. Daily stressors are unavoidable but stress coping makes an individual to tolerate stress. Many becomes the victims of alcohol drinking for the simple belief of 'tension -reduction' by the use of alcohol. Though, initially alcohol may mask few of the stress effects, its long term effects are dangerous as it may indulge in addiction behaviour. There are inconclusive reports on the interaction of stress and alcohol. There are lacunae in literature on the stress alcohol interaction especially with reference to the multi-ethnic population of the State of Sabah. Hence the objectives of the study was, to elucidate and possible stress- alcohol relationship. Whether alcohol drinking alleviates stress? Increases stress? Alcohol drinking aggravates stress? Was there any demographic, cultural factors in drinking patterns etc., Based on the previous studies, stress inventory was designed and using the DASS21 questionnaire and on its reliability and validity tests, with a voluntary consent of participants study questionnaires were introduced. Subjects of both sex 18-45 years of age were included. Exclusion criteria were chronic drinkers and those on medications for chronic diseases. The data was analysed by Structural Equation Modelling (SPSS AMOS ver 23, 2015). Results of the study revealed that, there is an association between stress and alcohol drinking. Level of stress is a major factor that is associated with level of drinking, cause of drinking among the study group. Drinking also increased the level of stress and there is interdependency between stress - alcohol drinking - stresses. In conclusion, present study confirms that, alcohol drinking does not alleviate the stress experience; on the contrary drinking alcohol increases the stress experience. It is a vicious cycle; stress experience leads to alcohol drinking, in turn alcohol drinking further increases the stress. Family and cultural drinking is one of the factors that promote alcohol drinking

Ultra brief psychological interventions for covid-19 pandemic: Introduction of a locally-adapted brief intervention for mental health and psychosocial support service

The ultra-brief psychological interventions (UBPI) was created in 2018 to empower healthcare providers with psychological skills that can be delivered within a short period. Techniques used within UBPI were adopted from a variety of well established psychotherapies and distilled into its core essentials. This enabled practitioners of UBPI to deliver specific psychological skills in the appropriate context to the client within a period of 15–20 min. UBPI was also manualised to standardised training of practitioners. During the novel coronavirus disease of 2019 (COVID-19) pandemic, UBPI was modified to suit the unique psychological demands of the pandemic. This article presents how UBPI was adapted and used with healthcare providers dealing with COVID-19 and also with the public who required psychological first aid (PFA)

The behaviour changes in response to COVID-19 pandemic within Malaysia

The novel coronavirus infection, COVID-19, is a pandemic that currently affects the whole world. During this period, Malaysians displayed a variety of behaviour changes as a response to COVID-19, including panic buying, mass travelling during movement restriction and even absconding from treatment facilities. This article attempts to explore some of these behaviour changes from a behaviourist perspective in order to get a better understanding of the rationale behind the changes