Displaying publications 21 - 35 of 35 in total

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  1. Nordin N, Sani NIM, Kadir AA, Shaari R, Mohamed M, Reduan MFH, et al.
    J Adv Vet Anim Res, 2021 Mar;8(1):101-104.
    PMID: 33860019 DOI: 10.5455/javar.2021.h491
    Objective: In this case report, we have investigated the infectious bronchitis (IB) virus (IBV) outbreak with the co-infection of Escherichia coli in 28-33-day-old broiler chickens in Malaysia.

    Materials and Methods: A farmer complained that Cobb 500 chickens, raised in the open house, were having bloody diarrhea, open mouth breathing, non-uniform growth, and ruffled feathers. The mortality was about 100 birds (from about 7000 birds) per day. The sick birds were isolated and subjected to physical examination, postmortem, and histopathological analyses. Gross lesions were observed and recorded. The lung samples have proceeded with histopathological evaluations. The lungs, kidneys, trachea, air sac, and heart samples were collected to isolate bacteria and fungi through a series of conventional cultural methods, followed by molecular confirmation of the IBV.

    Results: Postmortem examination revealed air sacculitis, hemorrhagic tracheitis, pulmonary congestion, fibrin deposition in the liver and air sac, hemorrhagic enteritis, and renomegaly. The bacterial culture and biochemical tests revealed E. coli in the lungs, trachea, liver, intestine, and kidney samples. However, no fungus could be isolated from those samples. Histological evaluation of lung samples demonstrated infiltration of inflammatory cells in the pulmonary tissues. Apart from this, reverse transcription-polymerase chain reaction confirmed the presence of avian coronavirus responsible for infectious bronchitis (IB).

    Conclusion: The chickens were diagnosed with IB concurrent with E.coli. The chickens exhibited typical nephropathogenic strain of IBV infection, causing high mortality.

  2. Nordin ML, Othman AA, Kadir AA, Shaari R, Osman AY, Mohamed M
    Vet World, 2019;12(2):236-242.
    PMID: 31040564 DOI: 10.14202/vetworld.2019.236-242
    Background and Aim: The increasing prevalence of drug resistance eventually leads scientist to discover new drugs that could solve the problem. Since ancient immemorial times, medicinal plants generally known as herbs were widely used in every culture throughout the world. In fact, currently up to 70,000 plant species have been screened for biological activities and about 70% ends up for commercialization. Therefore, this study was aimed to evaluate the potential cytotoxic and antibacterial effect of Syzygium polyanthum leaves which are local Malaysia plants, against 4T1 and MCF-7 mammary carcinoma cells, respectively, and also against bacteria causing mastitis in cows.

    Materials and Methods: The cytotoxic effect of hydromethanolic extract of S. polyanthum against 4T1 and MCF-7 mammary carcinoma cells was evaluated using 3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. The cells were treated with the concentration of extracts ranging from 15.63 µg/mL to 1000 µg/ml for 72 h, and the percentage of cell survivability was determined based on minimum concentration that was able to allow at least 50% growth of cancer cells (IC50) after 72 h. The antibacterial activity was tested against common bacteria causing mastitis in cow. The bacteria were isolated from milk samples. The antibacterial activity of the extract was determined by disk diffusion method and susceptibility test based on minimum inhibitory concentration (MIC).

    Results: Staphylococcus aureus, Staphylococcus hyicus, and Staphylococcus intermedius were isolated from the milk samples that positive for mastitis. The MIC values range from 7.12 mm to 13.5 mm. The extract exhibits the widest zone of inhibition (13.5±0.20 mm) at 1000 mg/ml of concentrations. The extract relatively has low cytotoxicity effect against 4T1 and MCF-7 cells with IC50 values ranging from 672.57±59.42 and 126.05±50.89 µg/ml, respectively.

    Conclusion: S. polyanthum exerts weak antibacterial activity and cytotoxic effect to mammary carcinoma cells. The extract does not toxic to cells. However, further study is recommended, especially, this plant should be tested for in vivo.

  3. Basit MA, Kadir AA, Loh TC, Abdul Aziz S, Salleh A, Zakaria ZA, et al.
    Animals (Basel), 2020 Nov 19;10(11).
    PMID: 33227911 DOI: 10.3390/ani10112150
    The current experiment was designed to estimate the comparative efficacy of selected phytobiotics Persicaria odorata leaf meal (POLM) and Piper betle leaf meal (PBLM) with halquinol, and tetracycline in broiler chickens. The 150-day-old broiler chickens were randomly assigned to five dietary groups. The dietary supplementation groups were the basal diet (BD), which served as the negative control (NC), and BD + 0.2 g/kg tetracycline, which served as the positive control (PC); BD + 0.03 g/kg halquinol (HAL), BD + 8 g/kg POLM (Po8), and BD + 4 g/kg PBLM (Pb4) were the treatment groups. Growth performance, gut morphology, ileal digestibility, and cecal microbiota composition were measured. On day 21, the body weight gain (BWG) was enhanced (p < 0.05) in the broiler chickens fed on phytobiotics (Po8 and Pb4) relative to the NC group, however, on day 42 and in terms of overall growth performance, BWG was enhanced (p < 0.05 in diets (Po8, Pb4, HAL and PC) in comparison with the NC group. Conversely, feed conversion ratio (FCR) was recorded reduced (p < 0.05) in Pb4, Po8, HAL, and PC group in comparison with the NC group. Supplementation of phytobiotics (Po8 and Pb4), HAL and PC, positively improved the gut morphology compared to the NC group. Furthermore, the maximum (p < 0.05) villus height (VH) in duodenum and jejunum was observed in broilers fed on diet Pb4. Supplementation of phytobiotics, HAL and PC, improved (p < 0.05) the digestibility of dry matter (DM) (except for HAL), organic matter (OM), crude protein (CP), ether extract (EE), and ash compared to the NC group. Dietary supplementation of phytobiotics (Po8 and Pb4), HAL and PC, significantly reduced the E. coli, Salmonella, and Staphylococcus aureus (except for HAL) counts compared to the NC group. However, supplementation of Pb4 resulted in significantly decreased total anaerobic bacteria and Clostridium spp. counts compared to the NC group. In addition, supplementation of phytobiotics significantly increased the Lactobacillus count compared to HAL, PC, and NC groups. In conclusion, dietary supplementation of phytobiotics improved the gut morphology, positively modulated and maintained the dynamics of cecal microbiota with enhanced nutrient digestibility, thus, increased the growth performance. Based on current results, phytobiotics could be used as an alternative to AGPs for sustainable broiler chicken production.
  4. Alkhadher SAA, Kadir AA, Zakaria MP, Al-Gheethi A, Asghar BHM
    Mar Pollut Bull, 2020 May;154:111115.
    PMID: 32319929 DOI: 10.1016/j.marpolbul.2020.111115
    The current study aimed to develop a suitable molecular marker [Linear alkylbenzenes (LABs)] approach for pollution determination in mangrove oysters of peninsular Malaysia. C. belcheri species were collected from rivers of Merbok, Perai, Klang, Muar and PulauMerambong (An Island). The LABs were extracted from C. belcheri and determined using GC-MS. The LABs indices which included I/E, L/S and C13/C12 were applied to describe the sources and biodegradation of LABs. The results revealed that the maximum concentrations were detected in oysters from Klang (27.91 ng g-1dw), while the lowest concentrations were detected in oysters from Merbok (8.12 ng g-1dw). Moreover, I/E ratios varied between 2.83 and 6.40, indicating the secondary treatment effluents being discharged to coastal zones. The results of this study suggested that the oysters absorbed LABs mainly in dissolved phase. Therefore, mangrove oysters are a good biosensor for LABs contamination in the aquatic environment.
  5. Cao W, Kadir AA, Tang W, Wang J, Yuan J, Hassan II
    BMC Med Inform Decis Mak, 2024 Jan 02;24(1):6.
    PMID: 38167316 DOI: 10.1186/s12911-023-02391-1
    BACKGROUND: Although smartphone usage is ubiquitous, and a vast amount of mobile applications have been developed for chronic diseases, mobile applications amongst stroke survivors remain unclear.

    OBJECTIVE: This systematic review and meta-analysis aimed to determine the effectiveness of mobile applications on medication adherence, functional outcomes, cardiovascular risk factors, quality of life and knowledge on stroke in stroke survivors.

    METHODS: A review of the literature was conducted using key search terms in PubMed, EMBASE, Cochrane and Web of Science databases until 16 March 2023 to identify eligible randomized controlled trials (RCTs) or controlled clinical trial (CCTs) of mobile application interventions among stroke survivors. Two reviewers independently screened the literature in accordance with the eligibility criteria and collected data from the articles included. Outcomes included medication adherence,functional outcomes,cardiovascular risk factors, quality of life,and knowledge of stroke.

    RESULTS: Twenty-three studies involving 2983 participants across nine countries were included in this review. Sixteen trials involved health care professionals in app use, and seven trials reported measures to ensure app-based intervention adherence. Mobile applications targeting stroke survivors primarily encompassed three areas: rehabilitation, education and self-care. The participants in the studies primarily included young and middle-aged stroke survivors. Meta-analysis results demonstrated that mobile application intervention significantly improved trunk control ability (mean differences [MD] 3.00, 95% CI [1.80 to 4.20]; P 

  6. Yong YK, Zakaria ZA, Kadir AA, Somchit MN, Ee Cheng Lian G, Ahmad Z
    BMC Complement Altern Med, 2013 Feb 14;13:32.
    PMID: 23410184 DOI: 10.1186/1472-6882-13-32
    BACKGROUND: Bixa orellana L. has been traditionally used in Central and South America to treat a number of ailments, including internal inflammation, and in other tropical countries like Malaysia as treatment for gastric ulcers and stomach discomfort. The current study aimed to determine the major chemical constituents of the aqueous extract of B. orellana (AEBO) and to evaluate the antihistamine activity of AEBO during acute inflammation induced in rats.

    METHODS: Acute inflammation was produced by subplantar injection of 0.1 mL of 0.1% histamine into the right hind paw of each rat in the control and treatment groups. The degree of edema was measured before injection and at the time points of 30, 60, 120, 180, 240 and 300 min after injection. Changes of peritoneal vascular permeability were studied using Evans blue dye as a detector. Vascular permeability was evaluated by the amount of dye leakage into the peritoneal cavity in rats. To evaluate the inhibitory effect of AEBO on biochemical mediators of vascular permeability, the levels of nitric oxide (NO) and vascular endothelial growth factor (VEGF) were determined in histamine-treated paw tissues. The major constituents of AEBO were determined by gas chromatography-mass spectrometry (GC-MS) analysis.

    RESULTS: AEBO produced a significant inhibition of histamine-induced paw edema starting at 60 min time point, with maximal percentage of inhibition (60.25%) achieved with a dose of 150 mg/kg of AEBO at 60 min time point. Up to 99% of increased peritoneal vascular permeability produced by histamine was successfully suppressed by AEBO. The expression of biochemical mediators of vascular permeability, NO and VEGF, was also found to be downregulated in the AEBO treated group. Gas chromatography-mass spectrometry (GC-MS) analysis revealed that the major constituent in AEBO was acetic acid.

    CONCLUSIONS: The experimental findings demonstrated that the anti-inflammatory activity of AEBO was due to its inhibitory effect on vascular permeability, which was suppressed as a result of the reduced expression of biochemical mediators (NO and VEGF) in tissues. Our results contribute towards the validation of the traditional use of Bixa orellana in the treatment of inflammatory disorders.

  7. Kadir AA, Abdullah SRS, Othman BA, Hasan HA, Othman AR, Imron MF, et al.
    Chemosphere, 2020 Nov;259:127468.
    PMID: 32603966 DOI: 10.1016/j.chemosphere.2020.127468
    In this study, two native duckweeds (Lemna minor and Azolla pinnata) were cultivated in Palm Oil Mill Effluent (POME) to extract nutrients from the effluent. Five grams of A. pinnata and 2 g of L. minor were transferred to 2 L POME (Initial concentrations: 198 mg/L COD, 4.3 mg/L nitrates, pH 9.53, 4 mg/L phosphate, 2.98 mg/L ammonia) with four different dilutions (2.5%, 5%, 10%, 15%) under greenhouse conditions. Samples of POME were taken every two days up to 10 days. Growth parameter, phosphate, ammonia, nitrates, pH, and COD were monitored within 10 days to select the most suitable growth medium for both plants. Results showed that 2.5% POME dilution had positive effect on L. minor growth and A. pinnata (wet weight increased by 8.7 g and 9.8 g, respectively), with all plants able to survive until the final day of exposure. The highest removal of ammonia was accomplished in 5% POME dilution by A. pinnata (98%) and L. minor (95.5%). The maximum phosphate removal was obtained in 10% POME dilution with 93.3% removal by A. pinnata and 86.7% by L. minor. Significant COD removal in 15% POME was obtained by L. minor (78%) and A. pinnata (66%). Both plants responded positively to the phytoremediation process, especially for A. pinnata which showed significant decreases in all parameters. The nutrient extraction by both plants from POME showed a positive effect on growth parameter, which has further promising potential to be used as animal feedstock.
  8. Alkhadher SAA, Kadir AA, Zakaria MP, Al-Gheethi A, Keshavarzifard M, Masood N, et al.
    Mar Pollut Bull, 2020 Apr;153:111013.
    PMID: 32275559 DOI: 10.1016/j.marpolbul.2020.111013
    Linear alkylbenzenes were determined in the surface sediments of Muar River and Pulau Merambong, Peninsular Malaysia. The concentrations ranged from 87.4 ng g-1 to 188.1 ng g-1 and from 67.4 ng g-1 to 98.2 ng g-1 of dry weight, respectively. The composition profiles of LABs were characterized, and sewage treatment levels were identified. The ratios of internal to external isomers (I/E ratios) of the linear alkylbenzenes in Muar River sediments ranged from 1.7 to 2.2, whereas those of Pulau Merambong sediments ranged from 1.6 to 1.7. The calculated LAB ratios indicated that the study areas received primary and secondary sewage effluents. The degradation of linear alkylbenzenes in Muar River ranged from 33% to 43%, and that in Pulau Merambong ranged from 33% to 34%. The higher degradation indices in Muar River are a sign of improvement in wastewater treatment.
  9. Ang KP, Tan HK, Selvaraja M, Kadir AA, Somchit MN, Akim AM, et al.
    Planta Med, 2011 Nov;77(16):1782-7.
    PMID: 21614753 DOI: 10.1055/s-0030-1271119
    Development of early stage atherosclerosis involves the activation of endothelial cells by oxidized low-density lipoprotein (oxLDL) with subsequent increases in endothelial permeability and expression of adhesion molecules favoring the adherence of monocytes to the endothelium. Cryptotanshinone (CTS), a major compound derived from the Chinese herb Salvia miltiorrhiza, is known for its protective effects against cardiovascular diseases. The aim of this study was to determine whether CTS could prevent the oxLDL-induced early atherosclerotic events. OxLDL (100 µg/mL) was used to increase endothelial permeability and induce monocyte-endothelial cell adhesion in human umbilical vein endothelial cells (HUVECs). Endothelial nitric oxide (NO) concentrations, a permeability-regulating molecule, and expressions of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were measured. Results show that a) endothelial hyperpermeability was suppressed by 94 % (p 
  10. Cao W, Kadir AA, Wang J, Hu L, Wen L, Yu M, et al.
    Front Pharmacol, 2022;13:1054603.
    PMID: 36506570 DOI: 10.3389/fphar.2022.1054603
    Aim: Medication non-adherence has remained a common and costly global health issue of growing importance among older adults. This study aims to determine the prevalence and associated factors related to medication non-adherence among older adult stroke survivors in China. Methods and results: In this cross-sectional study, a total of 402 older adult stroke survivors were recruited from three tertiary hospitals in China. The results of the survey showed that 61.4% exhibited medication non-adherence. The chances of medication non-adherence among older adult stroke survivors who had primary school or less educational levels were higher than those who had senior secondary and junior college educational levels [OR (95% CI) = 0.440(0.249, 0.778)] as well as those who had a bachelor's degree or above educational levels [OR (95%CI) = 0.367(0.202, 0.667)]. Moreover, the probability of medication non-adherence with 4-5 and ≥6 types of total prescription medications per day increased by 1.993 times [OR (95% CI) = 1.993(1.190, 3.339))] and 2.233 times [OR (95%CI) = 2.233(1.159, 4.300)], respectively, as compared to when there were ≤3 types. Furthermore, medication non-adherence decreased with the increase in health literacy scores (β = -0.641 (95% CI; (0.913, 0.965)) and BMQ specific-necessity scores (β = -0.131 (95% CI; 0.806, 0.995)). On the other hand, when the BMQ specific-concerns score increased by one unit, medication non-adherence increased by 11.1% [OR (95% CI) = 1.111(1.044, 1.182)]. Conclusion: The present study found that patient medication adherence among older adult stroke survivors in China is problematic and associated with educational levels, total prescribed drugs per day, beliefs about medication, and health literacy scores. This indicates that measures should be taken to enhance medication adherence among such higher-risk populations.
  11. Cao W, Kadir AA, Wang Y, Wang J, Dai B, Zheng Y, et al.
    Digit Health, 2023;9:20552076231181473.
    PMID: 37342095 DOI: 10.1177/20552076231181473
    BACKGROUND: As a principal cause of mortality and disability worldwide, stroke imposes considerable burdens on society and effects on the lives of patients, families, and communities. Owing to their growing global popularity, health-related applications (apps) offer a promising approach to stroke management but show a knowledge gap regarding mobile apps for stroke survivors.

    METHODS: This review was conducted across the Android and iOS app stores in September-December 2022 to identify and describe all apps targeting stroke survivors. Apps were included if they were designed for stroke management and contained at least one of the following components: medication taking, risk management, blood pressure management, and stroke rehabilitation. Apps were excluded if they were unrelated to health, not in Chinese or English, or the targeted users were healthcare professionals. The included apps were downloaded, and their functionalities were investigated.

    RESULTS: The initial search yielded 402 apps, with 115 eligible after title and description screening. Some apps were later excluded due to duplicates, registration problems, or installation failures. In total, 83 apps were included for full review and evaluated by three independent reviewers. Educational information was the most common function (36.1%), followed by rehabilitation guidance (34.9%), communication with healthcare providers (HCPs), and others (28.9%). The majority of these apps (50.6%) had only one functionality. A minority had contributions from an HCP or patients.

    CONCLUSION: With the widespread accessibility and availability of smartphone apps across the mHealth landscape, an increasing number of apps targeting stroke survivors are being released. One of the most important findings is that the majority of the apps were not specifically geared toward older adults. Many of the currently available apps lack healthcare professionals' and patients' involvement in their development, and most offer limited functionality, thus requiring further attention to the development of customized apps.

  12. ShujaaEdin HY, Al-Haj NA, Rasedee A, Alitheen NB, Kadir AA, How CW, et al.
    Saudi J Biol Sci, 2021 Apr;28(4):2549-2557.
    PMID: 33935571 DOI: 10.1016/j.sjbs.2021.01.059
    Recombinant human erythropoietin (rHuEPO) is the erythropoiesis-stimulating hormone that is being used concurrently with chemotherapeutic drugs in the treatment of anemia of cancer. The effect of rHuEPO on cancer cells in 3-dimensional (3D) cultures is not known. The objective of the study was to determine the effect of rHuEPO on the viability of MCF-7 breast cancer cells from 2-dimensional (2D) and 3D cell cultures. The monolayer MCF-7 cells from 2D culture and MCF-7 cell from 3D culture generated by ultra-low adhesive microplate technique, were treated with 0, 0.1, 10, 100 or 200 IU/mL rHuEPO for 24, 48 or 72 h. The effects of rHuEPO on MCF-7 cell viability and proliferation were determined using the (4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay (MTT), neutral red retention time (NRRT), trypan blue exclusion assay (TBE), DNA fragmentation, acridine orange/propidium iodide staining (AO/PI) assays. The MCF-7 cells for 3D culture were also subjected to caspase assays and cell cycle analysis using flow cytometry. rHuEPO appeared to have greater effect at lowering the viability of MCF-7 cells from 3D than 2D cultures. rHuEPO significantly (p 
  13. Ahmad S, Israf DA, Lajis NH, Shaari K, Mohamed H, Wahab AA, et al.
    Eur J Pharmacol, 2006 May 24;538(1-3):188-94.
    PMID: 16650843
    Some chalcones, such as hydroxychalcones have been reported previously to inhibit major pro-inflammatory mediators such as nitric oxide (NO), prostaglandin E(2) (PGE(2)), tumor necrosis factor-alpha (TNF-alpha) and reactive oxygen species production by suppressing inducible enzyme expression via inhibition of the mitogen-activated protein kinase (MAPK) pathway and nuclear translocation of critical transcription factors. In this report, the effects of cardamonin (2',4'-dihydroxy-6'-methoxychalcone), a chalcone that we have previously isolated from Alpinia rafflesiana, was evaluated upon two cellular systems that are repeatedly used in the analysis of anti-inflammatory bioactive compounds namely RAW 264.7 cells and whole blood. Cardamonin inhibited NO and PGE(2) production from lipopolysaccharide- and interferon-gamma-induced RAW cells and whole blood with IC(50) values of 11.4 microM and 26.8 microM, respectively. Analysis of thromboxane B(2) (TxB(2)) secretion from whole blood either stimulated via the COX-1 or COX-2 pathway revealed that cardamonin inhibits the generation of TxB(2) via both pathways with IC(50) values of 2.9 and 1.1 microM, respectively. Analysis of IC(50) ratios determined that cardamonin was more COX-2 selective in its inhibition of TxB(2) with a ratio of 0.39. Cardamonin also inhibited the generation of intracellular reactive oxygen species and secretion of TNF-alpha from RAW 264.7 cells in a dose responsive manner with IC(50) values of 12.8 microM and 4.6 microM, respectively. However, cardamonin was a moderate inhibitor of lipoxygenase activity when tested in an enzymatic assay system, in which not a single concentration tested was able to cause an inhibition of more than 50%. Our results suggest that cardamonin acts upon major pro-inflammatory mediators in a similar fashion as described by previous work on other closely related synthetic hydroxychalcones and strengthens the conclusion of the importance of the methoxyl moiety substitution on the 4' or 6' locations of the A benzene ring.
  14. Hamid NJA, Kadir AA, Hashar NNH, Pietrusiewicz P, Nabiałek M, Wnuk I, et al.
    Materials (Basel), 2021 May 24;14(11).
    PMID: 34074057 DOI: 10.3390/ma14112800
    Wastewater treatment activities in the chemical industry have generated abundant gypsum waste, classified as scheduled waste (SW205) under the Environmental Quality Regulations 2005. The waste needs to be disposed into a secure landfill due to the high heavy metals content which is becoming a threat to the environment. Hence, an alternative disposal method was evaluated by recycling the waste into fired clay brick. The brick samples were incorporated with different percentages of gypsum waste (0% as control, 10, 20, 30, 40 and 50%) and were fired at 1050 °C using 1 °C per minute heating rate. Shrinkage, dry density, initial rate of suction (IRS) and compressive strength tests were conducted to determine the physical and mechanical properties of the brick, while the synthetic precipitation leaching procedure (SPLP) was performed to scrutinize the leachability of heavy metals from the crushed brick samples. The results showed that the properties would decrease through the incorporation of gypsum waste and indicated the best result at 10% of waste utilization with 47.5% of shrinkage, 1.37% of dry density, 22.87% of IRS and 28.3% of compressive strength. In addition, the leachability test highlighted that the concentrations of Fe and Al was significantly reduced up to 100% from 4884 to 3.13 ppm (Fe) and from 16,134 to 0.81 ppm (Al), respectively. The heavy metals content in the bricks were oxidized during the firing process, which signified the successful remediation of heavy metals in the samples. Based on the permissible incorporation of gypsum waste into fired clay brick, this study promised a more green disposing method for gypsum waste, and insight as a potential towards achieving a sustainable end product.
  15. Webair HH, Ismail TAT, Ismail SB, Khaffaji AJ, Hussain NHN, Kadir AA, et al.
    BMC Med Res Methodol, 2021 09 20;21(1):188.
    PMID: 34544388 DOI: 10.1186/s12874-021-01376-w
    BACKGROUND: Patient-centered care is an essential component of health care quality. To achieve patient-centered care, health care authorities should have a clear definition and an applicable tool to measure the extent of its application. The real concept of patient centeredness should be developed by the patients themselves. We aimed to demonstrate a way to develop a draft Arabic patient-centered infertility care (PCIC) questionnaire for females clients following practical steps that address women with infertility.

    METHODS: An iterative process of questionnaire development was undertaken by combining two approaches: the steps proposed by Robert F. DeVellis for scale development and the recommended practices for questionnaire development and testing in the European statistical system. We attempted to develop the draft questionnaire that involved conceptualization and operationalization, generation of an item pool, development of the questionnaire format, review of the initial item pool by experts, and consideration of validation items for inclusion.

    RESULTS: We generated an item pool from in-depth interviews with 14 women who sought infertility care within 6 months before the interview time. We then added more items from a literature review. The item pool contained 123 items distributed through 10 domains. Ten women with infertility were included for face validation. Then, experts with backgrounds in Obstetrics and Gynecology, Family Medicine, and Public Health reviewed the item pool using content validation (n = 10 professors and/or specialists). The item pool was finally reduced to 57 items. We developed the draft Arabic patient-centered infertility care questionnaire for female clients (PCIQ-F) with three sections, including 66 items: background variables, PCIC experience variables, and a general question about the quality of infertility care in the health facility. The draft questionnaire was further reviewed and edited last by experts in preparation for part 2, which will test the questionnaire and prepare the final version.

    CONCLUSION: The PCIQ-F questionnaire development is a multi-step iterative process started and ended by the target users as experts. Experts' participation in infertility care and in questionnaire format development had a great impact on questionnaire development and conflict resolution. We recommend this transparent and replicable approach for new instrument developers; it is likely to generate a questionnaire that is valid and acceptable to target users. The draft PCIQ-F questionnaire is ready for testing of its psychometric properties before the final version to measure the PCIC level in health facilities.

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