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Fulltext Priority-setting to integrate sexual and reproductive health into universal health coverage: the case of Malaysia

Lim SC, Yap YC, Barmania S, Govender V, Danhoundo G, Remme M

Sex Reprod Health Matters, 2020 Dec;28(2):1842153.
PMID: 33236973 DOI: 10.1080/26410397.2020.1842153

Despite increasing calls to integrate and prioritise sexual and reproductive health (SRH) services in universal health coverage (UHC) processes, several SRH services have remained a low priority in countries' UHC plans. This study aims to understand the priority-setting process of SRH interventions in the context of UHC, drawing on the Malaysian experience. A realist evaluation framework was adopted to examine the priority-setting process for three SRH tracer interventions: pregnancy, safe delivery and post-natal care; gender-based violence (GBV) services; and abortion-related services. The study used a qualitative multi-method design, including a literature and document review, and 20 in-depth key informant interviews, to explore the context-mechanism-outcome configurations that influenced and explained the priority-setting process. Four key advocacy strategies were identified for the effective prioritisation of SRH services, namely: (1) generating public demand and social support, (2) linking SRH issues with public agendas or international commitments, (3) engaging champions that are internal and external to the public health sector, and (4) reframing SRH issues as public health issues. While these strategies successfully triggered mechanisms, such as mutual understanding and increased buy-in of policymakers to prioritise SRH services, the level and extent of prioritisation was affected by both inner and outer contextual factors, in particular the socio-cultural and political context. Priority-setting is a political decision-making process that reflects societal values and norms. Efforts to integrate SRH services in UHC processes need both to make technical arguments and to find strategies to overcome barriers related to societal values (including certain socio-cultural and religious norms). This is particularly important for sensitive SRH services, like GBV and safe abortion, and for certain populations.

Matched MeSH terms: Social Values
Cross-cultural psychotherapy: the Malaysian experience. An open system model

Kinzie JD

Am J Psychother, 1972 Apr;26(2):220-31.
PMID: 5024276
Matched MeSH terms: Social Values
Green dentistry: the art and science of sustainable practice

Mulimani P

Br Dent J, 2017 Jun 23;222(12):954-961.
PMID: 28642517 DOI: 10.1038/sj.bdj.2017.546

Dentistry is highly energy and resource intensive with significant environmental impact. Factors inherent in the profession such as enormous electricity demands of electronic dental equipment, voluminous water requirements, environmental effects of biomaterials (before, during and after clinical use), the use of radiation and the generation of hazardous waste involving mercury, lead etc have contributed towards this. With rising temperatures across the world due to global warming, efforts are being made worldwide to mitigate the effects of environmental damage by resorting to sustainability concepts and green solutions in a myriad of ways. In such a scenario, a professional obligation and social responsibility of dentists makes it imperative to transform the practice of dentistry from a hazardous to a sustainable one, by adopting environmental-friendly measures or 'green dentistry'. The NHS in the UK has been proactive in implementing sustainability in healthcare by setting targets, developing guidance papers, initiating steering groups to develop measures and implementing actions through its Sustainable Development Unit (SDU). Such sustainable frameworks, specific to dentistry, are not yet available and even the scientific literature is devoid of studies in this field although anecdotal narratives abound. Hence this paper attempts to present a comprehensive evaluation of the existing healthcare sustainability principles, for their parallel application in the field of dentistry and lays out a blueprint for integrating the two main underlying principles of sustainability - resource use efficiency and eliminating or minimising pollution - in the day-to-day practice. The article also highlights the importance of social values, community care, engaging stakeholders, economic benefits, developing policy and providing leadership in converting the concept of green dentistry into a practised reality.

Matched MeSH terms: Social Values
Ethical Concerns About Human Genetic Enhancement in the Malay Science Fiction Novels

Isa NM, Hj Safian Shuri MF

Sci Eng Ethics, 2018 02;24(1):109-127.
PMID: 28281149 DOI: 10.1007/s11948-017-9887-1

Advancements in science and technology have not only brought hope to humankind to produce disease-free offspring, but also offer possibilities to genetically enhance the next generation's traits and capacities. Human genetic enhancement, however, raises complex ethical questions, such as to what extent should it be allowed? It has been a great challenge for humankind to develop robust ethical guidelines for human genetic enhancement that address both public concerns and needs. We believe that research about public concerns is necessary prior to developing such guidelines, yet the issues have not been thoroughly investigated in many countries, including Malaysia. Since the novel often functions as a medium for the public to express their concerns, this paper explores ethical concerns about human genetic enhancement expressed in four Malay science fiction novels namely Klon, Leksikon Ledang, Transgenesis Bisikan Rimba and Transgenik Sifar. Religion has a strong influence on the worldview of the Malays therefore some concerns such as playing God are obviously religious. Association of the negative image of scientists as well as the private research companies with the research on human genetic enhancement reflects the authors' concerns about the main motivations for conducting such research and the extent to which such research will benefit society.

Matched MeSH terms: Social Values
Using Surplus Embryos and Research Embryos in Stem Cell Research: Ethical Viewpoints of Buddhist, Hindu and Catholic Leaders in Malaysia on the Permissibility of Research

Sivaraman MAF

Sci Eng Ethics, 2018 02;24(1):129-149.
PMID: 28281154 DOI: 10.1007/s11948-017-9893-3

The sources of embryos for Embryonic Stem Cell Research (ESCR) include surplus embryos from infertility treatments, and research embryos which are created solely for an ESCR purpose. The latter raises more ethical concerns. In a multi-religious country like Malaysia, ethical discussions on the permissibility of ESCR with regard to the use surplus and research embryos are diversified. Malaysia has formulated guidelines influenced by the national fatwa ruling which allows the use of surplus embryos in ESCR. Input from other main religions is yet to be documented. In light of this, this study addresses (i) the ethical viewpoints of Buddhist, Hindu and Catholic leaders on the permissibility of using surplus and research embryos; and (ii) the moral standpoints of religious leaders towards attaining a consensus on the practice of ESCR in Malaysia. Responses from the religious leaders were obtained via semi-structured, face-to-face interviews. The findings show that generally the Buddhist and Hindu leaders approve the use of surplus embryos. Their responses on the creation of research embryos for ESCR are varied. Meanwhile, the Catholic leaders distinctively objected to ESCR regardless of the embryo sources, referring to it as the destruction of life. Taking into account the diverse views, this study explores the response of the religious leaders for a general consensus wherever possible. The ethical discourse surrounding ESCR in a multi-religious setting offers new perspective, which needs to be explored in a broader global community.

Matched MeSH terms: Social Values
Living arrangements of older Malaysians: who coresides with their adult children?

DaVanzo J, Chan A

Demography, 1994 Feb;31(1):95-113.
PMID: 8005345

More than two-thirds of Malaysians age 60 or older coreside with an adult child. Data from the Senior sample of the Second Malaysian Family Life Survey (MFLS-2) are used to investigate which "seniors" (persons age 60 or older) live in this way. The analysis generally supports the notion that coresidence is influenced by the benefits, costs, opportunities, and preferences for coresidence versus separate living arrangements. For example, married seniors are more likely to coreside with adult children when housing costs are greater in their area or when the husband or wife is in poor health. This finding suggests that married parents and children live together to economize on living costs or to receive help with household services. Unmarried seniors who are better off economically are less likely to live with adult children, presumably because they use their higher incomes to "purchase privacy."

Matched MeSH terms: Social Values
On tests for sex preferences

Leung SF

J Popul Econ, 1988 Oct;1(2):95-114.
PMID: 12282511

"This paper presents a critical evaluation of three widely used tests for sex preferences: sex ratio, parity progression ratio and ordinary least squares [OLS] regression of birth interval. We show that under some appropriate conditions, the sex ratio is a valid test for sex preferences. The methods of parity progression ratio and OLS regression of birth interval fail to deal with right censoring and time varying covariates, which reduce the power of the tests. We suggest the use of hazard estimation to test for sex preferences. We demonstrate the differences among the tests by analyzing the retrospective fertility histories of the Chinese and the Malays in Malaysia. We find that unlike the two conventional methods, the hazard estimation gives clear and strong evidence of sex preferences among the Chinese in Malaysia."

Matched MeSH terms: Social Values
The impact of religion and cultural values on AIDS education programs in Malaysia and the Philippines

Osteria T, Sullivan G

AIDS Educ Prev, 1991;3(2):133-46.
PMID: 1873137

This paper examines the impact of cultural values and government policies on the content of AIDS educational literature prepared by public health agencies in Malaysia and the Philippines. The literature from these countries, which has been distributed to the public and is intended to inform them of the danger of AIDS, how the HIV is and is not transmitted, and how to avoid infection, is analyzed and evaluated for effectiveness and congruence with the dominant religious tenets and cultural practices in each country, and attitudes to sexual behavior. The paper also describes the response of these countries to the AIDS pandemic, and concludes with suggestions about how this form of AIDS education can be improved.

Matched MeSH terms: Social Values
Transcultural aspects of community psychiatry

Hartog J

Ment Hyg, 1971 Jan;55(1):35-44.
PMID: 5549644
Matched MeSH terms: Social Values
Fulltext Exploring patient values in medical decision making: a qualitative study

Lee YK, Low WY, Ng CJ

PLoS One, 2013;8(11):e80051.
PMID: 24282518 DOI: 10.1371/journal.pone.0080051

BACKGROUND: Patient decisions are influenced by their personal values. However, there is a lack of clarity and attention on the concept of patient values in the clinical context despite clear emphasis on patient values in evidence-based medicine and shared decision making. The aim of the study was to explore the concept of patient values in the context of making decisions about insulin initiation among people with type 2 diabetes.
METHODS AND FINDINGS: We conducted individual in-depth interviews with people with type 2 diabetes who were making decisions about insulin treatment. Participants were selected purposively to achieve maximum variation. A semi-structured topic guide was used to guide the interviews which were audio-recorded and analysed using a thematic approach. We interviewed 21 participants between January 2011 and March 2012. The age range of participants was 28-67 years old. Our sample comprised 9 women and 12 men. Three main themes, 'treatment-specific values', 'life goals and philosophies', and 'personal and social background', emerged from the analysis. The patients reported a variety of insulin-specific values, which were negative and/or positive beliefs about insulin. They framed insulin according to their priorities and philosophies in life. Patients' decisions were influenced by sociocultural (e.g. religious background) and personal backgrounds (e.g. family situations).
CONCLUSIONS: This study highlighted the need for expanding the current concept of patient values in medical decision making. Clinicians should address more than just values related to treatment options. Patient values should include patients' priorities, life philosophy and their background. Current decision support tools, such as patient decision aids, should consider these new dimensions when clarifying patient values.

Matched MeSH terms: Social Values
Psychological distress as a mediator in the relationships between biopsychosocial factors and disordered eating among Malaysian university students

Gan WY, Mohd Nasir MT, Zalilah MS, Hazizi AS

Appetite, 2012 Dec;59(3):679-87.
PMID: 22885453 DOI: 10.1016/j.appet.2012.08.002

The mechanism linking biopsychosocial factors to disordered eating among university students is not well understood especially among Malaysians. This study aimed to examine the mediating role of psychological distress in the relationships between biopsychosocial factors and disordered eating among Malaysian university students. A self-administered questionnaire measured self-esteem, body image, social pressures to be thin, weight-related teasing, psychological distress, and disordered eating in 584 university students (59.4% females and 40.6% males). Body weight and height were measured. Structural equation modeling analysis revealed that the partial mediation model provided good fit to the data. Specifically, the relationships between self-esteem and weight-related teasing with disordered eating were mediated by psychological distress. In contrast, only direct relationships between body weight status, body image, and social pressures to be thin with disordered eating were found and were not mediated by psychological distress. Furthermore, multigroup analyses indicated that the model was equivalent for both genders but not for ethnic groups. There was a negative relationship between body weight status and psychological distress for Chinese students, whereas this was not the case among Malay students. Intervention and prevention programs on psychological distress may be beneficial in reducing disordered eating among Malaysian university students.

Matched MeSH terms: Social Values
Regret and rationalization among smokers in Thailand and Malaysia: findings from the International Tobacco Control Southeast Asia Survey

Lee WB, Fong GT, Zanna MP, Omar M, Sirirassamee B, Borland R

Health Psychol, 2009 Jul;28(4):457-64.
PMID: 19594270 DOI: 10.1037/a0014669

OBJECTIVE: To test whether differences of history and strength in tobacco control policies will influence social norms, which, in turn, will influence quit intentions, by influencing smokers' regret and rationalization.
DESIGN: The data were from the International Tobacco Control (ITC) Policy Evaluation Southeast Asia Survey, a cohort survey of representative samples of adult smokers in Thailand (N = 2,000) and Malaysia (N = 2,006). The survey used a stratified multistage sampling design.
MAIN OUTCOME MEASURES: Measures included regret, rationalization, social norms, and quit intention.
RESULTS: Thai smokers were more likely to have quit intentions than Malaysian smokers. This difference in quit intentions was, in part, explained by the country differences in social norms, regret, and rationalization. Reflecting Thailand's history of stronger tobacco control policies, Thai smokers, compared with Malaysian smokers, perceived more negative social norms toward smoking, were more likely to regret, and less likely to rationalize smoking. Mediational analyses revealed that these differences in social norms, accounted, in part, for the country-quit intention relation and that regret and rationalization accounted, in part, for the social norm-quit intention relation.
CONCLUSION: The results suggest that social norms toward smoking, which are shaped by tobacco control policies, and smokers' regret and rationalization influence quit intentions

Matched MeSH terms: Social Values
An analysis of suicide and undetermined deaths in 17 predominantly Islamic countries contrasted with the UK

Pritchard C, Amanullah S

Psychol Med, 2007 Mar;37(3):421-30.
PMID: 17176500

Suicide is expressly condemned in the Qu'ran, and traditionally few Islamic countries have reported suicide. Undetermined deaths are classified by the World Health Organization (WHO) as Other Violent Deaths (OVD) in ICD-9, or Other External Causes (OEC) in ICD-10. It has been suggested that to avoid under-reporting of suicides, both formal suicide verdicts and OVD should be considered together because OVD may contain 'hidden' suicides.

Matched MeSH terms: Social Values
Help-seeking pathways among Malay psychiatric patients

Razali SM, Najib MA

Int J Soc Psychiatry, 2000;46(4):281-9.
PMID: 11201349

The aim of this study is to explore the help-seeking behaviour of Malay psychiatric patients. A semi-structured interview based on a standard proforma was conducted to assess help seeking process and delays for Malay psychiatric patients attending the psychiatric clinic for the first time. Help-seeking process and delays were defined. Among 134 patients evaluated in the study, 69% had visited traditional healers (bomoh) for the present illness before consulting psychiatrists. The second popular choice of treatment was medical practitioner and only a small percentage of them had consulted homeopathic practitioners and herbalists. Patients who had consulted bomohs were significantly delayed in getting psychiatric treatment compared with those who had not consulted them. Consultation of bomohs was significantly higher among married patients, those with major psychiatric illnesses and in family who believed in supernatural causes of mental illness. However, there was no significant difference in age, gender, educational status and occupation between patients who had consulted and not consulted bomoh. We concluded that majority of the Malay psychiatric patients had sought the traditional treatment prior to psychiatric consultation. The strength of social support and the belief of the patients, friends, and/or relatives in supernatural causes of mental illness were strongly associated with the rate of traditional treatment. Deep-seated cultural beliefs were major barrier to psychiatric treatment.

Matched MeSH terms: Social Values
Women--an endangered species

World Dev Forum, 1987 Nov 30;5(21):1-2.
PMID: 12269045

Throughout India and China, South Korea and Taiwan, Pakistan and Malaysia, the same sentiment recurs: "The birth of girl is an occasion for gloom, not cheer, for bitterness, not pleasure." In all these countries "patriarchal traditions and social stigmas" make females the unwanted sex, reports Asiaweek. The tragic result: prenatal gender tests are flourishing. And for many women, if the test indicates a female, they abort. In India, sex tests and abortions are legal, cheap and readily available. Some 1500 sex-tested girls are aborted annually in Bombay alone. In China, abortions are legal, but gender tests strictly forbidden. Says one official: We cannot afford to let people know what sex the fetus is because all the girls would be aborted." Yet the numbers of baby girls in China have been reduced--and illicit gender tests and female infanticide are considered partly to blame. In South Korea, gender tests have been banned and most abortions are illegal, but "clandestine tests" are available, and according to the government some 30,000 pregnancies are terminated annually. The number of aborted females is not known, but birth ratios have shown "an alarming swing towards males" in recent years. Can laws and education change the social attitudes against girls in these Asian countries? Indian activist Vibhuti Patel, a lobbyist for stronger controls over sex-testing, hopes so. She urges a "continuous campaign" to fight the "centuries-old values" that encourages gender tests. Says Patel: Nothing less than the very survival of women is at stake."

Matched MeSH terms: Social Values
Fulltext The role of general practitioners in the management of erectile dysfunction-a qualitative study

Ng CJ, Low WY, Tan NC, Choo WY

Int J Impot Res, 2004 Feb;16(1):60-3.
PMID: 14963472 DOI: 10.1038/sj.ijir.3901141

The objective of this study was to explore the roles and perceptions of general practitioners (GPs) in the management of erectile dysfunction (ED). This qualitative study used focus group discussions and in-depth interviews. This study was conducted based on 28 GPs from an urban area in Malaysia who had managed patients with ED and prescribed anti-ED drugs. Main outcome measures included the roles of GPs in managing patients with ED (active or passive), perceptions regarding ED and the treatment, and factors influencing their decision to prescribe. Majority of the GPs assumed a passive role when managing patients with ED. This was partly due to their perception of the disease being nonserious. Some also perceived ED as mainly psychological in nature. The anti-ED drugs were often viewed as a lifestyle drug with potentially serious side effects. The fear of being perceived by patients as 'pushing' for the drug and being blamed if the patients were to develop serious side effects also hampered the management of this disease. GPs who participated in this study remained passive in identifying and treating patients with ED and this was attributed to their perception of the disease, drug treatment and patient's background.

Matched MeSH terms: Social Values
Boys or girls? Parents' preferences and sex control

Williamson NE

Popul Bull, 1978 Jan;33(1):1-35.
PMID: 12260443
Matched MeSH terms: Social Values
Malaysian Moslem mothers' experience of depression and service use

Abdul Kadir NB, Bifulco A

Cult Med Psychiatry, 2010 Sep;34(3):443-67.
PMID: 20549550 DOI: 10.1007/s11013-010-9183-x

Standard psychiatric criteria for depression developed in the United States and United Kingdom are increasingly used worldwide to establish the prevalence of clinical disorders and to help develop services. However, these approaches are rarely sensitive to local and cultural expressions of symptoms or beliefs about treatment. Mismatch between diagnostic criteria and local understanding may result in underreporting of depression and underutilization of services. Little such research has been conducted in Malaysia, despite the acknowledged high rate of depression and low access to services. This study examines depression in Moslem Malay women living in Johor Bahru, Southern Peninsular Malaysia, to explore depression symptoms using the Structured Clinical Interview for DSM-IV. The 61 women interviewed were selected on the basis of high General Health Questionnaire scores from a large questionnaire survey of 1,002 mothers. The illustrative analysis looks at descriptions of depressed mood, self-depreciation and suicidal ideation, as well as attitudes toward service use. The women gave full and open descriptions of their emotional symptoms, easily recognizable by standard symptom categories, although somatic symptoms were commonly included, and the spiritual context to understanding depression was also prevalent. However, few women had knowledge about treatment or sought medical services, although some sought help from local spiritual healers. Attending to such views of depression can help develop services in Malaysia.

Matched MeSH terms: Social Values

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