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Fulltext A web-based dietary intervention for people with type 2 diabetes: development, implementation, and evaluation

Ramadas A, Chan CK, Oldenburg B, Hussien Z, Quek KF

Int J Behav Med, 2015 Jun;22(3):365-73.
PMID: 25274015 DOI: 10.1007/s12529-014-9445-z

BACKGROUND: Diabetes is becoming a very important health issue in rapidly developing nations and there is an urgent need to improve overall diabetes self-management education in these countries. Although e-health is an emerging theme, only a few successful web-based studies on diabetes self-management have been reported.
PURPOSE: We describe the development, implementation, and process evaluation of an Internet-delivered dietary intervention program (myDIDeA) for diabetic patients in a developing country.
METHOD: Specific dietary components to be included in the intervention module were first identified through a comprehensive review of literature and guidelines. The lesson plans and the study website were then developed based on the evidence, Transtheoretical Model's Stages of Change and user-centered design approach. Finally, the effectiveness of the website was tested through a randomized-controlled trial to promote dietary change in patients with type 2 diabetes. The participants in the intervention group (n = 66) were given access to myDIDeA for 6 months. Process evaluation in form of intervention adherence and program reception were conducted at post intervention.
RESULTS: The response rate for the process evaluation was 89%. On average, each participant logged in at least once for each lesson plan and spent almost 12 min on the site. The participants' content satisfaction, acceptability, and usability scores were satisfactory. The primary outcome of the trial, Dietary Knowledge, Attitude, and Behavior score was strongly correlated with content satisfaction (r = 0.826, p
Fulltext Secular versus religious norms against smoking: which is more important as a driver of quitting behaviour among Muslim Malaysian and Buddhist Thai smokers?

Yong HH, Savvas S, Borland R, Thrasher J, Sirirassamee B, Omar M

Int J Behav Med, 2013 Jun;20(2):252-8.
PMID: 22302214

BACKGROUND: This paper prospectively examined two kinds of social normative beliefs about smoking, secular versus religious norms.
PURPOSE: The purpose of this paper is to determine the relative importance of these beliefs in influencing quitting behaviour among Muslim Malaysian and Buddhist Thai smokers.
METHODS: Data come from 2,166 Muslim Malaysian and 2,463 Buddhist Thai adult smokers who participated in the first three waves of the International Tobacco Control Southeast Asia project. Respondents were followed up about 18 months later with replenishment. Respondents were asked at baseline about whether their society disapproved of smoking and whether their religion discouraged smoking, and those recontacted at follow-up were asked about their quitting activity.
RESULTS: Majority of both religious groups perceived that their religion discouraged smoking (78% Muslim Malaysians and 86% Buddhist Thais) but considerably more Buddhist Thais than Muslim Malaysians perceived that their society disapproved of smoking (80% versus 25%). Among Muslim Malaysians, religious, but not societal, norms had an independent effect on quit attempts. By contrast, among the Buddhist Thais, while both normative beliefs had an independent positive effect on quit attempts, the effect was greater for societal norms. The two kinds of normative beliefs, however, were unrelated to quit success among those who tried.
CONCLUSIONS: The findings suggest that religious norms about smoking may play a greater role than secular norms in driving behaviour change in an environment, like Malaysia where tobacco control has been relatively weak until more recently, but, in the context of a strong tobacco control environment like Thailand, secular norms about smoking become the dominant force.
A comparison of factors associated with physical inactivity among East Asian college students

Seo DC, Torabi MR, Chin MK, Huang SF, Chen CK, Mok MM, et al.

Int J Behav Med, 2012 Sep;19(3):316-23.
PMID: 21562780 DOI: 10.1007/s12529-011-9167-4

BACKGROUND: Little is known on the level of physical inactivity and its behavioral and cultural correlates among East Asian college students.
PURPOSE: The aim of this study is to examine and compare the level and behavioral and cultural correlates of physical inactivity among college students in Taiwan, Hong Kong, South Korea, Singapore, and Malaysia.
METHOD: Data were collected from a representative sample of college students (N = 12,137) in five East Asian economies during the 2008-2009 academic year. The stratified random sampling (stratum: geographic region) was used to select participating institutions. The overall response rate was 77%.
RESULTS: The percentage of physically inactive students was 7.2% for Singapore, 8.0% for Malaysia, 13.5% for Taiwan, 16.8% for Hong Kong, and 28.5% for South Korea. When gender, age, and body mass index were controlled, fruit and vegetable consumptions were significant correlates for physical inactivity across all the five economies. In Hong Kong, Korea, and Taiwan, those who engaged in binge drinking at least once during the past 2 weeks were less likely to be physically inactive than those who did not. Religion and military experience did not independently predict physical inactivity in any of the five economies.
CONCLUSION: Physical inactivity varies greatly across different economies in East Asia that are usually grouped together and considered a single homogeneous entity by some researchers. However, in terms of correlates of physical inactivity, findings of the current study indicate that the transversal value of physical activity might be transformed into a universal.
Fulltext Somatisation disorder and its associated factors in multiethnic primary care clinic attenders

Khoo EM, Mathers NJ, McCarthy SA, Low WY

Int J Behav Med, 2012 Jun;19(2):165-73.
PMID: 21562781 DOI: 10.1007/s12529-011-9164-7

Background Somatisation disorder (SD) has been reported as common in all ethnic groups, but the estimates of its prevalence have varied and the evidence for its associated factors has been inconsistent.
Purpose This study seeks to determine the prevalence of SD and its associated factors in multiethnic primary care clinic attenders.
Methods This cross-sectional study was on clinic attenders aged 18 years and above at three urban primary care clinics in Malaysia. The operational definition of SD was based on ICD-10 criteria for SD for research, frequent attendance, and excluded moderate to severe anxiety and depression. The instruments used were the ICD-10 symptom list, the Hospital Anxiety and Depression Scale, a semi-structured questionnaire, and SF-36.
Results We recruited 1,763 patients (response rate 63.8%). The mean age of respondents was 44.7±15.8 years, 807 (45.8%) were male; there were 35.3% Malay, 30.1% Chinese and 34.6% Indian. SD prevalence was 3.7%; the prevalence in Malay was 5.8%, Indian 3.0% and Chinese 2.1%. Significant associations were found between SD prevalence and ethnicity, family history of alcoholism, blue-collar workers and the physical component summary (PCS) score of SF-36. Multivariate analysis showed that SD predictors were Malay ethnicity (OR 2.7, 95% CI 1.6, 4.6), blue-collar worker (OR 2.0, 95% CI 1.2, 3.5) and impaired PCS score of SF-36 (OR 0.92, 95% CI 0.90, 0.95).
Conclusion The prevalence of SD was relatively uncommon with the stringent operational criteria used. SD preponderance in blue-collar workers may be attributable to secondary gain from getting sickness certificates and being paid for time off work.
Keywords Somatisation disorder . Associated factors . Primary care . Ethnic groups . Prevalence Questionnaire: ICD-10 symptom list; Hospital Anxiety Depression Scale; HADS; SF-36
Menstrual-related attitudes and symptoms among multi-racial Asian adolescent females

Wong LP, Khoo EM

Int J Behav Med, 2011 Sep;18(3):246-53.
PMID: 20440593 DOI: 10.1007/s12529-010-9091-z

Menstruation has important implications on the physical and emotional well-being of adolescents' reproductive health.
Knowledge and attitudes about HPV infection, HPV vaccination, and cervical cancer among rural southeast Asian women

Wong LP

Int J Behav Med, 2011 Jun;18(2):105-11.
PMID: 20524163 DOI: 10.1007/s12529-010-9104-y

BACKGROUND: The incidence of cervical cancer in developing countries is high and even higher among women in rural areas in these countries.
PURPOSE: The purpose of this study is to assess the knowledge and attitudes towards human papillomavirus (HPV), HPV vaccination, and cervical cancer among young women in rural settings in a Southeast Asia country.
METHODS: A convenience sample of ethnically diverse young rural women in Malaysia was surveyed. Participants were interviewed using a standard questionnaire.
RESULTS: Among the participants (N = 449), knowledge of HPV, HPV vaccination, cervical screening, and cervical cancer risk factors was extremely poor. The mean total knowledge score (14 items) was 2.37 (SD ± 1.97). Although many had never heard of the newly released HPV vaccine, two-thirds professed an intention to receive the HPV vaccine. Intention to receive the vaccine was significantly associated with knowledge of cervical screening and cervical cancer risk factors (OR 1.17; 95% CI 1.03-1.33; P = 0.013). Reasons for vaccine refusal were doubts about safety and efficacy of the new vaccine (27.4%), perceived embarrassment at receiving an STI vaccine (20.7%), and perception of not being at risk of HPV infection (20.0%).
CONCLUSIONS: Providing HPV education to the rural residents is a high priority.
Knowledge and attitudes in regard to pandemic influenza A(H1N1) in a multiethnic community of Malaysia

Wong LP, Sam IC

Int J Behav Med, 2011 Jun;18(2):112-21.
PMID: 20835855 DOI: 10.1007/s12529-010-9114-9

BACKGROUND: Assessment of general public's knowledge and attitudes toward the development and prevention of new disease outbreaks is imperative because they have profound effects on health behaviors and may contribute to the control of the epidemic.
PURPOSE: To investigate the level of knowledge and attitudes towards the influenza A(H1N1) outbreak across various ethnic groups and socio-demographic backgrounds in Malaysia.
METHOD: A cross-sectional, population-based, computer-assisted telephone interview exploring knowledge and attitudes regarding influenza A(H1N1) was conducted in Malaysia. Between July 11 and September 12, 2009, a total of 1,050 respondents were interviewed (response rate 69.3%).
RESULTS: The mean total knowledge score for the overall sample was 7.30 (SD ± 1.961) out of a possible score of 13 (Chinese had the highest scores, followed by Indians, then Malays). Some erroneous beliefs about the modes of transmission were identified. The majority of the participants (73.8%) perceived the A(H1N1) infection as often deadly. Despite the overestimation of the severity of A(H1N1) infection, high confidence in preventing infection and low perceived susceptibility of infection were reported. Influenza A(H1N1)-related stigma was prevalent and exhibited differences across ethnic groups.
CONCLUSIONS: Findings suggest that provision of education and clear information are essential to correct the misconceptions, and increase perceived susceptibility to infection so that the general public will take precautions against A(H1N1) infection.
Cervical cancer screening attitudes and beliefs of Malaysian women who have never had a pap smear: a qualitative study

Wong LP, Wong YL, Low WY, Khoo EM, Shuib R

Int J Behav Med, 2008;15(4):289-92.
PMID: 19005928 DOI: 10.1080/10705500802365490

Attitudes toward cervical cancer and participation in early detection and screening services are well known to be profoundly affected by cultural beliefs and norms.
Decision-making for Risk-reducing Salpingo-oophorectomy (RRSO) in Southeast Asian BRCA Mutation Carriers With Breast Cancer: A Qualitative Study

Sa'at H, Lee YK, Yoon SY, Wong SW, Woo YL, Barlow-Stewart K, et al.

Int J Behav Med, 2022 Feb;29(1):1-13.
PMID: 33791992 DOI: 10.1007/s12529-021-09984-y

BACKGROUND: The uptake of risk-reducing salpingo-oophorectomy (RRSO) in Asian countries is variable despite being the most effective option for ovarian cancer risk reduction in BRCA mutation carriers. Exploration of factors which may impact the RRSO decision-making of BRCA mutation carriers from Malaysia, a developing country in Southeast Asia, was undertaken.
METHODS: In-depth interviews with 28 Malaysian BRCA mutation carriers with a history of breast cancer were conducted in addition to observing their RRSO decision-making consultations in the clinic.
RESULTS: The decision-making considerations among the carriers were centered around the overarching theme of "Negotiating cancer risk and womanhood priorities," with the following themes: (1) risk perception, (2) self-preservation, (3) motherhood obligation, and (4) the preciousness of marriage. Cognitive knowledge of BRCA risk was often conceptualized based on personal and family history of cancer, personal beliefs, and faith. Many women reported fears that RRSO would affect them physically and emotionally, worrying about the post-surgical impact on their motherhood responsibilities. Nevertheless, some reported feeling obliged to choose RRSO for the sake of their children. For some, their husband's support and approval were critical, with emotional well-being and sexuality reportedly perceived as important to sustaining married life. Despite reporting hesitancy toward RRSO, women's decisions about choosing this option evolved as their priorities changed at different stages of life.
CONCLUSIONS: Recognizing during clinic encounters with Malaysian women that RRSO decision-making involves negotiating the likelihood of developing cancer with the societal priorities of being a woman, mother, and wife may serve to support their decision-making.