Development and Validation of a Health Belief Model-Based Health Education Toolkit in Measles Vaccination for Parents in Malaysia.

The rollout of successful vaccination programs during the COVID-19 pandemic has been impeded worldwide by high rates of vaccine hesitancy. We investigated vaccine hesitancy rates in Malaysia and Singapore, and explored whether these rates were associated with parents' health beliefs. A total of 226 Malaysian parents (MPs) and 635 Singaporean parents (SPs) participated in an online voluntary survey between November 2021 and August 2022. MPs were younger and had more children compared to SPs. SPs were more likely to have received the COVID-19 vaccine than MPs, and less likely to delay vaccinations for their children. SPs displayed greater trust in information about vaccines, their children's doctors and healthcare authorities than MPs. Despite the similarities in ethnography and geographic proximity, the prevalence of perceived parental vaccine hesitancy was higher in Malaysia than in Singapore; this was associated with differences in healthcare beliefs. Beyond educational campaigns, strengthening community-based healthcare support, addressing misinformation, and fostering transparent communication from healthcare authorities may further enhance parental trust in vaccine.

Measles remains a global health threat, and rising vaccine hesitancy in Malaysia underscores the need for locally tailored communication strategies to strengthen public trust and vaccination. This current research developed and validated the Parental Health Education (PaHE)-Measles toolkit, grounded in the Health Belief Model, to support parental confidence and the uptake of measles, mumps, and rubella (MMR) vaccination in Malaysia through a four-stage process: information gathering, preliminary adaptation design, preliminary adaptation testing, and adaptation refinement. Five multidisciplinary experts validated its content both in Malay and English, and 10 health care providers confirmed overall quality. The acceptability was assessed among 30 end-users. The PaHE-Measles achieved a Content Validity Index (CVI) score of 1.0 from expert reviewers, whereas health care providers rated its understandability and actionability more than 80%. End-users reported an average score of over 9.0. In conclusion, PaHE-Measles is a valid and ready toolkit for educating parents, countering misinformation, and strengthening vaccine confidence.

BackgroundThe initiation of a new drug, for instance, the coronavirus disease 2019 (COVID-19) vaccine in children could be a source of major concern for parents. This study aims to determine the willingness of parents in Malaysia to vaccinate their children younger than 12 years against COVID-19.MethodsAn online cross-sectional survey was conducted nationwide in Malaysia from August 29, 2021, to October 17, 2021. Parents with children younger than 12 years were enrolled via the snowball sampling method.ResultsThe analysis included data from 3,528 parents (79.5%) of the 4,438 survey responses received. Of these parents, 2,598 (73.6%) were willing, 486 (13.8%) were not willing, and 444 (12.6%) were still hesitant to vaccinate their children against COVID-19. Single parents (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.32–3.04; P = 0.001), parents with secondary or lower education (OR, 1.5; 95% CI, 1.21–1.96; P < 0.001), healthcare workers (OR, 1.7; 95% CI, 1.34–2.26; P < 0.001), parents who had significant contact with COVID-19 (OR, 1.3; 95% CI, 1.09–1.63; P = 0.006), and parents who had been vaccinated against COVID-19 (OR, 15.4; 95% CI, 9.76–24.33; P < 0.001) were found more willing to immunize their children. The common reasons for vaccination given by parents who were willing to immunize their children include protection of children (99.4%), protection of other family members (99.3%), and effectiveness (98.2%). The common reasons against vaccination given by parents who were not willing to immunize their children were uncertainty about the new vaccine (96.1%), concerns about vaccine contents (93.2%), limited vaccine information from physicians (82.3%), and the belief of vaccine was unsafe (79.8%).ConclusionsIn this study, nearly three-quarters of parents were willing to vaccinate their children younger than 12 years against COVID-19. The parents’ history of COVID-19 vaccination was the strongest independent predictor of their willingness to vaccinate their children. Therefore, future health education for the COVID-19 vaccine should focus on parents who are prone to vaccine refusal or hesitation, address the common reasons for vaccine refusal, and highlight the vaccine’s benefits.

The number of unvaccinated children and the rate of vaccination refusal among parents have recently increased despite the robust vaccination programme in Malaysia. The purpose of this study was to determine the level of knowledge of the Malaysian National Immunisation Programme among Malaysian parents as well as the variables that contribute to poor knowledge. Methods: This study used systematic random sampling to recruit 375 parents from seven health clinics in the Dungun District of Malaysia. The participants were asked to complete a selfadministered validated questionnaire that included sociodemographic and knowledge questions. A multiple logistic regression analysis was applied to determine the associated factors of poor knowledge of immunisation. P-values of <0.05 were considered statistically significant. A total of 189 (50.4%) respondents had poor knowledge of immunisation. The multiple logistic regression analyses revealed that a low educational level (adjusted odds ratio (OR): 1.92; 95% CI 1.25-2.95) was associated with poor knowledge while the age-group of 30-40 years old (adjusted OR: 0.56; 95% CI 0.34-0.93) was protected against it as compared to the age-group of <30 years old. The prevalence of poor knowledge of immunisation among parents in Dungun, Terengganu, is relatively high. The focus of health promotion and education must be switched to increasing immunisation knowledge among the public, particularly among high-risk groups.

In 2020, the Coronavirus disease 2019 (COVID-19) pandemic had triggered the lockdown in many countries around the world. School closure was no exception as a measure to limit the spread of the disease. This step was expected to bring some impact on parents, especially if both of them were working. In this study, we aimed to investigate Malaysian parental attitudes and experiences during the COVID-19 pandemic. We conducted an online cross-sectional survey by using a structured questionnaire, between May and June 2020. A total of 273 parents with children aged below 18 years old were involved. Descriptive analysis was done to determine the sociodemographic data of the respondents, their attitudes, and their experiences associated with the school closure during the outbreak. 97.4 % of parents agreed with the school closure. The majority of them believed the outbreak was serious and the school dismissal was appropriate to protect their children and the community. However, only 54.9 % were well prepared for the measure. 11.4 % of parents had difficulty arranging childcare. During the outbreak, 85.7 % experienced missing work and 71.4 % felt at risk of losing their jobs. The school closure also indirectly incurred additional costs for 88.6% of the parents and partially contributed to 75.5% of the parents losing income. Unexpected long-term school closure might cause some adverse outcomes to the employed parents during a pandemic, therefore, the health authority and education department should take this into consideration when mitigating this issue.

Background: Hand, foot mouth disease (HFMD)is caused by a virus and commonly affects children five years or below. However, the determinants of the associated factors with preventive behaviour among parents are still lacking. This study aims to assess the range of preventive behaviour towards HFMD among parents in Selangor, Malaysia. Materials and Methods: A cross-sectional survey was conducted using a three-stage cluster sampling method. The associations between independent variables and preventive behaviours were assessed with multivariate regressions. Result: In total, 556 parents completed the survey. The majority of the parents had good preventive behaviours towards HFMD. Age, gender, income, perceived susceptibility and the perceived benefit was associated with preventive behaviour. Conclusion: Although, the preventive behaviour of HFMD among parents is crucial, however, it is influenced by parents own perceptions. The strategies to enhancing the parent’s perception are needed to increase the preventive behaviour towards HFMD infection.

BackgroundComprehensive interventions are needed for smoking concerns among industrial workers. This study aimed to evaluate the effectiveness of a Health Belief Model-based integrated health education and mobile phone short message service intervention on improving health knowledge, perception, and self-efficacy toward smoking among industrial workers in Myanmar. This study uniquely integrates Health Belief Model-based health education sessions with short message service over three months, addressing the specific needs of this demographic.MethodsA quasi-experimental study involved 146 workers per group in Mandalay Industrial Zone, Myanmar. A Health Belief Model-based intervention included six health education sessions and daily short message service with weekly repeated content for the intervention group. The outcomes were health knowledge, perception (susceptibility, severity, barriers, and benefits), and self-efficacy, assessed at baseline, immediately after the 3-month training, and 3 months post-training completion in both groups. Homogeneity between groups at baseline was assessed using the chi-square test and the independent t-test. Between-group differences were compared using the independent t-test, and within-group changes were evaluated using repeated measures ANOVA. Generalized Estimating Equations was applied to adjust for baseline differences between groups, accounting for variables such as age, marital status, education status, income, age at first cigarette smoked, and years of smoking cigarettes. Significance level was set at p < 0.05.ResultsHealth knowledge in the intervention group significantly increased at immediately after the 3-month training but slightly declined at 3 months post-training completion (p < 0.001). Compared to the control group, perceived susceptibility, severity, barriers, and benefits, as well as self-efficacy, improved significantly immediately after the 3-month training (p < 0.001). Generalized Estimating Equations analysis revealed significant Group × Time interaction effects, showing positive effects on health knowledge (B = 0.991, p < 0.001), and notable improvements in perceived susceptibility (B = 5.091, p < 0.001), severity (B = 3.973, p < 0.001), barriers (B = 3.823, p < 0.001), benefits (B = 1.797, p < 0.001), and self-efficacy (B = 1.742, p < 0.001).ConclusionsThis study’s intervention significantly improved the health knowledge, perception, and self-efficacy toward smoking among industrial workers in Myanmar, highlighting the importance of targeted workplace interventions.

The present study examined the attitudes of Malaysian rural parents regarding sexual health education in elementary schools. Using a comprehensive list of sex education topics, parents were asked to examine which topics they believed should be taught at schools. In addition, the study also assessed the relationship between parents’ demographic characteristics such as age, gender, education, and occupation and their approval of sexual health education. The respondents of the study included parents (n=211) of children registered in four selected schools in Kedah, Malaysia. The majority of them (73%) supported the inclusion of various sexual health topics in school curriculum provided the contents were in line with religious teachings. The study has generated important empirical findings regarding local community’s response to school-based sexuality education. This information is needed in facilitating the development of sexual health policy at various institutional levels, and in the effective implementation of sexual health curriculum in Malaysian schools.

Evidence on theory-based workplace smoking cessation interventions in low- and middle-income countries remains limited, particularly regarding longitudinal behavioral outcomes. Our study aimed to examine the longitudinal associations between a Health Belief Model-based smoking cessation intervention and smoking-related behavioral outcomes among industrial workers in Myanmar. A quasi-experimental, two-group longitudinal study was conducted in an industrial zone in Mandalay, Myanmar (2018-2019). Two industries were selected and assigned at the industry level to intervention or control groups to minimize contamination. Current male cigarette smokers (n = 292; 146 per group) were assessed at baseline, immediately post-intervention (3 months), and 3 months post-intervention. Outcomes included number of cigarettes smoked per week, intention to quit, number of quit attempts, and self-reported 7-day point prevalence abstinence. Between-group comparisons used t-tests and chi-square/Fisher's exact tests. Adjusted associations over time were estimated using generalized estimating equations (GEE), controlling for age, marital status, education, income, age at smoking initiation, and smoking duration. Compared with the control group, the intervention group had significantly lower cigarette consumption and higher intention to quit and abstinence at follow-up. In adjusted GEE models, significant group × time associations were observed for cigarette smoked per week (β = -5.358, p < 0.001), intention to quit (AOR = 3.221, p < 0.001), and 7-day point prevalence abstinence (AOR = 1.825, p = 0.006). Quit attempts increased over time in both groups (time effect AOR = 1.741, p < 0.001), with no significant group × time association. Given the quasi-experimental design with only two industries, findings should be interpreted with caution. An HBM-based intervention combining workplace health education and mobile phone short message service support was associated with improvements in smoking-related behavioral outcomes among industrial workers in Myanmar, including reduced cigarette consumption, increased quit intention, and higher short-term abstinence. Integration of theory-based workplace health education with mobile messaging may support smoking cessation efforts in low- and middle-income countries.

Objective: This study was conducted to evaluate the effect of health education based on the health belief model and text messages on knowledge, awareness and quality of life regarding cardiovascular disease risk factors in firefighters. Methods: The research data were collected by the researcher between December 2023 and May 2024 at two different fire stations on the European side of Istanbul. The intervention group received a 3-session Health Belief Model-based health education on prevention of cardiovascular disease risk factors. Following the health education, a total of 39 reminder text messages were sent via WhatsApp three or four times a week for 12 weeks to increase self-efficacy and health motivation. Data were collected using the Introductory Information Form, Cardiovascular Disease Risk Awareness Rating Scale, Cardiovascular Disease Risk Factor Knowledge Level Scale and EQ-5D-5L Quality of Life Scale. Results: In the post-test, the mean scores of the intervention group on the Cardiovascular Disease Risk Awareness Rating Scale and Cardiovascular Disease Risk Factors Knowledge Level Scale were significantly higher than those of the control group (p

The adolescent dietary quality in Indonesia remains subpar, with a substantial proportion of ≤ 95% of adolescents not consuming enough or any fruits and vegetables. The main objective of this research was to evaluate the impact of nutrition education programs based on the Health Belief Model (HBM) and conventional methods on the knowledge, attitudes, and eating habits of adolescents, with the ultimate goal of promoting healthy dietary practices. This study was a quasi-experimental study with a non-randomized control group pre and post-test design to 78 adolescents 13-15 years who met the inclusion criteria at the Bogor Regency Junior High School. Diet quality data was collected using 2x24 hours of food recall. The knowledge, attitude, and health belief model questionnaires that had been collected through questionnaires were then analyzed using SPSS version 25.0 using the Wilcoxon and paired t-test. There was no change in the quality diet in the health belief model and control groups with p-value&gt;0.05. However, there was an increase in knowledge and attitude in both groups with a p-value&lt;0.05. Only three constructs that improved were vulnerability, seriousness and self-efficacy with p-value &lt; 0.05. Perceived benefits, barriers and action cues did not increase with p-value &gt; 0.05. Health belief model nutrition education methods can improve knowledge and attitude, but not give a change in behavior. Health belief model nutrition education method can improve knowledge and attitudes, but not changes in eating behavior. Further health belief model-based nutrition education programs are needed to increase motivation and willingness to act.

Engagement in diabetes early detection investigations plays a significant role in protecting people from this devastating disease. This study aims to determine the efficacy of the health belief model-based health education in improving diabetes early detection behaviors among Mosul University employees. The study is carried out by employing a randomized controlled trial approach and through the recruitment (of 81) individuals from Mosul University employees by adopting a multistage sampling method. The selected subjects were randomly divided into two groups: the experimental group (41) subjects and the control group (40) subjects. A constructed questionnaire is used thrice to gather participants' data (T0, T1, and T2). A Mixed-design split plot ANOVA was calculated to determine the significance of differences in the participants' belief scores among groups over time. The study revealed that the sample's age (M±SD) is (45.26 ± 8.59). In addition, the results show that most of the participants are male (59.3%) and hold bachelor's degree certificates (40.7%). On the other hand, the study indicated that the four health belief model concepts of seriousness, susceptibility, benefits, and barriers were significantly changed among experimental group participants after education p ˂ 0.001. As the first study conducted in Iraq, this experiment possesses significant importance. It has been considered a preliminary step to conduct other studies regarding the role of health beliefs in shaping diabetes-protective behaviors among the Iraqi population. The study tested the ability of the health belief model-based- health education to enhance participants' beliefs regarding diabetes early detection investigations. Keywords: Health Belief Model, Early Detection, Diabetes Miletus, Health Education

Objective To explore influence of multi-disciplinary team health education on knowledge-attitude-practice for non-osteoporosis patients. Methods A total of 70 patients without osteoporosis from two different wards of a tertiary hospital in Hangzhou were selected by convenience sampling method and divided into control group (n=35) and observation group (n=35). The control group was given osteoporosis health education only by nurses, while the observation group received osteoporosis health education by multi-disciplinary team including nurses, doctors, nutritionists and medical experts of endocrinology. The osteoporosis knowledge, health belief, self-efficacy and daily intake of calcium were evaluated before and after health education in hospital, one month and three months after health education. Results A total of 33 subjects in control group and 34 subjects in observation group completed the study. The differences in osteoporosis knowledge, self-efficacy and daily intake of calcium between two groups were statistically significant at different time points (P<0.05). After health education, the scores of osteoporosis knowledge, health belief, self-efficacy and daily intake of calcium in two groups were higher than before (P<0.05), while all of them declined one month and three months after health education. The indexes in observation group were better than those in control group one month after health education, the differences were statistically significant (P<0.05). The indexes except health belief in observation group were better than those in control group three months after health education, the differences were statistically significant (P<0.05). Conclusions The multi-disciplinary team osteoporosis health education in hospital can improve the osteoporosis knowledge, health belief, self-efficacy and daily intake of calcium. Key words: Osteoporosis; Health education; Multi-disciplinary team

Aim: In 2023, the average woman used 13 different personal care products (PCPs) daily, exposing them to 114 different chemical toxins, including carcinogens, synthetic preservatives, and fragrances. Parabens, commonly used as preservatives and fragrance ingredients, are found in household and PCPs, such as cosmetics and hair products. Exposure to parabens has been associated with an increased risk of breast cancer and endocrine disorders. This study aims to evaluate the effectiveness of the “Paraben-Free &amp; Me” educational toolkit (OSF Registration DOI: 10.17605/OSF.IO/WXU34) by exploring whether it influences changes of 3.5 points (10%) in paraben-free behaviour in women aged 18–35 years old when compared to the control group. Methods: This study consists of a randomized controlled trial to evaluate the effectiveness of the educational toolkit among 101 female students aged 18 to 35 years old following a four-week intervention period. Baseline and follow-up questionnaires were used to assess participants’ knowledge and access to information, risk perception, health beliefs, and paraben-free behaviour by providing composite scores for each construct. Results: The change in the knowledge and access to information score was significantly greater in the intervention group compared to the control group (+3.96, 95% CI [1.95, 5.96]). There were slight differences between groups in relation to health beliefs (+0.63, 95% CI [–1.02, 2.27]), risk perception (+0.96, 95% CI [–0.61, 2.54]), and paraben-free behaviour (–0.16, 95% CI [–2.88, 2.57]); however, these were not statistically significant. Conclusions: This study suggests that while the “Paraben-Free &amp; Me” educational toolkit was unsuccessful in promoting greater paraben-free behaviour in the intervention group, it can increase women’s knowledge and access to information related to parabens in their PCPs. Future studies can focus on evaluating paraben-free behaviour and the effectiveness of the educational toolkit by exploring biological measures, such as urinary concentrations of parabens, and air pollutant concentrations.

ObjectivesThis study examined oral hygiene behavior (OHB) and Health Belief Model-based (HBM) determinants among asylum seekers and refugees (ASR).MethodsCross-sectional survey data from 300 Arabic-speaking ASRs in Switzerland were analyzed for associations of two OHB outcomes (Adequate: toothbrushing twice a day; interdental cleaning at least each other day) with HBM-based explanatory variables. Mixed logistic regression models were used, adjusting for age, sex, education, and household.ResultsInadequate-OHB was common (toothbrushing: 47%; interdental cleaning: 65%). ASRs reporting higher self-efficacy under stress, more likely reported adequate-OHB (toothbrushing: odds ratio (95% confidence interval) 2.93 (0.68,12.70); interdental cleaning: 3.10 (2.28,4.22). Barriers (anticipating pain or breakage, lack of time, limited knowledge) were associated with reduced likelihood of adequate-OHB (interdental cleaning: don’t know how: 0.76 (0.61, 0.95)). Benefits were associated with adequate interdental cleaning (making mouth feel better: 1.61 (1.14, 2.27); saving money later: 1.36 (1.01; 1.82)). The likelihood of adequate toothbrushing increased with autonomy (control of decisions on one’s dental health: 1.40 (0.91, 2.17)).ConclusionSelf-efficacy, autonomy, barriers and benefits may be key OHB determinants among ASRs, but need testing in intervention studies.