Malaysian Healthcare Research Articles

Patients’ Satisfaction on Selangor Hospitals

Malaysian healthcare is nominated as one of the best healthcare providers in the world. However, does this fact reflect the patients' satisfaction? Therefore, this research aims to investigate whether empathy, competency, and service quality influence patients' satisfaction in healthcare services in Selangor, Malaysia. Primary data are collected using a self-administered questionnaire and a sample of 206 patients from four government and private hospitals in Selangor. Data were analysed through descriptive statistics, correlation and regression analysis. The findings show that empathy has the strongest relationship (β= .403) followed by service quality with (β=.284) and competency (β= .176). All factors also influenced patients' satisfaction. All identified variables contribute to a big amount of variances (R2=66.8percent) to the overall hospital performance that makes its client happy and satisfied. The understanding patients' satisfaction will lead to many improved services. Practically, this study can contribute to a better experience for patients and knowledge for hospitals to strive for a better service healthcare provider.

Netizens’ Perceptions Regarding Muslim-Unfriendly Dress Code for Clinical Personnel in Malaysia

The employee’s right to freedom of religious expression at work and the institution’s right to implement a uniform dress code policy have created many conflicts, including in the context of healthcare. Healthcare institutions implement strict hygiene and infection control policy which may include the banning of long sleeves and headscarves. This practice may be problematic for female Muslim personnel who prefer to cover their forearms, hair and necks. In the Malaysian healthcare sector, two events involving the alleged headscarf ban (in 2013) and long sleeves ban (in 2015) made national headlines that attracted many netizens to comment on the issue. This qualitative study thematically analyses the netizens’ perceptions of the issue shared on various online platforms. Netizens expressed numerous opinions regarding the alleged bans, the clinical dress code policy, the Islamic dress code, the status of religion and Islam in Malaysia and the healthcare sector, the status of Malays and non-Malays in Malaysia, and the pro- and anti-Islamic trends. The findings demonstrate various conflicting opinions regarding the above issues in Malaysia which highlight the need for guidelines or frameworks for the harmonisation between employees’ personal convictions and the institutions’ interests.

Rojak: An Ethnographic Exploration of Pluralism and Music Therapy in Post-British-Colonial Malaysia

Abstract The purpose of this discursive exploration that is influenced by ethnography and autoethnography is to present how Western-based music therapy intersects with the pluralistic healthcare culture in Malaysia. We will first be situating music therapy as a Eurocentric-based healthcare practice. We will then introduce the history of Malaysia and healthcare culture through a pluralistic lens, drawing inspiration from a popular Malaysian street food—rojak, a form of salad. We use rojak as an analogy to honor Malaysia’s food culture while drawing similarities between the diverse flavors and textures between the distinct components of rojak, with the unique pluralism that exists throughout Malaysian culture and healthcare practices. Through this rojak pluralist lens, we will share several unique Malaysian vignettes to explore the different ways we consider Eurocentric music therapy as a potentially colonial practice, ranging from postcolonial theory perspective to a pragmatic, inclusive perspective. As Malaysia has maintained its pluralistic culture as a uniquely multiracial Asian country despite the lengthy history of colonization, we offer these Malaysian, post-British-colonial music therapy vignettes in this article.

Information, Motivation and Behavioural Factors in Influencing Diabetes Self-Care: A Conceptual Paper

Globally, diabetes is a major public health concern and has impacted an estimated 425 million adults. The increasing trend of diabetes incidence has impacted the Malaysian population and healthcare system. Evidence from studies suggested that diabetes can be treated and controlled through behavioural intervention. These include combining lifestyle with pharmacotherapy. Scholars in health behaviour highlighted the importance of assessing and monitoring the behavioural intervention among diabetic patients in terms of psychosocial aspects, such as information, motivation and behavioural factors, in relations with diabetes self-care. This article provides an overview of the empirical evidence regarding the importance of identifying information, motivation and behavioural factors, in relations with diabetes self-care. Information is among the prominent factors in establishing good diabetes management. Motivation can be conceptually defined as factors that predispose one to action and cues to behaviour change. Behavioural factors identified in this review includes compliance towards diabetes self-care. The outcome of this review could provide a better understanding of information, motivation and behavioural factors, and its relations with diabetes self-care.

The Greatest Risk to Malaysian Healthcare Workers during COVID-19 Crisis: Lies of Patients

In Malaysia, the first case of the coronavirus disease 2019 (COVID-19) was reported on 25 January 2020 [1]. Reported cases remained relatively low until a surge of cases emerged in March 2020, most of them linked to a 'Tabligh' religious gathering held in the Seri Petaling Mosque in Kuala Lumpur. Despite the fact that mass gatherings are known to both pose & cause major public health challenges during outbreaks .

Malaysian Healthcare Sector: Service Quality and Patient Performance

Healthcare are often in particularly characterized in interacting the variety of wide in activities to provide the great quality while deliver the services. By adapting the technique for improvement in a business philosophy were lead for being the epitome of services. More recently the advantages increasing the service quality approach have become more acceptance in the organization process. Hence, the purpose of this study to determine the relationshio between service quality and patient performance in Malaysian healthcare sector. A structured technique has been used by Structural Equation Modeling (SEM – PLS).

Antibiotic resistance of ESKAPE bacteria in acute pharyngitis patients from private clinics in central Malaysia

Worldwide, the ESKAPE group of pathogens - Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species - are emerging as important pathogens which have acquired resistance towards different classes of antibiotics. Malaysia has also reported high levels of antibiotic resistance among these pathogens, based on prevalence data from hospital patients. However, the prevalence and antibiotic resistance rates of ESKAPE group members in the community are largely unknown. Therefore, this study focuses on acute pharyngitis (AP) patients from private primary care clinics in the Klang Valley, central Malaysia, as AP is the most common infection-associated reason for contact with private primary healthcare providers. Out of 205 patients, 119 were found to harbor ESKAPE group bacteria, where a total of 175 isolates were subjected to antibiotic susceptibility testing. Our results show that the most prevalent ESKAPE group member in this cohort is S. aureus, with one isolate found to be multidrug-resistant towards penicillin V, cefoxitin, erythromycin and azithromycin. We also report the first finding of community acquired resistance to cefotaxime in K. pneumoniae, imipenem in Enterobacter spp. and tetracycline, also in Enterobacter spp., in Malaysia, which were not derived from samples from a hospital setting. In conclusion, this study, which describes antibiotic resistance of community acquired ESKAPE pathogens in the Malaysian private primary healthcare setting highlights the need for a comprehensive centralized reporting system for community acquired antibiotic resistance to complement the Malaysian National Surveillance of Antibiotic Resistance.

The FutureChallenges of the Malaysian Health Care System in Medical Tourism

The FutureChallenges of the Malaysian Health Care System in Medical Tourism

Vertical Infestation Profile of Aedes in Selected Urban High-Rise Residences in Malaysia.

Dengue is placing huge burdens on the Malaysian healthcare system as well as the economy. With the expansion in the number of high-rise residential buildings, particularly in the urban centers, the flight range and behavior of Aedes mosquitoes may be altered in this habitat type. In this study, we aimed to expand the understanding of the vertical distribution and dispersal of Aedes in nine selected high-rise residences in Kuala Lumpur, Selangor, and Johor using ovitraps as the sampling method. We discovered that Ae. aegypti is the predominant species in all study sites. Both Ae. aegypti and Ae. albopictus are most abundant within the first three levels and could be found up to level 21 (approximately 61.1–63.0 m). Pearson correlation analyses exhibited negative correlations in eight out of nine study sites between the ovitrap indexes (OIs) within each floor level, suggesting that Aedes density decreased as the building level increased. Our findings provide information to the public health authorities on ‘hot spot’ floors for effective suppression of dengue transmission.

Automated Classification of Stroke Lesion Using Bagged Tree Classifier

Stroke is a “brain attack” that often causes paralysis, resulted from either bleeding in the brain (hemorrhagic) or the blockage of blood flow to the brain (ischemic). It posed a big challenge to Malaysian healthcare services with at least 32 deaths per day, while survivors were burdened with multiple problems. Conventionally, the diagnosis is performed manually by neuroradiologists during a highly subjective and time consuming tasks. Therefore, this paper intends to diagnose and classify stroke by investigating diffusion- weighted imaging (DWI) of brain stroke images using Bagged Tree classification. Stroke is classified into three main types which are acute stroke, chronic stroke and hemorrhage stroke. The performance of the proposed method is then verified using accuracy and Area Under the Curve (AUC). Based on the results, the overall accuracy for the classification is 96.7%. The AUC of each type of stroke for acute stroke, chronic stroke and hemorrhage stroke is 97%, 100% and 99%, respectively. This outcome could serve as an insight to improve the healthcare of the community by providing better solutions using such intelligent system.

The adaptation and validation of the satisfaction with stroke care questionnaire (Homesat) (SASC10-My\u2122) for use in public primary healthcare facilities caring for long- term stroke survivors residing at home in the community

BackgroundSatisfaction with post stroke services would assist stakeholders in addressing gaps in service delivery. Tools used to evaluate satisfaction with stroke care services need to be validated to match healthcare services provided in each country. Studies on satisfaction with post discharge stroke care delivery in low- and middle-income countries (LMIC) are scarce, despite knowledge that post stroke care delivery is fragmented and poorly coordinated. This study aims to modify and validate the HomeSat subscale of the Dutch Satisfaction with Stroke Care-19 (SASC-19) questionnaire for use in Malaysia and in countries with similar public healthcare services in the region.MethodsThe HomeSat subscale of the Dutch SASC-19 questionnaire (11 items) underwent back-to-back translation to produce a Malay language version. Content validation was done by Family Medicine Specialists involved in community post-stroke care. Community social support services in the original questionnaire were substituted with equivalent local services to ensure contextual relevance. Internal consistency reliability was determined using Cronbach alpha. Exploratory factor analysis was done to validate the factor structure of the Malay version of the questionnaire (SASC10-My™). The SASC10-My™ was then tested on 175 post-stroke patients who were recruited at ten public primary care healthcentres across Peninsular Malaysia, in a trial-within a trial study.ResultsOne item from the original Dutch SASC19 (HomeSat) was dropped. Internal consistency for remaining 10 items was high (Cronbach alpha 0.830). Exploratory factor analysis showed the SASC10-My™ had 2 factors: discharge transition and social support services after discharge. The mean total score for SASC10-My™ was 10.74 (SD 7.33). Overall, only 18.2% were satisfied with outpatient stroke care services (SASC10-My™ score ≥ 20). Detailed analysis revealed only 10.9% of respondents were satisfied with discharge transition services, while only 40.9% were satisfied with support services after discharge.ConclusionsThe SASC10-My™ questionnaire is a reliable and valid tool to measure caregiver or patient satisfaction with outpatient stroke care services in the Malaysian healthcare setting. Studies linking discharge protocol patterns and satisfaction with outpatient stroke care services should be conducted to improve care delivery and longer-term outcomes.Trial registrationNo.: ACTRN12616001322426 (Registration Date: 21st September 2016.

COVID-19 IMPACT ON E-COMMERCE USAGE: AN EMPIRICAL EVIDENCE FROM MALAYSIAN HEALTHCARE INDUSTRY

Purpose of the study: The purpose of the study is to investigate the COVID-19 impact on e-commerce usage in the Malaysian healthcare industry through the Technological, Organizational, and Environmental (TOE) model.
 Methodology: This is a quantitative online survey-based research. The questionnaires are distributed among 100 samples from a healthcare provider, namely doctors, hospital management, medical assistant nurses, and medical supplier, particularly in Peninsular Malaysia. The sample comprised 45% male and 55% female. The data were analyzed by using SPSS 25 and PLS-SEM 3.0 to examine the relationship between variables and to test the hypotheses.
 Main Findings: The finding reveals that organization readiness, e-commerce knowledge, and supply chain integration have a significant positive impact. In contrast, IT infrastructure and external pressure have an insignificant effect on e-commerce usage.
 Applications of the Study: The benefits obtained from this study can be used to empower e-commerce usage in the healthcare industry of Malaysia. Also, it will enhance the quality of services hence advancing the healthcare services and operations.
 Novelty/Originality of the Study: The combined effect of the TOE and DOI theory on e-commerce usage for the healthcare industry to contribute to the literature.

Implementing Uberization in Malaysian Healthcare Services

Getting appropriate healthcare is a challenge to the citizens in Malaysia due to the limited facilities, healthcare providers, and cost of healthcare. Uberization of healthcare will help fill this gap. Uberization helps modify the market or economic model with the introduction of a cheaper and more effective alternative service by introducing a different way of buying or using it, with the use of mobile technology. With powerful artificial intelligence engines operating on cloud servers, mobile apps can provide a better healthcare experience for patients. With uberization application, the patient need not come to the hospital to see a doctor before a treatment can be planned. Once a request is made by the patient, the healthcare providers can come to see the patient at an agreed place. This article aims to explore the possible uberization of healthcare in Malaysia.

The Awareness and Knowledge of Alternative Islamic Treatment: A Case Study in Malaysia

Technological advances and evolution in medicine have evolved and led humans to find alternative methods of modern medicine. Alternative treatment centers based on either "Islamic Treatment" or traditional ones are becoming more and more popular over time. Alternative treatments of Islam are treatments based on ruqyah, aura, inner, and homeopathy. In line with this rapid alternative to Islamic medicine, the Malaysian government supports Traditional and Complementary Medicine (TCM) in connection with any traditional medical practice among the local community except for medical or dental practices registered and recognized under the Malaysian healthcare system. However, to this day, the awareness, exposure and knowledge of alternative Islamic medicine are still in small scale and very limited in society. This issue needs to be taken into account for the importance of exposure and knowledge to the community not only to the Muslim community, but to all Malaysians. As such, this research aims to raise awareness and make research findings a platform to provide comprehensive information to the public. This can change the perception and resolve the community's doubts on alternative Islamic medicine as well as enhance the development of alternative Islamic medicine by offering a 'one-stop-center' hub for the needs of patients in need of alternative treatment. This study will use qualitative approach by interviewing the founder and practitioner of Islamic medicine Darul Ansar center and also observation method by observing the practice of medicine or treatment in accordance to Islamic syariah. The interview will be using thematic analysis whereby the data will be gathered and analysed.

Cardiovascular Disease Risk Factors among White-Collar Workers towards Healthy Communities in Malaysia

Cardiovascular disease (CVD) is the most common cause of mortality worldwide, including in most Western countries and Asian countries such as Malaysia. Reports by The Department of Statistics Malaysia highlighted that ischaemic heart diseases and cerebrovascular disease, which are a few of CVD, was the principal cause of death in 2016 and 2017. At the same time, big data is a part of Malaysia's fast-growing technology and has grown prominently in the six Malaysian government's public sector clustering which are profiling, social, economy, transportation, education, and also in healthcare. This paper focuses on healthcare big data, which is a prime example of how the three Vs of data, velocity (speed of generation of data), variety, and volume, are an innate aspect of the data it produces. Most healthcare data analytics has been conducted in the United States and Europe, however there were some studies in Canada and very little in Asia. This study will be conducted in Selangor, Malaysia focusing on white-collar workers among the Selangor healthy community. Interviews will be held within medical practitioner or healthcare provider in order to collected information. The information available from the National Cardiovascular Database (NCVD) published reports will be used to conduct the data analysis experiments which will lead towards the identification of CVD risk factors. The results obtained show that data crawling of social media data can be used as a means towards healthcare big data analytics. This will hence aid in the Malaysian healthcare integration process and aid the Malaysian government to provide better healthcare for the overall Malaysian healthy community and society.

KNOWLEDGE, ATTITUDE AND PRACTICE of MEDICAL PERSONNEL ON SMOKING CESSATION GUIDELINES: A REVIEW ON ASSOCIATIONS AND QUESTIONNAIRES

Number of active smokers in Malaysia is increasing despite availability of stop smoking clinics and smoking cessation medications. Other than smokers’ level of motivation to quit smoking, competency of the healthcare professionals involved in providing smoking cessation intervention using evidence-based guidelines needs to considered. Hence, knowledge, attitude and practice (KAP) of the healthcare providers in relation to existing clinical practice guidelines on smoking cessation should be assessed. In this review, we look at the previous available questionnaire, for the purpose of applying it to the context of the Malaysian healthcare providers.

Cost-Effectiveness Analysis of Ombitasvir/Paritaprevir/Ritonavir and Dasabuvir With or Without Ribavirin Regimen for Patients Infected With Chronic Hepatitis C Virus Genotype 1 in Malaysia

ObjectivesThe combination of pegylated-interferon and ribavirin (PegIFN+RBV) is currently the gold standard in treating chronic hepatitis C virus (HCV) patients in Malaysia and is reimbursed by the Malaysian authorities. This analysis evaluated the cost-effectiveness (CE) of the ombitasvir/paritaprevir/ritonavir and dasabuvir with or without ribavirin (OBT/PTV/r+DSB±RBV) regimen as compared with the PegIFN+RBV or no treatment in chronic HCV Genotype 1 (GT1) treatment-naïve and treatment-experienced cirrhotic and noncirrhotic patients in Malaysia. MethodsA Markov model based on previously published CE models of HCV was adapted for the Malaysian public healthcare payer perspective, based on good modeling practices. Treatment attributes included efficacy, regimen duration, and EQ-5D treatment-related health utility. Transitional probabilities and health state health utilities were derived from previous studies. Costs were derived from Malaysian data sources. Costs and outcomes were discounted at 3.0% per year. Deterministic and probabilistic sensitivity analyses were performed to evaluate the impact of uncertainties around key variables. ResultsBased on the analysis, patients treated with the OBT/PTV/r+DSB±RBV showed less frequent progression to compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and liver-related deaths when compared with standard care (ie, PegIFN+RBV or no treatment). At a price of MYR 1846/day, the OBT/PTV/r+DSB±RBV regimen is cost-effective over PegIFN+RBV and yields better outcomes in terms of life-years (LYs) gained and quality-adjusted life-years (QALYs) at a higher cost, which is still well below the implied willingness to pay threshold of MYR 384 503/QALY. ConclusionThe OBT/PTV/r+DSB±RBV regimen is cost-effective for treatment naïve, treatment experienced, cirrhotic, and noncirrhotic GT1 chronic HCV patients in Malaysia.

Issues and Challenges in Implementing Care Coordinator in Primary Healthcare in Malaysia: A Qualitative Study.

Background:Primary healthcare is the earliest gateway for patient care, and improvisations are often needed to accommodate the ever-increasing demand in public health. The Enhanced Primary Healthcare (EnPHC) initiative is aimed at improving such needs, and one core intervention is the introduction of a care coordinator (CC). The purpose of this study was to identify barriers and facilitators in implementing a new intervention in primary healthcare clinics.Methods:This qualitative exploration study. All healthcare providers who were involved in EnPHC at the intervention clinics were selected as participants. In-depth interviews and focus group discussions were carried out among healthcare providers working in the intervention clinic. Thematic analysis was used to categorize data, based on the consolidated framework for implementation research (CFIR) theoretical framework domains.Results:A total of 61 healthcare providers participated. All 5 domains with 19 CFIR constructs emerged from the analysis. Inner setting played a significant role in facilitating CC intervention, in which culture, networking, and collaboration and leadership engagement played an essential role in supporting CC activities. Although CC tasks are complex, concerns of losing clinical skill and resource constraints were identified as potential barriers in CC implementations. Criteria for appointing new CCs emerged from the characteristics of individual constructs, in which the individual must be familiar and interested in community health, have good communication skills, and at least 3 years’ experience in the primary healthcare setting.Conclusion:The implementation of the CC intervention faces varying challenges in different settings. This is partially resolved through teamwork, guidance from mentors, and support from superiors. The complexity of the responsibility of the CC intervention is perceived as both a validation and a burden. Above all, it is seen as paramount in EnPHC intervention.

Factors Influencing Intravenous-to-Oral Antibiotic Switch among Private Healthcare Providers in Malaysia

Intravenous-to-oral switch strategy is part of an antimicrobial stewardship programme that can reduce the length of hospitalization and lower associated costs. However, intravenous-to-oral switch data in the private healthcare setting in Malaysia is limited. The aim of this study was to explore factors that affect intravenous-to-oral switch decisions in the Malaysian private healthcare. This was a cross-sectional survey among four private hospitals. A total of 225 consultants, pharmacists and nurses were included. Mean assessment was based on a 5-point Likert scale; 1-very unimportant to 5-very important. Microbiology aetiology (4.12±0.93) was the most important clinical factor for deciding suitability of IVOS. Primary consultant preference (3.83±0.98) was the most important non-clinical factor. Respondents agreed that all healthcare professionals needed to be given intravenous-to-oral switch awareness (4.41±0.77). Understanding factors influencing Intravenous-to-oral switch decision and addressing misconceptions in beliefs are important to develop intravenous-to-oral switch and antimicrobial stewardship strategies in private hospitals.

Psychometric Evaluation of a Feedback Conception Scale: Building Positive Feedback Practises of Charge Nurses in Public Hospitals

Charge nurses who have a good level of understanding on feedback conceptions will be able to practise feedback effectively towards their staffs. The purpose of this pilot study was to provide the evidence of psychometric evaluation of ‘Teachers’ Conceptions of Feedback (TCoF) scale of charge nurses using the Rasch Measurement Model. There are 9 constructs with 37 items altogether. One hundred and sixty-three (N=163) charge nurses from three states had completed the questionnaire. The content validity was checked by three experts in the field of measurement and medical health. The findings revealed that most items fit the model as their MNSQ values are between 0.60 and 1.40 except for four items. PMC value for all items are more than 0.20 except for three items. Two items showed a negative value of PMC. Most items are in a same direction so the item discrimination is good. Item reliability and item separation is 0.87 and 7.29 respectively, while person reliability and person separation is 0.81 and 2.81 respectively. The reliability value for item and person is high and acceptable. The separation index for item and person are also acceptable. In total, five items were deleted. The statistical analysis provides strong evidence to support the validity and reliability of the scale. The findings show that sample selection is appropriate. Hence, this instrument could be adapted or adopted by other researchers in the Malaysian health care system context