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Fulltext Anteceding factors predicting absenteeism and presenteeism in urban area in Malaysia

Wee LH, Yeap LLL, Chan CMH, Wong JE, Jamil NA, Swarna Nantha Y, et al.

BMC Public Health, 2019 Jun 13;19(Suppl 4):540.
PMID: 31196096 DOI: 10.1186/s12889-019-6860-8

BACKGROUND: Organization productivity is strongly linked to employees' socioeconomic characteristics and health which is marked by absenteeism and presenteeism. This study aims to identify anteceding factors predicting employees' absenteeism and presenteeism by income, physical and mental health.
METHODS: An online health survey was conducted between May to July 2017 among employees from 47 private companies located in urban Malaysia. A total of 5235 respondents completed the 20-min online employee health survey on a voluntary basis. Chi-Square or Fisher's exact tests were used to determine association between income with demographic and categorical factors of absenteeism and presenteeism. Multivariate linear regression was used to identify factors predicting absenteeism and presenteeism.
RESULTS: More than one third of respondents' monthly income were less than RM4,000 (35.4%), 29.6% between RM4,000-RM7,999 and 35.0% earned RM8,000 and above. The mean age was 33.8 years (sd ± 8.8) and 49.1% were married. A majority were degree holders (74.4%) and 43.6% were very concerned about their financial status. Mean years of working was 6.2 years (sd ± 6.9) with 68.9% satisfied with their job. More than half reported good general physical health (54.5%) (p = 0.065) and mental health (53.5%) (p = 0.019). The mean hours of sleep were 6.4 h (sd ± 1.1) with 63.2% reporting being unwell due to stress for the past 12 months. Mean work time missed due to ill-health (absenteeism) was 3.1% (sd ± 9.1), 2.8% (sd ± 9.1) and 1.8% (sd ± 6.5) among employees whose monthly income was less than RM4,000, RM4,000-RM7,999 and over RM8,000 respectively (p = 0.0066). Mean impairment while working due to ill-health (presenteeism) was 28.2% (sd ± 25.3), 24.9% (sd ± 25.5) and 20.3% (sd ± 22.9) among employees whose monthly income was less than RM4,000, RM4,000-RM7,999 and over RM8,000 respectively (p
Fulltext Application of the Logic Model to the School-Based Fit and Smart Adolescent Smoking Cessation Programme

Abdul Halim NA, Wee LH, Mohd Saat NZ, Jit Singh SJ, Siau CS, Chan CMH

Malays J Med Sci, 2022 Oct;29(5):133-145.
PMID: 36474542 DOI: 10.21315/mjms2022.29.5.14

BACKGROUND: School-based smoking cessation intervention programmes are challenging to implement and evaluate. This study aimed to explain the process of developing the Fit and Smart Adolescent Smoking Cessation Programme (FSSCP). Logic model is a visual tool that helps programme planners to create an activity action plan that suits the target group to achieve programme objectives and goals.
METHODS: This two-arm cluster-randomised controlled trial was implemented between January 2018 and November 2018. Six schools were selected using stratified random sampling, whereby students were purposively selected and invited. The criteria of inclusion to the programme were secondary school students (aged 13 years old-17 years old) who smoked conventional cigarettes (CC) and electronic cigarettes (EC).
RESULTS: A total of 422 students from six schools participated in this study. Three schools were designated as intervention (n = 250) and the other three as control schools (n = 172). Formative evaluation of participants in the FSSCP using the logic model showed that participants were satisfied with the overall programme (91.5%), were motivated to stop smoking (90.4%) and were prevented from relapse (89.2%). The quit rate at a 3-month follow-up was 41.8%.
CONCLUSION: The logic model supported the development of the programme, with details on the processes, dissemination activities, identification of barriers, evaluation criteria and outcomes provided.
Fulltext Assessing predictors of intention to prescribe sick leave among primary care physicians using the theory of planned behaviour

Swarna Nantha Y, Wee LH, Chan CM

BMC Fam Pract, 2018 01 16;19(1):18.
PMID: 29338699 DOI: 10.1186/s12875-017-0690-5

BACKGROUND: Providing sickness certification is a decision that primary care physicians make on a daily basis. The majority of sickness certification studies in the literature involve a general assessment of physician or patient behaviour without the use of a robust psychological framework to guide research accuracy. To address this deficiency, this study utilized the Theory of Planned Behaviour (TPB) to specifically gauge the intention and other salient predictors related to sickness certification prescribing behaviour amongst primary care physicians.
METHODS: A cross-sectional study was conducted among N = 271 primary care physicians from 86 primary care practices throughout two states in Malaysia. Questionnaires used were specifically developed based on the TPB, consisting of both direct and indirect measures related to the provision of sickness leave. Questionnaire validity was established through factor analysis and the determination of internal consistency between theoretically related constructs. The temporal stability of the indirect measures was determined via the test-retest correlation analysis. Structural equation modelling was conducted to determine the strength of predictors related to intentions.
RESULTS: The mean scores for intention to provide patients with sickness was low. The Cronbach α value for the direct measures was good: overall physician intent to provide sick leave (0.77), physician attitude towards prescribing sick leave for patients (0.77) and physician attitude in trusting the intention of patients seeking sick leave (0.83). The temporal stability of the indirect measures of the questionnaire was satisfactory with significant correlation between constructs separated by an interval of two weeks (p
Fulltext Basic-SiM train-the-trainer: a model to prepare aviation educators for simulation based-first aid learning

Muhamad Nur Fariduddin, Wee, Lei Hum, Lilia Halim, Mohd Johar Jaafar

ASM Science Journal, 2018;11(1):32-44.
MyJurnal

Medical emergency on board is a new phenomenon that lack of attention. Despite the
presence of cabin crew who is certified to provide medical care to the passenger, failure to
acquire the non-technical skills and low level of knowledge and technical skills retention is
reported to be major challenges in developing a highly competent cabin crew in providing
effective medical care. Having the ability to design simulations, implement it into teaching,
and effectively evaluate simulated performance is starting to become a key role for educators
in health care. For most educators, a practical knowledge and skills gap resides between
the need for simulation learning and proficiencies in designing and utilising simulation. The
purpose of this model was to develop a ‘trained educators’ from the aviation industry with
the knowledge and skills to utilise simulation effectively. The steps involve identification,
development, and integration with a follow-up assessment. The implementation of the program
yielded a significant improvement on the participants’ knowledge, t (129) = -6.27, p
< .001 together with a total DASH-SV score of 6.32. The barriers, including difficulties
encountered executing the model, are discussed combined with the implication for future application.
This model is an effective approach for developing a trained educator in first aid
for aviation incorporated with simulation learning. The trained educator will then become
a pioneer and train another organisation.
Fulltext Behavioural and emotional issues among primary school pupils with congenital colour vision deficiency in the Federal Territory of Kuala Lumpur, Malaysia: A case-control study

Thomas BAWM, Kaur S, Hairol MI, Ahmad M, Wee LH

F1000Res, 2018;7:1834.
PMID: 30815251 DOI: 10.12688/f1000research.17006.1

Background: Congenital colour vision deficiency (CCVD) is an untreatable disorder which has lifelong consequences. Increasing use of colours in schools has raised concern for pupils with CCVD. This case-control study was conducted to compare behavioural and emotional issues among age, gender and class-matched pupils with CCVD and normal colour vision (NCV). Methods: A total of 1732 pupils from 10 primary schools in the Federal Territory of Kuala Lumpur were screened, of which 46 pupils (45 males and 1 female) had CCVD. Mothers of male pupils with CCVD (n=44) and NCV (n=44) who gave consent were recruited to complete a self-administered parent report form, Child Behaviour Checklist for Ages 4-18 (CBCL/ 4-18) used to access behavioural and emotional problems. The CBCL/ 4-18 has three broad groupings: Internalising, Externalising and Total Behaviour Problems. Internalising Problems combines the Withdrawn, Somatic Complaints and Anxiety/ Depression sub constructs, while Externalising Problems combines the Delinquent and Aggressive Behaviour sub constructs. Results: Results from CBCL/ 4-18 showed that all pupils from both groups had scores within the normal range for all constructs. However, results from the statistical analysis for comparison, Mann-Whitney U test, showed that pupils with CCVD scored significantly higher for Externalising Problems (U=697.50, p=0.02) and Total Behaviour Problems (U=647.00, p= 0.01). Significantly higher scores were observed in Withdrawn (U=714.00, p=0.02), Thought Problems (U=438.50, p<0.001) and Aggressive Behaviour (U=738.00, p=0.04). Odds ratios, 95% CI, showed significant relative risk for high Total Behaviour Problem (OR:2.39 ,CI:1.0-5.7), Externalising Problems (OR:2.32, CI:1.0-5.5), Withdrawn (OR:2.67, CI:1.1-6.5), Thought Problems (OR:9.64, CI:3.6-26.1) and Aggressive Behaviour (OR:10.26, CI:3.4-31.0) scores among pupils with CCVD. Conclusion: Higher scores among CCVD pupils indicates that they present more behavioural and emotional problems compared to NCV pupils. Therefore, school vision screenings in Malaysia should also include colour vision to assist in the early clinical management of CCVD children.
Beliefs, Facilitating Factors, and Barriers in Using Personal Dosimeter among Medical Radiation Workers in a Middle-Income Asian Setting

Mohd Ridzwan SF, Bhoo-Pathy N, Wee LH, Isahak M

Ann Work Expo Health, 2021 10 09;65(8):940-954.
PMID: 34037205 DOI: 10.1093/annweh/wxab025

This qualitative study explores the medical radiation workers' (MRWs) beliefs with the support of the theory of planned behaviour's constructs regarding the use of personal dosimeters in order to identify the facilitating factors and barriers to practising good personal dose monitoring. The exploration was conducted through semi-structured face-to-face interviews with 63 MRWs from the public, private, and university hospitals. Belief statements from the informants were organized under the behavioural, normative, and control belief, as guided by the theory. A thematic analysis found that a majority of informants acknowledged the benefits of using dosimeters. However, several factors influenced the actual usage. The informants were hesitant to use the dosimeter as the loss of the device involved an expensive penalty. They also mentioned that delayed dosimeter supplies due to late budget approval in the hospitals and some other reasons had got them disconnected from the monitoring system. The workers' attitudes and social norms highly induced their dosimeter usage as well; some perceived themselves to be at low risk for high exposure to radiation, and forgetfulness was also mentioned as a reason for lack of adherence. Device physical factor influenced low dosimeter use too. This study highlighted some unique findings in Asian settings. A better understanding of the underlying reasons for the lack of dosimeter use will be useful in developing strategies to increase good practices in personal radiation monitoring.
Fulltext Course and predictors of post-traumatic stress disorder in a cohort of psychologically distressed patients with cancer: A 4-year follow-up study

Chan CMH, Ng CG, Taib NA, Wee LH, Krupat E, Meyer F

Cancer, 2018 01 15;124(2):406-416.
PMID: 29152719 DOI: 10.1002/cncr.30980

BACKGROUND: Scant evidence exists on the long-term course of cancer-related post-traumatic stress disorder (PTSD). This is among the few studies worldwide, and the first in the South-East Asian region, to prospectively evaluate PTSD in patients with cancer using gold-standard clinical interviews. The objective of the study was to assess the course and predictors of PTSD in adult patients with cancer in a South-East Asian population.
METHODS: A prospective, longitudinal study was conducted in a cohort of 469 consecutively recruited patients (aged ≥18 years) with various cancer types within 1 month of diagnosis at a single oncology referral center. Only patients who had significant psychological distress (Hospital Anxiety and Depression Scale total cutoff score ≥16) underwent the PTSD module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (SCID) at at 6-months follow-up. All patients completed the SCID at the 4-year follow-up assessment regardless of their initial Hospital Anxiety and Depression Scale score.
RESULTS: In an analysis combining patients who had both full and subsyndromal PTSD, there was a 21.7% incidence of PTSD at the 6-month follow-up assessment (n = 44 of 203 SCID-interviewed patients), with rates dropping to 6.1% at the 4-year follow-up assessment (n = 15 of 245 SCID-interviewed patients). Patients with breast cancer (compared with those who had other types of cancer) were 3.68 times less likely to develop PTSD at 6-months, but not at 4-years follow-up.
CONCLUSIONS: The overall rates of PTSD decreased with time, but one-third of patients (34.1%) who were initially diagnosed had persistent or worsening PTSD 4 years later. There is a need for early identification of this subset of patients who have cancer with PTSD to design risk-targeted interventions. Cancer 2018;124:406-16. © 2017 American Cancer Society.
Fulltext Cross-Cultural Adaptation and Validation of the Attitudes Toward Suicide Questionnaire Among Healthcare personnel in Malaysia

Siau CS, Wee LH, Ibrahim N, Visvalingam U, Wahab S

Inquiry, 2017 01 01;54:46958017707295.
PMID: 28486042 DOI: 10.1177/0046958017707295

Understanding attitudes toward suicide, especially among healthcare personnel, is an important step in both suicide prevention and treatment. We document the adaptation process and establish the validity and reliability of the Attitudes Toward Suicide (ATTS) questionnaire among 262 healthcare personnel in 2 major public hospitals in the Klang Valley, Malaysia. The findings indicate that healthcare personnel in Malaysia have unique constructs on suicide attitude, compared with the original study on a Western European sample. The adapted Malay ATTS questionnaire demonstrates adequate reliability and validity for use among healthcare personnel in Malaysia.
Depression and Anxiety Predict Healthcare Workers' Understanding of and Willingness to Help Suicide Attempt Patients

Siau CS, Chan CMH, Wee LH, Wahab S, Visvalingam U, Chen WS, et al.

Omega (Westport), 2023 Jun;87(2):469-484.
PMID: 34096373 DOI: 10.1177/00302228211021746

We examined whether burnout, depression, anxiety, stress, lifetime suicidal ideation, self-efficacy in preventing suicide and demographic factors predicted the understanding of and willingness to help suicidal patients among hospital healthcare workers. A total of 368 healthcare workers from the major surgical and medical departments in a general hospital setting were recruited. Participants responded to the Depression Anxiety and Stress Scale-21, Self-efficacy in Suicide Prevention, and Understanding Suicide Attempt Patient Scale. Those from the psychiatric department, with higher suicide prevention self-efficacy, and lower personal accomplishment indicated more understanding and helpful attitudes; doctors, depressed and anxious healthcare workers reported less understanding and helpful attitudes. Suicide prevention efforts must be conducted in tandem with equipping and supporting the healthcare workers who manage suicidal patients.
Fulltext Do depression literacy, mental illness beliefs and stigma influence mental health help-seeking attitude? A cross-sectional study of secondary school and university students from B40 households in Malaysia

Ibrahim N, Amit N, Shahar S, Wee LH, Ismail R, Khairuddin R, et al.

BMC Public Health, 2019 Jun 13;19(Suppl 4):544.
PMID: 31196033 DOI: 10.1186/s12889-019-6862-6

BACKGROUND: Mental illness rates among young people is high, yet the frequency of help-seeking is low, especially among those from lower socioeconomic backgrounds. Understanding factors influencing help-seeking, such as mental illness beliefs, stigma and literacy among B40 individuals is important, but past studies are sparse. Hence, we aimed to examine the factors associated with mental help-seeking attitude among students from the B40 income bracket. Differences in beliefs toward mental illness, stigma and help-seeking attitudes among university and secondary school students were also investigated.
METHODS: University and secondary school students from low-income households (N = 202) were involved in this cross-sectional study. Participants completed the Depression Literacy Questionnaire (D-Lit), General Help Seeking Questionnaire (GHSQ), Mental Help Seeking Attitudes Scale (MHSAS), Self-Stigma of Seeking Help Scale (SSOSH), and Beliefs toward Mental Illness (BMI).
RESULTS: Mental help-seeking attitude had a significant relationship with self-stigma on seeking help (r = -.258, p
Fulltext Effective practice of debriefing after simulation-based non-technical skills in healthcare professionals: a systematic review

Muhamad Nur Fariduddin, Wee Lei Hum, Lilia Halim, Mohd Johar Jaafar

Jurnal Sains Kesihatan Malaysia, 2019;17(2):51-62.
MyJurnal

The importance of non-technical skills among healthcare professionals is gaining a widespread recognition as critical elements complementing the technical skills used for improving patients’ safety. These skills are typically acquired through simulation training, which emerged as an effective way to complement clinical training. Non-technical skills frequently use high-fidelity simulation followed by a facilitated discussion known as debriefing. Debriefing by a skilled facilitator is thought to be essential for effective learning through reflective processes. Unfortunately, evidence to support the elements which contributes towards the effectiveness of debriefing remains sparse. We review the studies where elements of debriefing that have been manipulated and its effectiveness on the acquisition of non-technical skills among healthcare professionals through eight publications across four different databases. Non-technical skills performance improved after manipulated debriefing such as multimedia debrief, self-led debrief or no debrief. Besides, there was no added performance when video recording was added to facilitator-led debriefing. The application of learning theory on specific elements together with the application of selected debriefing models is highly encouraging for effective debriefing.
Fulltext Effectiveness of debriefing towards healthcare professionals’ nontechnical skills: a critical review

Muhamad Nur Fariduddin Abdul Aziz, Wee, Lei Hum, Lilia Halim, Mohd Johar Jaafar

Jurnal Sains Kesihatan Malaysia, 2018;16(1):17-28.
MyJurnal

The importance of nontechnical skills among healthcare professionals is gaining widespread recognition as critical
elements complementing technical skills that are used to improve patients’ safety. These skills are typically acquired
through simulation training which has emerged as an effective way to complement clinical training. Effective simulation
requires structure and effective debriefing methods to enhance its learning outcome. In previous literature, evidence of the
effectiveness of healthcare simulation was available but studies evaluating debriefing method(s) remain sparse. In this
paper, the effectiveness of debriefing methods in eight studies on the acquisition of nontechnical skills among healthcare
professionals is reviewed. Articles published from 1st January 2016 across three different databases were referred to. The
results of the review show a statistically significant improvement in the performance of nontechnical and technical skills
across different professionals through various methods of debriefing. Nontechnical skills such as teamwork, effective
communication, decision-making, and situational awareness have improved significantly. In addition, integration of
realism in simulation learning has begun to emerge as an effective technique of providing a real world experience.
However, there was lack of detailed information on the length and type of debriefing conducted in the studies. These
methods clearly require further research since the key to successful simulation learning is through debriefing which is
the heart of simulation.
Fulltext Effectiveness of training stop-smoking advisers to deliver cessation support to the UK national proposed standard versus usual care in Malaysia: a two-arm cluster-randomized controlled trial

Wee LH, West R, Tee GH, Yeap L, Chan CMH, Ho BK, et al.

Addiction, 2021 08;116(8):2150-2161.
PMID: 33220115 DOI: 10.1111/add.15346

AIMS: To assess the effectiveness of training stop smoking services providers in Malaysia to deliver support for smoking cessation based on the UK National Centre for Smoking Cessation and Training (NCSCT) standard treatment programme compared with usual care.
DESIGN: Two-arm cluster-randomized controlled effectiveness trial across 19 sites with follow-up at 4-week, 3-month, and 6-month.
SETTING: Stop smoking services operating in public hospitals in Malaysia.
PARTICIPANTS: Five hundred and two smokers [mean ± standard deviation (SD), age 45.6 (13.4) years; 97.4% male] attending stop smoking services in hospital settings in Malaysia: 330 in 10 hospitals in the intervention condition and 172 in nine hospitals in the control condition.
INTERVENTION AND COMPARATOR: The intervention consisted of training stop-smoking practitioners to deliver support and follow-up according to the NCSCT Standard Treatment Programme. The comparator was usual care (brief support and follow-up).
MEASUREMENTS: The primary outcome was continuous tobacco smoking abstinence up to 6 months in smokers who received smoking cessation treatment, verified by expired-air carbon monoxide (CO) concentration. Secondary outcomes were continuous CO-verified tobacco smoking abstinence up to 4 weeks and 3 months.
RESULTS: Follow-up rates at 4 weeks, 3 months and 6 months were 80.0, 70.6 and 53.3%, respectively, in the intervention group and 48.8, 30.8 and 23.3%, respectively, in the control group. At 6-month follow-up, 93 participants in the intervention group and 19 participants in the control group were abstinent from smoking, representing 28.2 versus 11.0% in an intention-to-treat (ITT) analysis assuming that participants with missing data had resumed smoking, and 52.8 versus 47.5% in a follow-up-only (FUO) analysis. Unadjusted odds ratios (accounting for clustering) were 5.04, (95% confidence interval (CI) = 1.22-20.77, P = 0.025) and 1.70, (95% CI = 0.25-11.53, P = 0.589) in the ITT and FUO analyses, respectively. Abstinence rates at 4 week and 3 month follow-ups were significantly higher in the intervention versus control group in the ITT but not the FUO analysis.
CONCLUSIONS: On an intention-to-treat analysis with missing-equals-smoking imputation, training Malaysian stop smoking service providers in the UK National Centre for Smoking Cessation and Training standard treatment programme appeared to increase 6 month continuous abstinence rates in smokers seeking help with stopping compared with usual care. However, the effect may have been due to increasing follow-up rates.
Erratum to: The Attitude of Psychiatric and Non-psychiatric Health-care Workers Toward Suicide in Malaysian Hospitals and Its Implications for Training

Siau CS, Wee LH, Yacob S, Yeoh SH, Adnan THB, Haniff J, et al.

Acad Psychiatry, 2017 10;41(5):701.
PMID: 28795362 DOI: 10.1007/s40596-017-0789-y
Fulltext Factors associated with different smoking statuses among Malaysian adolescent smokers: a cross-sectional study

Nur Atikah AH, Wee LH, Nur Zakiah MS, Chan CMH, Mohamed Haniki NM, Swinderjit JS, et al.

BMC Public Health, 2019 Jun 13;19(Suppl 4):579.
PMID: 31196055 DOI: 10.1186/s12889-019-6857-3

BACKGROUND: This study focused on the associations between socioeconomic status (SES) and adolescent smoking among secondary school students (13 to 17 years) in the Federal Territory of Kuala Lumpur, Malaysia. Our objective was to evaluate the relationships between adolescent demographics, socioeconomic status and smoking status.

METHODS: The survey data were based on baseline findings from a cross-sectional study (N = 422 adolescents). Chi-square test was used to assess the relationship between demographic characteristics, socioeconomic status (household monthly income and daily allowance) and adolescent smoking status. Exhaled carbon monoxide (CO) reading and the Hooked on Nicotine Checklist (HONC) were used to evaluate adolescent smoking status. A Multivariate Multinomial Logistic Regression (MMLR) was employed to test selected demographic and socioeconomic predictors of smoking status.

RESULTS: Of the 422 adolescents (M age = 15.58, SD = 1.24), more than half of the participants initiated smoking between 13 to 17 years old (59.0%). A total of 308 (73.0%) were electronic cigarette users, with more than 50% comprising of single users. The mean CO reading was 2.14 ppm with 78.0% of adolescents scoring more than 0 on the Hooked on Nicotine Checklist (HONC). Males and participants aged 15 and 16 years were at increased risks of sole CC smoking. Meanwhile, males, those who are not hooked on smoking and with a non-smoker CO reading were at increased risks of sole EC smoking. Finally, Bumiputeras were at less risk of EC smoking.

CONCLUSIONS: Demographic variables such as age, gender and ethnicity predicted smoking status predicted smoking risk, but not socioeconomic factors. The findings allow policy makers to target specific high-risk demographic groups when designing smoking cessation programs for adolescents.
Fulltext Factors influencing sustainability of juara sihat obesity intervention from the perspective of children: a qualitative study

Mok, Wilfred Kok Hoe, Devanthini Dewi Gunasekaran, Wee, Lei Hum, Poh, Bee Koon, Ruzita Abd. Talib

Jurnal Sains Kesihatan Malaysia, 2019;17(3):157-167.
MyJurnal

Global prevalence of childhood overweight and obesity have increased drastically in the past years, including in Malaysia. School-based obesity intervention is important to promote healthy eating and behavioural change. Many obesity interventions have been conducted to combat childhood obesity; however, the sustainability of childhood obesity interventions are often overlooked. This study aimed to explore the factors that influenced sustainability of Juara Sihat intervention programme in Kuala Lumpur primary school. Face-to-face in-depth interviews were conducted with 26 children aged 12- 14 years old whom participated in the Juara Sihat intervention programme were purposively selected. Data was transcribed verbatim and analysed using thematic analysis. The main themes identified as motivators are (1) support from family, facilitators, school teachers, and friends; (2) physical activity and healthy eating practices after intervention; (3) self-awareness; (4) knowledge on food pyramid and healthy eating; and (5) home environment. While the barriers are (1) knowledge inconsistency; (2) own safety; (3) peers influence; (4) self-attitude; (5) boredom towards programme. The results showed that the main promoting factor for sustainability of Juara Sihat intervention programme is continued practice of physical activity and healthy eating, while the main barrier is knowledge inconsistency. Therefore, school-based obesity intervention programmes should consider these promoting and hindering factors that could influence the sustainability of intervention programmes. Future studies should consider those factors during program intervention planning especially when factors that influence implementation and sustainability are carefully considered and taken care of to ensure long-term success.
Gatekeeper Suicide Training's Effectiveness Among Malaysian Hospital Health Professionals: A Control Group Study With a Three-Month Follow-Up

Siau CS, Wee LH, Ibrahim N, Visvalingam U, Yeap LLL, Wahab S

J Contin Educ Health Prof, 2018;38(4):227-234.
PMID: 30036213 DOI: 10.1097/CEH.0000000000000213

INTRODUCTION: There is a lack of suicide-related training in the nonpsychiatric health professional's basic education. We suggest that a continuing education through a brief gatekeeper suicide training program could be a suitable platform to improve suicide-related knowledge, self-efficacy, and attitudes. This study aimed at examining the effectiveness of the Question, Persuade, Refer gatekeeper program on improving the knowledge, self-efficacy in suicide prevention, and understanding of/willingness to help suicidal patients of Malaysian hospital health professionals.
METHODS: The Question, Persuade, Refer program materials were translated and adapted for implementation in the hospital setting for nonpsychiatric health professionals. There were 159 (mean age = 35.75 years; SD = 12.26) participants in this study. Most participants were female (84.9%), staff/community nurses (52.2%), who worked in the general medical department (30.2%) and had no experience managing suicidal patients (64.2%). Intervention participants (n = 53) completed a survey questionnaire at pretraining, immediately after training, and after three months. Control participants (n = 106) were not exposed to the training program and completed the same questionnaire at baseline and three months later.
RESULTS: Significant improvement occurred among intervention participants in terms of perceived knowledge, self-efficacy, and understanding of/willingness to help suicidal patients immediately after training and when compared with the control participants 3 months later. Improvements in declarative knowledge were not maintained at the 3-month follow-up.
DISCUSSION: This study confirmed the short-term effectiveness of the gatekeeper training program. Gatekeeper suicide training is recommended for implementation for nonpsychiatric health professionals nationwide.
Health-Care Workers' Perception of Patients' Suicide Intention and Factors Leading to It: A Qualitative Study

Wee LH, Ibrahim N, Wahab S, Visvalingam U, Yeoh SH, Siau CS

Omega (Westport), 2020 Dec;82(2):323-345.
PMID: 30482086 DOI: 10.1177/0030222818814331

This study explored health-care workers' perception of patients' suicide intention and their understanding of factors leading to particular interpretations. Semistructured face-to-face in-depth interviews were conducted with 32 health-care workers from a general hospital in Klang Valley, Malaysia. Interview data were transcribed verbatim and analyzed using the interpretative phenomenological analysis. The health-care workers were found to have four types of perceptions: to end life, not to end life, ambivalence about intention, and an evolving understanding of intention. Factors leading to their perceptions of patients' suicide intention were patient demographics, health status, severity of ideation/attempt, suicide method, history of treatment, moral character, communication of suicide intention, affective/cognitive status, availability of social support, and health-care workers' limited knowledge of patients' condition/situation. Insufficient knowledge and negative attitudes toward suicidal patients led to risk minimization and empathic failure, although most health-care workers used the correct parameters in determining suicide intention.
Malaysian Nurses' Attitudes Toward Suicide and Suicidal Patients: A Multisite Study

Siau CS, Wee LH, Adnan TH, Yeoh SH, Perialathan K, Wahab S

J Nurses Prof Dev, 2019 2 12;35(2):98-103.
PMID: 30741918 DOI: 10.1097/NND.0000000000000520

The aim of this study was to examine Malaysian nurses' attitudes toward suicide. Nurses from five hospitals participated in this study. Studying the attitudes of nurses toward suicidal patients and its application to nursing professional development practitioners is an important topic. Most nurses were agreeable to assuming responsibility and to be trained in suicide prevention. Suicide-related training should focus on improving the attitudes of nonpsychiatric nurses, those with no experience in caring for suicidal patients, and those with less nursing experience, all of whom reported more negative attitudes toward suicidal patients.
Perception of Harms and Benefits of Electronic Cigarettes Among Adult Malaysian Men: A Comparison by Electronic Cigarette Use and Smoking Status

Chan CMH, Ab Rahman J, Tee GH, Wee LH, Ho BK, Robson NZMH, et al.

Asia Pac J Public Health, 2019 10;31(7_suppl):32S-43S.
PMID: 31328531 DOI: 10.1177/1010539519860730

Little is known about the perceptions of harm and benefit associated with the use of e-cigarettes in Malaysia. This was a cross-sectional analysis of a nationally representative sample comprising 1987 males (≥18 years of age). Current, former, and never users of conventional cigarettes and/or e-cigarettes participated in a questionnaire study conducted via face-to-face interviews. The relationship between participant characteristics and perceptions of harm and benefit of e-cigarettes were determined with multivariable logistic regression. There were 950 current, 377 former, and 660 never users of e-cigarettes. Government employees (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.29-2.66, P = .001), private sector employees (OR = 1.67, 95% CI = 1.27-2.18, P = .001), and the self-employed people (OR = 1.68, 95% CI = 1.31-2.17, P = .001) were more likely to perceive e-cigarettes as more harmful than conventional cigarettes compared with respondents who were not wage earners. All current users in the form of e-cigarette users (OR = 7.87, 95% CI = 3.23-19.18), conventional cigarette smokers (OR = 1.80, 95% CI = 1.39-2.33), and dual users (OR = 8.59, 95% CI = 4.76-15.52) were more likely to perceive e-cigarettes as useful in quitting conventional cigarette smoking compared with former and never users. Our findings constitute an important snapshot into the perceptions of e-cigarette harms and benefits, which could inform targeted public health messaging strategies.

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