METHODS: A study involving two groups of current smokers (commissioned officers and non-commissioned officers) was conducted using the modified nominal group technique (mNGT), a qualitative research method of judgmental decision-making involving four phases: Generating ideas, recording, evaluation, and prioritization. The mNGT was used to solicit respondents' barriers to smoking cessation.
RESULTS: The mNGT yielded seven main barriers to smoking cessation: (1) Addiction, (2) difficulty in staying focused without the usage of cigarettes, (3) smoking has been incorporated into an individual's lifestyle, (4) environmental influence, (5) coping mechanism, (6) the long-interval period between orders and duties exacerbates the desire to smoke, and (7) smoking has evolved into a permanent habit. Although nicotine addiction and habit were ranked as the most important barriers, the military working environment and nature of the job exposed them physically and mentally to unfavorable situations, complicating the quitting attempt. Furthermore, the acceptance of smoking in military culture leads to a positive smoker identity, further hindering cessation.
CONCLUSIONS: The findings indicate that in addition to barriers affecting the general population, military-specific barriers related to the nature of the job exist, complicating cessation. Hence, any intervention program should address these barriers to achieve positive outcomes.
OBJECTIVE: We aimed to identify a posteriori dietary patterns for Chinese, Malay, and Indian ethnic groups in an urban Asian setting, compare these with a priori dietary patterns, and ascertain associations with cardiovascular disease risk factors including hypertension, obesity, and abnormal blood lipid concentrations.
METHODS: We used cross-sectional data from 8433 Singapore residents (aged 21-94 y) from the Multi-Ethnic Cohort study of Chinese, Malay, and Indian ethnicity. Food consumption was assessed using a validated 169-item food-frequency questionnaire. With the use of 28 food groups, dietary patterns were derived by principal component analysis, and their association with cardiovascular disease risk factors was assessed using multiple linear regression. Associations between derived patterns and a priori patterns (aHEI-2010-Alternative Healthy Eating Index-2010, aMED-alternate Mediterranean Diet, and DASH-Dietary Approaches to Stop Hypertension) were assessed, and the magnitude of associations with risk factors compared.
RESULTS: We identified a "healthy" dietary pattern, similar across ethnic groups, and characterized by high intakes of whole grains, fruit, dairy, vegetables, and unsaturated cooking oil and low intakes of Western fast foods, sugar-sweetened beverages, poultry, processed meat, and flavored rice. This "healthy" pattern was inversely associated with body mass index (BMI; in kg/m2) (-0.26 per 1 SD of the pattern score; 95% CI: -0.36, -0.16), waist circumference (-0.57 cm; 95% CI: -0.82, -0.32), total cholesterol (-0.070 mmol/L; 95% CI: -0.091, -0.048), LDL cholesterol (-0.054 mmol/L; 95% CI: -0.074, -0.035), and fasting triglycerides (-0.22 mmol/L; 95% CI: -0.04, -0.004) and directly associated with HDL cholesterol (0.013 mmol/L; 95% CI: 0.006, 0.021). Generally, "healthy" pattern associations were at least as strong as a priori pattern associations with cardiovascular disease risk factors.
CONCLUSION: A healthful dietary pattern that correlated well with a priori patterns and was associated with lower BMI, serum LDL cholesterol, total cholesterol, and fasting triglyceride concentrations was identified across 3 major Asian ethnic groups.
Methods: Following Cochrane methodology, we searched ten databases (January 1990 - June 2018; updated October 2019), without language restriction. We included controlled experimental studies whose interventions targeted health literacy to improve asthma self-management. Selection of papers, extraction of data and quality assessment were done independently by two reviewers. The primary outcomes were clinical (asthma control) and implementation (adoption/adherence to intervention). Analysis was narrative.
Results: We screened 4318 titles and abstracts, reviewed 52 full-texts and included five trials. One trial was conducted in a LMIC. Risk of bias was low in one trial and high in the other four studies. Clinical outcomes were reported in two trials, both at high risk of bias: one of which reported a reduction in unscheduled care (number of visits in 6-month (SD); Intervention:0.9 (1.2) vs Control:1.8 (2.4), P = 0.001); the other showed no effect. None reported uptake or adherence to the intervention. Behavioural change strategies typically focused on improving an individual's psychological and physical capacity to enact behaviour (eg, targeting asthma-related knowledge or comprehension). Only two interventions also targeted motivation; none sought to improve opportunity. Less than half of the interventions used specific self-management strategies (eg, written asthma action plan) with tailoring to limited health literacy status. Different approaches (eg, video-based and pictorial action plans) were used to provide education.
Conclusions: The paucity of studies and diversity of the interventions to support people with limited health literacy to self-manage their asthma meant that the impact on health outcomes remains unclear. Given the proportion of the global population who have limited health literacy skills, this is a research priority.
Protocol registration: PROSPERO CRD 42018118974.
STUDY DESIGN: Systematic review.
METHODS: A search for relevant articles was carried out using Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE (via EBSCOhost), Scopus, Science Direct, PubMed and Google Scholar with multiple search terms. Inclusion criteria comprised articles published in English language and assessing general health literacy. Risk of bias reduced with the involvement of two independent reviewers in the screening of the literature and the quality assessment process.
RESULTS: A total of 11 studies were included, which only consist of studies from five countries out of 11 making up the Southeast Asian region. The overall prevalence of limited health literacy varied considerably, 1.6%-99.5% with a mean of 55.3% (95% confidence interval [CI]: 35.1%-75.6%). A much higher prevalence was noted in studies conducted in healthcare settings, 67.5% (95% CI: 48.6%-86.3%). The most common factors associated with limited health literacy were education attainment, age, income and socio-economic background. Other factors identified were gender and health behaviours.
CONCLUSIONS: In summary, despite the little evidence available and existences of high heterogeneity among studies, limited health literacy is still prevalent in Southeast Asian countries. Urgent strategies to improve and promote health literacy in the region are highly warranted. Besides, more studies on health literacy with better quality on the methodology aspect are needed.
METHODS: 151 adolescent vaccine providers and 118 mothers of adolescent girls aged 9-14 were recruited from five geographically-diverse countries: Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers' preferences for single-purpose human papillomavirus (HPV) vaccine versus MPVs (including HPV+herpes simplex virus (HSV)-2, HPV+HIV, or HPV+HSV-2+HIV) via quantitative surveys. Maternal MPV attitudes were assessed in four focus group discussions (FGDs) in each country.
RESULTS: Most providers preferred MPVs over single-purpose HPV vaccination, with preference ranging from 61% in Malaysia to 96% in South Africa. HPV+HSV-2+HIV was the most preferred MPV formulation (56-82%). Overall, 53% of the mothers preferred MPVs over single-purpose HPV vaccines, with strongest support in South Africa (90%) and lowest support in South Korea (29%). Convenience and trust in the health care system were commonly-cited reasons for MPV acceptability. Safety and efficacy concerns were common barriers to accepting MPVs, though specific concerns differed by country. Across FGDs, additional safety and efficacy information on MPVs were requested, particularly from trusted sources like HCPs.
CONCLUSIONS: Though maternal acceptability of MPVs varied by country, MPV acceptability would be enhanced by having HCPs provide parents with additional MPV vaccine safety and efficacy information. While most providers preferred MPVs, future health behavior research should identify acceptability barriers, and targeted provider interventions should equip providers to improve vaccination discussions with parents.
METHODOLOGY: This cross-sectional study was conducted using a validated self-administered questionnaire at 18 hospitals in six states of Malaysia, namely, Selangor, Kuala Lumpur, Penang, Kelantan, Sabah, and Sarawak in 2015. The study sample comprised 1600 TB patients who were randomly selected using data obtained from the Disease Control Division, Ministry of Health Malaysia. A total of 1368 of the completed questionnaires were considered usable and included in the statistical analysis.
RESULTS: Overall, the level of TB awareness was found to be high, and the respondents possessed positive attitudes towards TB and health-seeking behaviours. Self-preventive care among the TB patients was determined as being at a moderate level. With regard to contact with others, the patients were more comfortable around their families than their friends and neighbours.
CONCLUSIONS: More health education programmes are recommended to cultivate positive attitudes towards TB, to encourage communities to have a better understanding of TB, and to create awareness among patients of the proper ways to practice self-preventive care.