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Fulltext Patterns and predictors of non-prescription medicine use among Malaysian pharmacy patrons: a national cross sectional study

Hassali MA, Mohamad Yahaya AH, Shafie AA, Saleem F, Chua GN, Aljadhey H

PLoS One, 2013;8(4):e59231.
PMID: 23573195 DOI: 10.1371/journal.pone.0059231

The study aims to evaluate the predictors of non-prescription medicine purchasing patterns among pharmacy patrons in Malaysia.
Disease related knowledge and quality of life: a descriptive study focusing on hypertensive population in Pakistan

Saleem F, Hassali MA, Shafie AA, Atif M, Ul Haq N, Aljadhey H

South Med Rev, 2012 Jul;5(1):47-52.
PMID: 23093899

This study aims to evaluate association between Health related quality of lifeand disease state knowledge among hypertensive population of Pakistan.
Complementary and alternative medicines (CAM) disclosure to the health care providers: a qualitative insight from Malaysian cancer patients

Farooqui M, Hassali MA, Abdul Shatar AK, Shafie AA, Farooqui MA, Saleem F, et al.

Complement Ther Clin Pract, 2012 Nov;18(4):252-6.
PMID: 23059441 DOI: 10.1016/j.ctcp.2012.06.005

This study sought to evaluate Malaysian oncology patients CAM disclosure to the health care providers. Patients were interviewed across three major Malaysian ethnic groups, Malay, Chinese and Indian. Thematic content analysis identified three themes: reasons of CAM disclosure, reasons of CAM non-disclosure and preference of CAM discussion to health care providers. Patients agreed that CAM disclosure is important to avoid any interaction with the conventional medicines. Perceived lack of physicians' knowledge & interest in CAM, fear of termination of therapy by the physicians upon CAM disclosure, and perceived simplicity of some of the CAM therapies were among the reasons of non-disclosure. Given the option of oncologists, pharmacists or nurses, patients described oncologists as the most suitable person to discuss or disclose CAM use due to confidence in their clinical skills. Understanding the underlying beliefs of patients' reluctance to disclose CAM to health care providers is important especially when they are on an ongoing treatment for cancer.
Fulltext A qualitative exploration of Malaysian cancer patients' perceptions of cancer screening

Farooqui M, Hassali MA, Knight A, Shafie AA, Farooqui MA, Saleem F, et al.

BMC Public Health, 2013;13:48.
PMID: 23331785 DOI: 10.1186/1471-2458-13-48

Despite the existence of different screening methods, the response to cancer screening is poor among Malaysians. The current study aims to examine cancer patients' perceptions of cancer screening and early diagnosis.
Does Treatment Adherence Correlates With Health-Related Quality of Life: Findings From A Cross Sectional Analysis of Type 2 Diabetes Mellitus Patients In Pakistan

Nazir SU, Hassali MA, Saleem F, Bashir S, Aljadhey H

Value Health, 2015 Nov;18(7):A613.
PMID: 26533443 DOI: 10.1016/j.jval.2015.09.2129
Association between knowledge and medication adherence in patients with type 2 diabetes mellitus in Pakistan. [Abstract]

Nazir SU, Hassali MA, Saleem F, Bashir S, Aljadhey H

Value Health, 2015 Nov;18(7):A613.
PMID: 26533439 DOI: 10.1016/j.jval.2015.09.2128

Objectives: Diabetes mellitus is a serious health problem. Medication adherence is a key determinant of therapeutic success in patients with diabetes mellitus. The purpose of this study was to assess medication adherence and its potential association with diabetes related knowledge in patients with type 2 diabetes mellitus.
Methods: This study was carried out at the outpatient clinics of a public sector teaching hospital in Sargodha, Pakistan. Besides demographic and disease-related questions, previously validated questionnaires, Morisky Medication Adherence Scale and Michigan diabetes knowledge test was used to assess the medication adherence and diabetes related knowledge, respectively. Descriptive statistics were used to determine the demographic and disease characteristics of the patients while Spearman rank correlation was employed to measure the association between medication adherence and knowledge.
Results: Three hundred and ninety two patients were interviewed. Out of 392 patients, 245 (62.5%) of the patients had average knowledge about diabetes while 282 (71.9 %) were categorized as poor adherent. Only 13 patients (3.3 %) were considered as good adherent in the study. The correlation coefficient between total scores of knowledge and total medication adherence score was 0.036 (p< 0.05), indicating a weak correlation between knowledge scores and adherence level.
Conclusions: Knowledge of diabetes mellitus among these patients was average; however, adherence to drug therapy was also poor. Patients’ knowledge about diabetes had positive association with medication adherence. Improving diabetes knowledge of people can result in better adherence, which may result in better control of diabetes.
Students' Knowledge and Perceptions Towards Quality Use of Medicines: A Descriptive Analysis From Universiti Sains Malaysia

Verma AK, Hassali MA, Saleem F, Aljadhey H

Value Health, 2015 Nov;18(7):A744.
PMID: 26534167 DOI: 10.1016/j.jval.2015.09.2866
Disease related knowledge, medication adherence and glycaemic control among patients with type 2 diabetes mellitus in Pakistan

Nazir SU, Hassali MA, Saleem F, Bashir S, Aljadhey H

Prim Care Diabetes, 2016 Apr;10(2):136-41.
PMID: 26476867 DOI: 10.1016/j.pcd.2015.09.004

AIMS: The purpose of this study was to investigate the association of diabetes-related knowledge and treatment adherence with glycaemic control among patients with type 2 diabetes mellitus (T2DM) in Pakistan.
METHODS: The study was designed as a questionnaire-based, cross-sectional analysis. T2DM patients attending a public outpatient clinic in Sargodha, Pakistan, were targeted for the study. In addition to the demographic information, the Urdu version of Michigan Diabetes Knowledge Test and Morisky Medication Adherence Scale was used for data collection. Patients' medical records were reviewed for glycated haemoglobin levels (HbA1c). Descriptive statistics were used to elaborate sociodemographic characteristics. The Spearman's Rho correlation was used to measure association of disease-related knowledge and treatment adherence with glycaemic control. SPSS V 20.0 was used for data analysis and p<0.05 was taken as significant.
RESULT: In total, 392 T2DM patients were included in the study. The mean age (SD) of these patients was 50.77±9.671 years, 56.6% were males and 90% (n=353) of respondents were married. The mean (SD) duration of disease was 5.58 (4.09) years with median HbA1c of 9.00 (IQR=8.20-10.40). The median knowledge score was 8.0 (IQR=6.0-10.0), while the median adherence score was 4.7 (IQR=3.0-6.0). HbA1c had non-significant and weak negative association with diabetes-related knowledge (r=-0.036, p=0.404) and treatment adherence (r=-0.071, p=0.238).
CONCLUSION: There was negative association reported between HbA1c, treatment adherence and diabetes-related knowledge. Greater efforts are clearly required to investigate other factors affecting glycaemic control among T2DM patients in Pakistan.
KEYWORDS: Adherence; Correlation; Diabetes-related knowledge; Glycaemic control; Type 2 diabetes
Incorporating the concept of leadership in pharmacy curriculums of developing nations

Saleem F, Hassali MA, Aljadhey H

Res Social Adm Pharm, 2016 03 04;12(4):668.
PMID: 26997135 DOI: 10.1016/j.sapharm.2016.02.011
Fulltext A cross-sectional assessment of health-related quality of life among type 2 diabetic patients in Pakistan

Nazir SU, Hassali MA, Saleem F, Bashir S, Hashmi F, Aljadhey H

J Pharm Bioallied Sci, 2016 Jan-Mar;8(1):64-8.
PMID: 26957872 DOI: 10.4103/0975-7406.171734

OBJECTIVE: This study aims to describe the health-related quality of life (HRQoL) profile of Type 2 diabetes mellitus (T2DM) population attending outpatient clinics in Sargodha City, Pakistan.
METHODS: The study was designed as a cross-sectional descriptive survey. T2DM patients attending a tertiary care institute in Sargodha, Pakistan were targeted for the study. The EuroQol EQ-5D was used for the assessment of HRQoL and was scored using values derived from the UK general population survey. Descriptive statistics were used for the elaboration of sociodemographic characteristics. The Chi-square test was used to depict the possible association between study variables and HRQoL. Where significant associations were noted, Phi/Cramer's V was used for data interpretation accordingly. SPSS version 21 (SPSS Inc., Chicago, IL, USA) was used for data analysis and P < 0.05 was taken as significant.
RESULTS: Three hundred and ninety-two patients were approached for the study. The cohort was dominated by males (n = 222, 56.60%) with 5.58 ± 4.09 years of history of T2DM. The study highlighted poor HRQoL among the study participants (0.471 ± 0.336). Gender, marital status, education, monthly income, occupation, location and duration of the disease were reported to be significantly associated with HRQoL (P < 0.001).
CONCLUSION: T2DM imposes a negative effect on HRQoL of the patients. Attention is needed to highlight determinants of HRQoL and to implement policies for better management of T2DM, particularly in early treatment phases where improving HRQoL is still possible.
KEYWORDS: EQ-5D; Pakistan; health-related quality of life; type 2 diabetes mellitus
Perspectives of physicians practicing in low and middle income countries towards generic medicines: a narrative review

Hassali MA, Wong ZY, Alrasheedy AA, Saleem F, Mohamad Yahaya AH, Aljadhey H

Health Policy, 2014 Sep;117(3):297-310.
PMID: 25129135 DOI: 10.1016/j.healthpol.2014.07.014

This review was conducted to document published literature related to physicians' knowledge, attitudes, and perceptions of generic medicines in low- and middle-income countries (LMICs) and to compare the findings with high-income countries.
Impact of Ramadan focused education program on hypoglycemic risk and metabolic control for patients with type 2 diabetes

Tourkmani AM, Hassali MA, Alharbi TJ, Alkhashan HI, Alobikan AH, Bakhiet AH, et al.

Patient Prefer Adherence, 2016;10:1709-17.
PMID: 27660420 DOI: 10.2147/PPA.S113324

Fasting during the month of Ramadan could lead to acute complications and increased hypoglycemic risk of patients with type 2 diabetes. Therefore, diabetes is one of the diseases that need careful observation and special considerations during Ramadan including patients' education and counseling.
A pilot study measuring knowledge and attitudes towards diabetes mellitus In Kedah, Malaysia [Abstract]

Saleem F, Hassali MA, Verma AK, Aljadhey H

Value Health, 2015 Nov;18(7):A614-5.
PMID: 26533446 DOI: 10.1016/j.jval.2015.09.2138

Objectives: An adequate disease-related knowledge is important in treatment and management of ailments. Within this context, patients are needed to have correct knowledge and positive attitude especially when they are faced with an emergence of chronic diseases. The aim of this study therefore is to assess the level of type 2 diabetes mellitus (T2DM) awareness and disease related attitude among general population at Bujang Valley, Merbok, Kedah, Malaysia.
Methods: A questionnaire based, cross sectional study was conducted. The Diabetes Attitude Scale was used to assess the knowledge and attitude of respondents towards T2DM. Data was described descriptively and SPSS v.22 was used for data analysis.
Results: Out of three hundred and seventy seven respondents, majority of the respondents (n=156, 41.4%) were in age group of more than 40 years old and the cohort was dominated by Malay ethnic group. Females subjugated over males (n=229, 60.7%) and the highest number of respondents were working as businessman (n=115, 30.5%). Corresponding to the marital status, majority of the respondent were married (n=247, 65.5%). Majority of the respondents (n=274, 72.7%) were reported as healthy with no chronic disease. The respondents reported certain misapprehensions where they believed that T2DM have lesser complications, blood glucose control is needed for Type 1 Diabetes Mellitus only and the emotional effects of T2DM are minor.
Conclusions: The study reported insufficient level of knowledge among the respondents in management of T2DM. General population needs to have good collaboration with healthcare professionals to get more education and knowledge related to T2DM for their empowerment.
Does adherence to the therapeutic regimen associate with health related quality of life: Findings from an observational study of type 2 diabetes mellitus patients in Pakistan

Nazir SR, Hassali MA, Saleem F, Bashir S, Aljadhey H

Pak J Pharm Sci, 2017 Nov;30(6):2159-2165.
PMID: 29175785

Patient adherence with a therapeutic regimen predicts successful treatment and reduces the severity of negative complications. The purpose of this work was to find the relationship between general Health Related Quality of Life (HRQoL) and compliance to the treatment among type 2 diabetes mellitus patients (T2DM) in Sargodha, Pakistan. The research was planned as a cross-sectional survey. T2DM patients attending a tertiary care institute in Sargodha, Pakistan were targeted for the study. The Urdu version of the Morisky Medication Adherence Scale (MMAS-Urdu) and EuroQol Quality of Life Scale were employed to evaluate adherence to treatment regimen and HRQoL correspondingly. Descriptive statistics were used for the elaboration of socio-demographic characteristics. The Spearman rank order test was employed to determine the relationship between medicine adherence and HRQoL. P<0.05 was considered statistically significant. A total of 392 patients were selected for the survey. Most participants were males (n=222, 56.6%) with 5.58±4.09 years of history of T2DM. Majority of respondents (n=137, 34.9%) were categorized in age group of 51 to 60 years with mean age of 50.77±9.671 years. The present study highlighted that individuals with type 2 diabetes mellitus had decreased HRQoL (0.4715±0.3360) and poor medication adherence (4.44±1.8). Significant, yet weak positive correlations were observed between medication adherence and HRQoL (r=0.217 and 0.136 for EQ-5D and EQVAS respectively). Although the association between adherence to therapeutic regimen and HRQoL in the present study cohort was significant, it was rated as weak, hence failed in producing an overall impression on quality of life. The study highlights the need of identifying other individual factors affecting HRQoL among T2DM patients in Pakistan.
Fulltext Patients' beliefs about generic medicines in Malaysia

Wong ZY, Hassali MA, Alrasheedy AA, Saleem F, Yahaya AH, Aljadhey H

Pharm Pract (Granada), 2014 Oct;12(4):474.
PMID: 25580171

BACKGROUND: Acceptance of generic medicines by patients is an essential factor given that they are the end users of these medicines. In fact, adequate knowledge and positive perceptions are prerequisite to patients' acceptance and use of generic medicines.
OBJECTIVE: To assess the current belief and views of patients about generic medicines in Malaysia.
METHOD: This was a self-administered questionnaire-based study. The study was conducted with patients visiting outpatient pharmacy department at a tertiary care hospital in Malaysia. The Malaysian version of Generic Medicines Scale (GMS) was used. The GMS consists of two subscales: efficacy and similarity of generic medicines to original brand medicines. The efficacy subscale consists of 10 items while the similarity subscale consists of 6 items. The responses to the items were framed as a five-point Likert scale (1=strongly disagree to 5=strongly agree).
RESULTS: A total of 202 out of 300 patients participated in the study, giving a response rate of 67.3%. In this study, only 49% of them (n=99) knew the term 'generic medicine'. Moreover, only 53.5% of the respondents (n=108) believed that the efficacy of generic medicines was the same as original brand medicines. In terms of quality, only 44% of the respondents (n=89) disagreed that generic medicines were of a lower quality. About one third (n=65, 32.2%) believed that generic medicines were cheaper because they were less efficacious. In terms of side effects, 44.5% of the respondents (n=90) believed that generic medicines had the same side effect profile as original brand medicines.
CONCLUSIONS: The study finding showed that almost half of the respondents had negative belief in generic medicines. Similarly, many patients were not aware of the similarities and differences between generic and original brand medicines. Therefore, there is a need to provide patients with adequate information about generic medicines.

Study site: outpatient pharmacy department at a tertiary care hospital in Malaysia
Fulltext A cross sectional assessment of health related quality of life among patients with Hepatitis-B in Pakistan

ul Haq N, Hassali MA, Shafie AA, Saleem F, Aljadhey H

Health Qual Life Outcomes, 2012 Aug 06;10:91.
PMID: 22866752 DOI: 10.1186/1477-7525-10-91

OBJECTIVE: The study aims to assess Health Related Quality of Life (HRQoL) among Hepatitis B (HB) patients and to identify significant predictors of the HRQoL in HB patients of Quetta, Pakistan.
METHODS: A cross sectional study by adopting European Quality of Life scale (EQ-5D) for the assessment of HRQoL was conducted. All registered HB patients attending two public hospitals in Quetta, Pakistan were approached for study. Descriptive statistics were used to describe demographic and disease related characteristics of the patients. HRQoL was scored using values adapted from the United Kingdom general population survey. EQ-5D scale scores were compared with Mann-Whitney and Kruskal-Wallis test. Standard multiple regression analysis was performed to identify predictors of HRQoL. All analyses were performed using SPSS v 16.0.
RESULTS: Three hundred and ninety HB patients were enrolled in the study. Majority of the participants (n = 126, 32.3%) were categorized in the age group of 18-27 years (36.07 ± 9.23). HRQoL was measured as poor in the current study patients (0.3498 ± 0.31785). The multivariate analysis revealed a significant model (F(10, 380) = 40.04, P
Hypoglycemia in Type 2 Diabetes Mellitus patients: A review article

Tourkmani AM, Alharbi TJ, Rsheed AMB, AlRasheed AN, AlBattal SM, Abdelhay O, et al.

Diabetes Metab Syndr, 2018 Sep;12(5):791-794.
PMID: 29678605 DOI: 10.1016/j.dsx.2018.04.004

Hypoglycemia is an essential issue for diabetic patients and considered a limiting factor in the glycemic management. Heterogeneity of the diseases in Type 2 Diabetes Mellitus can affect the frequency of hypoglycemia, especially when the patient has cardiovascular diseases. There are several factors that lead to hypoglycemia including sulfonylurea therapy, insulin therapy, delaying or missing a meal, physical exercise, or alcohol consumption. Long-term studies reported that repeated hypoglycemia could increase the risk of cardiovascular diseases. During Ramadan fasting, diabetic patients have high incidence of hypoglycemia. Therefore, focused education about hypoglycemia in routine life of diabetic patients and during fasting in Ramadan is important to reduce the complications.
Fulltext A cross-sectional assessment of health-related quality of life among type 2 diabetes patients in Riyadh, Saudi Arabia

Al-Aboudi IS, Hassali MA, Shafie AA, Hassan A, Alrasheedy AA

SAGE Open Med, 2015;3:2050312115610129.
PMID: 26770806 DOI: 10.1177/2050312115610129

This study aimed to describe the health-related quality of life profile among type 2 diabetes patients in Riyadh, Saudi Arabia.
Fulltext Drug attitude and adherence: a qualitative insight of patients with hypertension

Saleem F, Hassali M, Shafie A, Atif M

J Young Pharm, 2012 Apr;4(2):101-7.
PMID: 22754262 DOI: 10.4103/0975-1483.96624

The study is aimed to explore the perceptions and experiences of hypertensive patients toward medication use and adherence. The study was qualitative in nature conducted at Sandamen Provisional Hospital of Quetta city, Pakistan; a public hospital catering to the health needs of about 40% of the population. A qualitative approach was used to gain an in-depth knowledge of the issues. Sixteen patients were interviewed, and the saturation point was achieved after the 14(th) interview. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Thematic content analysis yielded five major themes. (1) Perceived benefits and risks of medications, (2) physician's interaction with patients, (3) perception toward traditional remedies, (4) layman concept toward medications, and (5) beliefs toward hypertension and its control. The majority of the patients carried specific unrealistic beliefs regarding the long-term use of medication; yet these beliefs were heavily accepted and practiced by the society. The study indicated a number of key themes that can be used in changing the beliefs and experiences of hypertensive patients. Physician's attitude, patient's past experiences, and knowledge related to hypertension were noted as major contributing factors thus resulting in nonadherence to therapy prescribed.
Fulltext Public knowledge and attitudes towards antibiotic usage: a cross-sectional study among the general public in the state of Penang, Malaysia

Oh AL, Hassali MA, Al-Haddad MS, Syed Sulaiman SA, Shafie AA, Awaisu A

J Infect Dev Ctries, 2011 May;5(5):338-47.
PMID: 21628809

INTRODUCTION: Public knowledge and attitudes towards antibiotics play a vital role in the success of the treatment process. This study aimed to assess public knowledge and attitudes toward antibiotic usage which could serve as baseline data for future studies within a government hospital setting in Malaysia.
METHODOLOGY: A self-administered cross-sectional survey involving 408 respondents was conducted using a validated questionnaire at an outpatient pharmacy department in Penang Hospital, Malaysia, from February to March 2009.
RESULTS: Nearly 55% of the respondents had a moderate level of knowledge. Three quarters of the respondents (76.7%) could correctly identify that antibiotics are indicated for the treatment of bacterial infections. However, 67.2% incorrectly thought that antibiotics are also used to treat viral infections. About 59.1% of the respondents were aware of antibiotic resistance phenomena in relation to overuse of antibiotics. With regard to attitudes, 38% believed that taking antibiotics when having cold symptoms could help them to recover faster, while 47.3% expected antibiotics to be prescribed for common cold symptoms. Age, race and educational level were among the demographic characteristics significantly associated with knowledge and attitudes toward antibiotic use. Poor level of knowledge was found in less than one-third of the respondents whereas more than one-third of the respondents wrongly self-medicate themselves with antibiotics once they have a cold.
CONCLUSION: Educational interventions are needed to promote prudent use of antibiotics among the public.
Study site: outpatient pharmacy, Hospital Pulau Pinang, Malaysia

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