Displaying publications 41 - 60 of 70 in total

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  1. Hidrus AB, Kueh YC, Arifin WN, Konter E, Kuan G
    PMID: 32155904 DOI: 10.3390/ijerph17051736
    Sports courage is one of the most important attributes to help competitive athletes overcome anxiety, nervousness, and other psychological obstacles, but this field of study is still being overlooked by most athletes and coaches. The purpose of this study is to validate the Malay language version of the Sports Courage Scale (SCS-M) for Silat athletes using confirmatory factor analysis (CFA). Data were collected during 9th UPSI International Pencak Silat Championship in Malaysia. A total of 258 competitors (male = 66.7%, female = 33.3%), with a mean age of 18 years (SD = 2.6), volunteered to participate in this study. The original SCS with 50 items underwent forward and backward translations into the Malay language and was pre-tested with ten martial arts athletes. Then, Silat athletes were asked to complete the translated SCS-M questionnaire. There were five factors in the SCS-M (i.e., mastery, determination, assertiveness, venturesome, and self-sacrificial behaviour). The first hypothesised model with 50 items did not result in a good fit to the data (RMSEA = 0.06, CFI = 0.93, NFI = 0.87, NNFI = 0.93, RMR = 0.14, SRMR = 0.09). A total of 17 problematic items were identified and were removed iteratively. The final measurement model with 33 items fit the data well (RMSEA = 0.06, CFI = 0.94, NFI = 0.89, NNFI = 0.94, RMR = 0.05, SRMR = 0.07). The reliability of each subscale based on Cronbach's alpha ranged from 0.64 to 0.76. The convergent and discriminant validities were achieved for the final measurement model. The revised version of SCS-M with 33 items was considered valid and reliable for measuring the sports courage in Silat athletes in Malaysia.
  2. Abdul Wahab P, Mohd Yusoff D, Abdul Kadir A, Ali SH, Lee YY, Kueh YC
    PeerJ, 2020;8:e8581.
    PMID: 32175185 DOI: 10.7717/peerj.8581
    Background: Chronic constipation is a common symptom among the elderly, and it may affect their quality of life (QoL). A lack of available research focused on the elderly means that this effect is not well understood. This study aimed to develop and validate a new scale (Elderly-Constipation Impact Scale (E-CIS)) to measure the impact of chronic constipation on QoL among the elderly.

    Methods: A pool of items was generated from a qualitative study, literature reviews, and expert reviews. Exploratory factor analysis (EFA) was performed on the original 40 items of the E-CIS and followed by 27 items for confirmatory factor analysis (CFA). A total of 470 elderly people with chronic constipation were involved.

    Results: The mean age of the participants was 68.64 ± 6.57. Finally, only 22 items were indicated as appropriately representing the E-CIS, which were grouped into seven subscales: 'daily activities', 'treatment satisfaction', 'lack of control of bodily function', 'diet restriction', 'symptom intensity', 'anxiety' and 'preventive actions'. The scale was confirmed as valid (root mean square error of approximation (RMSEA) = 0.04, comparative fit index (CFI) = 0.961, Tucker-Lewis index (TLI) = 0.952 and chi-square/degree of freedom (chiSq/df) = 1.44) and reliable (Cronbach's alpha: 0.66-0.85, composite reliability (CR) = 0.699-0.851) to assess the impact of chronic constipation on the elderly's QoL.

    Conclusions: The E-CIS is useful to measure the impact of chronic constipation on the elderly's QoL. A further test is needed to determine the validity and reliability of this scale in other elderly population.

  3. Noor AKCM, Tai ELM, Kueh YC, Siti-Azrin AH, Noordin Z, Shatriah I
    PMID: 31906417 DOI: 10.3390/ijerph17010310
    Vitrectomy surgery in proliferative diabetic retinopathy improves the vision-related quality of life. However, there is lack of data on the duration of maintenance of visual gains post vitrectomy. This study thus aimed to determine the survival time of visual gains and the prognostic factors of vision loss after vitrectomy surgery for complications of proliferative diabetic retinopathy. A retrospective cohort study was conducted in an ophthalmology clinic in Malaysia. We included 134 patients with type 2 diabetes mellitus on follow-up after vitrectomy for proliferative diabetic retinopathy. Visual acuity was measured using the log of minimum angle of resolution (LogMar). A gain of ≥0.3 LogMar sustained on two subsequent visits was considered evidence of visual improvement post vitrectomy. Subjects were considered to have vision loss when their post-operative visual acuity subsequently dropped by ≥0.3 LogMar. Kaplan-Meier analysis was used to determine the survival time of visual gains. Cox Proportional Hazard regression was used to determine the prognostic factors of vision loss. The median age of patients was 56.00 years (IQR ± 10.00). The median duration of diabetes mellitus was 14.00 years (IQR ± 10.00). Approximately 50% of patients with initial improvement post vitrectomy subsequently experienced vision loss. The survival time, i.e., the median time from surgery until the number of patients with vision loss formed half of the original cohort, was 14.63 months (95% CI: 9.95, 19.32). Ischemic heart disease was a significant prognostic factor of vision loss. Patients with underlying ischemic heart disease (adjusted HR: 1.97, 95% CI: 1.18, 3.33) had a higher risk of vision loss post vitrectomy, after adjusting for other factors. Approximately half the patients with initial visual gains post vitrectomy maintained their vision for at least one year. Ischemic heart disease was a poor prognostic factor for preservation of visual gains post vitrectomy.
  4. Hidrus A, Kueh YC, Norsaádah B, Chang YK, Hung TM, Naing NN, et al.
    PMID: 32268601 DOI: 10.3390/ijerph17072507
    Brain Breaks videos are web-based structured physical activity (PA) videos that aim at stimulating an interest in learning and promoting health. Exercise is one of the important treatment regimens for people with type 2 diabetes mellitus (T2DM). Thus, the objective of this study was to determine the effects that Brain Breaks videos have on the motives for PA, as measured by the Physical Activity and Leisure Motivation Scale-Malay (PALMS-M), and the amount of PA, as measured by the International Physical Activity Questionnaire-Malay (IPAQ-M), in T2DM patients (the most common type of diabetes mellitus patients). This study was conducted using a randomized, double-blind design and grouped subjects under two research conditions: an experimental group given Brain Breaks videos and a control group. Purposive sampling was employed to recruit 70 T2DM patients (male = 39, female = 31) with the mean age of 57.6 (SD = 8.5) from Hospital Universiti Sains Malaysia, Kelantan. Over a four-month period, the participants in the experimental group were asked to perform PA daily based on a Brain Breaks video (10 min in duration) that was shared through a WhatsApp group. All participants from both groups answered the PALMS-M questionnaire five times: pre-intervention, the end of the first month, second month, and third month, and post-intervention. A repeated measure multivariate analysis of variance and a repeated measure analysis of variance were performed for the analyses of the data. The results demonstrated that four (appearance, others' expectations, physical condition, and mastery) out of eight motives for PA produced a significant mean score difference between the two study groups. All eight motives for PA showed an upward trend for the experimental group during the study period, while the control group showed a downward trend for all motives during the study period. As for the amount of PA, both groups showed significant differences (p = 0.001). The amount of PA increased in the experimental group during the study period, while it decreased in the control group. Therefore, Brain Breaks videos can be considered as an effective intervention for motivating T2DM patients for PA and improving their amount of PA.
  5. Ibrahim MF, Kuan G, Hashim HA, Hamzah NA, Kueh YC
    BMC Public Health, 2021 10 07;21(1):1798.
    PMID: 34620133 DOI: 10.1186/s12889-021-11869-4
    BACKGROUND: This study aimed to verify a translated Malay version of the Achievement Emotions Questionnaire for Physical Education (AEQ-PE) by assessing the level of achievement emotions in six constructs among the Malaysian primary school pupils using the Confirmatory Factor Analysis (CFA).

    METHODS: A total of 607 Malay pupils, comprising 240 (39.5%) boys and 367 (60.5%) girls aged between 10 and 11, were recruited from 10 schools to answer the questionnaire, which measured their views on 24 items through a five-point Likert scale. The AEQ-PE was translated into Malay language (AEQ-PE-M) using forwarding to backward translation techniques. Certain phrases were adopted in accordance with the local culture and vocabulary appropriate for primary school pupils. CFA was performed using the Mplus 8.0 software, and the final model demonstrated high reliability in terms of the composite reliability and Cronbach's alpha.

    RESULTS: Analysis of the CFA showed an acceptable fit indices in CFI (0.936), TLI (0.926), RMSEA = 0.039 (90% CI, 0.034, 0.045) and SRMR (0.049) of the AEQ-PE measurement model. All of the items in the original AEQ-PE version were retained and deemed suitable for Malay primary school pupils.

    CONCLUSION: The AEQ-PE-M with 24 items was a suitable tool for measuring the level of school children's involvement in determining achievement emotions and their motivation towards physical education.

  6. Chin NS, Liew GC, Kueh YC, Hashim HA, Tee V, Kuan G
    PMID: 34770207 DOI: 10.3390/ijerph182111694
    The 18-item Sport Motivation Scale (SMS-II) is one of the most-utilised scales measuring athletes' motivation and its psychometric properties. However, we found no Malay version used to examine the Malaysian multi-ethnic population. Thus, the study aimed to translate and validate the SMS-II into the Malay version using confirmatory factor analysis. A total of 436 (16.44 ± 1.22) state athletes were asked to complete the SMS-II Malay version, which utilised the forward-backwards translation method. The results showed an acceptable fit with the data (CFI = 0.906, SRMR = 0.064; RMSEA = 0.056) and internal consistency, with a Cronbach's alpha value that exceeded 0.50, which supported its usage for the assessment of motivation among the multi-ethnic Malaysian athletes. The Cronbach's alpha values of all the factors were satisfactory, except for introjected regulation. Thus, further studies are needed to improve the reliability of such factors. Nonetheless, the Malay version of SMS-II was found to be valid and reliable for assessing the level of motivation of the multi-ethnic Malaysian athletes.
  7. Tai ELM, Kueh YC, Wan Hitam WH, Wong TY, Shatriah I
    PLoS One, 2018;13(2):e0191434.
    PMID: 29389952 DOI: 10.1371/journal.pone.0191434
    PURPOSE: Childhood obesity is associated with adult cardiometabolic disease. We postulate that the underlying microvascular dysfunction begins in childhood. We thus aimed to compare retinal vascular parameters between obese and non-obese children.

    METHODS: This was a cross-sectional study involving 166 children aged 6 to 12 years old in Malaysia. Ocular examination, biometry, retinal photography, blood pressure and body mass index measurement were performed. Participants were divided into two groups; obese and non-obese. Retinal vascular parameters were measured using validated software.

    RESULTS: Mean age was 9.58 years. Approximately 51.2% were obese. Obese children had significantly narrower retinal arteriolar caliber (F(1,159) = 6.862, p = 0.010), lower arteriovenous ratio (F(1,159) = 17.412, p < 0.001), higher venular fractal dimension (F(1,159) = 4.313, p = 0.039) and higher venular curvature tortuosity (F(1,158) = 5.166, p = 0.024) than non-obese children, after adjustment for age, gender, blood pressure and axial length.

    CONCLUSIONS: Obese children have abnormal retinal vascular geometry. These findings suggest that childhood obesity is characterized by early microvascular abnormalities that precede development of overt disease. Further research is warranted to determine if these parameters represent viable biomarkers for risk stratification in obesity.

  8. Ho JJ, Adnan AS, Kueh YC, Ambak NJ, Van Rostenberghe H, Jummaat F
    Cochrane Database Syst Rev, 2019 Jul 12;7(7):CD009692.
    PMID: 31425606 DOI: 10.1002/14651858.CD009692.pub2
    BACKGROUND: Oedema is a common clinical symptom in people with nephrotic syndrome and human albumin has been widely used in the treatment of oedema by increasing vascular volume and this inducing diuresis. It may be used with or without diuretics such as furosemide. However, the quantitative contribution of human albumin in treating oedema is not fully understood. If human albumin were found to be effective and safe in the treatment of oedema, it could help clinicians to develop therapeutic strategies to improve the management of diuretic resistance associated with nephrotic syndrome.

    OBJECTIVES: This review aimed to examine the benefits and harms of human albumin infusion for treating oedema associated with nephrotic syndrome.

    SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 23 June 2019 through contact with the Information Specialists using search terms relevant to this review. Studies in the Specialised Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.

    SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs evaluating the effect of human albumin infusion compared with placebo or no intervention, human albumin with diuretics compared with diuretic alone, human albumin compared with diuretics and other treatments, clinical outcomes, death, quality of life, kidney function and adverse effects in people with nephrotic syndrome. We excluded cross-over studies but data for the first period was to be included if available.

    DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration were used. Two authors independently assessed eligibility, risk of bias, study quality and extracted data. We calculated mean difference (MD) for continuous data with 95% confidence intervals (CI). We assessed the certainty of the evidence using GRADE.

    MAIN RESULTS: One study met our inclusion criteria (26 children with minimal change nephrotic syndrome) and 11 were excluded (nine cross-over studies, one where albumin was not used for nephrotic syndrome and one where authors did not state whether the children had oedema). Risk of bias for the included study was unclear for selection bias, high for performance and detection bias, low for attrition bias, and high for selective reporting. The included study compared albumin plus furosemide with an equal volume of dextrose. Of our prespecified outcomes, the authors reported clinical improvement as weight change, serum sodium and adverse outcomes (blood pressure). The authors reported a greater weight loss in the albumin treated group initially but no difference overall at 10 days. However, the data in the text and the figures were inconsistent so we could not confirm the authors statements (very low certainty evidence). It is uncertain whether albumin infusion improves serum sodium when compared with an equal volume of dextrose (MD 2.00 mEq/L, 95% CI -0.09 to 4.09), systolic blood pressure (MD 2.00 mmHg, 95% CI -3.52 to 7.52) or diastolic blood pressure (MD 2.00 mmHg, 95%CI -4.29 to 8.29). Death, quality of life, and kidney function were not reported.

    AUTHORS' CONCLUSIONS: We identified only one small study that was relevant to our review, therefore we are unable to draw any conclusions regarding the use of human albumin with or without diuretics in nephrotic syndrome. More RCTs are needed.

  9. Ng PY, Nafi SNM, Jalil NAC, Kueh YC, Lee YY, Zin AAM
    Croat Med J, 2023 Feb 28;64(1):29-36.
    PMID: 36864816
    AIM: To assess the association of the expression of apolipoprotein B (apoB) and 4-hydroxynonenal (4HNE) with the clinicopathological data of patients with colorectal cancer (CRC).

    METHODS: We obtained 80 CRC histopathological specimens sent to the Pathology Laboratory of Hospital Universiti Sains Malaysia from 2015 to 2019. Data on demographic factors, body mass index (BMI), and clinicopathological characteristics were also collected. Formalin-fixed paraffin-embedded tissues were stained by using an optimized immunohistochemical protocol.

    RESULTS: Patients were mostly older than 50 years, male, Malay, and overweight or obese. A high apoB expression was observed in 87.5% CRC samples (70/80), while a high 4HNE expression was observed in only 17.5% (14/80) of CRCs. The expression of apoB was significantly associated with the sigmoid and rectosigmoid tumor sites (p =0.001) and tumor size 3-5 cm (p =0.005). 4HNE expression was significantly associated with tumor size 3-5 cm (p =0.045). Other variables were not significantly associated with the expression of either marker.

    CONCLUSION: ApoB and 4HNE proteins may play a role in promoting CRC carcinogenesis.

  10. Leong FW, Mohd Yasin MA, Muhd Ramli ER, Fadzil NA, Kueh YC
    Int J Environ Res Public Health, 2019 Nov 12;16(22).
    PMID: 31726715 DOI: 10.3390/ijerph16224434
    There has been an increasing interest in personality study over the years. This has led to the necessity for personality measures with good psychometric properties. However, good personality measures are usually too cumbersome to apply in real practical settings due to their length. This study aims to validate a commonly used short personality measure of the Big Five model, i.e., Mini-IPIP (Mini International Personality Item Pool), which has never been validated and used in the substance abuse population in the local setting. The participants were 239 individuals attending one of the six methadone clinics in Malaysia. Structural analysis was conducted using confirmatory factor analysis. Results showed a good model fit for Mini-IPIP when item-parcelling and adding-in correlated uniqueness items were applied (fit indices: Comparative Fit Index = 0.949, Standardised Root Mean Residual = 0.044). Our study supported the five-factor solution for the Mini-IPIP. It is valid and reliable to be used among individuals with drug abuse in Malaysia.
  11. Njaka S, Mohd Yusoff D, Anua SM, Kueh YC, Edeogu CO
    Heliyon, 2021 Feb;7(2):e06130.
    PMID: 33644447 DOI: 10.1016/j.heliyon.2021.e06130
    Quarry workers are commonly afflicted with musculoskeletal disorders (MSDs). This health problem has been recognized as a significant threat to the quarry workers' safety but is rarely reported, particularly in Nigeria. Therefore, this study aimed to assess the prevalence of MSDs and their associated factors among quarry workers.

    METHOD: A cross-sectional study was conducted, and data were collected using a self-administered Standard Nordic Musculoskeletal Questionnaire. A total of 266 participants were selected through systematic random sampling method among male and female quarry workers in Ebonyi State, Nigeria. The data were analysed using SPSS version 26, and descriptive statistics were used to determine the prevalence and types of MSDs. Simple and multiple logistic regressions were used to identify the factors associated with MSDs.

    RESULTS: The results revealed that majority of the respondents (89.8%) had MSDs, with the most common types being lower back pain (83.1%) and elbow pain (45.9%). Based on multiple logistic regression modelling, BMI (Adjusted OR 0.17, 95% CI 0.06,0.55, p = 0.003), age (Adjusted OR 1.14, 95% CI 1.07, 1.23, p < 0.001), work experience (Adjusted OR 2.08, CI 1.00, 4.30, p = 0.049), Vibration exposure (Adjusted OR 0.45, CI 0.27, 0.74, P = 0.002), working hour (Adjusted OR 6.84, CI 0.84, 53.4, p = 0.007) and break time (Adjusted OR 0.95, 95% CI 0.91,0.98, p = 0.006) were significantly associated with MSDs.

    CONCLUSION: MSDs are prevalent among the quarry workers in Ebonyi State, Nigeria. Thus, there is an urgent need to increase the workers' and employers' awareness of appropriate ergonomic and personal measures needed to improve the workers' safety and well-being.

  12. Wu J, Kuan G, Lou H, Hu X, Masri MN, Sabo A, et al.
    Front Psychol, 2023;14:1134703.
    PMID: 37691784 DOI: 10.3389/fpsyg.2023.1134703
    INTRODUCTION: Since the emergence of COVID-19 in 2019, every country in the world has been affected to varying degrees. Long-term psychological pressure and anxiety will inevitably damage the physical and mental health of students. This study aimed to examine the effects of the COVID-19 pandemic on students who experienced stress and anxiety and to clarify which intervention was more effective.

    METHODS: A comprehensive literature search was conducted between January 2020 and December 2022 using online databases such as PubMed, Web of Science, Scopus, and Google Scholar by using the following keywords in combination: "COVID-19," "stress," "anxiety," "depression," and "intervention." The retrieved literature was screened and reviewed.

    RESULTS: A total of 2,924 articles were retrieved using subject and keyword searches. After screening through the titles and abstracts, 18 related studies were retained. Their review revealed that: (1) most studies did not use medication to control stress and anxiety; (2) the standard methods used to reduce stress and anxiety were religion, psychological counseling, learning more about COVID-19 through the media, online mindfulness courses, improving sleep quality, and physical exercise; (3) the most effective interventions were physical activity and raising awareness about COVID-19 through the media and online mindfulness programs. However, some studies show that physical activity cannot directly relieve psychological stress and anxiety.

    CONCLUSION: Limited interventions are effective, but learning more about COVID-19 and using active coping strategies may help reduce stress and anxiety. The implications of COVID-19 are also discussed.

  13. Hidrus A, Kueh YC, Norsa'adah B, Kim Y, Chang YK, Kuan G
    PLoS One, 2022;17(3):e0266104.
    PMID: 35358248 DOI: 10.1371/journal.pone.0266104
    BACKGROUND: This study aimed determine the structural relationship between psychological constructs of the transtheoretical model (TTM; processes of change, decisional balance, and exercise self-efficacy), motives for physical activity (PA), and amount of PA among Malaysians with type 2 diabetes mellitus (T2DM).

    METHOD: All participants were recruited from the Hospital Universiti Sains Malaysia using a cross-sectional study design with purposive) sampling method. A total of 331 participants were recruited for the present study. Before participation in the study, they were informed that participation in the study was totally voluntary. Those who agreed to participate voluntarily were required to complete the self-administered questionnaire set, which included the processes of change, decisional balance, exercise self-efficacy, physical activity and leisure motivation, and international physical activity questionnaires. Data analysis of structural equation modeling was performed using Mplus 8.

    RESULTS: From the 331 participants, most of whom were male (52%) and Malay (89.4%), with a mean age of 62.6 years (standard deviation = 10.29). The final structural equation model fit the data well based on several fit indices [Root Mean Square Error of Approximation (RMSEA) = 0.059, Comparative Fit Index (CFI) = 0.953, Tucker-Lewis Index (TLI) = 0.925, Standardized Root Mean Square Residual (SRMR) = 0.031]. A total of 16 significant path relationships linked between the TTM, motives for PA, and amount of PA.

    CONCLUSION: The pros of decisional balance, others' expectations, and psychological condition were constructs that directly affected PA, whereas the other constructs had a significant indirect relationship with the amount of PA. A positive mindset is crucial in deciding a behavioral change toward an active lifestyle in people with T2DM.

  14. Hajar MS, Rizal H, Kueh YC, Muhamad AS, Kuan G
    Int J Environ Res Public Health, 2019 Jul 02;16(13).
    PMID: 31269644 DOI: 10.3390/ijerph16132331
    Brain breaks is a physical activity (PA) video designed for school settings that is used to stimulate student's health and learning. The purpose of this study is to measure the effects of brain breaks on motives of participation in PA among primary school children in Malaysia. Purposive sampling was used to divide 159 male and 176 female students aged 10 to 11 years old, mean (standard deviation (SD)) = 10.51 (0.50), from two schools in Kelantan, Malaysia into intervention (n = 183) and control (n = 152) groups. Students undertook brain breaks activities on school days (five minutes per session) spread out for a period of four months. Mixed factorial analysis of variance (ANOVA) was used to test the students' motives of participation in PA for pre-, mid-, and post-tests using the Physical Activity and Leisure Motivation Scale-Youth-Malay (PALMS-Y-M). Mixed factorial ANOVA showed significant changes in enjoyment, F(2, 392) = 8.720, p-value (ηp2) = 0.001 (0.043); competitiveness, F(2, 195) = 4.364, p-value (ηp2) = 0.014 (0.043); appearance, F(2, 392) = 5.709, p-value (ηp2) = 0.004 (0.028); and psychological condition, F(2, 392) = 4.376, p-value (ηp2) = 0.013 (0.022), whereas mastery, affiliation, and physical condition were not significant (p < 0.05). Further post-hoc analysis revealed a significant downward trend in the control group (p < 0.05). Brain breaks is successful in maintaining students' motives for PA in four of the seven factors.
  15. Liu KT, Kueh YC, Arifin WN, Kim Y, Kuan G
    Front Psychol, 2018;9:2402.
    PMID: 30618907 DOI: 10.3389/fpsyg.2018.02402
    This study's purpose was to examine the structural relationship of the transtheoretical model (TTM) and the amount of physical activity (PA) among undergraduate students in health and medicine at Universiti Sains Malaysia. A cross-sectional study was carried out among students who took part in the co-curricular program. Co-curricular program includes activities that take place outside of the regular lectures or tutorials in the University. Students recruited through purposive sampling were informed that their participation was entirely voluntarily. Those interested completed the self-administered questionnaire, which consisted of the decisional balance, processes of change, self-efficacy, stages of change scales, and Godin leisure-time exercise questionnaire. Data were analyzed using Mplus version 8 for descriptive statistics and structural equation modeling analysis for inferential statistics. A total of 562 students participated in the study. The majority of the students was female (79.0%) and Malay (73.3%) and average of exercise sessions per week was 2.62, with a mean of 43.37 min per exercise session. The final structural model fit the data well based on several fit indices (SRMR = 0.046, RMSEA (CI: 90%) = 0.061 (0.045, 0.078), RMSEA p = 0.130). The model showed that stages of change significantly affected self-efficacy (p < 0.001), pros (benefits of exercise; p < 0.001), cons (barriers to exercise; p = 0.022), and processes of change (p < 0.001). The model also showed significant inter-relationships among the TTM constructs and supported seven hypotheses. Among all the variables examined, only processes of change significantly affected PA (p < 0.001). However, stages of change (p < 0.001) and pros (p =< 0.001) had significant indirect effects on PA via processes of change. The findings support that individuals' stages of change affect their self-efficacy level, or the ability to make positive and negative decisions and perform behavior accordingly. The study confirms that making correct decisions and taking action accordingly can increase PA levels.
  16. Zhao M, Kuan G, Zhou K, Musa RM, Majeed APPA, Kueh YC
    PLoS One, 2024;19(1):e0296035.
    PMID: 38166088 DOI: 10.1371/journal.pone.0296035
    BACKGROUND: To assess emotion regulation strategies in a clear and direct manner, Emotion Regulation Questionnaire (ERQ) was developed based on the process model of emotion regulation. ERQ primarily assesses an individual's propensity for reappraisal (a cognitive change in the individual's psychological state in specific situations) and expressive suppression (a regulatory response where an individual alters their emotional response after the onset of an emotional reaction). Recent studies have suggested that the abbreviated 8-item version of the ERQ exhibits comparable model fit to the original version. The present study aimed to explore the psychometric properties and assess cross-gender invariance of the ERQ-8 in Chinese university students.

    METHODS: University students from Jiangsu Province participated in this study. Participants completed self-report surveys assessing emotion regulation strategies. It was conducted from May 2022 to July 2022. The study employed confirmatory factor analysis (CFA) to assess the two-factor model of ERQ-8 and measurement invariance across male and female samples.

    RESULTS: The mean age of 1534 participants was 19.83 years (SD = 1.54), and the majority were female (70.4%). The initial ERQ-10 model with ten items demonstrated good fit for all indicators, CFI (Comparative Fit index) = 0.967, TLI (Tucker-Lewis Index) = 0.957, RMSEA (Root Mean Square Error of Approximation) = 0.043, SRMR (Standardised Root Mean Square Residual) = 0.029. However, to assess the fit of the previously proposed ERQ-8 model, two items (Q1 and Q3) were excluded. The fit of the ERQ-8 model was further improved (CFI = 0.989, TLI = 0.984, RMSEA = 0.029, SRMR = 0.021). All item loadings exceeded or were equal to 0.573. Internal consistency analysis based on the ERQ-8 model revealed Cronbach's alpha values of 0.840 for reappraisal and 0.745 for suppression, and corresponding composite reliability (CR) values of 0.846 and 0.747, respectively. Test-retest reliability, assessed using the intraclass correlation coefficient (ICC) (95% CI) within a one-week interval, ranged from 0.537 to 0.679. The correlation coefficient between the two factors was 0.084, significantly below 0.85, which suggested a low correlation between the two factors. The results of the invariance analysis across gender demonstrated that the values of ΔCFI and ΔTLI were both below 0.01. It was supported the gender invariance of the ERQ-8 among university students.

    CONCLUSION: The eight-item ERQ demonstrated validity and reliability in evaluating emotion regulation strategies, and measurement invariance was observed across gender among university students. The ERQ-8 may prove to be a practical and cost-effective tool, particularly in time-constrained situations.

  17. Yao L, Zhou K, Zhou Y, Kueh YC, Liu H, Liu Z, et al.
    BMC Public Health, 2024 Jan 10;24(1):151.
    PMID: 38200518 DOI: 10.1186/s12889-023-17596-2
    BACKGROUND: Self-efficacy has been recognized as a critical component in people's participation and maintenance of physical activity. This study aims to validate the Chinese version of the Exercise Self-Efficacy Scale (ESE) among Chinese children and adolescents using confirmatory factor analysis (CFA).

    METHODS: A cross-sectional study was conducted on two primary and two secondary schools in central China. The ESE scale was translated into Chinese (ESE-C) using the standard forward-backward translation method. Data were analyzed using Mplus 8 for the CFA.

    RESULTS: The final model showed a satisfactory level of goodness-of-fit (CFI = 0.918; TLI = 0.905; SRMR = 0.043; RMSEA = 0.066), indicating a good construct validity of the ESE-C for children and adolescents in mainland China. Furthermore, the final ESE-C model achieved composite reliability values of 0.963 and average variance extraction values of 0.597, indicating sufficient convergent and discriminant validity. Besides, the Cronbach's alpha value was 0.964, demonstrating excellent internal consistency of the ESE-C scale.

    CONCLUSION: The ESE-C scale is a valid instrument for assessing exercise self-efficacy among children and adolescents in mainland China.

  18. Rizal H, Hajar MS, Kueh YC, Muhamad AS, Kuan G
    Malays J Med Sci, 2019 Mar;26(2):99-113.
    PMID: 31447613 MyJurnal DOI: 10.21315/mjms2019.26.2.11
    Introduction: The transtheoretical model (TTM) is an integrative model of intentional change consisting of stages of change, processes of change, decisional balance and self-efficacy. This study aimed at validating the TTM questionnaires on physical activity for Malaysian children using confirmatory factor analysis.

    Methods: The participants were 381 Malay students (188 male; 193 female), aged 10-12 years old, with a mean age of 10.94 (SD = 0.81). The original version of the TTM was translated into the Malay language using forward and backward translation. Certain phrases were adapted based on the local culture and vocabulary suitable for primary school students.

    Results: The final measurement models and their fit indices were: processes of change (CFI = 0.939, TLI = 0.925, SRMR = 0.040, RMSEA = 0.030); decisional balance (CFI = 0.897, TLI = 0.864, SRMR = 0.045, RMSEA = 0.038); and self-efficacy (CFI = 0.934, TLI = 0.915, SRMR = 0.042, RMSEA = 0.032).

    Conclusion: Care must be taken when using the TTM with children, as it has been prevalently validated with adults. The final version of the TTM questionnaire for Malay primary school children had 24 items for process of changes, 13 items for self-efficacy and 10 items for decisional balance.

  19. Kuan G, Abdullah N, Kueh YC, Ismail M, Shafei MN, Morris T
    Malays J Med Sci, 2019 Jan;26(1):138-146.
    PMID: 30914901 MyJurnal DOI: 10.21315/mjms2019.26.1.13
    Background: The purpose of the study was to compare the motives for participating in physical activity (PA) through the different types of co-curricular activities chosen by health sciences undergraduate students at Universiti Sains Malaysia (USM), Malaysia.

    Methods: The participants were university students at USM's Health Campus, who were invited to volunteer and complete two measures: a demographic form, including the types of co-curricular activities in which the students chose to enrol (sports, uniform and art), and the Physical Activity and Leisure Motivation Scale (PALMS).

    Results: A total of 588 university students (female = 79.1%, male = 20.9%) with a mean age of 19.77 (SD = 1.39) participated in the study. The results showed significant differences in the motives of affiliation (P < 0.001), appearance (P = 0.008) and physical condition (P = 0.010) across the types of co-curricular activities in which the students participated. The students who enrolled in sports generally showed higher motives of affiliation, appearance and physical condition for participating in PA than other types of co-curricular activities.

    Conclusion: The study findings can provide further insights into the motives for participating in PA among health sciences students and encouragement for students to integrate PA into their daily routines.

  20. Abdullah N, Kueh YC, Kuan G, Yahaya FH, Lee YY
    Malays J Med Sci, 2022 Dec;29(6):77-88.
    PMID: 36818903 DOI: 10.21315/mjms2022.29.6.8
    BACKGROUND: Abdominal bloating (AB) is a common medical complaint known to diminish patients' quality of life. However, lifestyle and behavioural changes could mitigate its expression and severity. This study sought to explore the health beliefs, intentions and health-promoting behaviours among people with AB in Kelantan, Malaysia.

    METHODS: The theory of planned behaviour (TPB) was employed to explore the factors that influence the management of adults with AB, namely health beliefs and intentions. An interview guide was developed by adapting the TPB and the findings of prior studies concerning the factors associated with AB management. All eligible participants took part in in-depth interviews.

    RESULTS: The mean age of the participants was 32.5 years old (standard deviation [SD] = 14.19 years old) and the majority of participants were female (58.3%). The themes and sub-themes that emerged following the application of the TPB framework represented the qualitative results of this study, which indicated that the health beliefs, intentions and health-promoting behaviours observed among people with AB were closely related.

    CONCLUSION: The findings of this study suggest that the adoption of a healthy lifestyle could be an effective means of improving AB. Thus, it is vital to implement a health education programme that promotes health-related beliefs and intentions in order to trigger health-promoting behaviour among people with AB.

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