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Fulltext Transgender women in Malaysia, in the context of HIV and Islam: a qualitative study of stakeholders' perceptions

Barmania S, Aljunid SM

BMC Int Health Hum Rights, 2017 10 18;17(1):30.
PMID: 29047415 DOI: 10.1186/s12914-017-0138-y

BACKGROUND: Globally, one of the key groups considered to be at high risk of acquiring HIV are transgender women, often a marginalised group. In the Malaysian context there has been a scarcity of published research relating to transgender women, a sensitive issue in a Muslim majority country, where Islam plays an influential role in society. Furthermore, there has been a paucity of research relating to how such issues relate to HIV prevention in transgender women in Malaysia. Thus, the aim of this study is to explore the attitudes of stakeholders involved in HIV prevention policy in Malaysia towards transgender women, given the Islamic context.
METHODS: In-depth interviews were undertaken with stakeholders involved in HIV prevention, Ministry of Health, Religious Leaders and People Living with HIV, including transgender women. Thirty five participants were recruited using purposive sampling from June to December 2013 within Kuala Lumpur and surrounding vicinities. Interviews were in person, audiotaped, transcribed verbatim and used a framework analysis.
RESULTS: Five central themes emerged from the qualitative data; Perceptions of Transgender women and their place in Society; Reaching out to Transgender Women; Islamic doctrine; 'Cure', 'Correction' and finally, Stigma and Discrimination.
DISCUSSION: Islamic rulings about transgenderism were often the justification given by participants chastising transgender women, whilst there were also more progressive attitudes and room for debate. Pervasive negative attitudes and stigma and discrimination created a climate where transgender women often felt more comfortable with non-governmental organisations.
CONCLUSION: The situation of transgender women in Malaysia and HIV prevention is a highly sensitive and challenging environment for all stakeholders, given the Muslim context and current legal system. Despite this apparent impasse, there are practically achievable areas that can be improved upon to optimise HIV prevention services and the environment for transgender women in Malaysia.

Matched MeSH terms: Social Stigma*
Fulltext Adherence to antiretroviral therapy, stigma and behavioral risk factors in HIV-infected adolescents in Asia

Prasitsuebsai W, Sethaputra C, Lumbiganon P, Hansudewechakul R, Chokephaibulkit K, Truong KH, et al.

AIDS Care, 2018 06;30(6):727-733.
PMID: 29336591 DOI: 10.1080/09540121.2018.1425363

We studied behavioral risks among HIV-infected and uninfected adolescents using an audio computer-assisted self-interview. A prospective cohort study was initiated between 2013 and 2014 in Malaysia, Thailand, and Vietnam. HIV-infected adolescents were matched to uninfected adolescents (4:1) by sex and age group (12-14 and 15-18 years). We enrolled 250 HIV-infected (48% male; median age 14.5 years; 93% perinatally infected) and 59 uninfected (51% male; median age 14.1 years) adolescents. At enrollment, HIV-infected adolescents were on antiretroviral therapy (ART) for a median (IQR) of 7.5 (4.7-10.2) years, and 14% had HIV-RNA >1000 copies/mL; 19% reported adherence <80%. Eighty-four (34%) HIV-infected and 26 (44%) uninfected adolescents reported having ever smoked cigarettes or drunk alcohol (p = 0.13); 10% of HIV-infected and 17% of uninfected adolescents reported having initiated sexual activity; 6 of the HIV-infected adolescents had HIV-RNA >1000 copies/mL. Risk behaviors were common among adolescents, with few differences between those with and without HIV.

Matched MeSH terms: Social Stigma*
Fulltext Prevalence and correlates of community re-entry challenges faced by HIV-infected male prisoners in Malaysia

Choi P, Kavasery R, Desai MM, Govindasamy S, Kamarulzaman A, Altice FL

Int J STD AIDS, 2010 Jun;21(6):416-23.
PMID: 20606222 DOI: 10.1258/ijsa.2009.009180

HIV-infected prisoners face an inordinate number of community re-entry challenges. In 2007, 102 HIV-infected prisoners in Malaysia were surveyed anonymously within six months prior to release to assess the prevalence and correlates of community re-entry challenges. Staying out of prison (60.8%), remaining off drugs (39.2%), finding employment (35.3%) and obtaining HIV care (32.4%) were the re-entry challenges reported most frequently. Global stigma, negative self-image and public attitudes-related stigma were independently associated with challenges to obtaining HIV care. In multivariate analyses, those with previous incarcerations (adjusted odds ratio [AOR], 3.2; 95% confidence interval [CI], 1.4-7.6), higher HIV-related symptoms (AOR, 2.0; 95% CI, 1.0-4.1) and higher public attitudes-related stigma (AOR, 2.5; 95% CI, 1.2-5.1) had a significantly higher likelihood of identifying more re-entry challenges. Targeted interventions, such as effective drug treatment, HIV care and public awareness campaigns, are crucial for stemming the HIV epidemic and improving health outcomes among HIV-infected prisoners in Malaysia.

Matched MeSH terms: Social Stigma
Fulltext Assessing HIV/AIDS knowledge and stigmatizing attitudes among medical students in Universiti Putra Malaysia

Chew BH, Cheong AT

Med J Malaysia, 2013;68(1):24-9.
PMID: 23466762 MyJurnal

OBJECTIVE: Medical students are future doctors who are trained to treat all kind of diseases including people living with HIV/AIDS (PLWHA) without prejudice. This study was to determine the factors associated with knowledge on HIV/AIDS and stigma towards PLWHA among medical students.
METHODS: This was a cross sectional study with stratified random sampling conducted in a public university, Malaysia. The participants were preclinical-year (year 1 and year 2) and clinical-year (year 3 and year 4) medical students. Simple randomisation was carried out after stratification of medical students into preclinical and clinical-year. The self-administered questionnaires were consisted of socio-demographic data, items assessing HIV/AIDS knowledge and items assessing stigmatisation attitudes towards PLWHA.
RESULTS: We had 100% response rate of 340 participants. Pre-clinical and clinical year medical students each contributed 170 (50%). Majority was female (64.1%). About two-thirds (60.6%) was Malay, followed by Chinese (31.2%) and Indian (7.1%). Pre-clinical students were significantly more stigmatizing in subscale of "attitudes towards imposed measures" (t=3.917, p<0.001), even with adjustment for previous encounter and ethnicity (B= 1.2, 95% CI 0.48 to 1.83, p=0.001). On the other hand, clinical students were found to be significantly less comfortable in handling HIV/AIDS cases (t=0.039, p=0.039), even after controlled for previous encounter and ethnicity (B=0.6, 95% CI 0.29 to 0.98, p< 0.001).
CONCLUSION: Clinical encounter with PLWHA was associated with higher knowledge in HIV/AIDS. Medical students in preclinical years were having stigmatizing attitude towards imposed measures compared to the clinical years who had more stigmatizing attitude in being less comfortable with PLWHA.

Matched MeSH terms: Social Stigma
Fulltext Fitness to practise for doctors and medical students with mental issues in Malaysia

Muhammad Darwiis Abdullah, Aiman Faiz Ahmad Fuad, Hafiz Ilmie Rahman, Mark Tan Kiak Min

Journal of Clinical and Health Sciences, 2019;4(1):22-29.
MyJurnal

Mental illness is expected to become the second biggest health problem affecting Malaysians by 2020. Doctors and medical students are more prone to mental illness compared to the general population. However, they are often reluctant to and resist seeking help because of stigma and a (strong) sense of shame. This can lead to detrimental consequences for themselves and their patients. That said, a doctor with a mental illness receiving appropriate treatment and who is in a stable condition may still be permitted to practise provided patient safety is not compromised. Determining this is a key responsibility of a healthcare regulator like the Malaysian Medical Council (MMC). Using some prominent cases to illustrate this point, this article reviews the MMC guideline on ‘Managing Impaired Registered Medical Practitioners’. In the absence of similar local guidelines for medical students, we also allude to the UK General Medical Council’s guideline on ‘Supporting Medical Students with Mental Health Conditions’. The article recommends that doctors and medical students with mental illness should seek help; outlines a number of factors to consider in deciding whether a doctor should continue practising; and explores alternative career paths in instances where they should not. The article concludes that appropriate support goes a long way for doctors and medical students who grapple with mental health issues in that there is hope and a way through a seemingly devastating situation.

Matched MeSH terms: Social Stigma
Fulltext Stigmatizing attitudes toward people living with HIV/AIDS (PLWHA) among primary health care providers in Kinta District, Perak

Chan YC, Binti Mawardi M, Ismail Daud AH

Malays Fam Physician, 2021 Mar 25;16(1):31-38.
PMID: 33948140 DOI: 10.51866/oa0001

Background: Stigmatizing attitudes expressed by health care providers prevent some members of at-risk populations from accessing human immunodeficiency virus (HIV) screening and care. This attitude contributes to the continuity of the infection dissemination within our community, which gives an impact on the healthcare service and the curtailment of the global HIV/acquired immunodeficiency syndrome (AIDS) pandemic.
Objective: This study was conducted to identify stigmatizing attitudes toward people living with HIV/AIDS (PLWHA) and their determinants among primary health care providers in Kinta District, Perak.
Methodology: A cross-sectional study was conducted in 36 primary care clinics in Kinta District, Perak. Using stratified random sampling, 365 primary health care providers were recruited into the study. A validated self-administered questionnaire was used to obtain sociodemographic data as well as information on the healthcare experiences of healthcare providers, their knowledge of HIV/AIDS, and attitudes toward PLWHA. Determinants were identified using multiple linear regression.
Results: More than half of the respondents (54.1%) had never provided care to HIV/AIDS patients. A minority (29.9%) had received training on HIV/AIDS. This study shows that doctors (Coef.= -9.50, 95% CI: -18.93, -0.07, p= 0.048), respondents with HIV-positive relatives, (Coef.= -5.61, 95% CI: -10.57, -0.65, p= 0.027), those who had provided care to HIV/AIDS patients (Coef.= -2.38, 95% CI: -4.31, -0.45, p= 0.016), and those with a higher knowledge score on HIV/AIDS (Coef.= -0.86, 95% CI: -1.59, -0.13, p= 0.021) were less likely to show stigmatizing attitudes toward PLWHA.
Conclusion: The issue of stigmatizing attitudes toward PLWHA among primary health care providers needs to be addressed. This study finds that knowledge, profession, experiences with caring for PLWHA, gender, and having HIV-positive relatives are significant predictors of stigmatizing attitudes toward PLWHA among primary health care providers in Kinta District, Perak. Interventional programs to improve knowledge and awareness, as well as decrease stigma toward PLWHA, should be implemented among all health care providers, especially those who have no opportunity to provide direct care.

Matched MeSH terms: Social Stigma
Fulltext Relationship and career challenges faced by people infected with HIV in Malaysia

Tuan Abdullah TN, Mat Min R, Hossain M, Abdullah SS

F1000Res, 2019;8:1994.
PMID: 33214871 DOI: 10.12688/f1000research.21079.3

Background: In Malaysia, there are still lack of studies related to the challenges of people infected with HIV (PIWH). Therefore, this study was conducted to explore the experiences of PIWH and how they cope with HIV. Methods: This qualitative study was based on a social constructivist and grounded theory approach. A total of 12 PIWH were selected by purposive sampling, all of whom participated in semi-structured and audio-recorded interviews, which were supported with non-participant observations and diary entries on three occasions for each participant. The interviews and diaries were transcribed and analysed using the grounded theory approach, which was assisted by utilizing NVIVO-8 to identify the themes related to the experiences of the participants. Results: PIWH experienced challenges related to their career and relationships with family and others. These challenges led to difficulties in gaining employment and career development, as well as feelings of denial, being uncomfortable, rejection, and labelling. They found that their lives were totally and dramatically changed after being tested positive for HIV. Conclusions: Among PIWH, HIV impacted relationships with significant others and career development. The absence of support and acceptance from significant others affected the ability of PIWH to cope with their daily challenges. The results of this study have implications for policymakers in terms of gaining sufficient knowledge and awareness to provide prevention programmes for HIV/AIDS.

Matched MeSH terms: Social Stigma
Fulltext Healthcare Student Attitudes Toward Vulnerable Patient Populations: Potential Impact For Perpetuating Suboptimal Care [Thesis]

Jin H

Citation: Jin H. Healthcare Student Attitudes Toward Vulnerable Patient Populations: Potential Impact For Perpetuating Suboptimal Care. PhD Thesis. Yale University, United States, 2013.
Objective: Stigma endorsed by healthcare providers has been found to be a barrier to care for vulnerable populations, including HIV-infected, people who inject drugs (PWID), and men who have sex with men (MSM) in multiple clinical contexts. We therefore sought to better understand the extent to which stigma is levied toward these three populations by medical and dental students.
Design: This cross-sectional study assessed the attitudes of 1,296 medical and dental students towards HIV-infected, PWID, and MSM patients.
Methods: Students were asked to score their attitudes towards these patient groups using a feeling thermometer, indicating their attitudes on a sliding scale from 0, meaning very negative, to 100, meaning very positive.
Results: The mean attitude score towards the general patient population (M = 76.50, SD = 20.35) was significantly higher than the scores for HIV-infected patients (M = 54.04, SD = 20.99), PWID patients (M = 37.50, SD = 24.41), and MSM patients (M = 32.13, SD = 29.33).Further, certain demographic variables, most notably religion, ethnicity, and personally knowing someone of these populations, were associated with significant differences in attitudes.
Conclusion: Healthcare students represent the next generation of clinicians who will be responsible for HIV prevention and treatment efforts in the future. Our findings suggest that negative attitudes towards these patients is extremely high, and it is therefore crucial to design interventions to ameliorate the negative attitudes of medical students towards vulnerable populations.

Matched MeSH terms: Social Stigma
Fulltext Knowledge of HIV/Aids and attitudes towards people living with HIV/Aids (PlWHA) among undergraduate students in University Malaysia Sabah

Zulkhairul Naimbin Sidek Ahmad, Siti Fatimah Sa’at, Farrah Ilyanibinti Che Jamalludin, Mazlinda Musa

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):69-0.
MyJurnal

Introduction: Globally, HIV/AIDS has been a growing global threat and one of the major public health challenges. In Malaysia, the number of PLWH is continued to increase year by year. What is of alarming concern is that the prejudices related to HIV/AIDS still exist within the community. Stigma and discrimination towards people living with HIV have been widely documented. It has extended their impact into the workplace and this hinders HIV pre- vention efforts and indirectly affected the national developmentprocesses. The aim of this study was to determine the knowledge of HIV/AIDS and the attitude of PLWHA among students in Universiti Malaysia Sabah. Methods: This is a cross-sectional study with convenience sampling techniques used. Data were collected among the 300 medical students and non-medical students. Self-administered questionnaires were distributed and comprise of; socio-de- mographic characteristics, items assessing knowledge of HIV/AIDS and attitudes towards PLWHA. Results: The majority of respondents were female (74%) who had never encountered PLWH (76%). The mean score of knowl- edge and attitudes were 4.04±1.12 and 27.18±4.0, respectively. Year 1 male students were found to have more comprehensive knowledge of HIV/AIDS. They were also having a more positive attitude toward PLWH as compared to female students. Conclusion: Stigma and discrimination associated with HIV/AIDS are the most challenges issues- experienced by people suffering from the disease and it has been recognized. It is regarded as a serious threat to the fundamental rights of all infected people who are affected by or associated with this disease. This study highlights the need for better education programs on HIV/AIDS at the undergraduate level in order to increase knowledge of HIV/ AIDS andshape the positive attitude toward PLWH.

Matched MeSH terms: Social Stigma
Fulltext Knowledge, attitude, practice and stigma of tuberculosis among healthcare providers in Hospital Ampang

Hafridz Murshid al-Wafi Shahbuddin, Ummi Affah Mahamad, Abdul Aziz Marwan

Malaysian Journal of Medicine and Health Sciences, 2020;16(108):42-46.
MyJurnal

Introduction: Malaysia is an intermediate tuberculosis burdened country as classified by WHO. There was a recent rise in TB incidence. Healthcare providers, especially in secondary or tertiary centers, were constantly exposed to TB infected patients, which is a hazard source for TB infection. Thus, assessment of behavior towards TB is paramount through knowledge, attitude, health-seeking practice, and stigma domains. Method: A cross-sectional survey was carried out between November 2014 and February 2015 among healthcare providers in Medical Department, Hos- pital Ampang. Data were analyzed using SPSS ver 21. Results: Despite overall good knowledge on TB, only 20% of the correspondence knew which patient’s population is at risk of TB infection. Almost all perceived TB as a health threat and willing to seek medical care if they developed TB symptoms. However, a small proportion (5.3%) will keep it a secret if they contracted TB. This is contrasted by the majority that perceived TB patients will not be accept- ed by the community. Conclusion: Knowledge and attitude towards TB was adequate within the healthcare providers in Medical Department, Hospital Ampang despite the presence of some knowledge gaps. However, there was high perceived stigma that needed to be addressed in order for them to deliver the best medical care.

Matched MeSH terms: Social Stigma
Western Lessons/Eastern Perspectives: Combining Neurology and Psychiatry in Preclinical Medical Student Education in Malaysia

Schiess N, Rao A, Mohanraj A, Wiener CM

Acad Psychiatry, 2017 08;41(4):551-555.
PMID: 27738999 DOI: 10.1007/s40596-016-0616-x
Matched MeSH terms: Social Stigma
Fulltext Epilepsy stigma in Asia: the meaning and impact of stigma

Lim, Kheng-Seang, Tan, Chong-Tin

Neurology Asia, 2014;19(1):1-10.
MyJurnal

Stigma is conceptually broad and culturally variable. Understanding stigma from the conceptual theories, culturally application based on the word stigma in other languages, the definition of stigma and its synonyms, as well as the medical implications in other stigmatized disease such as AIDS, will help us to understand the complexity of stigma in epilepsy. This review investigated the meaning and types of stigma from different perspectives, leading to staging stigma into 5 levels, i.e. social identity, stereotype, prejudice, discrimination and social disability. In addition to the conventional categorization of stigma into social, felt, self-perceived or internalized stigma, new categories of stigma i.e. personal and general attitudes towards epilepsy based on a newly developed Public Attitudes Toward Epilepsy (PATE) scale was introduced. Courtesy stigma was further elaborated in related to Asian culture. Based on well-established and recently developed theories, the causation and impact of epilepsy stigma was discussed in an Asian context, especially from the aspects of language and society values which are culturally specific. Integrating these theories of causation, illness and stereotype perceptions were proposed to be the mediating mechanism of stigma, which led to the development of a practical and multi-dimensional stigmatization model, aiming to guide, widen and deepen the scope of future stigma research in epilepsy. Using the established model, together with review of related studies, research priorities in epilepsy stigma research especially in Asia focusing on five aspects, i.e. expanding population studies especially on significant others, understanding stigma from personal attitude perspective, investigating the cultural and social causation of stigma, and the impacts of stigma on patients as well as the family members, were proposed.

Matched MeSH terms: Social Stigma
Fulltext Nurses awareness and attitude towards HIV/Aids and universal precautions: a cross-sectional study in UKMMC

Gulifeiya, A., Rahmah, M.R.

Malaysian Journal of Community Health, 2008;14(2):36-45.
MyJurnal

Introduction : AIDS stigma and incorrect HIV/AIDS information among health care workers will influence the quality of care received by persons living with HIV/AIDS (PLHA). A cross-sectional study was conducted amongst nurses in the Hospital University Kebangsaan Malaysia (HUKM) with the objective of determining their knowledge and attitudes regarding HIV/AIDS and Universal Precautions (UP).
Methods : A total of 450 female nurses were recruited in this study and data were collected via a self-administered questionnaire.
Results : A total of 393 female nurses had completed the questionnaires and majority of them were Malays (95.4%) with mean age of 28.4±3.9 years old. The mean duration of work in the hospital was 6.2±3.6 years. The study results showed a satisfactory level of good knowledge among nurses (69%) and this is statistically significant (p

Matched MeSH terms: Social Stigma
Fulltext Carers as teachers

Loh, Sit Fong, Sinniah, Aishvarya, Ruzanna Zamzam, Marhani Midin, Wan Salwina Wan Ismail, Mahadevan, Raynuha

ASEAN Journal of Psychiatry, 2009;10(2):186-193.
MyJurnal

Objectives: This paper reports the outcome of Session With Carer, one of the activities in the Year 4 Personal and Professional Development (PPD) module in the new integrated curriculum of the Undergraduate Medical Programme at the Faculty of Medicine,
Universiti Kebangsaan Malaysia (UKM). Methods: This activity involves groups of 14 – 15 students sitting in with family members of individuals with mental illness. The session starts with the carer giving his or her perspective of patient’s care and the challenges involved. This is followed by a question and answer session. Finally, the carer provides a written feedback by way of scoring certain items as well as brief comments. After the session, each student is required to prepare an individual report in the form of reflective writing. Results: Out of a total of 224 students, the reflections of 126 students were reviewed to assess what they had learnt from the Session With Carer. Among the more significant findings were: 100% learnt about the various challenges faced by carers. 31.7% learnt the importance of
faith/spirituality of the carer in caring for a mentally ill family member. 29.4% learnt the importance of family and others’ support. An equal number, that is, 26.2% learnt that it helps for the carer to have good mental health and a positive attitude, as well as good
knowledge of the illness. Those who became aware of the benefits of the carer having patience and determination made up 23.8% of the total reflections reviewed. Conclusion: The findings show that the Session With Carer is very educational, and helps create more
awareness of the importance of the carer’s role in patient management and support. In other words, carers can act as teachers in creating more public awareness about mental illness and
ultimately, help in gradually removing the stigma associated with mental illness. Therefore, carers should be utilized for this purpose.

Matched MeSH terms: Social Stigma
Fulltext Mental health-related experiences and challenges of informal HIV/AIDS caregivers: a brief review and analysis

Pei, Lin Lua, Norhayati Mustapha

ASEAN Journal of Psychiatry, 2012;13(2):197-217.
MyJurnal

encountered particularly in mental health issues and to additionally analyze the methodologies used in studies involving HIV/AIDS informal caregivers.

Methods: Four electronic databases; Science Direct, EBSCOhost, Ovid and Springer Link were searched for articles published in the past 10 years (2002 - 2012). Only full-text English articles related to research on care giving of HIV-infected adult patients were selected.

Results: Twenty two out of 293 articles (7.5%) were reviewed, involving 2,765 caregivers in the USA (n=1,610), Africa (n=253), Asia (n=838) and Oceania (n=64) regions. A variety of age categories was involved in care giving with the youngest carer being 12 years old and the oldest, 60 years on average. Females and whites appeared to be dominant and 603 caregivers themselves were HIV positive. The main outcomes measured were care giving burden, challenges and coping. Stress and depression, stigma and discrimination, insufficient support, role overload and extreme poverty were the main challenges experienced in care giving. Both qualitative (n=11) and quantitative (n=9) were the equally preferred types of study. Purposive sampling emerged as the most preferred sampling technique. Various instruments were utilized, but the Beck Depression Inventory (BDI) was the most popular particularly in quantitative studies.

Conclusion: A variety of life aspects were negatively affected in the process of care giving for HIV/AIDS patients and studies of such nature commonly focused on caregivers' psychosocial burden.

Matched MeSH terms: Social Stigma
Fulltext The experiences and challenges in caring for HIV/AIDS patients: a qualitative exploration among Muslim family caregivers in Terengganu, Malaysia

Pei, Lin Lua, Norhayati Mustapha, Ramle Abdullah, Ahmad Kashfi Abdul Rahman

ASEAN Journal of Psychiatry, 2014;15(2):120-130.
MyJurnal

Objective: The family caregiver has a pivotal role in the management of HIV/AIDS patients and their well-being is consequently crucial as it could impact negatively on the quality of caregiving. This preliminary qualitative investigation intended to explore and describe the challenges and experiences of HIV/AIDS family caregivers in Terengganu, Malaysia. Methods: A convenient sample of family caregivers of HIV/AIDS patients who were aware of the diagnosis was enrolled. Recruitment was conducted in Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia and semi-structured interviews were used. Results: Results were transcribed into verbatim before being subjected to analysis. Twelve Muslim caregivers consented participation (age range = 18.0 - 81.0; female = 75.0%, mother/wife = 50.0%; married = 83.3%; ≤ primary school
= 50.0%; and self-employed = 66.7%). The four major themes that emerged were challenges of caregiving, financial issues, stigma and discrimination, and support for caregivers. Additionally, caregivers did mention several positive aspects of their caregiving role including satisfaction from helping family member and improved family relationships. Conclusion: A variety of life aspects were negatively affected by caring for HIV patients, thus requiring a multidisciplinary approach to address such issues. ASEAN Journal of Psychiatry, Vol. 15 (2): July - December 2014: 120-130.

Matched MeSH terms: Social Stigma
Primary care barriers to cataract surgery in the eastern zone of Peninsular Malaysia: an interpretative phenomenological analysis

Nurulain MZ, Ahmad S, Asma H, Abdul M

Med J Malaysia, 2018 04;73(2):67-72.
PMID: 29703868

OBJECTIVE: Cataract is the leading cause of blindness in Malaysia. There is an alarming backlog of cataract extraction surgery as the majority believes they did not require surgery. This study aimed to explore the barriers at the primary care level to cataract surgery from the perspective of patients with severe cataract blindness.
METHODS: Eleven participants were involved in this qualitative research which utilised the interpretative phenomenological analysis approach more renowned in health psychology research. All interviews conducted at their home. The interviews were recorded, typed verbatim, and the transcripts were analysed using NVivo software version 8.0.
RESULTS: The main barriers identified at the primary care level were 1) nondisclosure of their visual problems originated from their belated needs for better sight, delayed awareness of their visual status and social stigma and 2) patient-provider-related issues namely miscommunication and delayed referral. The first main theme explains their belief for not requiring surgery. This has led to their delayed awareness and impeded disclosure of their visual problems to family members or primary care providers. The second main theme reflects the provider-patient-related issues which retarded cataract detection and referral process required for earlier cataract extraction surgery.
CONCLUSION: Thus, the appropriate approach targeting these specific barriers at primary care level will be able to detect, motivate and assist patients for early uptake of cataract extraction surgery to improve their vision and prevent severe blindness.

Matched MeSH terms: Social Stigma
Development and Psychometric Properties of a Tuberculosis-Specific Multidimensional Health-Related Quality-of-Life Measure for Patients with Pulmonary Tuberculosis

Abdulelah J, Sulaiman SAS, Hassali MA, Blebil AQ, Awaisu A, Bredle JM

Value Health Reg Issues, 2015 May;6:53-59.
PMID: 29698193 DOI: 10.1016/j.vhri.2015.03.006

BACKGROUND: Various generic instruments exist to assess health-related quality of life (HRQOL) in patients with tuberculosis (TB), but a psychometrically sound disease-specific instrument is lacking.

OBJECTIVES: The present study aimed to develop and psychometrically validate a multidimensional TB-specific HRQOL instrument relevant to the value of patients with pulmonary TB in Iraq with an eye toward cross-cultural application.

METHODS: The core general HRQOL questionnaire is composed of the Functional Assessment of Cancer Therapy-General items. A modular approach was followed for the development of the Functional Assessment of Chronic Illness Therapy-Tuberculosis (FACIT-TB) questionnaire in which a set of items assessing quality-of-life (QOL) issues not sufficiently covered by the core Functional Assessment of Cancer Therapy-General items, but considered to be relevant to the target population, was added. Moreover, principal-component analysis was used to determine the new subscale structure of the questionnaire.

RESULTS: In addition to the 27 items of the core questionnaire, a set of 20 items referring to disease symptoms related to the site of infection, adverse effects, and additional QOL dimensions such as fatigue, social stigma, and economic burden of the illness was included. Factor analysis demonstrated that the FACIT-TB construct comprised five domains.

CONCLUSIONS: A rigorous method was applied in the development of the FACIT-TB measure to fully understand the impact of TB on patients' QOL. The instrument is psychometrically sound and portrays multiple important dimensions of HRQOL. FACIT-TB is relatively brief, is easy to administer and score, and is appropriate for use in clinical trials and practice.

Matched MeSH terms: Social Stigma
Caregiver depression: The contributing role of depression in patients, stigma, social support and religiosity

Chai YC, Mahadevan R, Ng CG, Chan LF, Md Dai F

Int J Soc Psychiatry, 2018 09;64(6):578-588.
PMID: 30074421 DOI: 10.1177/0020764018792585

BACKGROUND: Depression has been well studied as part of caregiver burden among patients with severe mental illnesses. Curiously, though, there has been little data in terms of caregiver burden with specific focus on depression among caregivers of patients with major depressive disorder (MDD).
AIM: This study aims to determine the rate of depression among caregivers of person with depression and its psychosocial correlates, which include stigma, perceived social support, religious commitment and the severity of the patient's symptoms.
METHODS: A cross-sectional study was conducted among 165 patients diagnosed with MDD using the Mini-International Neuropsychiatric Interview (M.I.N.I.) together with their caregivers. Apart from gathering social demographic data, patients were administered the 16-item Quick Inventory of Depressive Symptomatology-Self-Rated Version (QIDS-SR 16), whereas the caregivers were required to answer Patient Health Questionnaire-9 (PHQ-9), Multidimensional Scale of Perceived Social Support (MSPSS), Duke University Religion Index (DUREL) and Depression Stigma Scale (DSS). Those who scored ⩾5 on PHQ-9 were further assessed with interviewer-rated M.I.N.I. to diagnose the presence of depression.
RESULTS: A total of 47 (28.5%) caregivers were found to have depressive symptoms. Out of that total, 13 (7.9%) were diagnosed to have MDD using M.I.N.I. From univariate analysis, factors associated with depression in caregivers were the severity of symptoms in patients ( p stigma in caregivers ( p = .037), the patients' current depressive episode ( p = .026) and lower perceived social support from friends ( p = .048). From multivariate analysis, only the patients' severity of depressive symptoms ( p stigma in caregivers ( p = .048) were significantly associated with the caregivers' depressive symptoms.
CONCLUSION: Our findings suggested that the severity of patient depression and personal stigma of the caregivers were significant factors correlated with caregiver depression. Therefore, beyond optimizing the treatment of depression in patients, the issue of stigma among caregivers also needs to be addressed as a potential target of intervention.

Matched MeSH terms: Social Stigma
Fulltext Faktor perbezaan tahap pengetahuan HIV/AIDS dan stigma pelajar GMI dan UKM mengikut tahap pendidikan

Muhammad Ajib bin Abd R, Nasrudin S

Jurnal Psikologi Malaysia, 2016;30:61-68.

HIV /AIDS is a global epidemic problem that is faced by many countries. There is a drastic increase of infection cases in children, youths, adults and elderly. Among students, there is a low level of knowledge that affects the comprehension elasticity based on the educational level which contributes to the increasing stigma among students. The focus of this study is to examine the differences of HIV/AIDS knowledge levels and students' stigma according to their levels of education. This study used HIV Knowledge Questionnaires (HIV-K-Q) version of 45 items and The Berger HIV Stigma Scale version of 40 items. 130 students from UKM and GMI participated in the study. Results showed that there were significant differences in the knowledge levels and stigma of HIV/AIDS between students' educational levels (Diploma level, Bachelor and Masters). The findings can assist educational institutions to develop the awareness of HIV/AIDS knowledge by targeting all levels of students' education. The implementation of various campaigns, talks, and interventions of reducing the stigma should be refined and planned as an annual program.

Matched MeSH terms: Social Stigma

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