OBJECTIVE: This study aims to test the feasibility and acceptability of an AI chatbot in promoting the uptake of HIV testing and pre-exposure prophylaxis (PrEP) in MSM.
METHODS: We conducted beta testing with 14 MSM from February to April 2022 using Zoom (Zoom Video Communications, Inc). Beta testing involved 3 steps: a 45-minute human-chatbot interaction using the think-aloud method, a 35-minute semistructured interview, and a 10-minute web-based survey. The first 2 steps were recorded, transcribed verbatim, and analyzed using the Unified Theory of Acceptance and Use of Technology. Emerging themes from the qualitative data were mapped on the 4 domains of the Unified Theory of Acceptance and Use of Technology: performance expectancy, effort expectancy, facilitating conditions, and social influence.
RESULTS: Most participants (13/14, 93%) perceived the chatbot to be useful because it provided comprehensive information on HIV testing and PrEP (performance expectancy). All participants indicated that the chatbot was easy to use because of its simple, straightforward design and quick, friendly responses (effort expectancy). Moreover, 93% (13/14) of the participants rated the overall chatbot quality as high, and all participants perceived the chatbot as a helpful tool and would refer it to others. Approximately 79% (11/14) of the participants agreed they would continue using the chatbot. They suggested adding a local language (ie, Bahasa Malaysia) to customize the chatbot to the Malaysian context (facilitating condition) and suggested that the chatbot should also incorporate more information on mental health, HIV risk assessment, and consequences of HIV. In terms of social influence, all participants perceived the chatbot as helpful in avoiding stigma-inducing interactions and thus could increase the frequency of HIV testing and PrEP uptake among MSM.
CONCLUSIONS: The current AI chatbot is feasible and acceptable to promote the uptake of HIV testing and PrEP. To ensure the successful implementation and dissemination of AI chatbots in Malaysia, they should be customized to communicate in Bahasa Malaysia and upgraded to provide other HIV-related information to improve usability, such as mental health support, risk assessment for sexually transmitted infections, AIDS treatment, and the consequences of contracting HIV.
METHODS: A cross-sectional online survey conducted between January and April 2019 assessed the interest in HIVST in 544 MSM in Malaysia. Participants ranked eight hypothetical HIVST service delivery program elements with varied combinations of six, two-level HIVST service delivery program attributes (cost, privacy, accuracy, kit collection site, kit type, and testing support). SPSS conjoint procedure was used to estimate the relative importance of each attribute and preference across eight possible HIVST service delivery programs.
RESULTS: Overall, 70.4% had previously tested for HIV, and of those, 64.0% had done so in the past 6 months (45.0% of all participants). Of all the participants, 25.2% reported having used HIVST previously. The acceptability for HIVST service delivery models ranged from 44.9 to 77.1%, with mean acceptability of 56.2% across the eight hypothetical HIVST distribution scenarios. The HIVST service delivery scenario with the highest acceptability had the following attributes: no cost (free), anonymity (name not required), 99-100% accuracy, home-delivered, fingerstick, and testing support using telephone hotline or texting. HIVST cost was the most important attribute (relative importance score: RIS = 19.30) associated with acceptability, followed by anonymity (RIS = 18.41), accuracy (RIS = 17.33), kit delivery (RIS = 16.99), fingerstick kit (RIS = 15.86), and support (RIS = 12.08).
CONCLUSIONS: Acceptability for HIVST in Malaysian MSM was high but differed markedly by a number of HIVST delivery scenarios and attributes. These findings could be relevant as the Malaysian Ministry of Health is in the process of developing a regulatory framework for ensuring the quality of kits, as well as policies supporting safe use while broader implementation under national AIDS programs.
METHODS AND FINDINGS: A total of 36603 subjects who were tested for COVID-19 infection via molecular assays at Sunway Medical Centre between Oct 1, 2020 and Jan 31, 2021, and consented to participate in this observation study were included for analysis. Descriptive statistics was used to summarize the study cohort, whereas logistic regression analysis was used to identify risk factors associated with SARS-CoV-2 positivity. Among the reasons listed for COVID-19 screening were those who needed clearance for travelling, clearance to return to work, or clearance prior to hospital admission. They accounted for 67.7% of tested subjects, followed by the self-referred group (27.3%). Most of the confirmed cases were asymptomatic (62.6%), had no travel history (99.6%), and had neither exposure to SARS-CoV-2 confirmed cases (61.9%) nor exposure to patients under investigation (82.7%) and disease clusters (89.2%). Those who presented with loss of smell or taste (OR: 26.91; 95% CI: 14.81-48.92, p<0.001), fever (OR:3.97; 95% CI: 2.54-6.20, p<0.001), running nose (OR: 1.75; 95% CI:1.10-2.79, p = 0.019) or other symptoms (OR: 5.63; 95% CI:1.68-18.91, p = 0.005) were significantly associated with SARS-CoV-2 positivity in the multivariate logistic regression analysis.
CONCLUSION: Our study showed that majority of patients seeking COVID-19 testing in a private healthcare setting were mainly asymptomatic with low epidemiological risk. Consequently, the average positivity rate was 1.2% compared to the national cumulative positivity rate of 4.65%. Consistent with other studies, we found that loss of smell or taste, fever and running nose were associated with SARS-CoV-2 positivity. We believe that strengthening the capacity of private health institutions is important in the national battle against the COVID-19 pandemic, emphasizing the importance of public-private partnership to improve the quality of clinical care.
METHODS: An online cross-sectional survey assessing female undergraduate students' intention to obtain the HPV vaccine and their acceptability of 2-, 4- and 9-valent HPV vaccines (2vHPV, 4vHPV, and 9vHPV, respectively).
RESULTS: Of a total of 997 complete responses, 55.2% reported intent to obtain the HPV vaccine. Some of the significant factors exerting influence on intent to obtain HPV vaccination were high knowledge score (OR = 1.469, 95% CI:1.087-1.987), perceived high risk of HPV infection (OR = 1.466, 95%CI:1.017-2.114), perception of no serious side effects (OR = 1.562, 95%CI:1.150-2.121), and mass media exposure to HPV vaccination information (OR = 2.196, 95%CI: 1.625-2.966). Socioeconomic status indicators did not significantly influence intent to obtain the HPV vaccine. A higher proportion of respondents were willing to pay for 2vHPV (78.6%) and 4vHPV (68.0%) compared with 9vHPV (49.3%). Socioeconomic status indicators were the strongest correlates of acceptability for all the three vaccines. Exposure to mass media reporting about HPV vaccination is the factor which exerts the most influence on acceptance of 9vHPV after socioeconomic status indicators.
CONCLUSIONS: It is important to improve knowledge and health beliefs, and to establish a mass media marketing strategy to promote HPV vaccination in order to enhance HPV vaccine uptake. Undergraduate female students should be provided with detailed information about the different valency vaccine choices to help them make informed decisions about immunization.
METHODS AND ANALYSIS: Arksey and O'Malley's scoping review methodology framework will guide the conduct of this scoping review. The search strategy will involve electronic databases including PubMed, Excerpta Medica Database, Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, Google Scholar and ScienceDirect, in addition to grey literature sources and hand-searching of reference lists. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Data will be charted and sorted through an iterative process by the research team. The extracted data will undergo a descriptive analysis and simple quantitative analysis will be conducted using descriptive statistics. Engagement with relevant stakeholders will be carried out to gain more insights into our data from different perspectives.
ETHICS AND DISSEMINATION: Since the data used are from publicly available sources, this study does not require ethical approval. Results will be disseminated through academic journals, conferences and seminars. We anticipate that our findings will aid technology developers and health professionals working in the area of ageing and rehabilitation.
METHODS: Monthly OPD attendance from 1,053 public primary care health clinics in Malaysia, from January 1, 2019, to June 30, 2021, was analysed. The study duration was divided into four distinct periods: pre-pandemic, pandemic with the first lockdown implementation, pandemic after the first lockdown was lifted, and pandemic with the second lockdown implementation. An interrupted time series analysis was conducted to assess the impact of different interventions at national, regional, urban-rural, and district levels. Data were then aggregated at the district level and the utilisation changes were visualised in a choropleth map. Additionally, simple linear regression (SLR) was performed to explore the association between utilisation changes and urbanisation rates of the district, for each period.
RESULTS: Nationally, OPD utilisation dropped by nearly 13% at the onset of the first lockdown and continued to decline by almost 24% monthly thereafter. In terms of urban-rural differences, urban areas in the Central and Eastern Regions showed greater fluctuations in OPD utilisation during different periods. Results from the SLR revealed that higher urbanisation rates were associated with more pronounced changes in utilisation, although the direction of these changes varied across time periods.
CONCLUSION: The OPD utilisation was affected during the COVID-19 and sporadic urban-rural differences were observed in some areas of the country. This study offers important insights into the geographic and urban-rural patterns of healthcare utilisation during the pandemic, which are crucial in improving healthcare equity in Malaysia.
METHOD: Between July and October 2022, a survey was conducted using a sample of n = 507 Venezuelan migrants. We examined the relationship between COVID-19 vaccine hesitancy, migrant's attitudes toward past vaccinations, their beliefs and perceptions about COVID-19 disease, and health-service related factors. Descriptive statistics summarized the characteristics of these migrants. Odds ratios with 95% confidence intervals and multivariable logistic regression was used to examine factors and attitudes associated with COVID-19 vaccine hesitancy.
RESULTS: Our findings showed that 89% of the migrants accessed publicly available health services while in Trinidad and Tobago, 72.4% reported that they did not refuse other vaccines in the past, and 23% reported being hesitant to take the COVID-19 vaccine. Females had higher odds of being COVID-19 vaccine hesitant compared to males, and participants expressing doubts about the source of vaccine information also had greater odds of vaccine hesitancy. Long waiting times at a public health clinic and costs associated with traveling to a clinic were associated with higher odds of COVID-19 vaccine hesitancy.
CONCLUSION: A National Immunization Policy inclusive of the unmet needs of vulnerable migrant populations is needed to ensure equitable access to vaccinations.
AIM: To determine the influence of psychosocial factors and health-seeking behaviour on the risk of falling among individuals with type 2 diabetes.
METHODS: This prospective study included community-dwelling adults aged ≥55 years selected through stratified random sampling from three neighbouring parliamentary constituencies. Data was collected at baseline in 2013-2015 with computer-assisted home-based interviews and follow-up in 2019 via telephone interviews.
RESULTS: Data on diabetes status and falls were available for 908 participants at baseline and follow-up. Diabetes was present in 42.2% of included participants at follow-up, of whom 22.8% at baseline and 25.3% at 5-year follow-up had at least one fall within the last 12 months. Diabetics had a higher risk of falls at baseline (OR: 1.484; 95% CI: 1.060-2.077) and follow-up (OR: 1.424; 95% Cl: 1.038-1.954) than non-diabetics. It was found that female gender, arthritis, alcohol and presence of depression anxiety or stress were associated with increased risk of falls in diabetics. The presence of any depression, anxiety or stress remained significantly associated with falls in diabetics (OR: 1.947; 95% Cl: 1.115-3.402) after adjustments for age, gender, ethnicity, and education but this relationship was attenuated after additional adjustment for arthritis (OR: 1.763; 95% CI: 0.996-3.122).
CONCLUSION: Our findings suggest that psychological issues are significantly associated with increased risk of falls at five-year follow-up in individuals aged 55 years and over with diabetes. These findings highlight the potential importance of psychosocial support among diabetics to reduce the risk of falls, improve patient outcomes and quality of life.
METHODS: This study presents cross-sectional survey data collected as part of the Responsive and Equitable Health Systems-Partnership on Non-Communicable Diseases (RESPOND) project, a longitudinal observational study in low-income communities. The study participants were 1191 randomly selected adults aged 35-70 years with a self-reported history of hypertension or identified as hypertensive through blood pressure screening.
RESULTS: While most low-income individuals with hypertension in both countries were diagnosed and receiving medication, Malaysians demonstrated higher self-reported medication adherence. Urban areas in the Philippines showed better hypertension management outcomes compared to rural areas. The study also provides insights into the care seeking pathways followed by low-income adults diagnosed with hypertension. Nearly half of these individuals in Malaysia and a third in the Philippines were following pathways where they had never changed or stopped treatment without professional advice, and where they were using and adhering to their prescribed medication. Following such pathways was strongly associated with a greater likelihood blood pressure control in the Philippines, but less so in Malayisa.
CONCLUSIONS: These findings highlight the need for a contextualised understanding of care seeking choices and the importance of person-centred solutions. They offer a typology of hypertension care seeking pathways and a foundation for similar research in other settings.
OBJECTIVE: This study aimed to explore cultural beliefs, barriers, and healthcare access challenges influencing breast cancer awareness and screening among Sarawak's indigenous and rural communities.
METHODS: This qualitative study explores how rural Sarawakian women perceive breast cancer and their access to healthcare. Twenty women from three main geographical terrains in Borneo-coastal, riverine, and highland areas participated in the study. After informed consent was obtained, semi-structured interviews were conducted. Data was coded and thematically analyzed to identify cultural nuances affecting their knowledge.
RESULTS: The study found a strong link between cancer and negative beliefs rooted in sociocultural backgrounds. Myths varied, but most associated cancer with death, a fatalistic culture relying on spiritual faith for healing. Participants delayed seeking medical help until "the pain is unbearable," often using oils and herbs first. Lack of knowledge and lack of access to information about cancer are two main findings from the study. Although the majority of the respondents were not equipped with adequate information, they expressed interest in learning about breast screening programs and attending breast cancer awareness campaigns.
CONCLUSION: The findings will be used to design behavioral intervention modules to educate rural Sarawak populations about the importance of breast self-examination (BSE) practices, early detection, and screening.