MyMedR

Fulltext Exploring patient values in medical decision making: a qualitative study

Lee YK, Low WY, Ng CJ

PLoS One, 2013;8(11):e80051.

PMID: 24282518 DOI: 10.1371/journal.pone.0080051

BACKGROUND: Patient decisions are influenced by their personal values. However, there is a lack of clarity and attention on the concept of patient values in the clinical context despite clear emphasis on patient values in evidence-based medicine and shared decision making. The aim of the study was to explore the concept of patient values in the context of making decisions about insulin initiation among people with type 2 diabetes.

METHODS AND FINDINGS: We conducted individual in-depth interviews with people with type 2 diabetes who were making decisions about insulin treatment. Participants were selected purposively to achieve maximum variation. A semi-structured topic guide was used to guide the interviews which were audio-recorded and analysed using a thematic approach. We interviewed 21 participants between January 2011 and March 2012. The age range of participants was 28-67 years old. Our sample comprised 9 women and 12 men. Three main themes, 'treatment-specific values', 'life goals and philosophies', and 'personal and social background', emerged from the analysis. The patients reported a variety of insulin-specific values, which were negative and/or positive beliefs about insulin. They framed insulin according to their priorities and philosophies in life. Patients' decisions were influenced by sociocultural (e.g. religious background) and personal backgrounds (e.g. family situations).

CONCLUSIONS: This study highlighted the need for expanding the current concept of patient values in medical decision making. Clinicians should address more than just values related to treatment options. Patient values should include patients' priorities, life philosophy and their background. Current decision support tools, such as patient decision aids, should consider these new dimensions when clarifying patient values.

Fulltext Self-determination and goal orientation in track and field

Chin NS, Khoo S, Low WY

J Hum Kinet, 2012 Jun;33:151-61.

PMID: 23486244 DOI: 10.2478/v10078-012-0054-0

This study investigated gender, age group and locality differences in adolescent athletes' self-determination motivation and goal orientations in track and field. It also examined the relationship between the self-determination theory and achievement goal theory. A total of 632 (349 boys, 283 girls) adolescent athletes (aged 13-18 years) completed the Sports Motivation Scale and Task and Ego Orientation in Sport Questionnaire. Results indicated significant differences between gender on intrinsic motivation, extrinsic motivation, amotivation (t(630) = 4.10, p < 0.05) and ego orientation (t(630) = 2.48, p < 0.05). Male students reported higher intrinsic motivation, extrinsic motivation, amotivation and ego orientation. A significant difference was found between age groups on task orientation (t(630) = 1.94, p < 0.05) and locality on ego orientation (t(630) = 1.94, p < 0.05). Older athletes showed significantly higher task orientation. Rural athletes had higher ego orientation whereas urban athletes have higher intrinsic motivation. Task orientation was related to intrinsic motivation (r = 0.55, p < 0.01), extrinsic motivation (r = 0.55, p < 0.01), but weakly related to amotivation (r = 0.10, p < 0.01). Ego orientation was related to intrinsic motivation (r = 0.30, p < 0.01), extrinsic motivation (r = 0.36, p < 0.01) and amotivaion (r = 0.36, p < 0.01). Task orientation was related to ego orientation (r = 0.29, p < 0.01). Multiple regression analysis showed intrinsic motivation, extrinsic motivation and amotivation accounted for 30.5% of the variances in task orientation.

Dragons, Condoms, and World Health Organization Anniversaries

Binns C, Low WY, Shunnmugam B

Asia Pac J Public Health, 2024 Mar;36(2-3):169-171.

PMID: 38476015 DOI: 10.1177/10105395241238062

The Long-Term Public Health Benefits of Breastfeeding

Binns C, Lee M, Low WY

Asia Pac J Public Health, 2016 Jan;28(1):7-14.

PMID: 26792873 DOI: 10.1177/1010539515624964

Breastfeeding has many health benefits, both in the short term and the longer term, to infants and their mothers. There is an increasing number of studies that report on associations between breastfeeding and long-term protection against chronic disease. Recent research evidence is reviewed in this study, building on previous authoritative reviews. The recent World Health Organization reviews of the short- and long-term benefits of breastfeeding concluded that there was strong evidence for many public health benefits of breastfeeding. Cognitive development is improved by breastfeeding, and infants who are breastfed and mothers who breastfeed have lower rates of obesity. Other chronic diseases that are reduced by breastfeeding include diabetes (both type 1 and type 2), obesity, hypertension, cardiovascular disease, hyperlipidemia, and some types of cancer.

Fulltext Content Analysis of Food and Beverages Advertisements Targeting Children and Adults on Television in Sri Lanka

Prathapan S, Wijewardena K, Low WY

Asia Pac J Public Health, 2016 Jan;28(1 Suppl):86S-92S.

PMID: 26658325 DOI: 10.1177/1010539515620481

Food marketing is one of the main factors in the increase in childhood obesity. The objective is to compare the strategies used for promotion of food and beverages advertisements on Sri Lankan television for children and adults.

Fulltext Social influences of help-seeking behaviour among patients with type 2 diabetes mellitus in Malaysia

Low LL, Tong SF, Low WY

Asia Pac J Public Health, 2016 Jan;28(1 Suppl):17S-25S.

PMID: 26219560 DOI: 10.1177/1010539515596807

This qualitative study aimed to explore the influence of social networks such as family members, friends, peers, and health care providers toward the help-seeking behaviour (HSB) of patients with type 2 diabetes mellitus in the public and private primary care settings. In-depth interviews of 12 patients, 9 family members, and 5 health care providers, as well as 3 focus groups among 13 health care providers were conducted. All interviews were audio-taped and transcribed verbatim for qualitative analysis. Social influences play a significant role in the help-seeking process; once diagnosed, patients source information from people around them to make decisions. This significant influence depends on the relationship between patients and social networks or the level of trust, support, and comforting feeling. Thus, the impacts on patients' help-seeking behavior are varied. However, the help-seeking process is not solely an individual's concern but a dynamic process interacting with the social networks within the health care system.

Impact of maternal marital status on birth outcomes among young Malaysian women: a prospective cohort study

Mohd Zain N, Low WY, Othman S

Asia Pac J Public Health, 2015 Apr;27(3):335-47.

PMID: 25005933 DOI: 10.1177/1010539514537678

This study evaluated the impact of maternal marital status on birth outcomes among young Malaysian women and investigated other risk factors influencing the birth outcomes. Pregnant women with and without marital ties at the point of pregnancy diagnosis were invited to participate in this study. Participants were interviewed using a structured questionnaire at pregnancy diagnosis and shortly after childbirth. From a total of 229 unmarried and 213 married women who participated, marital status was significantly associated with preterm birth (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.05-2.61) and low birth weight (OR, 3.61; 95% CI, 1.98-6.57). Other factors significantly associated with birth outcomes was prenatal care (OR, 4.92; 95% CI, 1.43-16.95), "use of drugs" (OR, 10.39; 95% CI, 1.14-94.76), age (OR, 1.12; 95% CI, 1.07-1.16), and number of prenatal visits (OR, 1.03; 95% CI, 1.00-1.07). Promoting access to prenatal care and social support programs for unmarried mothers may be important to reduce adverse pregnancy outcomes.

Children and e-cigarettes: a new threat to health

Binns C, Lee MK, Low WY

Asia Pac J Public Health, 2018 05;30(4):315-320.

PMID: 29978722 DOI: 10.1177/1010539518783808

The widespread availability and use of e-cigarettes in many countries has established the need for an assessment of their effect on children. By the end of 2017 the number published annually on e-cigarettes had increased to 2976 and included 171 papers on e-cigarettes and children. The objective of this commentary is to provide a review and public health perspective on the effects of e-cigarettes on children. There are four public health questions to be answered: 1. Are e-cigarettes and replenishing fluids toxic on accidental ingestion? 2. If children smoke e-cigarettes is this harmful? 3. Does exposure to second hand vapour from e-cigarettes cause harm to children? 4. Are children (adolescents) who use e-cigarettes more likely to begin smoking conventional cigarettes? There were 2229 reported exposures to e-cigarette fluids and liquid nicotine in the USA in 2017 causing cardiovascular symptoms of varying severity. No deaths were reported although the potential is always there. Exposure to e-cigarette vapor is less dangerous than cigarette smoke. However it does damage pulmonary endothelium in experimental models. No long term studies are yet available on chronic diseases although vapor does contain carcinogens. Adolescents who use e-cigarettes are more likely to become tobacco smokers. Because of the accumulating evidence of harm to children great caution should be exercised in widening the public promotion and usage of e-cigarettes. Children should avoid any contact with E-cigarettes or their vapour.

The impact of social media on mental health among young people

Tong WT, Bono SA, Low WY

Asia Pac J Public Health, 2023 Sep;35(6-7):449-450.

PMID: 37649284 DOI: 10.1177/10105395231198919

Fulltext The Year of the Rabbit and the COVID Pandemic

Binns C, Low WY, Shunnmugam B

Asia Pac J Public Health, 2023 Jan;35(1):5-6.

PMID: 36694949 DOI: 10.1177/10105395221150836

Red Alert: Climate Change and Public Health in the Asia Pacific Region

Binns C, Low WY, Wai Hoe VC

Asia Pac J Public Health, 2021 11;33(8):810-811.

PMID: 34763537 DOI: 10.1177/10105395211051322

Migrant Workers in Asia Pacific and Their Rights to Health

Low WY, Tong WT, Binns C

Asia Pac J Public Health, 2015 Sep;27(6):584-7.

PMID: 26294710 DOI: 10.1177/1010539515600007

Fulltext The COVID-19 Pandemic: Public Health and Epidemiology

Binns C, Low WY, Kyung LM

Asia Pac J Public Health, 2020 May;32(4):140-144.

PMID: 32429675 DOI: 10.1177/1010539520929223

Vale Professor Xiaoxian Liu

Xu F, Binns C, Low WY

Asia Pac J Public Health, 2020 5 16;32(2-3):134-135.

PMID: 32410510 DOI: 10.1177/1010539520915009

Factors influencing decision-making role preferences: A qualitative study of Malaysian patients with type 2 diabetes during insulin initiation

Lee YK, Low WY, Lee PY, Ng CJ

Int J Nurs Pract, 2015 May;21 Suppl 2:125-31.

PMID: 24804909 DOI: 10.1111/ijn.12355

Patient decision-making role preference (DMRP) is a patient's preferred degree of control when making medical decisions. This descriptive qualitative study aimed to explore Malaysian patients' views on their DMRP. Between January 2011 and March 2012, 22 individual face-to-face in-depth interviews were conducted with patients with type 2 diabetes who were deciding about insulin initiation. The interviews were audio-recorded and analysed using a thematic approach. The age range of participants was 28-67 years old with 11 men. Ten patients preferred to make the decision themselves, six patients indicated that the clinician should make the decision and only one patient expressed a preference for a collaborative role. The following factors influenced DMRP: trust in clinicians, responsibility for diabetes care, level of knowledge and awareness, involvement of family and personal characteristics. In conclusion, the concept of shared decision-making is still alien, and a more participative communication style might help to facilitate patients' expression of DMRP.
Study site: Public university hospital-based primary care clinic, Public health-care clinics (Klinik Kesihatan), Private specialist clinic, Malaysia

Cross-cultural adaptation and validation of the Malay language version of the TZO-AZL Preschool Children Quality of Life questionnaire: A health-related quality of life instrument for preschool children

Tay CG, Jalaludin MY, Low WY, Lim CT

J Child Health Care, 2015 Jun;19(2):167-81.

PMID: 24154842 DOI: 10.1177/1367493513503583

The aim of this study is to evaluate the psychometric properties of the translated Malay language version of TZO-AZL Preschool Children Quality of Life (TAPQOL) questionnaire in preschool children. Preterm children and term children aged between two and five years were enrolled into the study. The Malay language version of TAPQOL and a set of questions regarding the child's health status were answered by the caregivers. The internal consistency, Spearman's correlation coefficients and principal component analysis (PCA) with Varimax rotation and Mann-Whitney U test for group comparison were employed to evaluate the psychometric properties of this instrument. A total of 258 children (120 preterm children and 138 term children) were recruited to this study with a response rate of 94%. All (sub)domains except one had Cronbach's α coefficients of more than .7. The Spearman's correlation coefficients between 12 subdomains were generally low. PCA supported the structural unidimensionality of the items in the instrument. Preterm children had lower quality of life scores than that of term children. Malay version of TAPQOL has multidimensional construct. It is a reliable and valid instrument for preschool children, with almost similar psychometric properties to the original version.

How do men perceive erectile dysfunction and its treatment? A qualitative study on opinions of men

Low WY, Ng CJ, Choo WY, Tan HM

Aging Male, 2006 Sep;9(3):175-80.

PMID: 17050117 DOI: 10.1080/13685530600914601

INTRODUCTION: Erectile dysfunction (ED) is a common medical disorder affecting the aging male. A man's perception of a disease affects his health seeking behaviour. This study aimed to explore perceptions of ED among men with ED and how these perceptions came about.
METHODS: This qualitative study utilized in-depth interviews involving 17 urban men aged between 40 and 75 years old.
RESULTS: Misconceptions existed regarding the definitions of ED. Most men perceived impotence to be more serious than ED. Although most were aware of the medical causes of ED, 'overuse of penis' and black magic were mentioned as culturally-related causes. ED was perceived as a serious problem associated with loss of manhood and it had a significant impact on relationships with their partners. However, some adopted an 'accepting' view and attributed it to aging and fate. Most men were only familiar with PDE-5 inhibitors and traditional therapies. PDE-5 inhibitors were perceived to be effective but they were concerned about side effects and costs.
CONCLUSIONS: Identifying men's perceptions of ED and its treatment would help doctors in their consultation, and inform health policy makers in planning appropriate public education and services.

Fulltext Definitions of somatisation and cultural influences

Mathers N, Khoo EM, McCarthy S, Thompson J, Low WY

Br J Gen Pract, 2003 May;53(490):409.

PMID: 12830578

Addressing procedural challenges of ethical review system: Towards a better ethical quality of clinical trials review in Malaysia

See HY, Mohamed MS, Mohd Noor SN, Low WY

Account Res, 2019 01;26(1):49-64.

PMID: 30526066 DOI: 10.1080/08989621.2018.1556646

The review of clinical trials with human participants in Malaysia is governed by a decentralized control system. The clinical trial protocols are reviewed by 13 registered research ethics committees (RECs) in Malaysia. A governmental body, the National Pharmaceutical Control Bureau, is responsible for the inspection and oversight of these registered RECs to ensure that they comply with the regulatory requirements. However, this study highlights that each REC in Malaysia has a different standard operating procedure and ethical review process. Other procedural challenges identified include inadequate membership, poor mechanism for research monitoring after ethical approval, and insufficient resources. Establishments of a national standard of REC and a central ethics committee are suggested to ensure procedural compliance in the oversight of clinical trials in Malaysia. While there is a growing concern that procedural compliance may not have a direct impact on the protection of human subjects, our key point is that an ethical review system compliant with the national standards could serve as a strong framework to support and enhance the ethical quality of decision-making and judgement. We believe that being aware of how influential procedural compliance can be would help committees improve the ethical quality of their research review.

Mindfulness-based intervention to promote psychological wellbeing in people with epilepsy: A randomized controlled trial

Lai ST, Lim KS, Tang V, Low WY

Epilepsy Behav, 2021 05;118:107916.

PMID: 33743343 DOI: 10.1016/j.yebeh.2021.107916

BACKGROUND: We investigated the efficacy of mindfulness-based intervention (MBI) in promoting psychological wellbeing in people with epilepsy (PWE) using an assessor-blinded randomized controlled design.

METHODS: A total of 28 PWE were randomly assigned to either intervention (n = 14 cases) or control group (n = 14 controls). The intervention group received a six 2.5-hour weekly MBI, while the control group did not receive any intervention. They were assessed at three timepoints (T0: before intervention, T1: immediately after intervention, and T2: 6 weeks after intervention). Repeated measures of analyses of variance (RM-ANOVAs) were used for inter-group comparisons to determine intervention effect from baseline -to T1 and -to T2 for all outcome measures. The individual changes were calculated using the reliable change index (RCI). Key outcomes included depression (BDI-II), anxiety (BAI), epilepsy-related quality of life (QOLIE-31), satisfaction with life (SWLS), and level of mindfulness (MAAS).

RESULTS: Participants who participated in the MBI showed significant reduction in BDI-II (p = 0.001), significant increases in MAAS (p = 0.027) and QOLIE-31 (p = 0.001) at T1 when compared with the control group. However, BAI and SWLS were not significant. The trend was similar at 6-week follow-up, all outcome measures of MBI remained significant (p 

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