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Trends in Self-Harm in Kuala Lumpur, 2005-2011

Armitage CJ, Abdul Rahim W, Rowe R, O'Connor RC

Arch Suicide Res, 2016;20(1):22-8.
PMID: 26649775 DOI: 10.1080/13811118.2015.1004493

Acts of self-harm are not routinely tracked in Malaysia. The present study investigates the prevalence of self-harm in Kuala Lumpur, Malaysia, over a 7-year period. The aims were to: (a) assess the prevalence of self-harm; (b) examine any changes over a period of 7 years, and (c) identify correlates of methods of self-harm. Data were extracted from the hospital records of Kuala Lumpur Hospital to review trends in self-harm between 2005 and 2011. There were 918 episodes of self-harm across the 7-year period, with a significant peak in 2007-2009. The average rate of self-harm (7.7 per 100,000 population per year) was similar or lower than the rate of suicide (6-8 or 8-13 per 100,000) suggesting that genuine cases of self-harm are often attributed to other causes. Nevertheless, over-representation of young people, women and Indians suggest areas in which resources to prevent self-harm might usefully be targeted. Estimating rates of self-harm are fraught with problems and further research is needed to understand the economic and cultural barriers around seeking treatment for self-harm, reporting self-harm and classifying self-harm.
What do hearing healthcare professionals do to promote hearing aid use and benefit among adults? A systematic review

Ismail AH, Munro KJ, Armitage CJ, Dawes PD

Int J Audiol, 2019 02;58(2):63-76.
PMID: 30646766 DOI: 10.1080/14992027.2018.1531154

OBJECTIVE: To conduct a systematic review of the evidence in relation to what hearing healthcare professionals do during hearing aid consultations and identifying which behaviours promote hearing aid use and benefit among adult patients.
DESIGN: Searches were performed in electronic databases MEDLINE, EMBASE, CINAHL, PsycInfo, Web of Science, PubMed and Google Scholar. The Crowe Critical Appraisal Tool and Melnyk Levels of Evidence were used to assess quality and level of evidence of eligible studies. Behaviours of hearing healthcare professionals were summarised descriptively.
STUDY SAMPLE: 17 studies met the inclusion criteria.
RESULTS: Twelve studies described behaviours of audiologists and five studies were intervention studies. Audiologists were typically task- or technically-oriented and/or dominated the interaction during hearing aid consultations. Two intervention studies suggested that use of motivational interviewing techniques by audiologists may increase hearing aid use in patients.
CONCLUSIONS: Most studies of clinicians' behaviours were descriptive, with very little research linking clinician behaviour to patient outcomes. The present review sets the research agenda for better-controlled intervention studies to identify which clinician behaviours better promote patient hearing aid outcomes and develop an evidence base for best clinical practice.
A Systematic Review of the Psychometric Properties of Self-Report Measures of Attitudes to Aging

Faudzi FNM, Armitage CJ, Bryant C, Brown LJE

Res Aging, 2019 07;41(6):549-574.
PMID: 30700233 DOI: 10.1177/0164027518825117

The aim of this study was to describe and systematically evaluate the psychometric properties of attitudes to aging measures that have been validated in adults younger than 60 years. Studies were assessed for methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments. Best evidence synthesis was performed to summarize the levels of evidence. Systematic searching yielded 21 articles, relating to 10 different measures. Some instruments were validated only in middle-aged and older people, while others were validated in a wider age range. Measures differed in whether their items related to participants' own experiences of aging, their anticipated future aging, and/or aging in general. None of the measures had had all of its psychometric properties assessed. The Expectations Regarding Ageing-12 and the Anxiety About Ageing Scale received positive ratings for the greatest number of psychometric properties, but capture different constructs, and may be differentially suited to different age groups of younger adults.
Moderating effects of age on relationships between attitudes to aging and well-being outcomes

Faudzi FNM, Armitage CJ, Bryant C, Brown LJE

Aging Ment Health, 2020 10;24(10):1620-1626.
PMID: 31099260 DOI: 10.1080/13607863.2019.1619167

Objectives: More positive attitudes to aging are associated with better health and wellbeing outcomes. This study examined whether chronological age moderated relationships between attitudes to aging and wellbeing outcomes, and whether these relationships differ according to the specific attitudinal construct measured.Method: Participants were 911 adults aged 18-60 years (mean = 36.63 years). Attitudes to ageing were measured using the Malay Reactions to Ageing Questionnaire (M-RAQ), which focuses on respondents' anticipated reactions to being aged over 65 years, and the Malay Anxiety about Ageing Scale (M-AAS), which additionally captures respondents' fears and anxieties about current aging and older people. Wellbeing outcomes were measured using the Warwick- Edinburgh Mental Well-being Scale (WEMWBS) and the Satisfaction with Life Scale (SWLS).Results: More positive attitudes to ageing were associated with higher levels of wellbeing and life satisfaction after controlling for age, gender, education, and self-rated health. Age moderated the relationships between the M-AAS and wellbeing and life satisfaction, with stronger relationships in younger adults. No moderating effects of age were found for the M-RAQ.Conclusion: The difference in the moderating effects of age between measures suggests that the two attitudinal constructs captured by these two measures operate in different ways. In particular, the current emotional/anxiety components of attitudes to ageing may differentially affect wellbeing at different ages. This suggests that interventions aimed at the promotion of wellbeing through coping with aging-related anxieties might be particularly well-suited to younger adults, who may be less able to respond effectively to the anxieties they experience.
Cultural Adaptations to the Measurement of Attitudes to Ageing: Psychometric Assessment of the Malay Reactions to Ageing Questionnaire

Faudzi FNM, Armitage CJ, Bryant C, Brown LJE

Assessment, 2020 09;27(6):1272-1284.
PMID: 29649886 DOI: 10.1177/1073191118766400

The aims of this study were to culturally adapt the Reactions to Ageing Questionnaire (RAQ) for a non-Western (Malay) population, and explore attitudes to ageing in relation to age, gender, and education. Eight new culturally relevant items were generated by asking Malay-speaking participants about their reactions to ageing. A Malay version of the extended 35-item RAQ was then administered to 911 Malaysian participants aged 18 to 60 years. Exploratory factor analysis revealed four factors. Three of the factors were similar to those identified in the original RAQ, while "Family and Religion" emerged as a new factor. More negative attitudes to ageing were observed in younger and female respondents. There were no effects of education. This culturally adapted RAQ exhibits robust psychometric properties, and could be used to assess attitudes to ageing in Malaysia and other Southeast Asian countries. Moreover, we have identified a "core set" of RAQ items that could be applicable worldwide.
Fulltext Completed suicides and self-harm in Malaysia: a systematic review

Armitage CJ, Panagioti M, Abdul Rahim W, Rowe R, O'Connor RC

Gen Hosp Psychiatry, 2015 Mar-Apr;37(2):153-65.
PMID: 25636361 DOI: 10.1016/j.genhosppsych.2014.12.002

Most of the research into suicide and self-harm has been conducted in the United States and Europe, yet the volume of research does not reflect the distribution of suicide globally, with Asia accounting for up to 60% of all suicides. The present study systematically reviews the literature to assess the prevalence and correlates of suicidal acts in Malaysia in Southeast Asia.
Fulltext A Quasi-Randomized Controlled Trial of the I-PLAN Intervention to Promote Hearing Aid Use Among First-Time Adult Hearing Aid Users

Ismail AH, Munro KJ, Armitage CJ, Marsden A, Dawes PD

Trends Hear, 2021 6 1;25:2331216520969472.
PMID: 34057373 DOI: 10.1177/2331216520969472

Suboptimal hearing aid use negatively impacts health and well-being. The aim of this study was to conduct a controlled trial of a behavior change intervention to promote hearing aid use. This study was a quasi-randomized controlled trial with two arms. A total of 160 first-time hearing aid users were recruited at their hearing aid fitting appointments. The control arm received standard care. In addition to standard care, the intervention arm received I-PLAN, which comprised (a) information about the consequences of hearing aid use/nonuse, (b) reminder prompt to use the hearing aids, and (c) an action plan. The primary outcome, measured at 6 weeks, was self-reported proportion of time the hearing aid was used in situations that caused hearing difficulty. Secondary outcomes were data-logged hearing aid use, self-reported hearing aid benefit, self-regulation, and habit formation. The results showed that the proportion of time the hearing aids were used in situations that caused hearing difficulty was similar in both groups. There were no statistically significant differences between groups in any outcome measure including data-logged hearing aid use. The relatively high levels of hearing aid use across research participants may have limited the potential for the intervention to impact on hearing aid use. Although the intervention materials proved acceptable and deliverable, future intervention trials should target suboptimal hearing aid users.
Fulltext Evaluation of the I-PLAN Intervention to Promote Hearing Aid Use in New Adult Users: a Randomized Controlled Trial

Ismail AH, Armitage CJ, Munro KJ, Marsden A, Dawes PD

Ear Hear, 2022 01 06;43(4):1103-1113.
PMID: 34999593 DOI: 10.1097/AUD.0000000000001195

OBJECTIVE: Provision of information is already part of standard care and may not be sufficient to promote hearing aid use. The I-PLAN is a behavior change intervention that is designed to promote hearing aid use in adults. It consists of a prompt, an action plan and provision of information. The objective was to test the effectiveness of the I-PLAN prompt and plan components in promoting hearing aid use and benefit. Hypotheses were: there would be greater hearing aid use, benefit, self-regulation, and hearing aid use habit among participants who received the prompt or plan component, compared with no prompt or no plan component, and the effect would be the greatest in participants who received both prompt and plan; and self-regulation and habit would mediate the effect of prompt and/or plan components on hearing aid use and benefit.
DESIGN: A 2 x 2 factorial randomized controlled trial design. Two hundred forty new adult patients (60 in each group) were randomized to: information (info) only; info + prompt; info + plan; or info + prompt + plan. All participants received treatment as usual in addition to I-PLAN components, which were provided in a sealed envelope at the end of the hearing aid fitting consultation. Participants in the prompt group were instructed to use their hearing aid box as a physical prompt to remind them to use the device. Participants in the plan group were instructed to write an action plan to encourage them to turn their intentions into action. Participants, audiologists, and researchers were blinded to group allocation. The primary outcome was self-reported proportion of time hearing aids were used in situations where they had listening difficulties. Secondary outcomes were hearing aid use derived from data logging, self-reported hearing aid benefit, self-reported self-regulation, and habit. Outcomes were measured at 6-week post-fitting.
RESULTS: Contrary to predictions, participants who received the prompt component reported using their hearing aid less than participants without the prompt (p = 0.03; d = 0.24). The mean proportion of time hearing aid were used was 73.4% of the time in the prompt group compared with 79.9% of the time in the no prompt group. Participants who received the plan component reported using their hearing aids more frequently than those who did not receive the plan (Meanplan = 81.0% vs Meannoplan = 71.8% of the time; p = 0.01; d = 0.34). Receiving both prompt and plan components did not change self-reported proportion of time hearing aids were used but data-logging use was significantly reduced. The prompt reduced self-regulation of hearing aid use compared with the no prompt (p = 0.04; d = 0.28), while the plan promoted stronger hearing aid use habits than the no plan group (p = 0.02; d = 0.30).
CONCLUSIONS: Audiologists should consider using action plans to promote hearing aid use. Despite the decrease in hearing aid use when using the hearing aid box as a physical prompt, hearing aid use was still high (≈70% of the time). The hearing aid box may have slightly reduced hearing aid use by undermining self-regulation. Participants may have delegated responsibility for hearing aid use to the prompt. Subsequent studies should evaluate different prompts and test the long-term benefit of the plan on hearing aid use via habit formation.