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  1. Marthoenis, Htay MNN, Arafat SMY
    Indian J Psychiatry, 2021 12 03;63(6):597-600.
    PMID: 35136259 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_285_21
    Background: Media reporting of suicide has an essential role in the suicidal behavior of the general population.

    Aims: The aim of this study is to assess the quality of online news reports of suicidal behavior in Myanmar against the World Health Organization (WHO) reporting guidelines.

    Methods: We performed a content analysis of all available suicide-related news reports published in vernacular online newspapers of Myanmar.

    Results: A total of 285 reports were analyzed, consisting of 87.4% suicides and 12.6% nonfatal suicidal attempts. Potentially, harmful information reported in the text includes the methods of suicide (100%), the word or term in Burmese related to suicide (89.5%), the name of the person (56.5%), life event (50.5%), and photo or suicidal person (17.9%). Meanwhile, helpful information such as prevention programs and the contact information for suicide services to the readers have been infrequently reported.

    Conclusion: The study found that the newspaper reporting of suicide in Myanmar is grossly nonadherent to the WHO media guidelines.

  2. Htay MNN, Su TT, Donnelly M
    Asian Pac J Cancer Prev, 2024 Mar 01;25(3):785-791.
    PMID: 38546061 DOI: 10.31557/APJCP.2024.25.3.785
    INTRODUCTION: Breast cancer is the commonest cancer among Malaysian women. Current clinical practice guidelines (CPG) by the Ministry of Health, Malaysia comprise recommendations based on a risk stratification approach.

    AIM: This paper reviewed and reflected on the challenges and uncertainties that needed to be considered regarding the implementation and delivery of risk-stratified breast cancer screening in Malaysia.

    METHODS: Our iterative writing, discussions and reflections revolved around the results of key relevant literature search from the Ministry of Health Malaysia website, PubMed, and Google Scholar, and on feedback from local clinical experts in the field of breast cancer screening practice. The articles related to risk-stratified breast cancer screening, genetic testing, screening guidelines for the Malaysia population, and articles published in English were included in this narrative review.

    RESULT: Further infrastructure and workforce capacity building is needed in order to achieve successful wider implementation e.g.; genetic counselling and testing services are limited in Malaysia. Furthermore, there is a need to elicit Malaysian women's views and evaluate their acceptance of risk-stratified breast cancer screening. The primary healthcare setting is an obvious potential avenue to introduce and deliver initial risk assessment and stratification. However, the workload and willingness of Malaysian primary healthcare doctors to practice risk-stratified screening is yet to be explored to have a better understanding on their perspective.

    CONCLUSION AND RECOMMENDATION: Identifying a valid and appropriate risk model tailored to the population profile and needs of Malaysian women and conducting a pilot project of risk-stratified screening, guided by implementation science would provide lessons and insights for policymakers, health service managers, and public and primary health care professionals. The results of these activities would increase the likelihood that decisions and plans would lead to the successful implementation in Malaysia of a sustainable and effective breast cancer screening strategy that incorporates a patient-sensitive, risk-stratified approach.

  3. Htay MNN, McMonnies K, Kalua T, Ferley D, Hassanein M
    PMID: 32489996 DOI: 10.4103/jehp.jehp_321_18
    CONTEXT: In the era of technology, social networking has become a platform for the teaching-learning process. Exploring international students' perspective on using Twitter would reveal the barriers and potential for its use in higher educational activities.

    AIMS: This study aimed to explore the postgraduate students' perspective on using Twitter as a learning resource.

    SUBJECTS AND METHODS: This qualitative study was conducted as part of a postgraduate program at a university in the United Kingdom. A focus group discussion and five in-depth interviews were conducted after receiving the informed consent. The qualitative data were analyzed by R package for Qualitative Data Analysis software.

    ANALYSIS USED: Deductive content analysis was used in this study.

    RESULTS: Qualitative analysis revealed four salient themes, which were (1) background knowledge about Twitter, (2) factors influencing the usage of Twitter, (3) master's students' experiences on using Twitter for education, and (4) potential of using Twitter in the postgraduate study. The students preferred to use Twitter for sharing links and appreciated the benefit on immediate dissemination of information. Meanwhile, privacy concern, unfamiliarity, and hesitation to participate in discussion discouraged the students from using Twitter as a learning platform.

    CONCLUSIONS: Using social media platforms in education could be challenging for both the learners and the educators. Our study revealed that Twitter was mainly used for social communication among postgraduate students however most could see a benefit of using Twitter for their learning if they received adequate guidance on how to use the platform. The multiple barriers to using Twitter were mainly related to unfamiliarity which should be addressed early in the learning process.

  4. Htay MNN, Latt SS, Abas AL, Chuni N, Soe HHK, Moe S
    PMID: 30596109 DOI: 10.4103/jehp.jehp_104_18
    INTRODUCTION: Family planning and contraception is the effective strategy to reduce maternal mortality, child mortality, abortion, and unwanted pregnancies. Since the medical students are the future doctors, it is important to have proper knowledge and training on family planning services. This study aimed to explore the effect of teaching-learning process at maternal and child health (MCH) clinics on the students' knowledge, perceptions toward contraception methods, and family planning counselling.

    METHODS: This quasi-experimental study was conducted in the private medical institution in Malaysia. The same questionnaire was used to administer twice, before and after the posting. Moreover, a qualitative question on the issues related to family planning and contraception utilizations in Malaysia was added to the after posting survey. The quantitative data were analyzed using IBM SPSS (version 20) and qualitative data by RQDA software.

    RESULTS: A total of 146 participants were recruited in this study. Knowledge on contraception method before posting was 5.11 (standard deviation [SD] ±1.36) and after posting was 6.35 (SD ± 1.38) (P < 0.001). Thematic analysis of the students' answer revealed four salient themes, which were as follows: (1) cultural barrier, (2) misconception, (3) inadequate knowledge, and (4) improvement for the health-care services.

    CONCLUSIONS: The teaching-learning process at the MCH posting has an influence on their perception and upgraded their knowledge. It also reflects the role of primary health-care clinics on medical students' clinical exposure and training on family planning services during their postings.

  5. Htay MNN, Latt SS, Maung KS, Myint WW, Moe S
    Asia Pac J Public Health, 2020 07 16;32(6-7):320-327.
    PMID: 32672053 DOI: 10.1177/1010539520940199
    International migration has become a global phenomenon bringing with it complex and interrelated issues related to the physical and mental well-being of the people involved. This study investigated the mental well-being and factors associated with mental health among Myanmar migrant workers (MMW) in Malaysia. The cross-sectional study was conducted in Penang, Malaysia by using the WHO-5 Well-Being Index Scale (WHO-5) and the Mental Health subscale of 36 items in the Short Form Health Survey (SF-36). Among 192 migrant workers who were understudied, 79.2% had poor mental well-being according to the WHO-5 scale. The duration of stay in Malaysia and without receiving financial aid from their employers despite having a physical illness were significantly associated with poor mental well-being. Mental health support groups should target migrant workers for mental health education and find ways to provide assistance for them. Furthermore, premigration training should be delivered at the country of origin that also provides information on the availability of mental health support in the host country.
  6. Kyaw Soe HH, Than NN, Lwin H, Nu Htay MNN, Phyu KL, Abas AL
    PMID: 29629384 DOI: 10.4103/jehp.jehp_61_17
    CONTEXT: Scientific research not only promotes health and combats diseases of an individual, but also it can strengthen the effectiveness of health systems. Hence, understanding of scientific methods becomes a crucial component in the medical profession.
    AIMS: This study was conducted to assess the knowledge, attitudes, and barriers toward research among undergraduate medical and dental students.
    SETTINGS AND DESIGN: This cross-sectional study was conducted among 295 undergraduate Bachelor of Medicine and Bachelor of Surgery (MBBS) and Bachelor of Dental Surgery (BDS) students from a private medical college in Malaysia.
    MATERIALS AND METHODS: We purposively selected 360 students attending the 3rd, 4th, and 5th year in MBBS course and BDS course in September 2015. A total of 295 students who were willing to provide written informed consent were included in this study. We collected data using a validated, self-administered, structured questionnaire which included 20 questions about knowledge toward scientific research, 21 attitude items in regard to scientific research, a list of 10 barriers toward conducting medical research, and 5 questions of confidence to conduct the medical research.
    STATISTICAL ANALYSIS USED: Data were analyzed using descriptive statistics, independent t-test, ANOVA, and multiple linear regression.
    RESULTS: Among the students, 56.9% had moderate knowledge while the majority (83.3%) had moderate attitude toward scientific research. The majorly cited barriers were the lack of time (79.9%), lack of knowledge and skills (72.1%), lack of funding (72.0%) and facilities (63.6%), and lack of rewards (55.8%). There was a significant association between age, academic year, and knowledge of research as the older age group, and 4th- and 5th-year students had higher knowledge score. The students of higher attitude score had better-perceived barriers score toward research with regression coefficient 0.095 (95% confidence interval 0.032-0.159).
    CONCLUSIONS: Even though the students had the positive attitudes toward scientific research, a supportive and positive environment is needed to improve skills and knowledge of research and to overcome the barriers toward the conduct of scientific research.
    Study site: Melaka-Manipal Medical College (MMMC), Melaka, Malaysia
  7. Htay MNN, Than NN, Abas AL, Lwin H, Moe S
    PMID: 30079358 DOI: 10.4103/jehp.jehp_144_17
    CONTEXT: Family planning is crucial for everyone within the reproductive age to promote the health and welfare of every member of the family. For the medical students, it is essential to have core knowledge, understanding of family planning concept, and competency in communication skills with the patients. The final-year medical students are posted in Maternal and Child Health Clinics for 3 weeks to gain the knowledge and practical experiences on the primary healthcare in the community.

    AIMS: The aim of this study was to explore the experiences of final-year medical students on family planning services offered at community clinics in Malaysia.

    SETTINGS AND DESIGN: This was qualitative study.

    SUBJECTS AND METHODS: This qualitative study used the data of the students' reflection written in the case reports on family planning. Coding, identification of subthemes, and themes were done by two researchers independently using RQDA software.

    STATISTICAL ANALYSIS USED: Thematic analysis.

    RESULTS: Final-year medical students who had exposure to the clinical services at primary care clinic, regarding Malay word (Klinik Kesihatan) gained the learning opportunities during family planning session such as learning by observation, clerking, and counseling the patients, understanding the barriers to utilizing services and learning for their self-improvement. These learning opportunities lead to developing the positive attitudes on their learning experiences and the positive attitudes toward the concept and services of family planning.

    CONCLUSIONS: To have the better understanding of family planning services and provide the better care to the community in the future, the clinical exposure at the primary care clinics should be promoted for medical students in Malaysia.
  8. Soe HHK, Than NN, Lwin H, Phyu KL, Htay MNN, Moe S, et al.
    J Family Med Prim Care, 2018 9 21;7(4):756-761.
    PMID: 30234049 DOI: 10.4103/jfmpc.jfmpc_300_17
    Background: Disease surveillance is one of the major components to combat against infectious diseases. As health-care professionals are indispensable to mandatory notifiable disease surveillance, their knowledge and attitudes toward infectious disease notification played an important role for timely and effective reporting to the surveillance system. Therefore, we aimed to determine the knowledge of mandatory notifiable infectious diseases in Malaysia and attitude towards infectious disease reporting among final year medical students.

    Methods: A cross-sectional study was conducted from May to June 2017 in the private medical college in Malaysia.

    Materials and Methods: We purposively selected the final year (semester 10) medical students and a total of 124 students participated in this study. We collected data using a self-administered, structured questionnaire. Data were analyzed using descriptive statistics, independent t-test, and one-way analysis of variance.

    Results: Among the final year medical students, 47.5% had moderate knowledge but 4.2% had good knowledge of mandatory infectious disease notification. Only 3.2% of the students correctly answered all the notifiable diseases listed in the questionnaire. Most of the students had positive attitude toward communicable diseases reporting, rewards, and penalty for notification. There was no significant relationship between sociodemographic characteristics and knowledge and attitude of infectious disease notification.

    Conclusions: The majority of the final year medical students had moderate level of knowledge and positive attitude of infectious disease notification; however, there were some deficiencies. Better instruction and training on infectious disease notification procedures of Malaysia should be provided to the final year medical students which could not only reduce underreporting but also improve timely and effective reporting in future.

  9. Rillera Marzo R, Villanueva Iii EQ, Chandra U, Htay MNN, Shrestha R, Shrestha S
    J Public Health Res, 2021 Dec 15;10(s2).
    PMID: 34911287 DOI: 10.4081/jphr.2021.2604
    BACKGROUND: COVID-19 pandemic has caused an extraordinary situation, especially for the healthcare workers (HCWs), leading to increased psychological stress. The aim of the study was to estimate the prevalence of different grades of anxiety and depression across different centers in the Philippines and identify demographic factors associated with them.

    DESIGN AND METHOD: A cross-sectional, web-based, multi-center study was conducted among HCWs of Philippines from April 20- May 20, 2020. The study instruments used were the Generalized Anxiety Disorder (GAD-7) scale and Patient Health Questionnaire (PHQ-9). Risk perception scores were analyzed using Mann-Whitney and Kruskal-Wallis test. Logistic regression was done to identify factors significantly associated with symptoms of anxiety and depression determined.

    RESULTS: A total of 516 HCWs were included in the study. Most of them have anxiety symptoms (70.74%), but only half of them have symptoms of depression (50.97%). In addition, gender, age, marital status, living status, occupation, work premises, and availability of mental health services were significantly associated with the participants' anxiety symptoms. In contrast, gender, marital status, occupation, and work premises were significantly associated with depression symptoms.

    CONCLUSION: This study reiterates the fact and demonstrates that COVID-19 has disrupted the mental well-being of HCWs in the Philippines. Majority of HCW was psychologically affected by COVID-19. Therefore, there is a dire need to address mental illness amongst HCWs and frame guidelines based on proven algorithms to overcome these mental illnesses.

  10. Htay MNN, Parial LL, Tolabing MC, Dadaczynski K, Okan O, Leung AYM, et al.
    PLoS One, 2022;17(4):e0266276.
    PMID: 35417478 DOI: 10.1371/journal.pone.0266276
    During the COVID-19 pandemic, there is a growing interest in online information about coronavirus worldwide. This study aimed to investigate the digital health literacy (DHL) level, information-seeking behaviour, and satisfaction of information on COVID-19 among East and South-East Asia university students. This cross-sectional web-based study was conducted between April to June 2020 by recruiting students from universities in China, Malaysia, and the Philippines. University students who have Internet access were invited to participate in the study. Items on sociodemographic variables, DHL, information-seeking behaviour, and information satisfaction were included in the questionnaire. Descriptive statistics and logistic regression analysis were conducted. A total of 5302 university students responded to the survey. The overall mean score across the four DHL subscales was 2.89 (SD: 0.42). Search engines (e.g., Google, Bing, Yahoo) (92.0%) and social media (88.4%) were highly utilized by the students, whereas Websites of doctors or health insurance companies were of lower utilization (64.7%). Across the domains (i.e., adding self-generated content, determining relevance, evaluating reliability, and protecting privacy) higher DHL was positively associated with higher usage of trustworthy resources. Providing online information on COVID-19 at official university websites and conducting health talks or web-based information dissemination about the strategies for mental health challenges during pandemic could be beneficial to the students. Strengthening DHL among university students will enhance their critical thinking and evaluation of online resources, which could direct them to the quality and trustworthy information sources on COVID-19.
  11. Htay MNN, Donnelly M, Schliemann D, Loh SY, Dahlui M, Somasundaram S, et al.
    Asian Pac J Cancer Prev, 2021 Jun 01;22(6):1685-1693.
    PMID: 34181322 DOI: 10.31557/APJCP.2021.22.6.1685
    BACKGROUND: Breast cancer is the leading cause of cancer among Malaysian women. The implementation of prevention measures including screening has the potential to reduce the burden of breast cancer which caused by late presentation.

    AIMS: This paper aimed to review the public health policy relating to breast cancer screening in Malaysia that was undertaken in order to contribute to policy development regarding cancer prevention, detection and the improvement of services for Malaysian women.

    METHODS: The policy review strategy included a specific search of the website of the Ministry of Health in Malaysia for relevant policies. In addition, we searched Google and Pubmed for breast cancer screening programmes, policies, and guidelines for women in Malaysia. In addition, experts and stakeholders provided additional resources, published in Malay language. Relevant guidelines in the Malay language were translated into English and included the document review.

    RESULTS: The policy analysis indicated that although it is known that screening, early detection and diagnosis improve survival rates, delayed diagnosis remains a significant issue.  The Ministry of Health policy stipulates the provision of opportunistic mammography screening. However, the uptake is varied, and implementation is challenging due to a lack of awareness about screening and difficulties related to accessing services, especially in rural areas. The establishment and implementation of referral guidelines is essential to receive timely treatment for breast cancer patients. There is a need to enhance the cancer reporting by the doctors to the national cancer registry, in collaboration with government services and the private cancer-care sector to improve the monitoring and evaluation of cancer control policies and programmes.

    CONCLUSION: A focus on raising awareness, increasing the accessibility of screening facilities and improving referral processes and the overall connectivity of the cancer care system are key steps to down-staging breast cancer in Malaysia.
    .
  12. Htay MNN, Dahlui M, Schliemann D, Loh SY, Ibrahim Tamin NSB, Somasundaram S, et al.
    Eur J Cancer Care (Engl), 2022 Sep;31(5):e13675.
    PMID: 35946147 DOI: 10.1111/ecc.13675
    OBJECTIVES: This study investigated women's health beliefs, the use of breast cancer (BC) screening services, and the factors that potentially influence uptake of screening.

    METHODS: Face-to-face interviews were conducted with a randomly selected community sample of 992 women (>40 years old) in Selangor State, Malaysia.

    RESULTS: Approximately 35% of women received a clinical breast examination (CBE) and 27% had a mammogram within the last 1 to 2 years. The regression analyses indicated that Chinese ethnicity has higher perceived susceptibility to BC compared to Malay ethnicity (mean 7.74, SD: 2.75; 95% CI 0.09, 1.03) whilst a lower perceived susceptibility was observed in women aged ≥70 years (mean 6.67, SD: 3.01; 95% CI -1.66, -0.24) compared to women aged 40-49 years. Indian Malaysian women (mean 16.87, SD: 2.59; 95% CI 0.12, 1.01) and women who had received a CBE (mean 16.10, SD:2.35; 95% CI 0.18, 0.89) were more likely to have higher perceived benefits scoring. Indian ethnicity, secondary education and tertiary education, top 20% income group, past history of CBE and mammogram uptake were significantly associated with lower barriers scoring.

    CONCLUSIONS: There is a need to target BC screening uptake improvement programmes towards communities in which women experience disadvantages related to income, education, employment, and, in particular, to tailor programmes to take into consideration differences between ethnic groups regarding their beliefs about cancer screening.

  13. Elsayed MEG, El-Abasiri RA, Marzo RR, Dardeer KT, Kamal MA, Abdelaziz H, et al.
    PLoS One, 2023;18(2):e0282264.
    PMID: 36848375 DOI: 10.1371/journal.pone.0282264
    BACKGROUND: Coronavirus disease-19 emerged in December 2019. Healthcare workers were exposed to this highly infectious virus during the pandemic and suffered several social and psychological consequences, such as anxiety, psychological distress, and burnout.

    OBJECTIVES: To assess the psychological distress, anxiety, depression, coping strategies, risk perception, and attitude toward interprofessional teamwork among Egyptian healthcare workers during the COVID-19 pandemic.

    METHODS: We conducted a cross-sectional online survey which consisted of five sections. The primary outcomes were anxiety (GAD-7), depression (PHQ-9), risk perception towards COVID-19, interprofessional teamwork attitude, and coping strategies during the Coronavirus disease-19 pandemic. The web-based questionnaire was distributed to Egyptian healthcare workers from the 20th of April 2020 to the 20th of May 2020. A snowball sampling method was used. Regression analysis was conducted to test the relationship between the socioeconomic characteristics and the previously mentioned outcomes.

    RESULTS: A total of 403 participants responded to the online questionnaire. The majority were females (70.5%) and within the age group of 26-40 years (77.7%), with 2-5 years of work experience (43.2%). Most participants were pharmacists (33%) and physicians (22.1%). Eighty-two participants (21%) reported moderate to severe anxiety, and 79 participants reported (19.4%) moderate to severe depressive symptoms. In the univariate model, the marital status was associated with depression (OR 0.47, 95% CI 0.28-0.78), anxiety (OR 0.52, 95% CI 0.32-0.85), and an attitude toward interprofessional teamwork (β = -1.96 95% CI -2.72 to -1.2). Providing direct care to the patients was associated with lower anxiety symptoms (AOR 0.256, 95% CI 0.094-0.697). More severe anxiety and depressive symptoms were associated with difficulties in everyday life and the professional work environment (AOR 4.246 and 3.3, P = 0.003 and 0.01, respectively). Availability of mental health facilities at the workplace was associated with a lower risk perception towards COVID-19 (β = -0.79, 95% CI -1.24 to -0.34) and a more positive attitude towards teamwork (β = 2.77 95% CI 1.38-4.15).

    CONCLUSIONS: According to our results, the COVID-19 pandemic was associated with mild anxiety and depression among healthcare workers in Egypt, especially pharmacists and physicians. We recommend more research targeting the mental health of healthcare workers in Egypt. If proven cost-effective and needed, wide-scale mental health screening and public health campaigns can facilitate effective prevention and treatment strategies. In addition, the availability of mental health facilities at the workplace could alleviate some of the risk perception associated with health emergencies and improve interprofessional teamwork.

  14. Su TT, Adekunjo FO, Schliemann D, Cardwell CR, Htay MNN, Dahlui M, et al.
    BMJ Open, 2023 Aug 31;13(8):e072166.
    PMID: 37652591 DOI: 10.1136/bmjopen-2023-072166
    OBJECTIVE: To conduct a cultural adaptation and validation of the Champion Health Belief Model Scale (CHBMS) for colorectal cancer (CRC) screening (CHBMS-CRC-M) in order to assess and investigate perceptions and beliefs about CRC screening in Malaysia.

    DESIGNS AND PARTICIPANTS: The results from an evidence synthesis and the outcomes from an expert panel discussion were used to shape CHBMS scale content into an assessment of beliefs about CRC screening (CHBMS-CRC). This questionnaire assessment was translated into the official language of Malaysia. An initial study tested the face validity of the new scale or questionnaire with 30 men and women from various ethnic groups. Factorial or structural validity was investigated in a community sample of 954 multiethnic Malaysians.

    SETTING: Selangor state, Malaysia.

    RESULTS: The new scale was culturally acceptable to the three main ethnic groups in Malaysia and achieved good face validity. Cronbach's alpha coefficients ranged from 0.66 to 0.93, indicating moderate to good internal consistency. Items relating to perceived susceptibility to CRC 'loaded' on Factor 1 (with loadings scoring above 0.90); perceived benefits of CRC screening items loaded on factor 2 and were correlated strongly (loadings ranged between 0.63 and 0.83) and perceived barriers (PBA) to CRC screening (PBA) items loaded on factor 3 (range 0.30-0.72).

    CONCLUSION: The newly developed CHBMS-CRC-M fills an important gap by providing a robust scale with which to investigate and assess CRC screening beliefs and contribute to efforts to enhance CRC screening uptake and early detection of CRC in Malaysia and in other Malay-speaking communities in the region.

  15. Arafat SMY, Menon V, Khan MAS, Htay MNN, Singh R, Biyyala D, et al.
    Health Sci Rep, 2023 Dec;6(12):e1781.
    PMID: 38130329 DOI: 10.1002/hsr2.1781
    BACKGROUND AND AIMS: The connection between marital status and suicidal behavior has been poorly assessed in South Asia. We aimed to see the proportion of marital status in individuals with suicidal behavior in South Asian countries.

    METHODS: We followed PRISMA guidelines and registered the protocol in advance (PROSPERO 2023 CRD42023399906). A systematic search was conducted in Medline, Embase, and PsycINFO. Meta-analyses were performed to pool the proportion of married individuals with suicidal behavior (total [suicide + suicide attempts], suicide, and suicide attempt) in South Asian countries. We considered suicidal behavior consist of suicide and suicide attempts (nonfatal).

    RESULTS: Our search identified 47 studies for this review from 6 countries published from 1999 to 2022 with a sample size ranging from 27 to 89,178. The proportion of married individuals was 55.4% (95% CI: 50.1-60.5) for suicidal behavior, 52.7% (95% CI: 44.5-60.7) for suicides, and 43.1 (95% CI: 32.9-53.9) for suicide attempts. The proportion of married persons among suicide attempts varied significantly across countries (p = 0.016) which was highest (61.8%; 95% CI: 57.2-66.2) in India, followed by Bangladesh (52.5%; 95% CI: 41.8%-62.9%) and Pakistan (45.1%; 95% CI: 30.9-59.9). The pooled proportions did not differ significantly in relation to the quality of the studies (p = 0.633).

    CONCLUSION: This review identified married persons died more than others by suicide in South Asian countries while single persons attempted suicide than married. As the current study did not assess any cause-and-effect association, a cautious interpretation is warranted while considering married marital status as a risk factor.

  16. Htay MNN, Donnelly M, Schliemann D, Loh SY, Dahlui M, Ibrahim Tamin NSB, et al.
    Asian Pac J Cancer Prev, 2020 Jan 01;21(1):217-223.
    PMID: 31983187 DOI: 10.31557/APJCP.2020.21.1.217
    BACKGROUND: Breast cancer is the most common cancer among women in Malaysia, and the incidence of 31.1 per 100,000 population is comparatively higher than other Southeast Asian countries. Diagnosis tends to occur at later stages which may be due, partly, to inadequate knowledge about warning signs and symptoms. Therefore, this study investigated the validity and reliability of a UK-developed measure in the context of assessing women's awareness of breast cancer in Malaysia.

    AIMS: This study aimed to translate, adapt and validate the internationally recognised Breast Cancer Awareness Measure (B-CAM) into the Malay language.

    METHODS: The original B-CAM (Cancer Research UK) was forward and backward translated and content validation was ascertained. Face validity (n=30), test-retest reliability (n=50) and the internal consistency of the B-CAM-M (M for Malay language) were assessed in a community sample of adults (n=251) in 2018.

    RESULTS: The translated B-CAM-M was validated by an expert panel. The Item-Content Validity Index ranged from .83 to 1.00. The results from the survey (n=251) indicated that the B-CAM-M was well received by Malay-speaking women across the main ethnic groups (85 Malay, 84 Chinese and 82 Indian adults). Cronbach alpha scores for the knowledge about breast cancer symptoms (0.83) and the barriers to healthcare seeking items (0.75) were high. Test-retest reliability (separated by 2-week-interval) with 50 randomly selected participants from the community survey produced intra-class correlations ranging from 0.39 to 0.69.

    CONCLUSION: The Malay-version, the B-CAM-M, is a culturally acceptable, valid and reliable assessment tool with which to measure breast cancer awareness among Malay-speaking women.

  17. Schliemann D, Htay MNN, Dahlui M, Paramasivam D, Cardwell CR, Ibrahim Tamin NSB, et al.
    BMJ Open, 2020 Aug 20;10(8):e036503.
    PMID: 32819988 DOI: 10.1136/bmjopen-2019-036503
    OBJECTIVE: To evaluate the impact of a mass media campaign in terms of improving breast cancer (BC) symptoms awareness and screening uptake.

    DESIGN: Before-and after-study with comparator groups.

    SETTING: Selangor State, Malaysia.

    PARTICIPANTS: Malaysian women aged >40 years (n=676) from randomly selected households.

    INTERVENTION: A culturally adapted mass media campaign (TV, radio, print media and social media).

    PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint was BC symptoms awareness, which was assessed with the Breast Cancer Awareness Measure precampaign and postcampaign. Secondary outcomes included campaign reach, self-efficacy to notice BC symptoms and clinical outcomes. Clinical breast examination and mammogram screening data were collected from hospitals and clinics.

    RESULTS: Most participants recognised at least one of the campaign materials (65.2%). The odds of seeing the campaign were lowest for Chinese women (adjusted OR 0.25, 95% CI 0.15 to 0.40) compared with Malays and for women aged >70 years (adjusted OR 0.47, 95% CI 0.23 to 0.94) compared with younger women. Participants who recognised the campaign were significantly more likely to have improved awareness postcampaign compared with non-recognisers particularly for key symptoms such as 'a lump or thickening in your breast' (88.9% vs 62.1%) and 'discharge or bleeding from nipple' (79.7% vs 55.3%). Improvement in symptoms awareness scores was not associated with sociodemographic variables.

    CONCLUSIONS: Implementation in Malaysia of an evidence-based mass media campaign from the UK that was culturally adapted appeared to lead to improved awareness about some BC symptoms, though various modes of media communication and perhaps other health education approaches may be required to extend the reach to diverse, multiethnic populations and all age groups.

  18. Htay MNN, Dahlui M, Schliemann D, Cardwell CR, Loh SY, Ibrahim Tamin NSB, et al.
    PMID: 35162641 DOI: 10.3390/ijerph19031618
    This study evaluated the impact of the 'Be Cancer Alert' mass media campaign for breast cancer (BCAC-BC) in terms of changes to women's health beliefs regarding BC susceptibility and the benefits and barriers of breast cancer screening in Malaysia. Pre- and post-campaign surveys evaluated changes in health beliefs among women aged 40 years and above (n = 676). The perceived susceptibility to breast cancer was significantly higher at follow-up (mean ± SD: 7.30 ± 2.77 vs. 7.63 ± 2.58, p = 0.008) whereas the mean score for the perceived benefits of undertaking screening was high at baseline and follow-up (16.34 ± 2.36 vs. 15.95 ± 2.07, p = 0.001). The perceptions or beliefs about barriers to screening did not change significantly (31.70 ± 8.26 vs. 31.77 ± 7.63, p = 0.841). Regression analyses indicated that mean scores for the barriers subscale were significantly lower among Chinese women (-2.61, 95% CI -4.67, -0.55, p = 0.013) compared to Malay, and among single compared to married women (-2.40, 95% CI -4.60, -0.21, p = 0.032) after adjustment for other demographic variables and past screening history. Malaysian women appeared to already have positive perceptions before the BCAC-BC mass media campaign about the benefits of BC screening. However, the campaign appeared to be linked to both an increased awareness of the susceptibility to breast cancer and to positive beliefs that countered emotional barriers to screening, particularly among single women and Chinese-Malay women.
  19. Htay MNN, Schliemann D, Dahlui M, Cardwell CR, Loh SY, Tamin NSBI, et al.
    Int J Environ Res Public Health, 2021 Sep 03;18(17).
    PMID: 34501903 DOI: 10.3390/ijerph18179311
    Breast cancer (BC) is the most common cancer among women globally, including in Malaysia. There is a need to assess women's beliefs about BC and screening in different cultural settings. This study aimed to translate and validate an adapted version of the United States (US) Champion Health Belief Model Scale (CHBMS) for an investigation of predictors of BC screening in Malaysia. The CHBMS was adapted, and forward and backward translated into the Malay language. The validity and reliability of the CHBMS-BC-M (M for Malay language) was investigated in a community sample of 251 multi-ethnic Malay-speaking women. Principal component analysis with varimax rotation indicated that the structure of the adapted CHBMS-BC-M comprised three subscales with 21 items, and an Item-Content Validity Index (I-CVI) of 0.83 and above for all items. The explanatory factor analysis (EFA) showed acceptable to high factor loadings on items. Cronbach's alpha for the subscales ranged from 0.59 to 0.87. The reproducibility of the scale was fair to high, with an Intraclass Correlation Coefficient (ICC) of 0.53 to 0.80 for the subscales. Overall, the analysis indicated that the translated CHBMS-BC-M is a valid and reliable scale to measure beliefs about BC and screening in the Malay-speaking ethnic population of Malaysia.
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