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  1. Abu Bakar FA, Ismail TAT
    Oman Med J, 2021 Jul;36(4):e282.
    PMID: 34267954 DOI: 10.5001/omj.2021.125
    Objectives: Glucose testing at six weeks after delivery has been recommended by the World Health Organization as the earliest period to detect abnormal glucose tolerance among women with gestational diabetes mellitus (GDM). However, the rate of postpartum glucose testing in many parts of the world is low, between 30-60%. Therefore, we sought to determine the proportion of women with GDM who underwent glucose testing at six weeks postpartum and the factors associated with the compliance to the test.

    Methods: We conducted a cross-sectional study between January and April 2017 in 13 governmental primary health care clinics in the southern part of Peninsular Malaysia. All eligible postpartum women registered from January to June 2016 who had GDM during their most recent pregnancy were included. Descriptive and multiple logistic regression analyses were performed.

    Results: Out of 341 women, 35.8% attended primary health care clinics for glucose testing six weeks postpartum. The factors significantly associated with the compliance to postpartum glucose testing were GDM diagnosis in previous pregnancy (adjusted odds ratio (AOR) = 1.76; 95% confidence interval (CI): 1.04-2.99; p = 0.036) and normal level of glycated hemoglobin during the most recent pregnancy (AOR = 2.49; 95% CI: 1.06-5.86; p = 0.036).

    Conclusions: The proportion of women with GDM who underwent postpartum glucose testing remained low. Hence, strategies should be reinforced to encourage all women with GDM to undergo postpartum glucose testing.

  2. Webair HH, Ismail TAT, Ismail SB, Khaffaji AJ
    BMJ Open, 2021 06 18;11(6):e044300.
    PMID: 34145008 DOI: 10.1136/bmjopen-2020-044300
    OBJECTIVE: The current study aims to define patient-centred infertility care (PCIC) from the perspective of Arab women with infertility.

    DESIGN: Semistructured in-depth telephone interviews.

    SETTING: Hospitals providing infertility care, Jeddah, Saudi Arabia.

    PARTICIPANTS: Arab women who received infertility treatment during the 6 months preceding the interview at any hospital in Jeddah, Saudi Arabia. Interviews were conducted with Arab women experiencing infertility from January 2017 to December 2018. A purposive sample of 14 women were included in the final analysis with maximum variation.

    RESULTS: Participants highlighted nine important PCIC dimensions. Of these, four were agreed on by all participants: accessibility, minimising cost, information and education, and staff attitudes and communication. The remaining five dimensions were staff competence, physical comfort, privacy, psychological and emotional support, and continuity and coordination of care. The concept of PCIC was related to three major contributors: participants' demographics, patient experience with infertility care and health-seeking behaviour.

    CONCLUSIONS: The current study provided nine PCIC dimensions and items, which can guide efforts to improve the quality of infertility care in Arab countries in two ways: first, by raising infertility care providers' awareness of their patients' needs, and second, by developing a validated tool based on the dimensions for measuring PCIC from Arab patients' perspective. Clear differences between the Arab and the European PCIC model were found. Our findings concluded that women continued to exhibit basic unmet needs.

  3. Webair HH, Ismail TAT, Ismail SB, Mohd Noor N
    BMJ Open, 2019 11 14;9(11):e032266.
    PMID: 31727658 DOI: 10.1136/bmjopen-2019-032266
    INTRODUCTION: Patient-centred infertility care (PCIC) is one of the quality indicators of effective fertility care. The application of this indicator requires a clear definition from the patient's perspective. This proposed scoping review aims to explore the extent and nature of published scientific literature on PCIC in the past decade, identify gaps in the literature and define PCIC from infertile patients' perspectives.

    METHODS AND ANALYSIS: We will conduct the proposed scoping review following the method of Arksey and O'Malley. The literature search will include studies published from 2009 to 2019, and will be conducted on the MEDLINE, PsycINFO, Scopus, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases; reference lists will be mined for literature not contained on these databases. A grey literature search will also be conducted. To be included in the review, studies should have been conducted on people with a history of infertility, with a focus on patient-centred fertility care. Studies that have not been published in full text and studies published in languages other than English will be excluded. After study selection, data will be charted in a prepared form. We will analyse the data using descriptive numerical and qualitative thematic analyses to answer the research questions. NVivo V.12 will be used for data extraction.

    ETHICS AND DISSEMINATION: This work does not warrant any ethical or safety concerns. This scoping review will synthesise existing literature on PCIC, and the results will be published to be readily available for clinical audiences and policymakers. These findings may support clinicians and decision-makers in applying PCIC, thereby promoting high-quality healthcare in the concerned population.

  4. Che Abdul Rahim N, Sulaiman Z, Ismail TAT
    PLoS One, 2024;19(1):e0291758.
    PMID: 38277383 DOI: 10.1371/journal.pone.0291758
    BACKGROUND: Induction of lactation occurs when breast milk is produced in a human (woman), without going through the process of pregnancy and delivery. Efforts to produce milk by women who had never been pregnant and give birth are not easy. According to the many who have attempted it, it is far more arduous a task than initiating postpartum lactation, but it is possible and worth the effort.

    RESEARCH AIM: This study aimed to explore and understand the challenges for women during induced lactation in Malaysia.

    METHODS: This qualitative study was done in 2017 and utilized in-depth interview among women who induced lactation in five states based on five regions in Malaysia [Central Region (Selangor), Northern Region (Penang), Southern Region (Johor), East Coast Region (Kelantan), Malaysia Borneo (Sabah)]. All interviews were consented, audio-recorded then transcribed verbatim, followed by identification of main themes.

    RESULTS: Data saturation was achieved after interviewing a total of 23 induced lactation women. Data synthesized using thematic analysis revealed six themes describing the main challenges during the induction process were (1) health condition, (2) work commitment, (3) overexertion, (4) not eligible to take leave, (5) inability to follow the treatment plan, and (6) difficulty attaching the adopted baby to initiate breastfeeding during induced lactation process.

    CONCLUSIONS: The challenges faced by women during the process of induced lactation were complex and the induced lactation process requires considerable dedication and determination. The findings of this research will help other women and their spouses/partners comprehend the challenges, obstacles, and support that are needed along the induced lactation process. The Government and other stakeholders have roles in more efforts and programs to help these mothers breastfeed their adoptive child and make them feel more accomplished as women and mothers.

  5. Rahim NCA, Sulaiman Z, Ismail TAT
    Malays J Med Sci, 2017 Aug;24(4):5-17.
    PMID: 28951685 MyJurnal DOI: 10.21315/mjms2017.24.4.2
    Induced lactation is a method of stimulating the production of breast milk in women who have not gone through the process of pregnancy. Recent advances in technology have given such women the opportunity to breastfeed adopted children. Previous studies conducted in Western countries have explored the breastfeeding of adopted children, as well as the experiences, successes and challenges of this process. However, research on procedures for breastfeeding adopted children is lacking in Malaysia. The authors have therefore reviewed literature related to induced lactation in Malaysia to fill this gap. Of the 30 related articles identified, 19 described the breastfeeding practices and experiences of adoptive mothers in Malaysia. Out of 19 articles, there were four journal articles, five circulars and regulations, two books, two post-graduate theses, four blogs posts and forum discussions, and two online newspaper articles. Medical information relating to induced lactation procedures was also reviewed, showing that there was a lack of scientific studies focusing on induced lactation practices among adoptive mothers. Information on religious, specifically Islamic, perspectives on breastfeeding and child adoption laws was gathered from websites, social networks, blogs, magazines and online news sources. In consideration of recent advancements in medical technology and the dire need among Malaysians, it is crucial that evidence-based, accurate and reliable information on induced lactation is made available to professionals and other individuals in this country.
  6. Muda CMC, Ismail TAT, Jalil RA, Hairon SM, Sulaiman Z, Johar N
    Women Birth, 2019 Apr;32(2):e243-e251.
    PMID: 30057368 DOI: 10.1016/j.wombi.2018.07.008
    BACKGROUND: The first week after childbirth is a crucial period for exclusive breastfeeding initiation.

    OBJECTIVE: This study aims to determine the association of postnatal breastfeeding education with knowledge, attitude, and exclusive breastfeeding practice at six months after childbirth among women who delivered at two district hospitals in the northeast part of Peninsular Malaysia.

    METHODS: This is a quasi-experimental study design. A newly developed and validated questionnaire was used to determine scoring for baseline and six months after childbirth. The intervention consisted of individualized postnatal breastfeeding education delivered by researchers using flipchart one week after childbirth and breastfeeding diary in addition to usual care. The comparison group received the usual postnatal care by health clinics. Repeated measure analysis of variance and multiple logistic regression analysis were used.

    RESULTS: A total of 116 participants were included in this study (59 in intervention group and 57 in comparison group). Six months after childbirth, the adjusted mean score of knowledge and attitude of the intervention group were significantly higher than that of the comparison group (p<0.001 and p=0.002, respectively). More participants in the intervention group (n=26, 44.1%) exclusively breastfed their infants compared with 15 (26.3%) in the comparison group (p=0.046). Postnatal breastfeeding education was significantly associated with exclusive breastfeeding practice six months after childbirth [adjusted odds ratio 2.31; 95% confidence interval: 1.02, 5.14; p=0.040].

    CONCLUSIONS: Postnatal breastfeeding education was significantly associated with an improvement in women's knowledge, attitude and exclusive breastfeeding practice six months after childbirth.
  7. Dwekat IMM, Ismail TAT, Ibrahim MI, Ghrayeb F, Hanafi WSWM, Ghazali AK
    Midwifery, 2021 Nov;102:103076.
    PMID: 34224953 DOI: 10.1016/j.midw.2021.103076
    OBJECTIVE: This study aims to develop and validate a new questionnaire to measure mistreatment of women during childbirth and its association with satisfaction and perceived quality of care among women in West Bank, Palestine.

    RESEARCH DESIGN /SETTING: A cross-sectional validation study was conducted in middle and south of West Bank from February 2019 to June 2020. Two-hundred postpartum women were given self-administered and online questionnaire. Content and face validity were assessed. The "satisfaction of care" and "perceived quality of care" domains were analyzed using exploratory factor analysis, while items in "experience of mistreatment" domain were evaluated descriptively. Cronbach's alpha was used to assess the reliability of the questionnaire items.

    FINDINGS: The new questionnaire consisted of three domains: "satisfaction of care", "perceived quality of care", and "experience of mistreatment" during childbirth. Five new items were added and two items were removed during content validation. Another two items were deleted through face validation. Exploratory factor analysis was conducted for the "satisfaction of care" and "perceived quality of care" domains. Two factors were identified for each domain, with a factor loading of more than 0.5. Twelve items were deleted from "satisfaction of care" domain and two items from "perceived quality of care" domain. The Cronbach's alpha values for the two factors in both domains were more than 0.87. The items in the "experience of mistreatment during childbirth" domain were evaluated descriptively.

    KEY CONCLUSIONS: The new questionnaire is valid and reliable. The final questionnaire consists of 11 items for "satisfaction of care", 16 items for "perceived quality of care" and 43 items for "experience of mistreatment of women during childbirth".

  8. Dwekat IMM, Ismail TAT, Ibrahim MI, Ghrayeb F, Abbas E
    Int J Environ Res Public Health, 2022 Oct 13;19(20).
    PMID: 36293759 DOI: 10.3390/ijerph192013180
    Mistreatment of women during childbirth is a clear breach of women's rights during childbirth. This study aimed to determine the prevalence and associated factors of mistreatment of women during childbirth in the north of West Bank, Palestine. A cross-sectional study was conducted among 269 women within the first 16 weeks of their last vaginal childbirth to understand the childbirth events by using proportionate stratified random sampling. An Arabic valid questionnaire was used as a study instrument. Simple and multiple logistic regression analyses were conducted to determine the factors associated with each type of mistreatment. The mean age of the women was 26.5 (SD 4.77) years. The overall prevalence of mistreatment was 97.8%. There were six types of mistreatment. Nine factors were significantly associated with the occurrence of one or more types of mistreatment. Delivery at a public childbirth facility was associated with all of the six types (aAdjOR: 2.17-16.77; p-values < 0.001-0.013). Women who lived in villages (aAdjOR 2.33; p-value = 0.047), had low education (aAdjOR 5.09; p-value = 0.004), underwent induction of labour (aAdjOR 3.03; p-value = 0.001), had a long duration of labour (aAdjOR 1.10; p-value = 0.011), did not receive pain killers (aAdjOR: 2.18-3.63; p-values = 0.010-0.020), or had an episiotomy or tear (aAdjOR 5.98; p-value < 0.001) were more likely to experience one or more types of mistreatment. With every one-hour increase in the duration of labor, women were 1.099 times more likely to experience a failure to meet the professional standard of care. Women were less likely to experience mistreatment with increasing age. Women with increasing age (aAdjOR: 0.91-0.92; p-values = 0.003-0.014) and parity (aAdjOR 0.72; p-value = 0.010) were less likely to experience mistreatment. Awareness of women's fundamental rights during childbirth, making the childbirth process as normal as possible, and improving the childbirth facilities' conditions, policies, practices and working environment may decrease mistreatment occurrence.
  9. Hanafi WSWM, Ismail TAT, Ghazali AK, Sulaiman Z, Daud A
    PMID: 35565113 DOI: 10.3390/ijerph19095718
    Intimate partner violence (IPV) is a serious public health issue, which is health threatening across all age groups, including young adults, and makes them and vulnerable. The rejection of IPV and willingness to disclose IPV as part of the solution are important as they correlate to this concealed violent behavior. This study aimed to investigate determinants of attitudes towards rejecting IPV among young adults. A cross-sectional study was carried out on 405 young adults attending premarital courses who were selected using purposive sampling. A validated questionnaire (MYPAIPVQ) was used as the study instrument. Logistic regression analyses were performed to test for associations between sociodemographic characteristics and relationship status with attitudes towards IPV. Attitudes towards rejecting IPV included not accepting IPV and have the willing to disclose it. About half of the premarital young adults (50.4%) had attitudes towards rejecting IPV. In the regression analysis, age (AdjOR 1.12), female (AdjOR 2.49), self-employed (AdjOR 0.20), and drama as sources of information (AdjOR 3.66) were significantly associated with attitudes towards rejecting IPV. The findings have potentially important implications for interventions aimed at preventing violence among the young adult population as they are vulnerable to being involved in IPV in the future.
  10. Webair HH, Ismail TAT, Ismail SB, Khaffaji AJ, Hussain NHN, Kadir AA, et al.
    BMC Med Res Methodol, 2021 09 20;21(1):188.
    PMID: 34544388 DOI: 10.1186/s12874-021-01376-w
    BACKGROUND: Patient-centered care is an essential component of health care quality. To achieve patient-centered care, health care authorities should have a clear definition and an applicable tool to measure the extent of its application. The real concept of patient centeredness should be developed by the patients themselves. We aimed to demonstrate a way to develop a draft Arabic patient-centered infertility care (PCIC) questionnaire for females clients following practical steps that address women with infertility.

    METHODS: An iterative process of questionnaire development was undertaken by combining two approaches: the steps proposed by Robert F. DeVellis for scale development and the recommended practices for questionnaire development and testing in the European statistical system. We attempted to develop the draft questionnaire that involved conceptualization and operationalization, generation of an item pool, development of the questionnaire format, review of the initial item pool by experts, and consideration of validation items for inclusion.

    RESULTS: We generated an item pool from in-depth interviews with 14 women who sought infertility care within 6 months before the interview time. We then added more items from a literature review. The item pool contained 123 items distributed through 10 domains. Ten women with infertility were included for face validation. Then, experts with backgrounds in Obstetrics and Gynecology, Family Medicine, and Public Health reviewed the item pool using content validation (n = 10 professors and/or specialists). The item pool was finally reduced to 57 items. We developed the draft Arabic patient-centered infertility care questionnaire for female clients (PCIQ-F) with three sections, including 66 items: background variables, PCIC experience variables, and a general question about the quality of infertility care in the health facility. The draft questionnaire was further reviewed and edited last by experts in preparation for part 2, which will test the questionnaire and prepare the final version.

    CONCLUSION: The PCIQ-F questionnaire development is a multi-step iterative process started and ended by the target users as experts. Experts' participation in infertility care and in questionnaire format development had a great impact on questionnaire development and conflict resolution. We recommend this transparent and replicable approach for new instrument developers; it is likely to generate a questionnaire that is valid and acceptable to target users. The draft PCIQ-F questionnaire is ready for testing of its psychometric properties before the final version to measure the PCIC level in health facilities.

  11. Hamzah N, Musa KI, Romli MH, Chen XW, Rahim MZA, Abdullah JM, et al.
    BMC Public Health, 2023 Jan 30;23(1):198.
    PMID: 36717840 DOI: 10.1186/s12889-023-15076-1
    BACKGROUND: Post-stroke complications affect the informal caregivers equally as the stroke survivors, especially those who have a moderate to worst prognosis in functional capacity recovery. Caregiver Assessment of Function and Upset (CAFU) is one of the common tools used in both research and clinical practice to measure the patient's dependency level and the stroke caregivers' upset level.

    OBJECTIVE: This study aimed to translate and validate the CAFU instrument into the Malay language and test the validity and reliability of the CAFU among informal stroke caregivers in Malaysia.

    METHODS: A standard forward-backward translation method was employed to translate CAFU. Subsequently, 10 expert panels were included in the validation process, and thereafter reliability testing was conducted among 51 stroke caregivers. The validation of the instrument was determined by computing the content validity indices (CVIs), and we used the Cronbach's alpha method to explore the internal consistency of the overall score and subscales scores of the Malay-CAFU. Finally, the explanatory factor analysis used principal component extraction and a varimax rotation to examine construct validity.

    RESULTS: All items of the Malay-CAFU had satisfactory item-level CVI (I-CVI), with values greater than 0.80, and the scale-level CVI (S-CVI) was 0.95. These results indicate that the Malay-CAFU had good relevancy. The internal consistency for the reliability test showed a Cronbach's alpha value of 0.95 for the overall score. The eigenvalues and scree plot supported a two-factor structural model of the instrument. From the explanatory factor analysis, the factor loadings ranged from 0.82 to 0.90 and 0.56 to 0.83, respectively.

    CONCLUSION: The Malay-CAFU questionnaire is a valid and reliable instrument to assess the dependence level of stroke survivors and the upset level of informal stroke caregivers in Malaysia.

  12. Ismail TAT, Jalil RA, Wan Ishak WR, Hamid NF, Wan Nik WS, Jan Mohamed HJ, et al.
    Korean J Fam Med, 2018 Jan;39(1):15-22.
    PMID: 29383207 DOI: 10.4082/kjfm.2018.39.1.15
    Background: A qualitative study providing an in-depth exploration of people's view and the increasing burden of overweight and obesity is required. This study aimed to explore the understanding of dieting and previous experiences on weight loss attempts among overweight and obese government employees in Kelantan, Malaysia, prior to recruitment into the intervention program.

    Methods: Thirteen focus group discussions involving 129 participants from a weight-loss intervention program were conducted within the first 1 month of recruitment. These discussions were moderated by two trained researchers in the Malay language and assisted by an interview guide. They were audio-recorded and transcribed verbatim. A thematic analysis was performed, and codes and themes from each discussion were constructed.

    Results: The participants understood dieting with various meanings, including skipping meals and removing rice from daily diets. They applied numerous methods to lose weight and achieved various outcomes. Health and appearance, social support, and compliance with current trends were the factors motivating these participants to lose weight. Their determination to lose weight was limited by lack of self-control and motivation, experiences of unpleasant effects, influence on weight, and environmental and health factors.

    Conclusion: Real-life weight loss experiences and perceptions provided relevant insights into current weight loss management strategies. Some of these issues and misunderstandings should be emphasized in weight loss strategies during health promotion.

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