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  1. Hall K, Ono M, Kohno A
    Comp Migr Stud, 2021;9(1):7.
    PMID: 33654657 DOI: 10.1186/s40878-020-00217-x
    Most research on international retirement migration has focused on the Western context and the motivations and lifestyle choices of migrants when they are healthy. This paper instead explores how British retirees in Spain and Japanese retirees in Malaysia respond to declining health and increasing care needs through bricolage as they begin to 'age in place'. The paper combines qualitative interviews, focus groups and observations collected by the authors from 215 British and Japanese international retirement migrants. We focus on two key types of bricolage behaviour: 'within-system bricolage' undertaken by migrants to help them access and navigate existing health and care systems; and 'added-to-system bricolage' that is enacted to fill gaps in health and care provision. Our analysis suggests that IRMs engage in 'transnational care bricolage' by combining multiple economic, social and legal resources across local and transnational spaces to address their health and care needs.
  2. Kohno A, Dahlui M, Nik Farid ND, Safii R, Nakayama T
    BMC Womens Health, 2020 03 04;20(1):46.
    PMID: 32131810 DOI: 10.1186/s12905-020-00911-z
    BACKGROUND: Child marriage, a marriage that involves someone under the age of 18 years, is a long-standing social issue in Sarawak state, Malaysia. The state has taken several measures to improve situations of inequity for women who get married early; however, the practice is still a common part of the tradition and culture. The aim of this study was to explore the factors leading to child marriage in Sarawak state, Malaysia.

    METHODS: This was an exploratory qualitative study conducted via semi-structured interviews with twenty-two women who were married when they were younger than 18 years old in Kuching, Sarawak, Malaysia. Participants were recruited through purposive and convenient sampling with the use of data from a reproductive health clinic and recruitment in villages. Thematic analysis was used for data analysis.

    RESULTS: Four overarching themes were identified: health risk behaviour, family poverty, early marriage as fate, and family disharmony.

    CONCLUSIONS: In-depth understanding of the unique factors leading to child marriage locally will facilitate the introduction of new approaches to interventions to eradicate child marriage in Sarawak state, Malaysia.

  3. Kohno A, Nik Farid ND, Musa G, Abdul Aziz N, Nakayama T, Dahlui M
    BMJ Open, 2016;6(3):e010668.
    PMID: 27006344 DOI: 10.1136/bmjopen-2015-010668
    While living overseas in another culture, retirees need to adapt to a new environment but often this causes difficulties, particularly among those elderly who require healthcare services. This study examines factors affecting healthcare service utilisation among Japanese retirees in Malaysia.
  4. Kohno A, Musa G, Nik Farid ND, Abdul Aziz N, Nakayama T, Dahlui M
    BMC Health Serv Res, 2016 May 05;16:167.
    PMID: 27151089 DOI: 10.1186/s12913-016-1417-3
    BACKGROUND: Worldwide, international retirement migration is growing in its popularity and Japanese retirees choose Malaysia as their most preferred destination. This study examines the pertinent issues related to healthcare services as experienced by Japanese retirees in this country.

    METHODS AND RESULTS: From January to March 2015, we conducted focus group discussions with 30 Japanese retirees who live in Kuala Lumpur and Ipoh. Guided by the social-ecological model, we discovered seven pertinent themes: 'language barriers','healthcare decisions', 'medical check-ups','healthcare insurance', 'nursing and palliative care', 'trust and distrust of healthcare services', and 'word-of-mouth information'.

    DISCUSSION: We identified seven pertinent issues related to healthcare services among Japanese retirees in Malaysia, of which four are especially important. These issues are explained as integrated themes within the social-ecological model. Language barriers prohibit them from having difficulty accessing to healthcare in Malaysia, but lack of will to improve their language skills exist among them. For that reason, they rely heavily on word-of-mouth information when seeking for healthcare. As a consequence, some develop feelings of trust and distrust of healthcare services. In addition, we have identified the needs for provide nursing and palliative care among Japanese retirees in Malaysia.

    CONCLUSION: Based on the magnitude of the discussion, we concluded that there are four crucial healthcare issues among Japanese retirees; 'language barriers', 'trust and distrust of healthcare services', 'word-of-mouth information' and 'nursing and palliative care'. We propose that further dialogue by healthcare stakeholders should be carried out to improve further the healthcare service provisions for Japanese retirees in Malaysia.

  5. Kohno A, Dahlui M, Nik Farid ND, Ali SH, Nakayama T
    BMJ Open, 2019 09 03;9(9):e027377.
    PMID: 31481551 DOI: 10.1136/bmjopen-2018-027377
    OBJECTIVE: To examine individual, familial, community and societal issues surrounding the reasons for child marriage in Kelantan, Malaysia.

    DESIGN: Qualitative study by means of semistructured interviews with women and key informants, using social-ecological model as a conceptual framework.

    SETTING: Interviews were conducted in Kota Bharu district, Kelantan, a northeast state in Peninsular Malaysia.

    PARTICIPANTS: Eighteen women of reproductive age (18 to 44 years old) that experienced their first marriage below the age of 18, as well as five key informants, consisting of a government officer, a community leader, an officer from religious department and two mothers. The women were recruited from a reproductive health clinic. The key informants who had specialised knowledge related to child marriage were selectively chosen.

    RESULTS: Three themes emerged that aligned with the social-ecological model: immaturity in decision-making, family poverty and religious and cultural norms.

    CONCLUSIONS: The findings imply that sex education and awareness-building activities regarding the consequences of child marriage must be implemented to eradicate child marriage in Malaysia. Such implementation must be coordinated as a team-based approach involving experts in such fields as law, religion, psychology, social-welfare and public health. In order to increase the awareness of child marriage consequences, the target for awareness must extend not only to the adolescent girls and their families, but also to the community and society at large by clearly communicating the negative consequences of and addressing the drivers for child marriage.

  6. Kohno A, Techasrivichien T, Suguimoto SP, Dahlui M, Nik Farid ND, Nakayama T
    PLoS One, 2020;15(7):e0235959.
    PMID: 32678862 DOI: 10.1371/journal.pone.0235959
    In this study, we synthesized findings from qualitative studies to identify the key factors that influence child marriage. We used a meta-ethnographic approach coupled with thematic synthesis. We searched literature from nine databases, which were in English language, covering areas in public health, psychology, and social science between 2008 and 2018. Twelve studies were included in the synthesis. We identified six main themes: human insecurity and conflict; legal issues; family values and circumstances; religious beliefs; individual circumstances, beliefs, and knowledge; and social norms. Our findings highlight the impact of human insecurity and conflict, as well as legal issues. In spite of global progress scaling up legislation against child marriage, the legal framework is insufficiently enforced in many settings. Most of the included studies were from the Middle East, Africa, and South Asia. Studies from other parts of the world such as Latin America and Southeast Asia, which have the highest rates of child marriage, are needed.
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