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  1. Wan Nor Arifin
    Education in Medicine Journal, 2012;4(1):129-143.
    MyJurnal
    Among most important aspects in conducting a clinical trial are random sampling and allocation of subjects. The processes could be easier if done with familiar software used for data entry and analysis instead of relying on other programs or methods. The objective of this article is to demonstrate random sampling and allocation using SPSS in step-by-step manners using examples most relevant to clinicians as well as researchers in health sciences.
  2. Wan Nor Arifin
    MyJurnal
    Multivariate analyses depend on multivariate normality assumption. Although the analyses are available in SPSS, it is not possible to assess the assumption from the basic package. Statistical assessment of the normality is available in a specialized package, SPSS Amos, in form of Mardia's multivariate kurtosis. However, graphical assessment of the normality by chi-square versus Mahalanobis distance plot is not available in both of the packages. The aim of this article is to present the steps to construct the plot in SPSS in a point-and-click manner as expected by most SPSS users.
  3. Wan Nor Arifin
    MyJurnal
    For the purpose of teaching statistics, lecturers often rely on data from real studies, text book examples or painstakingly created datasets. The process of creating a dataset can be made easier with the utilization of PASW Statistics to generate random values. The objective of this article is to demonstrate the creation of data which are measured on continuous scale, using PASW Statistics menus and syntax.
  4. Wan Nor Arifin
    MyJurnal
    One of the most common reasons why researchers seek help from statistician is sample size calculation. However despite the common believe that it only involves formula and calculation, researchers often ignore other aspects of research design that leads to proper sample size calculation. In this article, the author outlines basic steps toward sample size calculation. The author also introduces the logic behind sample size calculation for single mean and single proportion in simplified and less intimidating forms to those not statistically inclined.
  5. Wan Nor Arifin
    MyJurnal
    Planning a validation study of a questionnaire or measurement tool requires consideration for testing
    the validity and reliability aspects of the measurement tool. When it comes to the reliability aspect,
    a number of commonly used statistical coefficients such as Cronbach’s alpha, intraclass correlation,
    kappa and Pearson’s correlation coefficients would be considered to provide empirical evidence of the
    reliability of the tool during the validation process. To ensure that the reliability is accurately assessed,
    a researcher must consider the sample size requirement for the statistical analyses. In this article, I will
    introduce a newly developed web-based sample size calculator, which includes the ability to calculate
    the sample sizes of these four important coefficients. I will also show how to use the calculator for each
    of the coefficients.
  6. Wan Nor Arifin, Muhamad Saiful Bahri Yusof
    MyJurnal
    Item analysis (IA) is commonly used to describe difficulty and discrimination indices of multiple
    true-false (MTF) questions. However, item analysis is basically a plain descriptive analysis with
    limited statistical value. Item response theory (IRT) can provide a better insight into the difficulty
    and discriminating ability of questions in a test. IRT consists of a collection of statistical models that
    allows evaluation of test items (questions) and test takers (examinees) at the same time. Specifically,
    this article focuses on two-parameter logistic IRT (2-PL IRT) model that is concerned with estimation
    of difficulty and discrimination parameters. This article shows how 2-PL IRT analysis is performed in
    R software environment, guides the interpretation of the IRT results and compares the results to IA on
    a sample of MTF questions.
  7. Wan Nor Arifin, Muhamad Saiful Bahri Yusoff, Nyi Nyi Naing
    MyJurnal
    Introduction: Emotional intelligence (EI) is deemed an important aspect of being good medical doctors. Universiti Sains Malaysia (USM) Emotional Quotient Inventory (USMEQ-i) is an EI inventory in Malay language developed primarily as medical student selection tool in USM. Although it was already validated by exploratory factor analysis (EFA), EFA is considered insufficient evidence of construct validity, thus confirmatory factor analysis (CFA) was conducted. Objectives: To determine measurement model validity and construct validity of USMEQ-i among medical degree program applicants in USM by CFA. Methods: USMEQ-i data file for medical degree program applicants in USM for year 2010/2011 and 2011/2012 academic sessions were obtained from Medical Education Department in USM. A random sample of 512 cases was drawn from the data file. Of the sample, only 453 cases were valid study sample after preliminary data screening and assumption checking. CFA was conducted on the sample using maximum likelihood (ML) estimation with bootstrapping technique due to violation of multivariate normality assumption. USMEQ-i measurement model was proposed as a second-order EI factor with seven first-order factors of EI and a Faking Index (FI) factor, with correlation between second-order EI factor and FI factor. Results: The proposed model could not be fit into the study sample data. EI factors and FI factor had to be analyzed separately due to non-positive definite problem. After modifications to the model, CFA of EI factors were suggestive of two-factor model instead of the proposed seven-factor model. Consciousness, Maturity and Control (CoMaCt). CFA of FI factor maintained one-factor model and also valid in term of construct. Conclusion: The modified USMEQ-i, which consisted of separate EI and FI models, was proven to have valid measurement models and reliable constructs. It is considered to be suitable for use among applicants to medical degree program in USM. However, its use as medical student selection tool may require further research, especially how predictive USMEQ-i scores with real performance of medical students, generalizability of the inventory and its stability over time.
  8. Fahisham Taib, Roslinda Isa, Wan Nor Arifin, Jayah K. Pubalan
    MyJurnal
    Background: The prevalence of asthma among children is common. In Malaysia, the clinical observations have demonstrated that many children with asthma were not properly assessed and did not get proper treatment. Hence, poor asthma control could cause disruption to the child's ability to get enough sleep, to pay attention, to participate in school activities and thus affecting their quality of life.nagement
    Aim: The objective was to determine the effect of PAEP to change the quality of life of children, parents' mapractice and parents' technique of using an inhaler for their asthmatic children.
    Methods: The study design was a one group pre-test-post-test intervention study. The respondents consisted of 78 parents with asthmatic children, aged between 8 to 12 years old. Parents were required to answer the Paediatric Quality of Life Inventory Questionnaire, Management Behaviour Survey for Familial Caregivers and skills of inhaler technique using the checklist at the Paediatric Clinic Hospital USM. Following that were given a date to attend PAEP and were assessed two months later for postintervention. The analysis for PedsQL, Management Behaviour Survey for Familial Caregivers and skill of inhaler technique was done by using paired t-test. A total of 70 parents completed the study.
    Results: The study showed that the mean age for children with asthma was 9.31 years. PedsQL pre-intervention scores were 75.8%, and post-intervention 82.8%. The Mean of Management Behaviour Surveyfor Familial Caregivers scores increased from 53.16 to 62.33 pre-intervention and post-intervention, respectively. While the mean skill scores for inhaler user had increased from 3.43 to 7.13 for the MDI with a spacer. The findings showed statistical significance with P-values (<0.001) for PedsQL, Management Behaviour Survey for Familial Caregivers and skill scores for inhaler use.
    Conclusion: The PAEP had improved the children's quality of life, parents management practice andinhaler skills among parents with asthmatic children.
    Keywords : Prevalence, asthma, quality of life
    Study site: Paediatric clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
  9. Siti Nur-Farliza, Wan Nor Arifin, Nyi, Nyi Naing, Muhamad Saiful Bahri Yusof, Nor Azwany Yaacob
    MyJurnal
    Introduction: USMaP-i is an English, 66-item self-administered inventory, consisting of personality
    (60 items, 5 factors) and faking (one factor) components, which was mainly developed to measure
    personality traits among Malaysian students based on local cultures and values. The personality
    component was based on the Big Five dimensions as suggested by numerous personality researchers.
    Previous exploratory studies showed promising validity, reliability and stability of USMaP-i.
    Objective: To provide further validity evidence of USMaP-i for use among medical degree program
    applicants by confirmatory factor analysis (CFA). Methods: Data were collected as a part of screening
    of medical degree program applicants for year 2010–2013 intakes in Universiti Sains Malaysia
    (USM), of which 657 cases were suitable for analyses following a data screening measures. CFA was
    performed by bootstrap maximum likelihood estimation due to non-normality of items at multivariate
    level. Results: Although the revised five-factor model of personality showed good model fit (X2(df) =
    144.36(55), P-value < 0.001; CFI = .944, TLI = .921; RMSEA = .050; SRMR = .032, Bollen-Stine
    bootstrap P-value = 0.004), the reliability of the factors is very poor (composite reliabilities (CR) =
    .483 to .650). In contrast, the unidimensional faking component exhibited good model fit (X2(df)
    = 14.15(5), P-value = 0.015; CFI = .984, TLI = .968; RMSEA = .053; SRMR = .011, BollenStine
    bootstrap P-value = 0.068) and factor reliability (CR = 0.731). Conclusion: The personality
    component should be revised and revalidated due to poor reliability, despite showing good model fit.
    In contrast, the faking component showed good model fit and reliability. Further validation studies are
    recommended before its use among medical degree program applicants.
  10. Wan Nor Arifin, Wan Arfah Nadiah, Muhammad Irfan, Chen, Xin Wee, Nani Draman, Nyi, Nyi Naing
    MyJurnal
    To ensure the reliability of manual blood pressure (BP) readings in a clinical trial, sources of error due to measurement must be reduced as much as possible. Apart from following standard procedure for BP measurement and ensuring good equipments, the measurement errors that come from the assessors themselves should be assessed. Objective: To demonstrate the use of two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) intraclass correlation coefficient (ICC) in the assessment of reliability of manual BP readings among assessors involved in a clinical trial using manual BP measurement, by using an interrater reliability study conducted by the authors as an example study. Methods: The steps involved in obtaining ICC in the study were discussed. Sample size given the number of assessors in the study was calculated. BP was measured using regularly maintained mercury sphygnomanometers, following recommendations by Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) for BP measurement in office setting. The outcomes were systolic and diastolic BP readings. A type of ICC, two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) ICC was chosen for the analysis and specifically discussed. Pre-requisite assumptions for ICC were meticulously checked and described. The interrater reliability for systolic and diastolic BP readings as expressed by ICC (single measure) were presented with confidence interval (CI). The ICCs obtained in the example study were discussed and concluded. The flaws of the study were also criticised. Results: The interrater reliability for systolic and diastolic BP measurements as expressed by ICC (single measure) were 0.87 (95% confidence interval [CI] 0.722, 0.956) and 0.77 (95% CI 0.560, 0.918) respectively. Conclusion: We demonstrated the steps required to obtain ICC. Since the use of manual BP measurement using mercury sphygmomanometer is still considered as gold standard of BP measurement, it is important that studies in which the BP outcome is measured using such method conduct interrater reliability studies properly.
  11. Muhamad Saiful Bahri Yusoff, Rogayah Ja'afar, Hafiza Arzuman, Wan Nor Arifin, Mohamad Najib Mat Pa
    MyJurnal
    Introduction: Medical and allied health educators around the globe agreed that an optimal educational climate is a vital aspect for effective learning to take place. Without a doubt, appraisal of the educational climate has been emphasized as a key to the delivery of high quality medical education. In addition, the appraisal provides useful feedback to particular institution to improve their curriculum.

    Objective: This study was employed as part of the School of Medical Sciences (SMS) Universiti Sains Malaysia curriculum review process. It aimed to explore the strengths and weaknesses of the current medical curriculum thus could provide useful information to guide the curriculum review committee during the review process.

    Method: A cross sectional study was conducted on a total of 656 medical students from the first, third and fifth year of study. Purposive sampling method was applied. DREEM was administered to the medical students to evaluate the educational climate in the studied medical school.

    Result: A total of 511 (77.9%) medical students completely responded to the 50 statements of DREEM. The mean global score across phases of medical training was 128.36/200. The global scores for year 1, year 3 and year 5 were 138.94/200, 122.27/200 and 125.49/200 respectively. Results showed that; 1) the medical school had reasonably level of educational climates across phases of medical training; 2) the medical teachers were knowledgeable and well prepared for the teaching; 3) the students were overloaded with factual knowledge; 4) the medical teachers were quite harsh to students during teaching session especially in clinical phase; 5) students experienced a significant amount of stress that led to poor memory; 6) the learning process was inclined toward teacher-centered rather than student-centered learning; 7) students had a considerable healthy social relationships with peers as well as others; and 8) academic dishonesty became more apparent in the clinical phase.

    Conclusion: The medical school's educational environment across different phases of study was more positive than negative. However, there are plenty of rooms for improvement as perceived by the medical students. The medical school should address various important issues highlighted in this article during the curriculum review process.
  12. Mat Din Hazwan, Wan Nor Arifin, Sarimah Abdullah, Muhammad Saiful Bahri Yusoff, Aniza Abd Aziz
    MyJurnal
    Universiti Sains Malaysia (USM) Attitudes toward Statistics (USM-AS) is a newly developed, selfadministered inventory for measuring attitudes toward statistics among postgraduate students. The
    USM-AS consists of three factors (affect, cognition, and behavior) and 58 items. This study was
    aimed to validate the USM-AS and provide evidence of its construct validity by investigating its
    internal structure. This study consists of four validation studies, which were conducted consecutively
    among postgraduate students (master’s degree and PhD students) in the medical and health sciences.
    The revised USM-AS, consisting of three factors and 12 items, was found to have good construct
    validity, which was demonstrated by good model fit, high factor loadings (0.62 to 0.92), high
    construct reliability (0.84 to 0.89), good discrimination between factors and good test-retest reliability
    (intraclass correlation coefficients = 0.63 to 0.82). However, validity was limited to postgraduate
    students in the medical and health sciences in Malaysia. Further validation studies among
    postgraduate students in other scientific fields are recommended to provide additional construct
    validity evidence of the USM-AS.
  13. Zun AB, Ibrahim MI, Mokhtar AM, Halim AS, Wan Mansor WNA
    PMID: 31185665 DOI: 10.3390/ijerph16112054
    BACKGROUND: Patient feedback is an important tool in assessing health system quality. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was developed in 2006 as a standardized instrument to assess patient perceptions in the United States of America. This study aimed to translate and validate the HCAHPS questionnaire into the Malay language in order to assess patient perceptions of health services in Malaysia.

    METHODS: The original HCAPHS in English was translated into Malay based on the established guideline. The content validation involved an expert panel of 10 members, including patients. The face validation pilot testing of the HCAHPS-Malay version was conducted among 10 discharged patients. The exploratory factor analysis (EFA) used principal axis factor, and varimax rotation was established based on a cross-sectional study conducted among 200 discharged patients from Hospital Universiti Sains Malaysia (Hospital USM).

    RESULTS: The overall content validity index was 0.87, and the universal face validity index was 0.82. From the EFA, the factor loading value ranged from 0.652 to 0.961 within nine domains. The internal consistency reliability with Cronbach's alpha was 0.844.

    CONCLUSION: The HCAHPS-Malay is a reliable and valid tool to determine patients' perception of healthcare services among inpatients in Hospital USM based on the content and face validation result together with a good construct validity and excellent absolute reliability. Further testing on HCAHPS-Malay version in other settings in Malaysia needs to be done for cross-validation.

  14. Zakria NM, Tengku Ismail TA, Wan Mansor WNA, Sulaiman Z
    PMID: 31213022 DOI: 10.3390/ijerph16122147
    The validation of a new questionnaire is essential to improving its credibility in the assessment and collection of evidence. This study aimed to validate a newly developed infant and young child feeding questionnaire for child care providers (IYCF-CCPQ) to measure the knowledge, attitudes, and practices regarding infant and young child feeding among them. A cross-sectional study was conducted with 200 child care providers who were involved in handling children less than two years old in child care centers in the northeastern part of Peninsular Malaysia. The IYCF-CCPQ was self-administered and consists of three domains: Knowledge (104 items), attitude (90 items), and practice (42 items). The dichotomous-scale items in the knowledge domain were analyzed using a two-parameter logistic model of item response theory (2-PL IRT). The Likert-type-scale items in the attitude section were assessed using exploratory factor analysis (EFA). The items in the practice section were assessed descriptively. Internal consistency by marginal reliability was assessed in the knowledge domain, and Cronbach's alpha coefficient was used for the attitude domain. The marginal reliability values were 0.91 and 0.74 for the knowledge domains related to breastfeeding/formula feeding and complementary feeding, respectively, and the Cronbach's alpha values were 0.89 and 0.90 for the attitude domains related to breastfeeding/formula feeding and complementary feeding, respectively. The analysis showed good psychometric properties (discrimination, difficulty index, factor loading, and communalities) and good reliability. The IYCF-CCPQ is valid for use assessing the knowledge, attitudes, and practices among Malaysian child care providers regarding infant and young child feeding.
  15. Siti Nurma Hanim Hadie, Asma' Hassan, Zul Izhar Mohd Ismail, Mohd Asnizam Asari, Aaijaz Ahmed Khan, Fazlina Kasim, et al.
    MyJurnal
    Anatomy is an important knowledge for medical practice. Insufficient anatomy knowledge leading to errors in identification of anatomical structures during medical practices has been reported in many countries. Many medical students seem to have difficulties in learning anatomy and retaining the knowledge for future practice, thus this might reflect the possible flaws in anatomy education. In order to achieve optimum anatomy education environment and to close the gaps in education, measuring the students' perception on anatomy teaching and learning is a pre-emptive measure needed by educationists. At present, there is no valid and reliable inventory available to specifically evaluate the anatomy education environment. Therefore, this article highlights the importance of having such inventory.
  16. Nik Adib NA, Ibrahim MI, Ab Rahman A, Bakar RS, Yahaya NA, Hussin S, et al.
    PMID: 31027225 DOI: 10.3390/ijerph16081468
    BACKGROUND: Caregivers of children with autism spectrum disorder (ASD) experience increased stress and more significant negative caregiving consequences than those with typically developing children. There is a lack of studies specifically focusing on stress among caregivers with ASD children in Asian countries. The current study examines levels of perceived stress and factors associated with it among caregivers in Kelantan, Malaysia.

    METHODS: In a cross-sectional study, the Malay version of the Perceived Stress Scale (PSS) was administered to 227 caregivers of children with ASD. The caregivers were recruited from ASD databases in four tertiary hospitals in Kelantan and a meeting was set up during the child's follow-up in the clinic. Multiple linear regression analyses were applied to determine the predictors of perceived stress.

    RESULTS: The mean total perceived stress score was 20.84 (4.72). This was considered higher than average. Higher perceived stress was significantly predicted among caregivers who live far from the health institution, caregivers who do not own transportation to bring the child to the treatment center, and caregivers who have an ASD child with a learning disability.

    CONCLUSION: Caregivers of an ASD child perceived significant stress while taking care of their children. Institutions should alleviate the factors that were predicted to increase the caregivers' perceived stress to improve the quality of the lives of children and ASD families as a whole.

  17. Nik Adib NA, Ibrahim MI, Ab Rahman A, Bakar RS, Yahaya NA, Hussin S, et al.
    PMID: 31091735 DOI: 10.3390/ijerph16101684
    BACKGROUND: Caregivers are the initial gatekeepers in the health care management of children with autism spectrum disorder (ASD).

    METHODS: This cross-sectional study aimed to determine the factors associated with caregivers' satisfaction with different levels of health care services in managing children with ASD in Kelantan. The satisfaction scores of 227 main caregivers of confirmed ASD children were assessed with a modified Parent Satisfaction Scale (PSS) questionnaire.

    RESULTS: The analysis showed that caregivers who waited longer for a doctor's consultation in primary care had a reduced PSS score, whereas caregivers who were satisfied with the waiting time in primary care had higher PSS scores. At the secondary care level, caregivers who possessed at least a diploma had reduced PSS scores, whereas caregivers who were satisfied with both doctors' consultation times and occupational therapy appointments had higher PSS scores. At the tertiary care level, caregivers with an underlying medical problem and who had children undergoing occupational therapy for two months or more had reduced PSS scores. Nevertheless, the analysis showed that caregivers who were concerned with their children's sleeping problems, who had been informed about parental support, who were satisfied with speech and occupational therapy appointments, who were satisfied with waiting times at tertiary care clinics, and who were satisfied with their doctor's knowledge and experience had higher PSS scores.

    CONCLUSIONS: This study elucidated the importance of understanding caregivers' satisfaction in attaining care for their ASD children and highlighted the need to promote factors that would increase caregivers' satisfaction with current ASD services.

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