OBJECTIVE: This umbrella review synthesizes findings from systematic reviews and meta-analyses to provide insights into global perceptions on COVID-19 vaccine acceptance and hesitancy across diverse populations and regions.
METHODS: We conducted a literature search across major databases to identify systematic reviews and meta-analysis that reported COVID-19 vaccine acceptance and hesitancy. The AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) criteria were used to assess the methodological quality of included systematic reviews. Meta-analysis was performed using STATA 17 with a random effect model. The data synthesis is presented in a table format and via a narrative.
RESULTS: Our inclusion criteria were met by 78 meta-analyses published between 2021 and 2023. Our analysis revealed a moderate vaccine acceptance rate of 63% (95% CI 0.60%-0.67%) in the general population, with significant heterogeneity (I2 = 97.59%). Higher acceptance rates were observed among health care workers and individuals with chronic diseases, at 64% (95% CI 0.57%-0.71%) and 69% (95% CI 0.61%-0.76%), respectively. However, lower acceptance was noted among pregnant women, at 48% (95% CI 0.42%-0.53%), and parents consenting for their children, at 61.29% (95% CI 0.56%-0.67%). The pooled vaccine hesitancy rate was 32% (95% CI 0.25%-0.39%) in the general population. The quality assessment revealed 19 high-quality, 38 moderate-quality, 15 low-quality, and 6 critically low-quality meta-analyses.
CONCLUSIONS: This review revealed the presence of vaccine hesitancy globally, emphasizing the necessity for population-specific, culturally sensitive interventions and clear, credible information dissemination to foster vaccine acceptance. The observed disparities accentuate the need for continuous research to understand evolving vaccine perceptions and to address the unique concerns and needs of diverse populations, thereby aiding in the formulation of effective and inclusive vaccination strategies.
TRIAL REGISTRATION: PROSPERO CRD42023468363; https://tinyurl.com/2p9kv9cr.
METHODS: A population-based survey using postal questionnaires was conducted among formerly pregnant women in the Northern parts of the Netherlands. A total of 986 women were invited to participate.
RESULTS: Of the 219 women who returned completed questionnaires (22.2% response rate), only 22.8% had heard of pharmacogenetics, although the majority understood the concept (64.8%). Women who had experience with drug side-effects were more likely to know about pharmacogenetics [OR = 2.06, 95% CI 1.16, 3.65]. Of the respondents, 53.9% were positive towards implementing pharmacogenetics in their future drug therapy, while 46.6% would be willing to participate in pharmacogenetic research. Among those who were either not willing or undecided in this regard, their concerns were about the consequences of the pharmacogenetic test, including the privacy and anonymity of their genetic information.
CONCLUSION: The knowledge and attitude regarding the concept of pharmacogenetics among our population of interest is good. Also, their interest in pharmacogenetic research provides opportunities for future research related to drug use during pregnancy and fetal outcome.
METHODS: A systematic review was conducted on breast cancer screening studies among Malaysian women, published between January 2006 and December 2015. Online databases were searched using keywords: "mammogram", "mammography", "uptake", "breast cancer screening" and "Malaysia".
RESULTS: Thirteen original articles were reviewed. The rate of mammography uptake ranged between 3.6% and 30.9% among the general population, and 80.3% among personnel of a tertiary hospital. Factors associated with mammogram screening were clinical breast examination, age, income, knowledge on breast cancer and mammogram, perceived susceptibility to breast cancer, ethnicity and education level. Barriers to mammogram screening were lack of knowledge, embarrassment, fear of cancer diagnosis, perception that breast screening was unnecessary, lack of coping skills and pain during procedure. However, almost all of the studies could not be generalised beyond the study sample because of the limited number of sites and respondents; and most data were self-reported with no objective measures of the responses.
CONCLUSION: Mammogram screening uptake among women in selected communities were generally low. Further studies involving the general population are essential. Future studies should also explore the availability, affordability and accessibility of this service especially in the pursuit of achieving universal health coverage in breast cancer management.
OBJECTIVE: To evaluate patients' perception of community healthcare seeking behaviour towards both acute and preventive physical and psychosocial health concerns by sex, age and type of primary care setting (as a proxy for affordability of healthcare).
METHODS: A total of 3979 patients from 221 public and 239 private clinics in Malaysia were interviewed between June 2015 and February 2016 using a patient experience survey questionnaire from the Quality and Cost of Primary Care cross-sectional study. Multivariable logistic regression analysis adjusted for the complex survey design was used.
RESULTS: After adjusting for covariates, more women than men perceived that most people would see their general practitioners for commonly consulted acute and preventive physical and some psychosocial health concerns such as stomach pain (adjusted odds ratio (AOR), 1.64; 95% confidence interval (CI), 1.22-2.21), sprained ankle (AOR, 1.29; 95% CI, 1.06-1.56), anxiety (AOR, 1.32; 95% CI, 1.12-1.55), domestic violence (AOR, 1.35; 95% CI, 1.13-1.62) and relationship problems (AOR, 1.24; 95% CI, 1.02-1.51). There were no significant differences in perceived healthcare seeking behaviour by age groups except for the removal of a wart (AOR, 1.41; 95% CI, 1.12-1.76). Patients who visited the public clinics had generally higher perception of community healthcare seeking behaviour for both acute and preventive physical and psychosocial health concerns compared to those who went to private clinics.
CONCLUSIONS: Our findings showed that sex and healthcare affordability differences were present in perceived community healthcare seeking behaviour towards primary care services. Also perceived healthcare seeking behaviour were consistently lower for psychosocial health concerns compared to physical health concerns.
METHODS: A cross-sectional online survey conducted between January and April 2019 assessed the interest in HIVST in 544 MSM in Malaysia. Participants ranked eight hypothetical HIVST service delivery program elements with varied combinations of six, two-level HIVST service delivery program attributes (cost, privacy, accuracy, kit collection site, kit type, and testing support). SPSS conjoint procedure was used to estimate the relative importance of each attribute and preference across eight possible HIVST service delivery programs.
RESULTS: Overall, 70.4% had previously tested for HIV, and of those, 64.0% had done so in the past 6 months (45.0% of all participants). Of all the participants, 25.2% reported having used HIVST previously. The acceptability for HIVST service delivery models ranged from 44.9 to 77.1%, with mean acceptability of 56.2% across the eight hypothetical HIVST distribution scenarios. The HIVST service delivery scenario with the highest acceptability had the following attributes: no cost (free), anonymity (name not required), 99-100% accuracy, home-delivered, fingerstick, and testing support using telephone hotline or texting. HIVST cost was the most important attribute (relative importance score: RIS = 19.30) associated with acceptability, followed by anonymity (RIS = 18.41), accuracy (RIS = 17.33), kit delivery (RIS = 16.99), fingerstick kit (RIS = 15.86), and support (RIS = 12.08).
CONCLUSIONS: Acceptability for HIVST in Malaysian MSM was high but differed markedly by a number of HIVST delivery scenarios and attributes. These findings could be relevant as the Malaysian Ministry of Health is in the process of developing a regulatory framework for ensuring the quality of kits, as well as policies supporting safe use while broader implementation under national AIDS programs.
METHODS: Monthly OPD attendance from 1,053 public primary care health clinics in Malaysia, from January 1, 2019, to June 30, 2021, was analysed. The study duration was divided into four distinct periods: pre-pandemic, pandemic with the first lockdown implementation, pandemic after the first lockdown was lifted, and pandemic with the second lockdown implementation. An interrupted time series analysis was conducted to assess the impact of different interventions at national, regional, urban-rural, and district levels. Data were then aggregated at the district level and the utilisation changes were visualised in a choropleth map. Additionally, simple linear regression (SLR) was performed to explore the association between utilisation changes and urbanisation rates of the district, for each period.
RESULTS: Nationally, OPD utilisation dropped by nearly 13% at the onset of the first lockdown and continued to decline by almost 24% monthly thereafter. In terms of urban-rural differences, urban areas in the Central and Eastern Regions showed greater fluctuations in OPD utilisation during different periods. Results from the SLR revealed that higher urbanisation rates were associated with more pronounced changes in utilisation, although the direction of these changes varied across time periods.
CONCLUSION: The OPD utilisation was affected during the COVID-19 and sporadic urban-rural differences were observed in some areas of the country. This study offers important insights into the geographic and urban-rural patterns of healthcare utilisation during the pandemic, which are crucial in improving healthcare equity in Malaysia.
METHODS: A cross-sectional study was conducted from December 2022 to April 2023, using a valid and reliable self-administered six sections questionnaire consisting of; (i) sociodemographic, (ii) work-related factors, (iii) MHSU, (iv) perception of stigmatisation by others, (v) enabling factors, and (vi) need factors. Respondents were selected through proportionate stratified random sampling based on job categories. Multiple Logistic Regression using SPSS version 26 was used to determine the predictors of MHSU.
RESULTS: A total of 294 respondents participated in this study, with a response rate of 83.5%. The 12-months MHSU prevalence was 45.6%. Mental health services were predominantly utilised for screening (96.3%) and treatment purposes (28.4%), primarily accessed through health clinics (85.1%), and interaction with paramedics (44.0%) and medical officers (38.8%). Significant drivers predicting MHSU were B40 household income (aOR = 3.426, 95% CI: 1.588, 7.393, p-value = 0.002) and M40 household income (aOR = 3.781, 95% CI: 1.916, 7.460, p-value<0.001), low supervisor support (aOR = 2.302, 95% CI: 1.206, 4.392, p-value = 0.011), received mental health training (aOR = 2.058, 95% CI: 1.221, 3.469, p-value = 0.007) and high co-worker support (aOR = 1.701, 95% CI: 1.034, 2.798, p-value = 0.036).
CONCLUSION: Almost half of respondents used mental health services, predicted by lower and middle household income, received mental health training and high co-worker support. Conversely, MHSU was also predicted by low supervisor support. To sustain high levels of MHSU, it is essential to implement regular mental health training targeted HCWs with lower to middle household incomes and those experiencing low supervisor support, while simultaneously enhancing co-worker support and screening program for early detection of mental health problems.
METHOD: Between July and October 2022, a survey was conducted using a sample of n = 507 Venezuelan migrants. We examined the relationship between COVID-19 vaccine hesitancy, migrant's attitudes toward past vaccinations, their beliefs and perceptions about COVID-19 disease, and health-service related factors. Descriptive statistics summarized the characteristics of these migrants. Odds ratios with 95% confidence intervals and multivariable logistic regression was used to examine factors and attitudes associated with COVID-19 vaccine hesitancy.
RESULTS: Our findings showed that 89% of the migrants accessed publicly available health services while in Trinidad and Tobago, 72.4% reported that they did not refuse other vaccines in the past, and 23% reported being hesitant to take the COVID-19 vaccine. Females had higher odds of being COVID-19 vaccine hesitant compared to males, and participants expressing doubts about the source of vaccine information also had greater odds of vaccine hesitancy. Long waiting times at a public health clinic and costs associated with traveling to a clinic were associated with higher odds of COVID-19 vaccine hesitancy.
CONCLUSION: A National Immunization Policy inclusive of the unmet needs of vulnerable migrant populations is needed to ensure equitable access to vaccinations.
METHODS: This study presents cross-sectional survey data collected as part of the Responsive and Equitable Health Systems-Partnership on Non-Communicable Diseases (RESPOND) project, a longitudinal observational study in low-income communities. The study participants were 1191 randomly selected adults aged 35-70 years with a self-reported history of hypertension or identified as hypertensive through blood pressure screening.
RESULTS: While most low-income individuals with hypertension in both countries were diagnosed and receiving medication, Malaysians demonstrated higher self-reported medication adherence. Urban areas in the Philippines showed better hypertension management outcomes compared to rural areas. The study also provides insights into the care seeking pathways followed by low-income adults diagnosed with hypertension. Nearly half of these individuals in Malaysia and a third in the Philippines were following pathways where they had never changed or stopped treatment without professional advice, and where they were using and adhering to their prescribed medication. Following such pathways was strongly associated with a greater likelihood blood pressure control in the Philippines, but less so in Malayisa.
CONCLUSIONS: These findings highlight the need for a contextualised understanding of care seeking choices and the importance of person-centred solutions. They offer a typology of hypertension care seeking pathways and a foundation for similar research in other settings.
OBJECTIVE: We aimed to explore factors influencing the adoption of telehealth services among older adults in Malaysia, going beyond the conventional framework by incorporating transition cost and subjective well-being as additional constructs.
METHODS: A cross-sectional survey was conducted among 119 adults aged ≥60 years in Malaysia, using 39 survey items adapted from existing studies. Data analysis was performed using partial least squares structural equation modeling, with both the measurement model and structural model being evaluated. To determine the predictive relevance of the model, PLSpredict was applied. In addition, importance-performance map analysis was conducted to further expand on the structural model results by assessing the performance of each variable.
RESULTS: Of the 119 participants, 52 (43.7%) were women and 67 (56.3%) were men. The study found that subjective well-being (β=0.448; Phealth care accessibility and quality for this vulnerable demographic.