BMC Nursing Tittle Meal Taking Behavior of Nurses in Government Health Clinics in Selangor and Its Associated Factors - A Cross Sectional Study

Introduction Meal taking behaviour MTB covers a broad definition, from food motive, pattern, dieting and diet related diseases. There are many factors that may affect MTB including social and environmental factors. Nurses were found to skip meals, take high calories food and fast foods. A good MTB is important for nurses ‘health, maintaining good job performance and as role model to the public.Materials and Methods: A cross-sectional study was conducted among randomly selected 178 staff nurses of public health clinics in Selangor who have fulfilled the inclusion and exclusion criteria Data was collected from September 2020 till March 2021 using pre-tested and validated self-administered questionnaire. Cronbach alpha were 0.78 for knowledge and 0.71 for MTB. Data was analysed using IBM Statistical Package for Social Science (SPSS) version 25.0 involving descriptive and inferential statistics. All ethical approval was obtained from ethical committees and written consent were received from all the respondents.Result: The response rate was 97%. Findings showed 42% of respondents had poor MTB, 47.1% had poor nutritional knowledge and 58.9% of nurses were overweight and obese. There was significant association between MTB with source of foods (breakfast and dinner) with p= 0.016 and p<0.001 and eating companion during lunch (p=0.003). Other factors, such as sociodemographic, working and employment factors were found to have not statistically significant association.Conclusion: MTB showed to be a problem among nurses at the study location with a 42.9% of them had poor MTB and half of them nurses have weight problem. We found that MTB is significantly associated with their food source and eating companion. Intervention should be taken to improve the MTB of nurses.

Factors influencing implementation of an insulin patient decision aid at public health clinics in Malaysia: A qualitative study

Background Many patient decision aids (PDAs) are developed in academic settings by academic researchers. Academic settings are different from public health clinics where the focus is on clinical work. Thus, research on implementation in public health settings will provide insights to effective implementation of PDA in real-world settings. This study explores perceived factors influencing implementation of an insulin PDA in five public health clinics. Methods This study adopted a comparative case study design with a qualitative focus to identify similarities and differences of the potential barriers and facilitators to implementing the insulin PDA across different sites. Focus groups and individual interviews were conducted with 28 healthcare providers and 15 patients from five public health clinics under the Ministry of Health in Malaysia. The interviews were transcribed verbatim and analysed using the thematic approach. Results Five themes emerged which were: 1) time constraint; 2) PDA costs; 3) tailoring PDA use to patient profile; 4) patient decisional role; and 5) leadership and staff motivation. Based on the interviews and drawing on observations and interview reflection notes, time constraint emerged as the common prominent factor that cut across all the clinics, however, tailoring PDA use to patient profile; patient decisional role; leadership and staff motivation varied due to the distinct challenges faced by specific clinics. Among clinics from semi-urban areas with more patients from limited education and lower socio-economic status, patients’ ability to comprehend the insulin PDA and their tendency to rely on their doctors and family to make health decisions were felt to be a prominent barrier to the insulin PDA implementation. Staff motivation appeared to be stronger in most of the clinics where specific time was allocated to diabetes team to attend to diabetes patients and this was felt could be a potential facilitator, however, a lack of leadership might affect the insulin PDA implementation even though a diabetes team is present. Conclusions This study found time constraint as a major potential barrier for PDA implementation and effective implementation of the insulin PDA across different public health clinics would depend on leadership and staff motivation and, the need to tailor PDA use to patient profile. To ensure successful implementation, implementers should avoid a ‘one size fits all’ approach when implementing health innovations.

Norwegian midwives’ experiences of relational continuity of midwifery care in the primary healthcare service: A qualitative descriptive study

The World Health Organization recommends that all countries with a well-developed midwifery service offer a midwifery-based practice formed on relational continuity of care. Pregnant women in Norway have stated that they experience the service throughout the childbearing process as fragmented. The present study aimed to gain knowledge about how midwives working in the primary healthcare service experience relational continuity of midwifery care and what challenges they encounter. In-depth interviews were conducted with 10 midwives working in different public health clinics in Norway. The qualitative data were carefully analysed using systematic text condensation. The COREQ checklist was applied. The participants indicated the importance of providing individualised midwifery care by meeting the women early in pregnancy and establishing a mutual relationship built on trust and safety. This helped ease the midwife’s work. The midwives expressed a desire for continuity in the follow-up of the women, but this was not always possible due to a lack of capacity. This study shows that relational continuity of midwifery care is important to midwives working in the primary healthcare service. The midwives wanted a midwifery-led practice that would allow them to lead their profession and use their full expertise. To achieve relational continuity in the primary healthcare service, the informants declared the importance of management seeing the midwives’ potential.

Psychological Insulin Resistance (PIR) Among Type 2 Diabetes Patients at Public Health Clinics in Federal Territory of Malaysia

Introduction: Insulin has been viewed as a treatment option of last resort in type 2 diabetes management. The decision to start insulin therapy is often diffi cult. Patients are usually reluctant to begin insulin and many cases delay the initiation of insulin therapy. The aim of this study is to determine the magnitude of insulin refusal or recognize as psychological insulin resistance (PIR) and to identify its predictors. Materials and Methods: This is a cross-sectional study and data was collected from two primary public health clinics in Kuala Lumpur and Putrajaya. The study sample consisted of 404 insulin naive patients with type 2 diabetes. A self-administered questionnaire was used to obtain demographic and clinical information. Results: Fifty-one percent of patients with type 2 diabetes were found to be unwilling to take insulin. Regression analysis revealed that females were 2.7 times more likely to resist insulin treatment compared to males and those with uncontrolled diabetes were 1.8 times more likely to resist insulin treatment compared to controlled diabetics. Patients will refuse insulin if they perceived their diabetes worsen with insulin use. After controlling for other attitudinal belief factors in the model, an increase in one unit of perceived disease severity will increase the likelihood of PIR around 2 times. Conclusion: Several misconceptions regarding insulin therapy were identifi ed and specifi c education intervention is recommended for successful transition to insulin therapy.

Factors associated with patient satisfaction towards pharmacy services among out-patients attending public health clinics: Questionnaire development and its application

Introduction Patient satisfaction is widely used to measure quality of healthcare by identifying potential areas for improvement. Aim of study is to assess patient satisfaction towards pharmacy services and its associated factors using newly developed questionnaire among outpatients attending public health clinics. Materials and methods Public Health Clinic Patient Satisfaction Questionnaire (PHC-PSQ) towards pharmacy services was developed using exploratory factor analysis and Cronbach’s α. A cross-sectional study was conducted among 400 patients visiting the pharmacy in three randomly selected public health clinics recruited via systematic random sampling. Data was collected using a set of questionnaire including PHC-PSQ. Factors associated with patient satisfaction was analysed using multiple linear regression. Results Final PHC-PSQ consisted of three domains (administrative competency, technical competency and convenience of location) and 22 items with 69.9% total variance explained. Cronbach's α for total items was 0.96. Total mean score for patient satisfaction was 7.56 (SD 1.32). Older age and higher education were associated with lower patient satisfaction mean score. Patients who had visited the pharmacy more than once in the past three months, perceived to be in better health status and had a more correct general knowledge of pharmacists expressed higher patient satisfaction mean score. Conclusions PHC-PSQ is a newly developedtool to measure patient satisfaction towards pharmacy services in public health clinics in Malaysia. Patient satisfaction was relatively high. Age, education, frequency of visit, self-perceived health status and general knowledge of pharmacists were factors significantly associated with patient satisfaction.

Predictors of Knowledge, Attitude and Practice of Mothers with Under 5 Years Malnourished Children in Kiribati

Background: Malnutrition among under 5 years old children is a common public health issue in both developed and developing countries. As mothers are the key persons responsible for their young children, this study aimed to assess the levels and predictors of knowledge, attitude and practice (KAP) of mothers of malnourished children less than 5 years old on South Tarawa, Kiribati. Methods: This study is a cross sectional prospective design. This study conducted in pediatric ward and public health clinics of 11 public health centers on South Tarawa in Kiribati and among 82 mothers with under 5 years old malnourished children who were admitted to the Pediatric ward and public health clinics. The knowledge, attitude and practice on breastfeeding, weaning, diet and immunization was collected using a self-administrated validated questionnaire. Bivariate correlation and linear regression were applied and the significance level for this study was 5%.Results: Majority of the mothers (66%) were 19-32 years old, 69.5% were Roman Catholics, 67% had attended high-school, 46% had husbands as breadwinners and 85% were married. The participants had a low level of knowledge and middle level of attitude and practice on breastfeeding, weaning, diet and immunization. Education level (r=0.319, p=0.004) and breadwinner at home (r=-0.239, p=0.031) were positively correlated with attitude. The results of linear regression were significant, F (2, 81) = 6.757, p= 0.002, r2 = 0.146, suggesting that education level and breadwinner accounted for 15% of the variance in attitude score. Conclusion: This study showed the importance of mothers’ attitude towards malnutrition. Encouraging female education could be a potential target for future policies to reduce malnutrition in Kiribati.

Prevalence and risk factors of postpartum depression, general depressive symptoms, anxiety and stress (PODSAS) among mothers during their 4-week postnatal follow-up in five public health clinics in Perak: A study protocol for a cross-sectional study

IntroductionPostpartum depression, general depressive symptoms, anxiety and stress (PODSAS) are often overlooked, and may cause morbidity to new mothers, their babies and families. This study aims to determine the point prevalence of depression (post partum and general), anxiety and stress among mothers in five public health clinics in Perak at 4 weeks postdelivery and identify their associated risk factors. Findings from this study will be used to identify the needs for early screening and detection, encourage development of interventions to reduce its occurrence and support mothers with PODSAS.Methods and analysisThis cross-sectional study will recruit 459 postpartum mothers during their 4-week postnatal follow-up in five selected public health clinics in Perak from September 2019 to May 2020. Participants will be mothers aged 18 years and above at 4 weeks postdelivery who are able to understand the English and Malay languages. Non-Malaysians and mothers with known diagnosis of psychotic disorders will be excluded from the study. Sociodemographic information and possible risk factors of the participants will be captured via a set of validated questionnaires, postpartum depression (PPD) will be measured using the Edinburgh Postpartum Depression Scale questionnaire and general depressive symptoms, anxiety and stress will be measured using the 21-item Depression, Anxiety and Stress Scale. Data analysis will be conducted using SPSS V.25.0 (IBM). Besides descriptive statistics, multivariable regression analyses will be done to identify possible risk factors and their independent associations with depression (PPD and general depressive symptoms, combined and separately), anxiety and stress.Ethics and disseminationThe study protocol was reviewed and approved by the Medical Research Ethics Committee, Ministry of Health Malaysia on 7 August 2019. Results of this study will be reported and shared with the local health stakeholders and disseminated through conference proceedings and journal publications.Registration numberThis study is registered in the Malaysian National Medical Research Register with the ID: NMRR-19-868-47647