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Background@#The patient’s intention to engage in diabetes care is the hallmark of role acceptance as a health manager and implies one’s readiness to change. The study aimed to understand the process of having the intention to engage in diabetes care. @*Methods@#A qualitative study using narrative inquiry was conducted at a public primary care clinic. Ten participants with type 2 diabetes of more than a 1-year duration were selected through purposive sampling. In-depth interviews were conducted using a semi-structured protocol guide and were audio-taped. The interviews were transcribed and the texts were analyzed using a thematic approach with the Atlas.ti ver. 8.0 software (Scientific Software Development GmbH, Berlin, Germany). @*Results@#Three themes emerged from the analysis. The first theme, “Initial reactions toward diabetes,” described the early impression of diabetes encompassing negative emotions, feeling of acceptance, a lack of concern, and low level of perceived efficacy. “Process of discovery” was the second overarching theme marking the journey of participants in finding the exact truth about diabetes and learning the consequences of ignoring their responsibility in diabetes care. The third theme, “Making the right decision,” highlighted that fear initiated a decision-making process and together with goal-setting paved the way for participants to reach a turning point, moving toward engagement in their care. @*Conclusion@#Our findings indicated that fear could be a motivator for change, but a correct cognitive appraisal of diabetes and perceived efficacy of the treatment as well as one’s ability are essentially the pre-requisites for patients to reach the stage of having the intention to engage.
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Background@#The patient’s intention to engage in diabetes care is the hallmark of role acceptance as a health manager and implies one’s readiness to change. The study aimed to understand the process of having the intention to engage in diabetes care. @*Methods@#A qualitative study using narrative inquiry was conducted at a public primary care clinic. Ten participants with type 2 diabetes of more than a 1-year duration were selected through purposive sampling. In-depth interviews were conducted using a semi-structured protocol guide and were audio-taped. The interviews were transcribed and the texts were analyzed using a thematic approach with the Atlas.ti ver. 8.0 software (Scientific Software Development GmbH, Berlin, Germany). @*Results@#Three themes emerged from the analysis. The first theme, “Initial reactions toward diabetes,” described the early impression of diabetes encompassing negative emotions, feeling of acceptance, a lack of concern, and low level of perceived efficacy. “Process of discovery” was the second overarching theme marking the journey of participants in finding the exact truth about diabetes and learning the consequences of ignoring their responsibility in diabetes care. The third theme, “Making the right decision,” highlighted that fear initiated a decision-making process and together with goal-setting paved the way for participants to reach a turning point, moving toward engagement in their care. @*Conclusion@#Our findings indicated that fear could be a motivator for change, but a correct cognitive appraisal of diabetes and perceived efficacy of the treatment as well as one’s ability are essentially the pre-requisites for patients to reach the stage of having the intention to engage.
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@#Introduction: Posttraumatic stress disorder (PTSD) is a mental health condition which develops following exposure to life-threatening events. This cross-sectional study was conducted among adult patients from all walks of life who had injuries related to motor vehicle accidents to determine the cut-off point of the Malay Posttraumatic Stress Disorder Checklist For DSM-5 (MPCLC-5) for its use as a screening tool for PTSD in the Malaysian population. Methods: Using convenient sampling method, 204 subjects who fulfilled the inclusion criteria were recruited and they were given the 17 item self-rated MPCLC-5 to fill up. Subsequently, trained personnel administered the gold standard Clinician Administered PTSD Scale for DSM 5 (CAPS-5). ROC curve analysis was done to determine appropriate cut-off point for the MPCLC-5. Results: Cut off point of 42/43 would yield the most preferable sensitivity and specificity for MPCLC-5 when compared to CAPS-5 (Sensitivity: 67.56% (95%CI 55.68% to 78.00%); Specificity : 80% (95% CI 72.08% to 86.50%) ). Conclusion: The easy to administer MPCLC-5 is suitable for screening of PTSD among local patients with a proposed cut off point of 42/43.
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Purpose@#This study was designed to develop an evaluation tool for assessing professional behavior and clinical competencies from the graduates’ perspective. @*Methods@#This study employed mixed method in a sequential exploratory design. The semi-structured interviews were conducted with three graduates from different cohorts. The qualitative analysis of the interviews found six emerging themes for professional behavior and clinical competencies development. These themes were then developed into a 55-item questionnaire. The questionnaire was then distributed to 84 medical graduates for exploratory factor analysis (EFA) from February to April 2019. The quantitative data were analyzed using IBM SPSS ver. 21.0 (IBM Corp., Armonk, USA) for principal axis factoring. After conducting EFA, we proceeded with confirmatory factor analysis (CFA) with another 120 graduates to validate the tool. @*Results@#Eighty-four graduates completed the questionnaire for EFA. Upon completion of EFA, 35 out of 55 items of the questionnaire were found to be valid and reliable. The most appropriate fit was seven factors, which explained 58.18% of variance between them after 15 iterations with Cronbach’s α of 0.916. The personal satisfaction factor was noted to be weak. It was therefore added to patient management factor due to its similar intention. The final EFA factor after the modification was six. The CFA found that 34 out of 35 items was valid and reliable that representation of the latent variables. @*Conclusion@#The questionnaire has achieved the desired construct validity score and can be used as an evaluation tool to assess professional behavior and clinical competencies from the graduates’ perspective.
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@#Introduction: Posttraumatic stress disorder (PTSD) commonly occur following exposure to traumatic events. Since its formal introduction into the Diagnostic and Statistical Manual of Mental Disorders 3rd Edition (DSM-III) in 1980, it has seen a few changes to its criteria. Currently in DSM-5, major changes was made and tools such as the PTSD Checklist for DSM-5 (PCL-5) were developed to reflect those changes. Tools to screen and diagnose PTSD is invaluable to properly manage the condition, but to date no measure, in keeping with the DSM-5, has been produced for the Malaysian population. The objective was to translate the PCL-5 into Malay and validate it for use in the Malaysian population. Methods: The PCL-5 was translated according to guidelines. A convenient sample of subject were recruited from those attending the Orthopaedic Ward and Outpatient Departments due to injuries from motor vehicle accidents (MVA). Subjects completed the Malay PCL-5 (MPCL-5) on the day of recruitment and were then interviewed using the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). Two weeks later they were followed-up to again complete the MPCL-5. Results: 204 subjects participated in the study. The MPCL-5 was found to have good face, content and construct validity. It also demonstrated strong internal consistency (Cronbach’s Alpha = .89) and inter-rater reliability (r = .81). Conclusion: The MPCL-5 is a valid and reliable measure for PTSD to be used in the Malaysian population.
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Stress, PhysiologicalABSTRACT
@#Introduction: Psychological consequences of traumatic events are often overlooked by both medical professionals and patients themselves. Post-traumatic stress disorder (PTSD) is the most serious condition in the spectrum of trauma- and stressor-related disorders. Left untreated, it may result in physical and mental illnesses as well as social and occupational dysfunction. In the Malaysian Muslim population, stigma against mental illnesses frequently deter individuals suffering from psychological trauma from presenting to mental health services. These people prefer the use of spiritual and religious healing approaches to manage their post-traumatic stress symptoms. The objective of this study was to describe the Islamic cognitive restructuring techniques employed by motor vehicle accident victims for post-traumatic stress. Methods: An exploratory qualitative study involving 9 Muslim motor vehicle accidents victims was conducted from May to September 2015. Subjects were interviewed in-depth using semi-structured interview schedules. These interviews were recorded, transcribed verbatim and analysed with the aid of Atlas.ti software. Results: Psychological intervention such as cognitive restructuring is an effective technique to overcome post-traumatic stress. In this study, our subjects employ cognitive restructuring techniques with predominantly Islamic content. Almost half of the subjects believe that God will not create hardship but some good will come out of it. Other subjects approach cognitive restructuring by being thankful for the small tests of hardships and compared their situation with others of worse fate. Conclusion: Islamic cognitive restructuring is a useful technique to manage posttraumatic stress symptoms. Further research is needed to determine the effectiveness of this approach.
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Objectives: There are a number of validated questionnaires available for the screening of Post-Traumatic Stress Disorder (PTSD), and the PTSD Checklist for Civilians is one of them. However, none was translated into the Malay Language and validated for use in the Malaysian population. The aim of this study is to translate and validate the Malay PTSD Checklist for Civilians (MPCL-C). Methods: The PCL-C was translated into the Malay Language and back-translated. The reliability and validity of the MPCL-C were then determined by administering them to those who presented at the emergency department for motor vehicle accident at least one month before. Results: The MPCL-C has good face and content validity. In terms of reliability, it is also good, with Chronbach’s alpha values of 0.90, 0.77, 0.75 and 0.74 for the full scale, re-experiencing, avoidance and arousal domains respectively. Conclusions: The MPCL-C is a valid and reliable instrument to screen for PTSD in motor vehicle accident victims for the studied population.