Development and validation of a medication non-adherence scale for Malaysian hypertensive patients: a mixed-methods study.

BACKGROUND: Non-adherence to anti-hypertensive medications can lead to hypertension-related complications. One of the most effective preventive measures to mitigate these complications is to understand the underlying determinants of medication non-adherence using various scales. Unfortunately, existing scales for measuring non-adherence to anti-hypertensive medications have certain limitations, such as insufficient consideration of validity, dimensionality, and cultural adaptation. In response, the current study aimed to develop and validate a measure of non-adherence to anti-hypertensive medications-known as the Malaysian Anti-hypertensive Agent Non-Adherence Scale (MAANS)-for use in local hypertensive patients. METHODS: A two-phase mixed-methods approach was used. Phase 1 involved qualitative interviews with hypertensive patients from two health clinics in Kuala Lumpur, Malaysia. The themes extracted from these interviews were used to generate items for the MAANS. In Phase 2, data from 213 participants were analysed using exploratory factor analysis (EFA) to establish the scale's factor structure, thereby created the modified version of the MAANS. Confirmatory factor analysis (CFA) was then conducted on a separate dataset of 205 participants to confirm the factor structure, resulted in the final version of the MAANS. The reliability of the final MAANS version was assessed using Cronbach's alpha coefficient. The MAANS scores were used to predict subscales of the Malay version of the WHO Quality-of-Life (QOL) BREF, demonstrating the scale's predictive validity. RESULTS: Ten qualitative interviews yielded 73 items. The EFA produced a modified MAANS with 21 items grouped into five factors. However, the CFA retained three factors in the final scale: Perceived Non-Susceptibility, Poor Doctor-Patient Relationship, and Unhealthy Lifestyle. The final 14-item, 3-factor MAANS demonstrated moderate reliability (Cronbach's alpha coefficient = 0.64) and exhibited partial predictive validity, with the Poor Doctor-Patient Relationship and Unhealthy Lifestyle subscales significantly predicting Social QOL and Environmental QOL. CONCLUSION: The MAANS is a reliable, valid, and multidimensional scale specifically developed to evaluate non-adherence to anti-hypertensive medications in local clinical settings with the potential to further the advancement of research and practice in sociomedical and preventive medicine.

Prevalence of Health-Risk Behaviors and Mental Well-Being of ASEAN University Students in COVID-19 Pandemic.

The prevalence of epidemiological health-risk behaviors and mental well-being in the COVID-19 pandemic, stratified by sociodemographic factors in Association of South East Asian Nations (ASEAN) university students, were examined in the research. Data were collected in March-June 2021 via an online survey from 15,366 university students from 17 universities in seven ASEAN countries. Analyzed data comprised results on physical activity, health-related behaviors, mental well-being, and sociodemographic information. A large proportion of university students consumed sugar-sweetened beverages (82.0%; 95%CI: 81.4, 82.6) and snacks/fast food daily (65.2%; 95%CI: 64.4, 66.0). About half (52.2%; 95%CI: 51.4, 53.0) consumed less than the recommended daily amounts of fruit/vegetable and had high salt intake (54%; 95%CI: 53.3, 54.8). Physical inactivity was estimated at 39.7% (95%CI: 38.9, 40.5). A minority (16.7%; 95%CI: 16.1, 17.3) had low mental well-being, smoked (8.9%; 95%CI: 8.4, 9.3), and drank alcohol (13.4%; 95%CI: 12.8, 13.9). Country and body mass index had a significant correlation with many health-risk behaviors and mental well-being. The research provided important baseline data for guidance and for the monitoring of health outcomes among ASEAN university students and concludes that healthy diet, physical activity, and mental well-being should be key priority health areas for promotion among university students.

Assessing social support impact on depression, anxiety, and stress among undergraduate students in Shaanxi province during the COVID-19 pandemic of China.

Following the 2019 coronavirus disease (COVID-19) outbreak in China, undergraduate students may experience psychological changes. During emergency circumstances, social support is an important factor influencing the mental health condition among undergraduate students in Shaanxi province. This study aims to find the factors associated with mental health symptoms of depression, anxiety, and stress among undergraduate students in Shaanxi province during the COVID-19 pandemic in China. A cross-sectional study was conducted from Feb 23 to Mar 7, 2020. A total of 1278 undergraduate students from the universities located in Shaanxi province participated in this study. The mental health symptoms were measured by 12-item Perceived Social Support Scale (PSSS) and Depression Anxiety Stress Scale (DASS-21) instruments. This survey showed that females receive more social support compared to males (t = -5.046, P<0.001); males have higher-level depression symptoms (t = 5.624, P<0.001); males have higher-level anxiety symptoms (t = 6.332, P<0.001), males have higher-level stress symptoms (t = 5.58, P<0.001). This study also found participants who have low social support was negatively correlated with mental health symptoms. In Conclusion, Males and low social support were associated with having the higher level of depression, anxiety, and stress symptoms among undergraduate students in Shaanxi province during the COVID-19 pandemic in China. Therefore, it is suggested that people should supply more social support for undergraduate students in Shaanxi province during COVID-19 pandemic.