Diabetes Self-Care Behaviors in Singapore and Their Associations With Patients' Characteristics and Health Literacy.

PURPOSE: The purpose of this study was to examine the relationship between self-management behaviors (eg, healthy eating, being active, medication taking, glucose monitoring, feet check), sociodemographic factors, disease-related characteristics, and health literacy among patients with type 2 diabetes in Singapore. METHODS: Data were analyzed from a nationwide survey conducted between 2019 and 2020 (n = 387). Self-management behaviors were assessed using the Dietary Approaches to Stop Hypertension questionnaire, the Global Physical Activity Questionnaire, and a diabetes care questionnaire. A linear regression model was generated to examine the association of healthy eating with the variables of interest (sociodemographic factors, disease-related characteristics, and health literacy), and logistic regression models were generated to investigate the significant correlates of the remaining self-care behaviors. RESULTS: Regression models showed that the 5 self-care behaviors have different correlates. Nonetheless, compared to individuals aged 50 to 64 years, those aged 65 years and above were less likely to be active, adhere to their medication prescription, and check their feet. Individuals with a higher number of diabetes-related complications were less likely to be sufficiently active but more likely to monitor their glucose level and check their feet. Moreover, individuals with poor health literacy were more likely to eat healthily and be sufficiently active. CONCLUSIONS: Programs related to self-care behaviors can be tailored to specific demographics to improve their uptake in the population. Furthermore, encouraging comprehensive self-care behaviors in those aged 65 years and above is crucial for effective diabetes management.

Exploring the Singapore general population's trust in COVID-19 information from different sources and its association with perceived risk of infection during the pandemic.

Background: The degree of public trust in the government's competence is crucial in preventing the spread of misinformation and reducing psychological distress during a pandemic. The study aimed to (i) explore the trust in COVID-19 information from different sources and trust in the ability of the World Health Organization (WHO), government departments and related institutions in handling the epidemic in Singapore and (ii) its association with perceived risk of infection among Singapore residents. Methods: A total of 1,129 participants (aged 21 and above) were recruited from a cross-sectional study examining the well-being and resilience of Singapore's population between May 2020 to June 2021. Trust in COVID-19 information from different sources was measured on a 10-point scale and an ordinal 7-point scale was used for perceived risk of infection. Descriptive statistics and multivariate logistic regression model were conducted. Results: 85.5% reported high trust in COVID-19 information from the government and their ability in handling the pandemic. Participants also reported high trust in COVID-19 information from local public health or infectious disease experts (84.4%) and traditional media (77.2%). Low trust in the ability of government departments and related institutions was associated with higher future (1 month) perceived risk of infection (OR: 5.7, 95% CI 1.02-32.45) and low trust in social media was associated with higher current perceived risk of infection (OR: 2.4, 95% CI 1.09-5.24). Discussion: The present study provided insight on the level of trust on COVID-19 information from different sources and its associated perceived risks of infection. Future qualitative studies are recommended to facilitate better understanding of public trust and identify strategies for how it can be effectively addressed to support future public health responses.

Public awareness of war on diabetes campaign and its association with behavioural outcomes.

The War on Diabetes campaign was launched in 2016, encouraging Singapore residents to engage in regular exercise, adopt healthy dietary habits and screen for early detection of diabetes. This study aims to examine campaign awareness and its associations with sedentary behaviour, dietary habits and identifying diabetes. Data were obtained from the nationwide Knowledge, Attitudes and Practices study on diabetes in Singapore. A total of 2895 participants responded to a single question assessing campaign awareness. The Dietary Approaches to Stop Hypertension (DASH) diet screener assessed dietary habits, and the Global Physical Activity Questionnaire (GPAQ) measured sedentary behaviour. Recognition of diabetes was established using a vignette depicting a person with diabetes mellitus. Logistic and linear regression models were used to measure the associations. Most participants were 18- to 34-years old (29.9%) and females (51.6%). About 57.4% identified the campaign. Campaign awareness exhibited positive associations with identifying diabetes based on the vignette [odds ratio (OR): 1.5; 95% confidence interval (CI): 1.1-2.2; P = 0.022], lower odds of sedentary behaviour ≥7 h/day (OR: 0.7; CI: 0.5-0.9; P = 0.018) and higher DASH scores (ß = 1.3; P < 0.001). The study recognized early significant associations between the behavioural outcomes and the campaign, emphasizing the need for ongoing campaign sustainability and evaluation of its long-term impact on population health.

Exploring views and experiences of the general public's adoption of digital technologies for healthy lifestyle in Singapore: a qualitative study.

Objective: Little is known about the general adult population's adoption of digital technology to support healthy lifestyle, especially when they are expected to take greater personal responsibility for managing their health and well-being today. The current qualitative study intended to gain an in-depth understanding of determinants of digital technology adoption for healthy lifestyle among community-dwelling adults in Singapore. Design: A qualitative study design, with thematic framework analysis was applied to develop themes from the data. Setting: Semi-structured individual interviews were conducted with participants either face-to-face or online through a videoconferencing platform. Participants: 14 women and 16 men from the general population who were between the ages of 22 and 71 years. Results: Three major themes were developed: (1) digitally disempowered (2) safety and perceived risks and harm; (3) cultural values and drives. Adoption of technology among the general population is needs-driven, and contingent on individual, technological and other cross-cultural contextual factors. Conclusion: Our findings highlight there is no one solution which fits all individuals, emphasizing the challenges of catering to diverse groups to reduce barriers to adoption of digital technologies for healthy lifestyle. Digital guidance and training, as well as social influences, can motivate technological adoption in the population. However, technical problems as well as data security and privacy concerns should first be adequately addressed. This study provides rich cross-cultural insights and informs policy-making due to its alignment with government public health initiatives to promote healthy lifestyle.

Sociodemographic and psychosocial factors associated with vaccine hesitancy - results from a longitudinal study in Singapore.

Singapore has one of the highest COVID-19 vaccination rates, however identifying vaccine-hesitant sub-groups and their concerns is vital given the need for future boosters in vulnerable populations. Furthermore, vaccine hesitancy remains a concern in the event of an emergence of a newer strain that necessitates the rolling out of a new vaccination programme. The aims of this study were to establish the extent of COVID-19 vaccine hesitancy and the factors influencing it among adults in Singapore using the Vaccine Hesitancy Scale (VHS). The study used a longitudinal methodology and participants were recruited in two waves from May 2020 to Sep 2022. In all 858 participants agreed to participate in both waves of the study. The two-factor structure of the VHS scale as established in earlier studies was tested using confirmatory factor analysis. The results revealed a two-factor structure of VHS comprising "lack of confidence" and "risks". Those who had higher stress, resilience, and concerns that they might be infected with COVID-19 at wave 1 were significantly associated with lower 'lack of confidence' scores i.e. lower vaccine hesitancy. In comparison, those with higher concerns about inadequate government preventive measures and unemployment at wave 1 were significantly associated with higher 'lack of confidence' scores. Those with higher concerns about inadequate government preventive measures in wave 1 were significantly associated with higher 'risks' scores i.e. higher vaccine hesitancy. The findings point toward the need for a nuanced messaging that considers the fears expressed by the populace and addresses them directly using clear simple language.

Benefits of leisure-related physical activity and association between sedentary time and risk for hypertension and type 2 diabetes.

Introduction: Lifestyle modifications can reduce the risk of type 2 diabetes mellitus (T2DM) and hypertension. Our study investigated whether domain-specific physical activity (such as work, transport and leisure) and sedentary behaviour were associated with T2DM and hypertension, and whether these associations were moderated by sex and age. Method: For this cross-sectional study, data were obtained from a population survey in Singapore (n=2,867) conducted from February 2019 to March 2020. T2DM and hypertension were self-reported. Global physical activity questionnaire was used to assess domain-specific physical activity (in metabolic equivalent of task [MET]-minutes) and sedentary time (in hours). Logistic regression models were generated to examine the abovementioned associations, and adjusted for age, sex, education, ethnicity, personal income, body mass index, diet and hypertension/diabetes. Interaction terms were included individually to investigate whether age and sex moderated the associations. Results: Individuals with >826 MET-minutes of leisure-related physical activity per week had lower odds of having T2DM (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.24-0.86) and hypertension (OR 0.59, 95% CI 0.37-0.94) than those with no leisure-related physical activity. Individuals with >8 hours of sedentary time daily had higher odds of having hypertension (OR 1.69, 95% CI 1.06-2.69) than those with 0-5 hours of sedentary time. Logistic regression models including interaction terms showed that the association between leisure-related physical activity and hypertension was significant for those aged 18-34 (OR 0.15, 95% CI 0.03-0.66) and 50-64 years (OR 0.44, 95% CI 0.21-0.91). The association between sedentary time and hypertension was significant for those aged 18-34 years (OR 15.07, 95% CI 1.69-133.92). Conclusion: Our results support the widespread promotion of an active lifestyle to lower the prevalence of diabetes and hypertension in Singapore.

Barriers and facilitators for adopting a healthy lifestyle in a multi-ethnic population: A qualitative study.

A healthy lifestyle is defined as 'a way of living that lowers the risk of being seriously ill or dying early.' Although barriers and facilitators of healthy lifestyles have been well-studied among populations like those with chronic non-communicable diseases, adolescents, and older adults in Asia, less information is available on barriers and facilitators perceived by the general adult population. Using a qualitative methodology and leveraging the socio-ecological model, the current study aimed to understand the barriers and facilitators of a healthy lifestyle in a sample of Singapore residents. Overall, 30 semi-structured interviews were conducted in English and other local languages from August 2020 to March 2021. Transcripts were analysed using framework analysis. Five main themes pertaining to personal, interpersonal, environmental, socio-cultural, and policy-level factors were classified under the two overarching categories of barriers and facilitators of healthy lifestyles. The results of this study offer important insights into understanding the barriers and facilitators to the adoption of a healthy lifestyle among people in Singapore. Furthermore, our findings illustrate the complex interplay between individuals, social relationships, environment, and policy that can act as either a barrier or a facilitator to adopting a healthy lifestyle.

Sources of information on diabetes and its demographic correlates: a nationwide survey among Singapore residents.

Diabetes is a major public health concern in Singapore, and the Singapore Government declared a 'War on Diabetes', which included a nationwide public health campaign. It is important to identify what sources of diabetes information reach the general population, whether this differs by socio-demographic characteristics and if the sources of information influence knowledge of diabetes to aid the successful dissemination of health information. Two thousand eight hundred ninety-five respondents were part of a population-based cross-sectional study conducted from February 2019 to September 2020. Respondents rated on a five-point scale whether they had obtained information on diabetes from eight different information sources, and responses were dichotomized into 'endorsed receiving information' or 'not endorsed receiving information'. Poisson regression models were conducted with the 'endorsement of receiving information' from each source as the outcome and socio-demographic variables as predictors. 95.9% of the study population had received information on diabetes from at least one source, and the mean number of sources was 4.2 ± 2.0. The leading source was media articles (82.1%), followed by health promotion videos/advertisements (77.9%), online websites (58.5%), books (56.5%), healthcare professionals (55.0%), radio (54.4%), public forums (27.7%) and support groups (15.5%). Endorsing a greater number of informational sources was associated with being younger, belonging to Malay or Indian instead of Chinese ethnicity, and having diabetes. An intensive nationwide diabetes awareness campaign successfully reached the public in Singapore with specific sources of information depending on socio-demographic characteristics. Findings suggest that diabetes information campaigns should utilize multiple channels for dissemination considering the different socio-demographic subgroups.

Factors influencing uptake of diabetes health screening: a mixed methods study in Asian population.

BACKGROUND: Health screens are the cornerstones for health promotion and preventive interventions at a community level. This study investigated the barriers and facilitators to the uptake of diabetes health screening in the general population of Singapore. METHODS: In this mixed methods study, participants without diabetes were recruited from the general population. The quantitative phase (n = 2459) included face to face survey of participants selected through disproportionate stratified random sampling. Those who participated in the quantitative survey were then randomly chosen for a one-to-one semi-structured interview (n = 30). RESULTS: Among the survey respondents, 73.09% (n = 1777) had attended a diabetes health screening in their lifetime whilst 42.36% (n = 1090) and 57.64% (n = 1328, p < 0.0001) attended the health screens regularly (every 12 months) and irregularly, respectively. A significantly higher proportion of older adults (≥ 40 years) attended regular diabetes health screening compared to younger adults (less than 40 years; 55.59% vs 24.90%, p < 0.001). The top 3 reasons for attending regular health screens were to detect diabetes early, to make lifestyle changes in case of a diagnosis and being health conscious. Qualitative interviews identified similar issues and complex nuances that influenced the uptake of regular diabetes health screening. Several personal factors (laziness, self-reliance, psychological factors, etc.), competing priorities, fatalistic beliefs, affordability, misconceptions about the screens, and appointment related factors (inconvenient location, time, etc.) were identified as barriers, while affordable screens, sense of personal responsibility, perception of susceptibility /risk, role of healthcare team (e.g. reminders and prescheduled appointments) and personal factors (e.g. age, family, etc.) were facilitators. Age, household income, ethnicity and educational level were associated with the uptake of regular diabetes health screening. CONCLUSION: The uptake of regular diabetes health screening can be improved. Several barriers and enablers to the uptake of diabetes health screening were identified which should be addressed by the policy makers to alleviate misconceptions and create greater awareness of the importance of the programme that will improve participation.