Affiliate Stigma, Resilience and Quality of Life among Parents of Children with Autism Spectrum Disorder in Two Public Hospitals in Kelantan, Malaysia.

Background: Often, the indirect impact of autism spectrum disorder (ASD) presents the family with significant challenges. One of these challenges is affiliate stigma due to parental affiliation with their child. This study aimed to explore affiliate stigma, resilience and quality of life (QoL) among parents of children with ASD. Methods: Cross-sectional study of 144 parents of children with ASD were recruited from two main tertiary hospitals in Kelantan, Malaysia, a developing country in Southeast Asia. Pearson correlation was used to examine the relationship between parental affiliate stigma, resilience and QoL. Simple and multiple linear regression analyses were used to identify the significant associated factors of affiliate stigma, resilience and QoL. Results: Correlational analyses revealed that perceived affiliate stigma demonstrated an inverse relationship with resilience and QoL. Additionally, resilience had a positive relationship with QoL. Regression analyses revealed that the father's employment status, the mother's level of education, having a disability card, the child's age at ASD diagnosis, comorbidities of the child and ASD severity perceived by parents were associated with parental affiliate stigma, resilience and QoL. Conclusion: Study findings highlight the contribution of socio-demographic characteristics of children with ASD and their families in the determination of affiliate stigma, resilience and QoL.

A structured laughter yoga therapy program on patients with chemotherapy-induced nausea and vomiting: A randomized clinical trial.

Objetive: Chemotherapy is a prevalent cancer treatment, often accompanied by debilitating side effects such as nausea and vomiting. This study explores the potential effectiveness of laughter yoga, a combination of exercise and voluntary laughter, in alleviating chemotherapy-induced nausea and vomiting. Methods: This two-group randomized clinical trial was conducted on 69 cancer patients undergoing chemotherapy at the Reza Chemotherapy and Oncology Center, Mashhad, Iran, in 2018. Patients were randomly divided into intervention and control groups. Both groups received routine self-care training, with the addition of four 20-min to 30-min laughter yoga sessions held immediately before one of their chemotherapy appointments for the intervention group only. Nausea and vomiting were assessed using the Morrow Assessment of Nausea and Emesis questionnaire at two stages, before and after the intervention. Data were analyzed with Chi-square, Independent-t, Mann-Whitney, Wilcoxon, and McNemar tests using Statistical Package for the Social Sciences (SPSS). Results: The mean age of patients in the intervention group was 49.0 ± 9.6 years, while in the control group, it was 45.2 ± 12.6 years. The intragroup comparison showed a statistically significant decrease in the severity and duration of nausea in the intervention group and a statistically significant increase in the severity and duration of nausea in the control group from pre-test to post-test (P < 0.05). The intergroup comparison showed no statistically significant difference between the two groups in terms of vomiting conditions. Conclusions: Laughter yoga demonstrates promise in improving chemotherapy-induced nausea, suggesting its potential recommendation for managing this distressing side effect. Further research is warranted to explore its broader application in cancer care. Trial registration: This study (No. IRCT20180429039463N1) was registered in the Iranian Registry of Clinical Trials on 21/08/2018.

An Explorative Study of Affiliate Stigma, Resilience, and Quality of Life Among Parents of Children with Autism Spectrum Disorder (ASD).

Purpose: Children diagnosed with ASD usually have impaired social functions, exhibit repetitive, stereotyped and self-stimulatory behaviors, which make them prone to be stigmatized by the public. However, stigma not only affects those with stigmatization characteristics such as children with ASD but also tends to include other people related to them including parents. This is called affiliate stigma. However, affiliate stigma is unlikely to occur if public awareness is high. Considering that awareness of ASD is still comparatively low in this region and that, as a review of the literature showed, there have been limited studies on stigma and ASD conducted in South-East Asia, particularly in Malaysia, this study is of great significance, especially in the context of the East and other developing countries. The aim of this study was to explore parents' experiences of caring and perceptions of affiliate stigma, resilience and quality of life (QoL) when caring for a child with ASD. Methods: This paper is part of the sequential explanatory mixed-methods study in which, after a cross-sectional study of 144 parents, a qualitative approach was used to explore parents' experiences of caring and their perceptions of affiliate stigma, resilience, and QoL. Participants were recruited when they were accompanying their children to therapy at two tertiary public hospitals in one of the north-eastern states of Malaysia. Eleven parents of children with ASD aged 2-12 years participated. Qualitative data analysis followed Braun and Clarke's methodology of thematic analysis. Results: Four themes were identified: the meaning of QoL, ASD and life adjustment, perceived stigma, and resilience. Conclusion: This is the first Southeast Asian study on parent-perceived affiliate stigma, resilience, and QoL in the context of ASD. These findings can inform healthcare personnel and policymakers into day-to-day parenting realities and therefore an effort to coordinate support services across all disciplines could be made to improve outcomes for both parents and children.

Utility of Equivalence and Cognition Models in Enhancing Validity of Translated Questionnaires: A Methodological Example Using the Heart Quality-of-Life Questionnaire.

BACKGROUND: The cross-cultural adaptation of questionnaires has tenuous theoretical underpinnings that limit the rigor of data collection and the meaningful analysis of cognitive interview data. An adaptation of existing models of equivalence and cognition provides structure to the comprehensive investigation of various equivalence types in enhancing the validity of translated questionnaires. PURPOSE: In this study, a framework comprising equivalence and cognition models was used to assess and finalize the Heart Quality-of-Life (HeartQoL)-Bahasa Malaysia (BM) questionnaire, which was derived from both forward-backward (FB) and dual-panel (DP) translation methods. METHODS: Investigation and finalization of two initial versions of the questionnaire were conducted based on findings from an expert assessment (n = 3 sociolinguists blinded to translation methods) and cognitive interviews with purposively sampled patients (FB: n = 11; DP: n = 11). The equivalence model of Herdman et al. and the question-and-answer model of Collins were adapted to form a "cognition-and-equivalence" model to guide data collection and analysis through modified cognitive interviews. The final HeartQoL-BM was completed by 373 patients with ischemic heart disease from two medical centers, and the data were analyzed using confirmatory factor analysis to assess the evidence of equivalence. RESULTS: Findings from the expert assessment and cognitive interview showed the existence of semantic and item equivalence on almost all of the FB and DP items, identified some subtle potential equivalence gaps, and guided the process of item finalization. Confirmatory factor analysis, including tests of factorial invariance on the final two-factor model of HeartQoL-BM, confirmed conceptual, item, measurement, and operational equivalence, which supports functional equivalence. CONCLUSIONS: The potential use of the cognition-and-equivalence model for modified cognitive interviewing and the application of the six equivalence types of Herdman et al. were supported by the HeartQoL-BM showing functional equivalence with its source. HeartQoL-BM is a potentially valid measure of health-related quality of life for patients with ischemic heart disease independent of conditions such as angina, myocardial infarction, and heart failure.

A systematic review of randomized controlled trials of psychoeducation interventions for patients diagnosed with schizophrenia.

BACKGROUND: Schizophrenia is one of the most complicated psychiatric disorders, and, although medication therapy continues to be the core treatment for schizophrenia, there is a need for psychotherapy that helps in providing patients comprehensive mental health care. Psychoeducation is one of the most recognized psychosocial interventions specific to schizophrenia. Further knowledge about the impact of this type of intervention on patients diagnosed with schizophrenia needs to be acquired. AIM: This review aimed to explore the effects of psychoeducational interventions on improving outcome measures for patients diagnosed with schizophrenia. METHODS: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was used in this systematic review. Two reviewers were involved in screening articles for inclusion and in the data extraction process. The selected studies were assessed for quality using the 'Consolidated Standards of Reporting Trial (CONSORT)' checklist. Out of the 441 records identified, 11 papers were considered for full review (from 2000 to 2018). RESULTS: The psychoeducational interventions showed a consistent improvement in many outcome measures. Most of the reviewed studies focused on outpatients and the method of delivering the psychoeducational interventions was mostly in lecture format. CONCLUSION: This systematic review of randomized controlled trial studies emphasizes the positive impact of psychoeducational interventions for patients diagnosed with schizophrenia concerning various outcome measures. The findings of this review have important implications for both nursing practice and research, as the information presented can be used by the administrators and stakeholders of mental health facilities to increase their understanding and awareness of the importance of integrating psychoeducational interventions in the routine care of patients diagnosed with schizophrenia.

The effect of mindfulness-based training on stress, anxiety, depression and job satisfaction among ward nurses: A randomized control trial.

AIM: To assess the effect of a 4-week mindfulness-based training intervention on improving stress, anxiety, depression and job satisfaction among ward nurses. BACKGROUND: Previous literature showed that mindfulness-based training is useful for helping nurses cope with stress. METHOD: Nurses who have mild to moderate levels of stress, anxiety and depression identified from a teaching hospital were invited to a randomized control trial. The intervention group had a 2-hr Mindfulness-Based Training workshop, followed by 4 weeks of guided self-practice Mindfulness-Based Training website. Both the intervention group (n = 118) and the control group (n = 106) were evaluated pre- and post-intervention, and 8 weeks later (follow-up) using the Depression, Anxiety, and Stress Scale-21, Job Satisfaction Scale and Mindful Attention Awareness Scale. RESULTS: There was a significant effect over time on stress, anxiety, depression and mindfulness level (p < .05). Regarding the difference between the groups and interaction between time and group, there was a significant effect for anxiety (p = .037 p = .008) and job satisfaction (p < .001, p = .40), respectively, with moderate effect size for anxiety reduction (.465) and small for job satisfaction increment (.221). CONCLUSION: Mindfulness-Based Training is effective in improving anxiety and job satisfaction among nurses. CLINICAL IMPLICATIONS FOR NURSING MANAGEMENT: Mindfulness-Based Training can be included as hospital policy to reduce anxiety and increase job satisfaction among nurses.

The effect of acute coronary syndrome care pathways on in-hospital patients: A systematic review.

BACKGROUND: Health care institutions need to construct management strategies for patients diagnosed with acute coronary syndrome (ACS) that focus on evidence-based treatments, adherence to treatment guidelines, and organized care. These help to reduce variations as well as the mortality and morbidity rates, which indicates the critical need for standardized care and adherence to evidence-based practices for patients hospitalized with ACS. The care pathways translate research and guidelines into clinical practice to close the gap between the guidelines and the clinical practices. OBJECTIVES: This review focuses on identifying the indicators used to evaluate ACS care pathways and their effect on the care process and clinical outcomes. METHODS: This review follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The systematic research was conducted using five research databases. Two groups were created by dividing the studies according to their year of publication. The first group included those studies published from 1997 to 2007 ("Group 1"), while the second included those published from 2008 to 2018 ("Group 2"). Selected studies were screened using the Effective Public Health Practice Project (EPHPP) quality assessment tool. RESULTS: Seventeen studies were included in this review. One study was a randomized controlled trial, 14 were predesigns and postdesigns, and two were longitudinal observational designs. The Group 1 studies demonstrated that ACS care pathways had a positive effect on reducing the length of the hospital stay and the door-to-balloon times. Similar effects were observed for the Group 2 studies. CONCLUSION: Implementing ACS care pathway helps to organize care processes and decrease treatment delays as well as improve the patient outcomes without adverse consequences for patients or additional resources and costs. While the current level of evidence is inadequate to warrant a formal recommendation, there is a need for more studies with an emphasis on well-designed randomization to measure patient outcomes.

Online STI information seeking behaviour and condom use intentions among young Facebook users in Malaysia.

The Internet has opened pathways for youth to find sexual health information which was not easily available to them in the past. Studies have shown that seeking sexual health information online may potentially influence an individuals' decision-making to change their sexual health behaviours. However, there is a gap in research on the associations of seeking online sexually transmitted infection (STI) information with STI prevention among young people, particularly in Malaysia. This study investigated the associations of seeking STI information online with the intentions of condom use among young adult online users in Malaysia. A cross-sectional online survey was conducted among Malaysian youth aged 18-25 years old who were recruited through Facebook. In total, 1530 respondents completed the survey, identifying 874 respondents who had sought STI information online. The majority of respondents had intentions to use condoms as protection against STI. Respondents who sought online STI information were significantly more likely to have the intention to use condoms compared to respondents who did not seek online STI information (OR = 1.33, 95% CI = 1.01-1.76, p = 0.040). Online STI information has the potential to increase access to STI information among young online users in Malaysia amid the stigma surrounding sex-related issues. Providing accurate STI information online from reliable sources may equip young people who have Internet access with awareness of sexual health protective behaviours such as condom use. It is recommended to facilitate Internet access to reach sectors of the population that currently do not have access, as the Internet is useful in STI prevention.

The forward-backward and dual-panel translation methods are comparable in producing semantic equivalent versions of a heart quality of life questionnaire.

AIM: To investigate semantic equivalence between two translated versions of the heart quality of life (HeartQoL) questionnaire produced by the forward-backward and dual-panel methods. METHODS: The forward-backward and dual-panel versions of HeartQoL were self-administered among 60 participants who met the inclusion criteria of being a native Bahasa Malaysia-speaking Malay, aged 18 and older, having an indexed diagnosis of ischaemic heart disease and being cognitively fit. The administration sequence of the two versions was randomized. Additionally, three sociolinguists, who were blinded to translation processes and survey findings, rated the translated versions against the source version on three aspects of semantic equivalence. RESULTS: Textual content in both translated versions was considerably similar (n = 9/14 items, ≈64%). The overall results from weighted kappa, raw agreement, intraclass correlations, and Wilcoxon signed-rank as well as experts' ratings were confirmative of semantic equivalence between the forward-backward and dual-panel versions of the HeartQoL. However, some mixed findings were indicative of potential gaps in both translated versions against the source version. CONCLUSION: Both the forward-backward and dual-panel methods produced semantically equivalent versions of HeartQoL; but translation alone is insufficient to narrow the subtle gaps caused by differences in culture and linguistic style.

Who Decides: Me or We? Family Involvement in Medical Decision Making in Eastern and Western Countries.

BACKGROUND: Research suggests that desired family involvement (FI) in medical decision making may depend on cultural values. Unfortunately, the field lacks cross-cultural studies that test this assumption. As a result, providers may be guided by incomplete information or cultural biases rather than patient preferences. METHODS: Researchers developed 6 culturally relevant disease scenarios varying from low to high medical seriousness. Quota samples of approximately 290 middle-aged urban residents in Australia, China, Malaysia, India, South Korea, Thailand, and the USA completed an online survey that examined desired levels of FI and identified individual difference predictors in each country. All reliability coefficients were acceptable. Regression models met standard assumptions. RESULTS: The strongest finding across all 7 countries was that those who desired higher self-involvement (SI) in medical decision making also wanted lower FI. On the other hand, respondents who valued relational-interdependence tended to want their families involved - a key finding in 5 of 7 countries. In addition, in 4 of 7 countries, respondents who valued social hierarchy desired higher FI. Other antecedents were less consistent. CONCLUSION: These results suggest that it is important for health providers to avoid East-West cultural stereotypes. There are meaningful numbers of patients in all 7 countries who want to be individually involved and those individuals tend to prefer lower FI. On the other hand, more interdependent patients are likely to want families involved in many of the countries studied. Thus, individual differences within culture appear to be important in predicting whether a patient desires FI. For this reason, avoiding culture-based assumptions about desired FI during medical decision making is central to providing more effective patient centered care.

Using a patient decision aid for insulin initiation in patients with type 2 diabetes: a qualitative analysis of doctor-patient conversations in primary care consultations in Malaysia.

OBJECTIVE: To investigate whether the use of apatient decision aid (PDA) for insulin initiation fulfils its purpose of facilitating patient-centred decision-making through identifying how doctors and patients interact when using the PDA during primary care consultations. DESIGN: Conversation analysis of seven single cases of audio-recorded/video-recorded consultations between doctors and patients with type 2 diabetes, using a PDA on starting insulin. SETTING: Primary care in three healthcare settings: (1) one private clinic; (2) two public community clinics and (3) one primary care clinic in a public university hospital, in Negeri Sembilan and the Klang Valley in Malaysia. PARTICIPANTS: Clinicians and seven patients with type 2 diabetes to whom insulin had been recommended. Purposive sampling was used to select a sample high in variance across healthcare settings, participant demographics and perspectives on insulin. PRIMARY OUTCOME MEASURES: Interaction between doctors and patients in a clinical consultation involving the use of a PDA about starting insulin. RESULTS: Doctors brought the PDA into the conversation mainly by asking information-focused 'yes/no' questions, and used the PDA for information exchange only if patients said they had not read it. While their contributions were limited by doctors' questions, some patients disclosed issues or concerns. Although doctors' PDA-related questions acted as a presequence to deliberation on starting insulin, their interactional practices raised questions on whether patients were informed and their preferences prioritised. CONCLUSIONS: Interactional practices can hinder effective PDA implementation, with habits from ordinary conversation potentially influencing doctors' practices and complicating their implementation of patient-centred decision-making. Effective interaction should therefore be emphasised in the design and delivery of PDAs and in training clinicians to use them.

Factors influencing job satisfaction among registered nurses: a questionnaire survey in Mashhad, Iran.

BACKGROUND: Job satisfaction is a critical factor in health care. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care. OBJECTIVE: To determine the level of nurses' job satisfaction and its associated factors. METHOD: A stratified random sample of 421 registered nurses working at a large hospital in Mashhad, Iran was surveyed. RESULT: The results showed that autonomy, task requirement and work interaction had scores higher than their respective median on the subscales. There were significant differences between demographic characteristics and the autonomy, task requirement, work interaction, salary, work condition, professional development, supportive nursing management, decision making, professional status subscales and mean total job satisfaction. In univariate analysis, young age, being female and being married were significantly associated with a higher level of job satisfaction. The adjusted R(2) for this model was 0.14, indicating that the model explained 14% of the variability. The regression model was highly significant, F (4298) = 13.194, P < 0.001. CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT: The authors emphasise that the human resources policies and incentives need to be re-visited. Efforts undertaken to improve working conditions, supportive nursing management, improved professional status, professional development and increased salaries are some of the ways for nurse managers to improve job satisfaction.