Psychometric properties of the Malay version of the difficulties in Emotion Regulation Scale-18 in Malaysian adolescents.

OBJECTIVE: The Difficulties in Emotion Regulation Scale-18 (DERS-18) is an instrument used to measure deficits in emotion regulation. However, the instrument has not been adapted to Malaysians and has never been validated in the Malay language. This study aimed to examine the psychometric properties of the Malay version of DERS-18. METHOD: The DERS-18 underwent forward-backward translation and assessment of face and content validity. Both Malay version of the DERS-18 and DASS-21 were completed by 701 adolescents (44.4% boys) aged 13 and 14 years old. To assess its dependability, a floor and ceiling effect evaluation and Cronbach's analysis were both performed. A series of confirmatory factor analyses (CFA), bivariate correlation, and regression were performed to evaluate the construct and criterion validity, respectively. RESULTS: The Malay version of DERS-18, after excluding "Awareness", indicated excellent reliability (Cronbach's α = 0.93), and acceptable internal consistency for each subscale (range of α from 0.63 to 0.82). Floor or ceiling effects were observed at item level and subscale level, but not at total level. CFA results revealed that the Malay version of the DERS-18 bifactor model (excluding "Awareness") portrayed the best construct validity (χ2/df = 2.673, RMSEA = 0.049, CFI = 0.977, TLI = 0.968) compared to a single factor, a correlated factor, and a higher-order factor model. The DERS-18 subscales (except "Awareness") and DERS-18 total scores were significantly correlated with stress, anxiety, and depression in a positive direction (r ranged from 0.62 to 0.64, p < 0.01). The general factor of the DERS-18 and its specific factors ("Clarity", "Goals", and "Non-Acceptance") significantly predicted the symptoms of stress, anxiety, and depression (R2 ranged from 0.44 to 0.46, p < 0.001). CONCLUSION: The Malay version of the DERS-18, excluding "Awareness", possessed good reliability, construct validity, and criterion validity to assess emotion dysregulation among Malaysian adolescents.

Assessing Autism Knowledge Across the Global Landscape Using the ASK-Q.

Substantial variability exists with regard to autism service provision around the world. Service disparities observed in many low- and middle-income countries may be driven, in part, by limited autism knowledge; however, measurement limitations have made it difficult to quantify autism knowledge across countries. The current study uses the autism stigma and knowledge questionnaire (ASK-Q) to quantify autism knowledge and stigma between different countries and demographics. The current study compiled data from 6830 participants collected using adapted versions of the ASK-Q administered in 13 different countries, representing four different continents. Structural equation modeling was used to examine how autism knowledge varied across country and individual factors. Results reveal cross country variability with a large, 17-point difference between the countries with the highest knowledge (Canada) and the lowest knowledge (Lebanon). As expected, countries with higher economies had higher levels of knowledge. We also documented differences based on country worldview, participant occupation, gender, age, and education level. These results help to identify specific regions and populations that might most need greater information about autism.

Digital behaviour change interventions to promote physical activity in overweight and obese adolescents: a systematic review protocol.

BACKGROUND: With the increasing prevalence of obesity in youth, behavioural interventions to alter its modifiable risk factors such as physical activity can support the management of this epidemic. Digital behaviour changes interventions (DBCI) such as mobile applications, websites and wearables have the potential to reach many adolescents to promote physical activity as its use may be more accessible, effective and engaging compared to traditional face-to-face approaches. However, there is insufficient evidence on their use at promoting physical activity amongst overweight and obese adolescents. This review aims to assess the effectiveness of DBCIs aiming to increase physical activity in overweight and obese adolescents (aged 10-19 years) and the behaviour change techniques used in these interventions. METHODS: Electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane and Scopus) will be searched for English language studies from January 2000 to December 2022 using appropriate search terms relating to digital interventions, physical activity, adolescents and obesity. Experimental studies (either randomised or non-randomised controlled trials) assessing effects of DBCIs on physical activity behaviour, objectively or subjectively measured, in overweight and obese (body mass index [BMI] ≥ 85th percentile for age) adolescents will be eligible for inclusion. Intervention characteristics will be coded using the Template for Intervention Description and Replication (TIDieR) checklist and the BCT taxonomy v1. Risk of bias and the overall quality of the included studies will be assessed using Cochrane's Collaboration's tool and GRADE approach respectively. If the data allows, meta-analyses using random effect models will be conducted to assess the effects of DBCIs on physical activity. DISCUSSION: The proposed systematic review will summarise the effectiveness of digital behaviour change interventions aiming to increase physical activity in overweight and obese adolescents, as well as adding new information on the behaviour change techniques used in these interventions. The findings of this review will facilitate stakeholders with a current, rigorous and reliable research base to support the development and implementation of effective health promotion interventions for this population. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021270008.

Translation and Validation of the Malay Version of the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA).

The Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA) has been translated and adapted globally. This study aimed to examine the psychometric properties of the Malay version of the ERQ-CA. The ERQ-CA underwent forward and back translation twice and was tested in two separate studies, Study 1 and Study 2, with 296 and 359 students aged between 13 and 14 years old, respectively. Cronbach's alpha values were calculated, and confirmatory factor analysis was conducted. The results from Study 1 demonstrate good internal consistency for cognitive reappraisal and expressive suppression. The results indicate a good factor loading for most of the items, but only one value of the goodness-of-fit met the criteria for a good fit. The results from Study 2 show improvements in the values of the goodness-of-fit that are comparable to previous studies, but there was a decrease in the factor loading scores. Overall, the Malay version of the ERQ-CA possesses acceptable reliability and validity. Further studies are required in the near future to develop a Malay version of the ERQ-CA that reasonably represents Malaysian adolescents.

The profile of headaches and migraine amongst medical students and its association to stress level, disability and self-management practices.

Introduction: Migraine is the most common headache affecting young people that impairs their functional ability. This study aimed to determine the frequency of migraines among Malaysian medical students, the association between migraines, stress level, and functional disability among these students, and describe their self-management practices. Methods: A cross-sectional study was conducted among medical students in a private medical school in Penang state. All medical students in the study site were screened for the presence of headache symptoms and the diagnosis of migraine using a self-administered questionnaire comprising International Headache Society (IHS) diagnostic criteria. Other domains that were assessed were perceived stress level and functional disability, which were measured using the Perceived Stress Scale and the Headache Impact Test-6 (HIT-6), respectively. The students' selfmanagement practices for their headaches were determined using a descriptive survey. Results: A total of 374 medical students participated in this study and 157 (42%) students reported experiencing headaches. More than half (n=97, 61.8%) of those with headaches fulfilled the IHS criteria for migraines. Migraines were significantly associated with functional disability compared with non-migraine headaches (p<0.001); however, no significant difference in stress levels were reported between the two groups. During migraine attacks, sleep (n=73, 60.33%) and self-medication (n=56, 69.14%) were the most common self-management practices. Only 11.46% of the 157 students with headaches consulted a doctor. Conclusion: A high proportion of medical students suffered from headaches and more than half of them had migraines. Migraine headaches were associated with significant functional disability. Very few students sought medical consultation and most students chose to self-manage their headaches.

A Malay Version of the Attitude to Ageing Questionnaire: Its Adaptation, Validation, and Reliability in the Malaysian Older Adult Population.

BACKGROUND: The Attitude to Ageing Questionnaire (AAQ) was developed to assess perceptions of the aging process among older adults. The 24 items were framed into three factors. This study aimed to translate the AAQ from English to the Malay language (AAQ-M) and determine its factorial structure and validity in a Malaysian population. METHODS: The original AAQ underwent a standard translation process, as well as content and face validation, to produce the AAQ-M. The construct validity of the AAQ-M was then assessed in 254 older adults aged 60 years and above attending a public primary care clinic in Seremban, Malaysia. RESULTS: Exploratory factor analysis showed a three-factor model for the AAQ-M with acceptable reliability and Cronbach α values ranging from 0.71 to 0.82 for each factor. A total of five items were omitted for poor factor loadings (<0.32) or because they did not conceptually fit into the factor they were loaded onto. Of the final 19 AAQ-M items, seven were physical change factors, eight were psychosocial loss factors, and four were psychological growth factors. This three-factor model explained 37.9% of the total variance. CONCLUSION: The AAQ-M version confirmed that the three-factor model, namely physical change, psychosocial loss, and psychological growth, was similar to that of the original AAQ. The AAQ-M is a valid and reliable instrument for assessing the three aspects of attitudes toward aging in the Malaysian older adult population.

Feasibility and Usability of Kegel Exercise Pregnancy Training App (KEPT App) among Pregnant Women with Urinary Incontinence.

Pelvic floor muscle training (PFMT) is crucial to improving urinary incontinence (UI). This study aimed to assess the Kegel Exercise Pregnancy Training (KEPT) app's feasibility and usability. This is a subgroup analysis from a researcher-blinded, randomised controlled pilot feasibility study among pregnant women with UI. The Malay version of the mHealth App Usability Questionnaire (Interactive) evaluated the app's usability. Ten pregnant women completed the study, with mean age (SD) of 28.9 years (3.1). The app's feasibility was rated above average. The app was reported with usable in all domains, (1) system information arrangement (4.98/7.0), (2) usefulness (4.89/7.0) and (3) ease-of-use and satisfaction (5.03/7.0). Education level was negatively correlated with the app's feasibility (r = −0.81, p < 0.001) and all domains of usability such as ease-of-use (r = −0.66, p = 0.01), system information (r = −0.81, p = 0.001) and usefulness (r = −0.81, p = 0.001). PFMT video was among the app features chosen to be helpful. This study demonstrates that the newly developed user-centred design KEPT app is feasible and usable. However, the future app should provide direct feedback about their exercise techniques to motivate PFMT adherence.

Preliminary Effectiveness of mHealth App-Based Pelvic Floor Muscle Training among Pregnant Women to Improve Their Exercise Adherence: A Pilot Randomised Control Trial.

This pilot randomised control trial (RCT) aimed to evaluate the feasibility and preliminary effectiveness of conducting a full-powered trial for a newly developed pelvic floor muscle training (PFMT) app among pregnant women with urinary incontinence (UI) in Malaysia. This was a prospective, single-centre, single-blind, parallel, randomised controlled, pilot feasibility study-the Kegel Exercise Pregnancy Training app (KEPT app) trial. In total, 26 pregnant women with urinary incontinence from an urban healthcare clinic were recruited and randomly assigned to either intervention or waitlist control group. The intervention group received the KEPT app, while the control group received usual antenatal care (waitlist control). Of the 26 pregnant women, 16 (61.5%) completed the two-month follow-up. The recruitment rate was 54.2%, and the retention rate was 62.5% in the intervention group and 60% in the control group. There was a significant difference between intervention and control groups' baseline measurement in the severity of UI (p = 0.031). The app improved their knowledge (p = 0.011) and self-efficacy (p = 0.038) after the first month and attitude (p = 0.034) after two months of intervention, compared with the control group. This study supports the feasibility of our future cluster RCT. The KEPT app demonstrates a promising effect in improving PFMT attitude and self-efficacy and potentially enhancing exercise adherence among pregnant women with UI. Trial registration: This study was prospectively registered on ClinicalTrials.gov on 19 February 2021 (NCT04762433).

Prevalence and description of digital device use among preschool children: A cross-sectional study in Kota Setar District, Kedah.

Introduction: Digital device helps children enhance academic, cognitive and psychomotor skills. However, prolonged use causes physical inactivity, poor interpersonal skills and communication problems. Information on digital device use among young children in Malaysia is currently limited. Hence, this study aimed to determine the prevalence of digital device utilisation among preschool children in Kota Setar District, Kedah. Method: A cross-sectional study at government preschools in Kota Setar District was conducted from February to April 2020. Selection of preschools and students was done using multistage simple randomisation. A self-administered questionnaire containing demographic and digital device use details was filled by parents. Results: The prevalence of digital device use among preschool children was 95.9% and mostly used smartphones (94.2%). Most children (95%) did not own the device, and usage was under supervision (95.7%). The reason for supervision was to prevent exposure to inappropriate content (70.5%). The common reasons for allowing digital device use were for educational (37.4%) and entertainment purposes (36%) through videos (30.9%) and games (30.2%). Approximately 21.5% and 50.3% of the children spent more than 1 and 2 hours on digital devices during weekdays and weekends, respectively. Conclusion: The prevalence of digital device use among the preschool children in Kota Setar District was very high. Most of them used digital devices for educational and entertainment purposes under parental supervision. However, some exceeded the recommended screen time on weekends. These findings could promote awareness of digital device use among young children and help design public health awareness programmes and future policies.

Case report: Bipolar disorder in 48,XXYY syndrome.

48,XXYY syndrome is a rare condition. The presentations of impulsive and aggressive behavior have been reported in several case reports among patients with 48,XXYY syndrome. The management of the psychological impact and neuropsychiatric sequela of this condition is a significant issue faced by families, carers, and healthcare professionals. We report a patient, 21-year-old Malay male, with underlying 48,XXYY syndrome with attention deficit hyperactivity disorder (ADHD) and intellectual disability, diagnosed later in adulthood with a bipolar mood disorder and benefited after being started on lithium. We describe the key clinical features and diagnostic workouts that allowed the arrival of the correct psychiatric diagnosis. Challenges in psychopharmacotherapy, including the risks of metabolic syndrome and deep vein thrombosis associated with 48,XXYY syndrome, are also considered. We suggest that for patients with 48,XXYY syndrome, routine psychological screening for mood symptoms such as mania and depression should be done by healthcare professionals with early involvement of psychiatrist in the multidisciplinary team due to the challenges in the management of these patients.

Internet pornography exposures amongst young people in Malaysia: A cross-sectional study looking into the role of gender and perceived realism versus the actual sexual activities.

Despite the wide accessibility to internet, pornography activities among youths are not well described in conservative countries like Malaysia. This study aimed to determine the prevalence, elicit gender differences and identify associated factors of pornographic exposure including perceived realism among college students. This cross-sectional study was conducted among students aged 18 to 25 years from seven colleges in Penang, Malaysia. A self-administered questionnaire was used to obtain data on socio-demographic characteristics, pornography exposure, pattern of use, sexual exposure and perceived realism. Among 986 participants, the prevalence of lifetime pornography exposure was 74.5%. More males (71.7%) were exposed to pornography, had started at earlier age, were frequent users and using the internet alone at home (p < 0.001). Males had higher odds of having exposure (Adjusted odds ratio, AOR = 20.44, 95% CI: 12.50 - 33.42, p < 0.001), whilst those who perceived pornography as real had lower odds of having pornographic exposure (AOR = 0.64, 95% CI: 0.43-0.94, p = 0.02). There is a high prevalence of pornography exposure among Malaysian college students, especially involving males. Easy access to pornographic materials at home facilitates this activity. Gender and perceived realism determined their pornographic exposure. Thus, parental monitoring of online access and planning structured activities to occupy free time are recommended at an early age.

Protocol of a Single-Blind Two-Arm (Waitlist Control) Parallel-Group Randomised Controlled Pilot Feasibility Study for mHealth App among Incontinent Pregnant Women.

BACKGROUND: The delivery of pelvic floor muscle training (PFMT) through mHealth apps has been shown to produce promising results in improving pelvic floor muscle strength and urinary incontinence (UI). However, there is limited evidence on mHealth apps designed for pregnant women who are at high risk of developing UI. This pilot study aims to evaluate the feasibility of conducting an effectiveness trial for a newly developed PFMT app among pregnant women in Malaysia. METHODS: This is a prospective, single-centre, single-blind, randomised controlled pilot feasibility study: The Kegel Exercise Pregnancy Training app (KEPT-app) Trial. Sixty-four incontinent pregnant women who attended one primary care clinic for the antenatal follow-up will be recruited and randomly assigned to either intervention or waitlist control group. The intervention group will receive the intervention, the KEPT-app developed from the Capability, Opportunity, Motivation-Behaviour (COM-B) theory with Persuasive Technology and Technology Acceptance Model. DISCUSSION: This study will provide a fine-tuning for our future randomised control study on the recruitment feasibility methods, acceptability, feasibility, and usability of the KEPT-app, and the methods to reduce the retention rates among pregnant women with UI. TRIAL REGISTRATION: This study was registered on ClinicalTrials.gov on 19 February 2021 (NCT04762433) and is not yet recruiting.

KEPT-app trial: a pragmatic, single-blind, parallel, cluster-randomised effectiveness study of pelvic floor muscle training among incontinent pregnant women: study protocol.

INTRODUCTION: Pelvic floor muscle training (PFMT) strongly recommended to incontinent pregnant women. The Kegel Exercise Pregnancy Training-app trial is a multicentre cluster-randomised study aims to assess the effectiveness and its cost-effectiveness of the mobile app guidance in PFMT among incontinent pregnant women. METHODS AND ANALYSIS: 370 pregnant women (aged 18 years old and above) will be recruited with International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form. Ten clusters (primary care clinics) will be randomly assigned to either PFMT or usual care in a 1:1 ratio by an independent researcher (sealed envelope). The primary outcome will be urinary incontinence, and the secondary outcomes (quality of life; PFMT adherence, psychological status and mobile apps' usability) will be assessed at four measurement time points (t0: baseline) and postintervention (t1: 4 weeks, t2: 8 weeks and t3: 8 weeks postnatal). T-test analysis will determine any significant differences at the baseline between the control and intervention groups. The mixed-model analysis will determine the effectiveness of the intervention at the population-average level for both the primary and secondary outcomes. For the cost-effectiveness analysis, expenditures during the study and 6 months after the intervention will be compared between the groups using the multiway sensitivity analysis. The recruitment planned will be in December 2020, and the planned end of the study will be in August 2021. ETHICS AND DISSEMINATION: This study protocol was approved by the Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia (JKEUPM-2019-368) and Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia, NMRR-19-412-47116 (IIR) with the ANZCTR registration. This study will obtain informed written consent from all the study participants. The results which conform with the Consolidated Standards of Reporting Trials and the Recommendations for Interventional Trials will be published for dissemination in peer-reviewed journals and conference proceedings. TRIAL REGISTRATION NUMBER: ACTRN12619000379112.

Anaemia among primary care patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD): a multicentred cross-sectional study.

OBJECTIVES: This study aimed to determine the prevalence of anaemia among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) at primary care settings and its associated factors. DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study involved 808 adult patients with T2DM and CKD who were recruited via systematic sampling from 20 public primary care clinics in Peninsular Malaysia. Their sociodemographic, clinical and biomedical profiles were collected through interviews, examination of medical records and blood testing. RESULTS: The prevalence of anaemia was 31.7% (256/808). The anaemia was mainly mild (61.5%) and normocytic normochromic (58.7%). About 88.7% of the patients with anaemia were not known to have anaemia prior to the study. Among 36 patients with documented history of anaemia, 80.6% were still anaemic, and only a half received iron therapy. Multivariate regression analysis showed that women (adjusted odd ratio (AOR): 1.57, 95% CI: 1.12 to 2.21, p=0.009) and those with older age (AOR: 1.04, 95% CI: 1.01 to 1.06, p<0.001), CKD stage 3a (AOR: 2.47; 95% CI: 1.25 to 4.87, p=0.009), CKD stage 3b (AOR: 4.36; 95% CI: 2.14 to 8.85, p<0.001), CKD stage 4 (AOR: 10.12; 95% CI: 4.36 to 23.47, p<0.001), CKD stage 5 (AOR: 10.80; 95% CI: 3.32 to 35.11, p<0.001) and foot complication (AOR 3.12, 95% CI: 1.51 to 6.46, p=0.002) were more likely to have anaemia. Having higher body mass index (AOR 0.95, 95% CI: 0.92 to 0.99, p=0.012) and higher diastolic blood pressure (AOR 0.97, 95% CI: 0.95 to 0.99, p<0.001) were associated with lower odds to have anaemia. CONCLUSION: Anaemia among patients with T2DM and CKD in primary care was common, and the majority was unrecognised. Inadequate treatment of anaemia was also prevalent. Therefore, screening of anaemia should be incorporated into the routine assessment of diabetic complications particularly for those with significant associated factors. It is hoped that such strategy could lead to early treatment and hence improve their overall care. TRIAL REGISTRATION NUMBER: NMRR-15-660-24324.

Clinical and Sociodemographic Predictors of the Quality of Life among Patients with Type 2 Diabetes Mellitus on the East Coast of Peninsular Malaysia.

BACKGROUND: The quality of life (QoL) describes the multidimensional self-perceived well-being of a person, which is an important diabetes outcome. This study aimed to measure the QoL scores among patients with type 2 diabetes mellitus (T2DM), as well as their clinical and sociodemographic predictors. METHODS: This cross-sectional study involved 180 randomly sampled patients at a primary care clinic on the East Coast of Peninsular Malaysia. A self-administered questionnaire containing the Audit of Diabetes Dependent Quality of Life-18 (ADDQoL-18) was used. RESULTS: Most of the respondents (96.7%) were Malay, with a median (interquartile range, IQR) age of 54.0 (14.0) years old. The majority of them were females (60.0%), married (81.1%) and from low-income families (63.3%), who attained a secondary education or lower (75.6%). Only 49.4% of them were employed. The mean (standard deviation, SD) ADDQoL-18 average weighted impact score was -4.58 (2.21) and all 18 domains were negatively affected, particularly the living condition, family life and working life. The multiple linear regression analysis showed that the age (adjusted B = 0.05, P = 0.004) and insulin use (adjusted B = -0.84, P = 0.011) were QoL predictors. CONCLUSION: T2DM negatively impacts the patient's QoL in all aspects of their life. The QoL improvement with age suggests that the older patients had accepted and adapted to their illness. The need to improve the QoL among insulin users was also highlighted.

The Cost and Quality of Life of Malaysian Type 2 Diabetes Mellitus Patients with Chronic Kidney Disease and Anemia.

BACKGROUND: Anemia is common among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) and an independent risk factor for renal disease progression. Health economic evidence is important in Malaysia and yet cost and quality-of-life (QOL) data are scarce. OBJECTIVES: To investigate prevalence, factors associated with anemia, and cost and QOL among T2DM patients with CKD. Here, we present the estimated 1-year cost and QOL related to anemia in this group. METHODS: A cross-sectional, observational study was performed at 20 government clinics. Treatment cost was calculated on the basis of resource utilization ascertained through data extracted from medical records and patient recall. QOL was elicited using the short form 36 health survey version 2 questionnaire. Propensity score matching was performed and costs and QOL were analyzed by anemia status and CKD stage. RESULTS: Data for 816 patients were obtained. The propensity score matching enabled a comparison of 257 patients with and without anemia. Annual treatment costs were significantly higher for patients with anemia (Ringgit Malaysia [RM] 4219 [US $983] vs. RM2705 [US $630]; P = 0.01). QOL scores were lower for patients with anemia but not statistically significant (physical component summary score: 44.8 vs. 46.2; P = 0.052; mental component summary score: 51.3 vs. 51.7; P = 0.562). Costs were higher and QOL lower among CKD stage 5 patients. CONCLUSIONS: This study was the first to examine anemia in this group of patients. Costs were significantly higher among anemic patients compared with nonanemic patients; patients with higher CKD stage 5 fared less well than did those in lower stages. This information suggests the need to increase detection, prevention, and early treatment of anemia when managing T2DM patients, particularly those with CKD.

Questionnaire development and validity to measure sexual intention among youth in Malaysia.

BACKGROUND: From the Theory of Planned Behaviour perspective, sexual intention is determined by a permissive attitude, perception of social norms and perceived self-efficacy in performing sexual activity. The aim of this study was to develop and validate the Youth Sexual Intention Questionnaire (YSI-Q), which was designed to measure sexual intention among youths in Malaysia. METHODS: A total of 25 items were developed based on literature reviews encompassing four main constructs: sexual intention, attitude, social norms and self-efficacy. The YSI-Q then underwent a validation process that included content and face validity, exploratory factor analysis (EFA), reliability analysis, and confirmatory factor analysis (CFA). This study was conducted on unmarried youths aged 18 to 22 years who were studying in colleges around Klang Valley, Malaysia. RESULTS: EFA supported the four factor structure, but five items were removed due to incorrect placement or low factor loading (<0.60). Internal reliability using Cronbach's alpha ranged between 0.89 and 0.94. The CFA further confirmed the construct, convergent and discriminant validity of the YSI-Q with χ 2 = 392.43, df = 164, p < 0.001, χ 2/df = 2.40, CFI = 0.93 and TLI = 0.92 and RMSEA = 0.08. CONCLUSION: The final set of YSI-Q consisted of 20 items measuring sexual intention (five items), attitude (five items), social norms (six items) and self-efficacy (four items) of practicing sexual activity. YSI-Q was shown to be a reliable and valid tool to be used among Malaysian youths.

Role of Religion in Preventing Youth Sexual Activity in Malaysia: A Mixed Methods Study.

One of the popular approaches of preventing youth sexual activity in Malaysia is using religion to promote premarital sexual abstinence. Despite this intervention, youth continue to practise premarital sex. Thus, the purpose of this exploratory mixed methods study was to understand the role of religion on sexual activity among college students in Klang Valley, Malaysia. A self-administered questionnaire survey to determine the relationship between religiosity and youth sexual activity was carried out on 1026 students recruited from 12 randomly selected colleges. Concurrently, face-to-face interviews were conducted on 15 students to explore how religiosity had influenced their decision on sexual activity. The survey data were analysed using logistic regression, while the qualitative data from the interviews were examined using thematic analysis with separate analysis for each gender. Both quantitative and qualitative results were then compared and integrated. Religious activity significantly reduced the risk of continuing sexual activity among female students (AOR = 0.67, CI = 0.47, 0.95, p = 0.02) but not male students. There was no significant relationship of religious affiliation and intrinsic religiosity (inner faith) to sexual activity by gender. Having faith in religion and strong sexual desire were the main themes that explained participants' sexual behaviour. Engaging in religious activity might be effective at preventing female students from being sexually active. However, when sexual urges and desires are beyond control, religiosity might not be effective.

Validation of the Malay Version of the Parental Bonding Instrument among Malaysian Youths Using Exploratory Factor Analysis.

BACKGROUND: Parenting behaviour is culturally sensitive. The aims of this study were (1) to translate the Parental Bonding Instrument into Malay (PBI-M) and (2) to determine its factorial structure and validity among the Malaysian population. METHODS: The PBI-M was generated from a standard translation process and comprehension testing. The validation study of the PBI-M was administered to 248 college students aged 18 to 22 years. RESULTS: Participants in the comprehension testing had difficulty understanding negative items. Five translated double negative items were replaced with five positive items with similar meanings. Exploratory factor analysis showed a three-factor model for the PBI-M with acceptable reliability. Four negative items (items 3, 4, 8, and 16) and item 19 were omitted from the final PBI-M list because of incorrect placement or low factor loading (< 0.32). Out of the final 20 items of the PBI-M, there were 10 items for the care factor, five items for the autonomy factor and five items for the overprotection factor. All the items loaded positively on their respective factors. CONCLUSION: The Malaysian population favoured positive items in answering questions. The PBI-M confirmed the three-factor model that consisted of care, autonomy and overprotection. The PBI-M is a valid and reliable instrument to assess the Malaysian parenting style. Confirmatory factor analysis may further support this finding. KEYWORDS: Malaysia, parenting, questionnaire, validity.