Changes in body mass index and its association with socio-demographic characteristics between 2010 and 2016 in Singapore.

Background: Epidemiological studies have observed an increase in the prevalence of obesity in both western and Asian countries. This study aims to compare the distribution of body mass index (BMI) in the general population of Singapore between 2010 and 2016, and to explore the socio-demographic risk factors associated with it. Methods: Data for this study were extracted from two national-wise studies in 2010 and 2016, two population-based, cross-sectional epidemiological studies. BMI cut-off scores were used as an indicator to assess obesity in this study, and the data included in the analysis was self-reported by the respondents. Results: Overall, the study observed decreasing prevalence in underweight and normal weight categories; and an increasing prevalence in overweight and obesity categories in the Singapore adult population between 2010 and 2016. Age, gender, ethnicity, marital status, and educational level were found to be significantly associated with BMI categories. Conclusion: The observed increase in the population's BMI between 2010 and 2016 may lead to an increase in the incidence of chronic diseases in Singapore. Our study findings add to the existing local literature and provides data for evidence-based policymaking on health-related interventions and program planning.

Association between sleep quality and quality of life in Singapore.

PURPOSE: Several studies have examined the relationship between sleep quality and health-related quality of life (HRQOL). However, there are a lack of generalizable data on this association in Singapore. Our study aimed to (1) investigate the association between sleep quality and HRQOL and (2) examine whether age moderated these associations. METHODS: Data were obtained from nationwide Singapore Mental Health Study 2016 (n = 6126, response rate = 69.5%). Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI) where higher scores indicate poorer sleep quality. HRQOL [Physical component summary (PCS) and Mental component summary (MCS)] were measured using 12-item Short-Form Survey. Associations were investigated using multivariable linear regression models, adjusted for sociodemographic, physical, and mental comorbidities. Interactions between age and sleep quality were examined by including interaction terms individually. RESULTS: Poorer PSQI score was significantly associated with lower PCS (ß = - 0.44) and lower MCS (ß = - 0.73). Among PSQI components, lower PCS was significantly associated with subjective sleep quality (ß = - 1.06), sleep duration (ß = - 0.30), sleep disturbance (ß = - 0.33), and daytime dysfunction (ß = - 0.75). Lower MCS was significantly associated with subjective sleep quality (ß = - 1.36), sleep latency (ß = - 0.24), sleep disturbance (ß = - 0.16), using of sleeping medication (ß = - 1.12), and daytime dysfunction (ß = - 2.08). Age moderated the association between PSQI score with PCS and MCS. Stronger association between PSQI score and MCS was observed in younger individuals (ß = - 0.90) than older adults (ß = - 0.45). CONCLUSION: Our study found that poor sleep quality was associated with HRQOL of certain age groups more than others. Future studies may identify potential mediators to help people with chronic sleep problems.

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.

Equipercentile linking of the Sheehan Disability Scale and the World Health Organization Assessment Schedule 2.0 scales in people with mental disorders.

BACKGROUND: The Sheehan Disability Scale (SDS) and the World Health Organization Disability Assessment Scale (WHODAS 2.0) have been widely used to measure functional impairment and disability. To ensure that the scores from these two scales are practically exchangeable across diseases, therapies, and care programmes, the current study aimed to examine the linkage of the WHODAS 2.0 with the SDS and develop a simple and reliable conversion table for the two scales in people with mental disorders. METHODS: A total of 798 patients (mean age = 36.1, SD = 12.7) were recruited from outpatient clinics of the Institute of Mental Health, and the Community Wellness Clinic in Singapore. Using a single-group design, an equipercentile equating method with log-linear smoothing was used to establish a conversion table from the SDS to the WHODAS 2.0 and vice versa. RESULTS: The conversion table showed that the scores were consistent for the entire range of scores when the scores were converted either from the SDS to the WHODAS 2.0 or from the WHODAS 2.0 to the SDS. The agreement between the WHODAS 2.0's raw and converted scores and SDS's raw and converted scores were interpreted as good with intraclass correlation coefficient of 0.711 and 0.725, respectively. CONCLUSION: This study presents a simple and reliable method for converting the SDS scores to the WHODAS 2.0 scores and vice versa, enabling interchangeable use of data across these two disability measures.

Treatment delays for mental disorders in Singapore: results from the Singapore Mental Health Study 2016.

PURPOSE: Although the trajectory of mental disorders can be improved with timely treatment, many people defer treatment-seeking. This study aimed to examine the prevalence and correlates of treatment delays for mental disorders in Singapore, as well as perceived effectiveness of treatment received. METHODS: A total of 6126 respondents, aged 18 and above, participated in the Singapore Mental Health Study 2016-a cross-sectional, nationwide study conducted in Singapore from 2016 to 2018. Lifetime treatment contact for mood, anxiety, and alcohol use disorders (AUD) was assessed using the World Mental Health-Composite International Diagnostic Interview (Version 3.0). Multivariable logistic regression was conducted to examine correlates of delayed treatment. RESULTS: A total of 137 participants had made lifetime treatment contact for a mental disorder. The proportion of respondents who received delayed treatment (i.e., at least one year after onset of disorder) was 60.8% for any disorder, 59.5% for mood disorders, 56.3% for anxiety disorders, and 92.7% for AUD. The median delay was 5 years for mood disorders, one year for anxiety disorders, and 4 years for AUD. Treatment delay was significantly associated with older age, higher educational qualification, lifetime AUD, and earlier age of onset of disorder. 58.4% of respondents with lifetime treatment contact had received treatment that they considered effective. CONCLUSION: The high prevalence and long durations of treatment delay underscore the need to encourage help-seeking for mental disorders, especially since treatment is generally perceived to be helpful. Our findings also highlight several population groups more susceptible to receiving delayed treatment.

Validation of the 12-item World Health Organization Disability Assessment Schedule 2.0 in individuals with schizophrenia, depression, anxiety, and diabetes in Singapore.

BACKGROUND: There is limited evidence on the reliability and validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in an Asian patient population with mental and physical disorders. The current study aimed to examine the psychometric properties of the WHODAS 2.0 among patients with schizophrenia, depression, anxiety, and diabetes. METHODS: A total of 1076 patients (M = 40.9 years, SD = 14.7) were recruited from the outpatient clinics of a tertiary psychiatric hospital and a primary care clinic. Internal consistency and test-retest reliability, structural validity, convergent validity, agreement, and floor and ceiling effects were examined. RESULTS: Our confirmatory factor analysis (CFA) showed that the 1-factor model fits our data. Multigroup CFA demonstrated metric and scalar invariance, indicating the scores can be compared across the four conditions. The WHODAS 2.0 scale had excellent reliability in the overall sample and good to excellent reliability across conditions. The test-retest reliability and agreement between self-administered and interviewer-administered modes were good. The WHODAS 2.0 scores had moderate to strong correlations with the Social and Occupational Functioning Scale and the Sheehan Disability Scale scores in the overall sample and across four conditions. CONCLUSION: Findings suggest that the WHODAS 2.0 is a valid tool to measure functioning and disability in those with schizophrenia, anxiety, depression, and diabetes in an Asian patient population.

COVID-19 Vaccination Willingness and Reasons for Vaccine Refusal.

Importance: Hong Kong was held as an exemplar for pandemic response until it recorded the world's highest daily COVID-19 mortality, which was likely due to vaccine refusal. To prevent this high mortality in future pandemics, information on underlying reasons for vaccine refusal is necessary. Objectives: To track the evolution of COVID-19 vaccination willingness and uptake from before vaccine rollout to mass vaccination, to examine factors associated with COVID-19 vaccine refusal and compare with data from Singapore, and to assess the population attributable fraction for vaccine refusal. Design, Setting, and Participants: This cohort study used data from randomly sampled participants from 14 waves of population-based studies in Hong Kong (February 2020 to May 2022) and 2 waves of population-based studies in Singapore (May 2020 to June 2021 and October 2021 to January 2022), and a population-wide registry of COVID-19 vaccination appointments. Data were analyzed from February 23, 2021, to May 30, 2022. Exposures: Trust in COVID-19 vaccine information sources (ie, health authorities, physicians, traditional media, and social media); COVID-19 vaccine confidence on effectiveness, safety, and importance; COVID-19 vaccine misconceptions on safety and high-risk groups; political views; and COVID-19 policies (ie, workplace vaccine mandates and vaccine pass). Main Outcomes and Measures: Primary outcomes were the weighted prevalence of COVID-19 vaccination willingness over the pandemic, adjusted incidence rate ratios, and population attributable fractions of COVID-19 vaccine refusal. A secondary outcome was change in daily COVID-19 vaccination appointments. Results: The study included 28 007 interviews from 20 waves of longitudinal data, with 1114 participants in the most recent wave (median [range] age, 54.2 years [20-92] years; 571 [51.3%] female). Four factors-mistrust in health authorities, low vaccine confidence, vaccine misconceptions, and political views-could jointly account for 82.2% (95% CI, 62.3%-100.0%) of vaccine refusal in adults aged 18 to 59 years and 69.3% (95% CI, 47.2%-91.4%) of vaccine refusal in adults aged 60 years and older. Workplace vaccine mandates were associated with 62.2% (95% CI, 9.9%-139.2%) increases in daily COVID-19 vaccination appointments, and the Hong Kong vaccine pass was associated with 124.8% (95% CI, 65.9%-204.6%) increases in daily COVID-19 vaccination appointments. Conclusions and Relevance: These findings suggest that trust in health authorities was fundamental to overcoming vaccine hesitancy. As such, engendering trust in health care professionals, experts, and public health agencies should be incorporated into pandemic preparedness and response.

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.

A retrospective database study on 2-year weight trajectories in first-episode psychosis.

Introduction: It is critical to focus on individual weight profiles in line with efforts to tailor treatment, given the heterogeneous nature of the clinical population. This study aims to identify and describe possible two-year weight trajectories among patients accepted to the Early Psychosis Intervention Programme (EPIP) in Singapore. Methods: De-identified data was extracted from EPIP's standing database for patients accepted from 2014 to 2018 with a schizophrenia spectrum disorder. Data collected at fixed time-points (baseline, 1-year, and 2-year) included anthropometric measures (height and weight), and sociodemographic (age, sex, highest education level, and vocational status) and clinical (duration of untreated psychosis, number of inpatient admissions, and scores on the Positive and Negative Syndrome Scale and Global Assessment of Functioning) information. Results: A total of 391 complete data sets were included for main analyses. Those with missing weight data were more likely to be males, older at baseline, have a highest education level of tertiary and above at baseline, and have a longer duration of untreated psychosis. The weight change across two years resulted in the following membership breakdown: 151 (38.6%) in super high risk; 133 (34.0%) in high risk mitigated; 17 (4.3%) in at risk; 34 (8.8%) in delayed risk; and 56 (14.4%) in low risk. Discussion: The lack of pharmacological, dietary, and physical activity data is a significant limitation in this study; however, the results reinforce the justification for future studies to prospectively capture and examine the influence of these data, with the aim of early detection and weight intervention for high risk groups.

Mapping the schizophrenia quality of life scale to EQ-5D, HUI3 and SF-6D utility scores in patients with schizophrenia.

OBJECTIVES: The current study aimed to map the disease-specific Schizophrenia Quality of Life Scale (SQLS) onto the three- and five-level EuroQol five-dimension (EQ-5D-3 L and EQ-5D-5 L), Health Utility Index Mark 3 (HUI3) and Short Form six-dimensional (SF-6D) preference-based instruments to inform future cost-utility analyses for treatment of patients with schizophrenia. METHODS: Data from 251 outpatients with schizophrenia spectrum disorders was included for analysis. Ordinary least square (OLS), Tobit and beta regression mixture models were employed to estimate the utility scores. Three regression models with a total of 66 specifications were determined by goodness of fit and predictive indices. Distribution of the original data to the distributions of the data generated using the preferred estimated models were then compared. RESULTS: EQ-5D-3 L and EQ-5D-5 L were best predicted by the OLS model, including SQLS domain scores, domain-squared scores, age, and gender as explanatory predictors. The models produced the best performance index and resembled most closely with the observed EQ-5D data. HUI3 and SF-6D were best predicted by the OLS and Tobit model respectively. CONCLUSION: The current study developed mapping models for converting SQLS scores into generic utility scores, which can be used for economic evaluation among patients with schizophrenia.

Measuring social desirability bias in a multi-ethnic cohort sample: its relationship with self-reported physical activity, dietary habits, and factor structure.

BACKGROUND: Social desirability bias is one of the oldest forms of response bias studied in social sciences. While individuals may feel the need to fake good or bad answers in response to sensitive or intrusive questions, it remains unclear how rampant such a bias is in epidemiological research pertaining to self-reported lifestyle indicators in a multicultural Asian context. The main purpose of the current study is, therefore, to examine the sociodemographic correlates and impact of social desirability responding on self-reported physical activity and dietary habits at an epidemiological scale in a non-western multi-cultural Asian setting. METHODS: Prior to the main analyses, confirmatory and exploratory factor analyses were conducted to determine the factorial validity of a western derived concept of social desirability. Multiple regression analyses were conducted on cross-sectional data (n = 2995) extracted from a nationwide survey conducted between 2019 and 2020. RESULTS: A unique factor structure of social desirability was found and was therefore used for subsequent analyses. Multiple regression analyses revealed older age groups, the Indian ethnic group, those with past or present marriages, and having no income, had a significantly greater tendency to act on the bias. CONCLUSION: The construct of social desirability bias was fundamentally different in a multicultural context than previously understood. Only a small proportion of variance of self-report lifestyle scores was explained by social desirability, thus providing support for data integrity.

Prevalence and correlates of suicide planning and attempt among individuals with suicidal ideation: Results from a nationwide cross-sectional survey.

BACKGROUND: Suicidality spans from having suicidal ideation to planning and making an attempt. However, not all individuals with suicidal thoughts will proceed to plan or attempt suicide. Our study investigated (i) the prevalence of suicide planning and attempt among those with suicidal ideation and (ii) their associations with sociodemographic characteristics, mental disorders, adverse childhood events and prior suicidal behaviour. METHOD: This cross-sectional analysis utilised data from Singapore Mental Health Study 2016. Only respondents with suicidal ideation were included. A total of 411 and 365 individuals were examined to establish the prevalence of suicide planning and attempt respectively. Multivariable logistic regressions were performed to determine associations. RESULTS: The prevalence of suicide planning and attempt were 17.7 % and 10.6 % respectively, with >80.0 % occurring within a year of suicidal ideation. Suicide planning was more likely among those who had mood disorders. Suicide attempt was more likely for those were currently married, had lower educational qualifications, history of anxiety disorders, history of emotional neglect and parental separation. LIMITATIONS: Recall bias may be present because the age of onset for various mental disorders and suicidal behaviours were self-reported. As suicide was criminalised when the study was conducted, the prevalence of suicidal behaviours may have been underestimated. CONCLUSION: Individuals at risk of suicide planning and attempt should be identified early since most of them progressed within a year. Findings suggest the importance of including prior suicide behaviour and history of dysfunctional family and emotional abuse in suicide risk assessment and intervention.

Effectiveness of Paliperidone Palmitate in Reducing Acute Psychiatric Service Use for Patients Suffering from Psychosis-A Retrospective Mirror-Image Study.

Poor adherence to antipsychotic treatment is a leading cause of relapse for patients suffering from psychotic disorders and the use of long-acting injectable antipsychotics (LAI) may lead to improved clinical outcomes. This was a 1-year mirror-image study examining the clinical outcomes after monthly administration of paliperidone palmitate (PP1M). The primary outcome measure was the total days of psychiatric hospitalization in the 1-year before and 1-year after initiation of PP1M. Data from 158 patients were included in the study. Most of the patients suffered from schizophrenia. In the year after initiation of PP1M, the mean number of hospitalization days fell from 106.53 to 19.10 (p < 0.001). There were significant reductions in the mean number of hospitalizations and emergency room visits. The use of paliperidone palmitate is associated with significant reduction in both the number of admissions and days of psychiatric hospitalization.

Food insufficiency, adverse childhood experiences and mental health: results of the Singapore Mental Health Study 2016.

OBJECTIVE: This study aimed to investigate the prevalence and correlates of food insufficiency and its association with mental disorders and adverse childhood experiences (ACE) in Singapore. DESIGN: This analysis utilised data from the Singapore Mental Health Study (SMHS 2016). SETTING: SMHS 2016 was a population-based, psychiatric epidemiological study conducted among Singapore residents. PARTICIPANTS: Interviews were conducted with 6126 respondents. Respondents were included if they were aged 18 years and above, Singapore citizens or permanent residents and able to speak in English, Chinese or Malay. RESULTS: The prevalence of food insufficiency was 2·0 % (95 % CI (1·6, 2·5)) among adult Singapore residents. Relative to respondents who did not endorse any ACE, those with ACE (OR: 2·9, 95 % CI (1·2, 6·6)) had higher odds of food insufficiency. In addition, there were significant associations between lifetime mental disorders and food insufficiency. Bipolar disorder (OR: 2·7, 95 % CI (1·2, 6·0)), generalised anxiety disorder (OR: 4·5, 95 % CI (1·5, 13·5)) and suicidal behaviour (OR: 2·37, 95 % CI (1·04, 5·41)) were shown to be significantly associated with higher odds of food insufficiency. CONCLUSIONS: The prevalence of food insufficiency is low in Singapore. However, this study identifies a vulnerable group of food-insufficient adults that is significantly associated with mental disorders, including suicidality. Government-funded food assistance programmes and multi-agency efforts to deal with the social determinants of food insufficiency, such as income sufficiency and early detection and intervention of mental distress, are key to ensuring a sustainable and equitable food system.

The economic burden of mental disorders among adults in Singapore: evidence from the 2016 Singapore Mental Health Study.

BACKGROUND: Little is known about the economic burden of mental disorders in multiethnic Asian populations. AIMS: The study aimed to estimate the economic cost of mental disorders in Singapore using data from the second Singapore Mental Health Study (SMHS 2016). METHOD: The SMHS 2016 is a nationally representative survey of the Singapore Resident population aged 18 years and above. Data on mental disorders and healthcare resource utilization were obtained from the World Mental Health Composite International Diagnostic Interview and the adapted version of the Client Service Receipt Inventory. RESULTS: The costs of visits to a restructured hospital doctor, other private health workers, accident and emergency, and intermediate and long-term care services and productivity losses tend to be much higher in those with mental disorders than those without mental disorders. The average annual excess cost associated with mental disorders per person was estimated to be S$3938.9 (95% CI, S$-100.8-S$7978.7). Extrapolation of these excess costs to the population suggests that the incremental costs of mental disorders in Singapore is about S$1.7 billion per year. CONCLUSION: This study provides evidence of the substantial burden of mental disorders on Singaporean society - both in terms of direct medical costs and loss of productivity costs.

Prevalence and impact of peer victimisation among youth seeking treatment at a tertiary psychiatric institution in Singapore: a cross-sectional study.

BACKGROUND: Peer victimization is common among adolescents and leads to negative consequences. However, few studies have examined the extent of peer-victimization and its correlates among adolescent patients in a psychiatric setting. The current study aimed to examine the prevalence and correlates of peer victimisation among youth with mental illness and to examine its association with depressive symptoms and health-related quality of life (HRQOL). METHODS: A sample of 239 youths aged 15-24 years were recruited from the outpatient clinics of a tertiary psychiatric hospital in Singapore using convenience sampling. All participants were administered the Multidimensional Peer Victimisation Scale (MPVS), Short Form 12 (SF-12) questionnaire and the Patient Health Questionnaire-8 (PHQ-8). The effect of MPVS  total and subscores on depression scores, quality of life subscores and quality of life total scores were examined using multiple linear regression analyses. RESULTS: The majority of the patients reported that they had experienced at least one form of peer victimisation (95.8%, n = 229) during their school years. Higher levels of 'verbal victimisation', 'attacks on property' and higher total MPVS scores were significantly associated with lower social functioning; additionally, higher levels of 'verbal victimisation' were significantly associated with lower mental component summary scores in the quality of life assessment. Higher scores on all four subscales as well as higher total scores on the MPVS were significantly associated with more severe depressive symptoms. CONCLUSIONS: Given the high prevalence of peer victimisation in our sample and its associations with more severe depressive symptoms and lower quality of life, it is vital to implement interventions that prevent peer victimisation in educational and other social settings and to provide youth with strategies to more effectively manage instances of peer victimisation.

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.

Factor structure of the diabetes knowledge questionnaire and the assessment of the knowledge of risk factors, causes, complications, and management of diabetes mellitus: A national population-based study in Singapore.

This study evaluated the knowledge of diabetes mellitus and predictors of the level of diabetes knowledge among the general public of Singapore. Confirmatory factor analysis and exploratory factor analysis were used to evaluate the fit of different factor models for the diabetes knowledge questionnaire. Multiple linear regressions were performed to determine the sociodemographic characteristics associated with diabetes knowledge. The final factor model identified three domains for diabetes knowledge: general knowledge, diabetes specific knowledge and causes of diabetes, and complications of untreated diabetes. Overall knowledge scores were 23.8 ± 2.4 for general diabetes knowledge, 2.3 ± 0.8 for diabetes specific knowledge, 2.3 ± 1.2 for causes, and 5.2 ± 1.2 for complications of untreated diabetes. Patients with diabetes were more knowledgeable than adults without diabetes in the population. While the general public in Singapore has adequate knowledge of diabetes, misconceptions were identified in both groups which underscores the need to tailor specific educational initiatives to reduce these diabetes knowledge gaps.

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.