Predictors of fall protection motivation among older adults in rural communities in a middle-income country: A cross-sectional study using the Protection Motivation Theory.

AIMS: To evaluate factors associated with fall protection motivation to engage in fall preventive behaviour among rural community-dwelling older adults aged 55 and above using the protection motivation theory scale. DESIGN: A cross-sectional study. METHODS: The study was conducted in a healthcare clinic in Malaysia, using multistage random sampling from November 2021 to January 2022. Three hundred seventy-five older adults aged 55 and older were included in the final analysis. There were 31 items in the final PMT scale. The analysis was performed within the whole population and grouped into 'faller' and 'non-faller', employing IBM SPSS version 26.0 for descriptive, independent t-test, chi-square, bivariate correlation and linear regressions. RESULTS: A total of 375 older participants were included in the study. Fallers (n = 82) and non-fallers (n = 293) show statistically significant differences in the characteristics of ethnicity, assistive device users, self-rating of intention and participation in previous fall prevention programmes. The multiple linear regression model revealed fear, coping appraisal and an interaction effect of fear with coping appraisal predicting fall protection motivation among older adults in rural communities. CONCLUSION: Findings from this study demonstrated that coping appraisal and fear predict the protection motivation of older adults in rural communities. Older adults without a history of falls and attaining higher education had better responses in coping appraisal, contributing to a reduction in perceived rewards and improving protection motivation. Conversely, older adults from lower education backgrounds tend to have higher non-preventive behaviours, leading to a decline in fall protection motivation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: These results contribute important information to nurses working with older adults with inadequate health literacy in rural communities, especially when planning and designing fall prevention interventions. The findings would benefit all nurses, healthcare providers, researchers and academicians who provide care for older adults. PATIENT OR PUBLIC CONTRIBUTION: Participants were briefed about the study, and their consent was obtained. They were only required to answer the questionnaire through interviews. Older individuals aged fifty-five and above in rural communities at the healthcare clinic who could read, write or understand Malay or English were included. Those who were suffering from mental health problems and refused to participate in the study were excluded from the study. Their personal information remained classified and not recorded in the database during the data entry or analysis.

Psychometric evaluation of the Protection Motivation Theory scale in assessing fall protection motivation among older adults to reduce fall risk.

BACKGROUND: Protection Motivation Theory could be another potential and good framework that addresses essential elements in a behavioural change leading to positive fall protective behaviours. The positive behavioural change could reduce the risk of falls and improve the quality of life of the older community. The study aims to evaluate the reliability and validity of the culturally adapted Protection Motivation Theory scale for older adults' fall protection motivation or protective behaviours to reduce fall risk. METHODS: A cross-sectional study was conducted to establish a psychometric instrument validation. A total of 389 participants aged 55 years and above were included. The study was conducted in Sarawak, Malaysia, from November 2021 to January 2022 in two phases, translation of the PMT Scale, cross-cultural adaptation, face validation and pre-testing of the PMT Scale. The participants were selected using multistage random sampling in a primary healthcare clinic. Data entry and statistical analysis were performed using IBM SPSS version 26 for exploratory factor analysis and SmartPLS version 3.3.7 for confirmatory factor analysis using partial least square structural equation modelling. RESULTS: The Kaiser-Meyer-Olkin value was 0.760, Bartlett's sphericity test was significant and the total variance explained was 61%. It identified 31 items within eight dimensions of the Protection Motivation Theory scale. The Higher Order Constructs' measurement model indicates that the convergent and discriminant validity were established (Cronbach's alpha and composite reliability: ≥ 0.740; average variance extracted: 0.619 to 0.935 and Henseler's Heterotrait-Monotrait criterion for all constructs' discriminant validity: < 0.9). Test-retest for the intraclass correlation coefficient was 0.745. The model's coefficient of determination demonstrated R2 = 0.375. CONCLUSION: Overall, the Protection Motivation Theory Scale has established its reliability and validity for assisting older adults in the community. The Protection Motivation Theory Scale could be used in fall prevention interventions by promoting fall protective behaviours to reduce fall risk among community-dwelling older adults. The scale could assist healthcare providers in assessing the intention of older adults to use fall protective behaviours to reduce fall risk and serve as an alternative reference in developing fall prevention education in a fall prevention strategy.

Falls risk screening tools intended to reduce fall risk among independent community-dwelling older adults: A systematic review.

AIMS: The aim of this study is to evaluate an evidence-based fall risk screening tool to predict the risk of falls suitable for independent community-dwelling older adults guided by the World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) components, and to examine the reliability and validity of the fall risk screening tool to predict fall risks, and to examine the feasibility of tools among independent community-dwelling older adults. METHODS: A systematic literature search guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed using the EBSCOHost® platform, ScienceDirect, Scopus and Google Scholar between July and August 2021. Studies from January 2010 to January 2021 were eligible for review. Nine articles were eligible and included in this systematic review. The risk of bias assessment used the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. The WHO-ICF helped to guide the categorization of fall risk factors. RESULTS: Seven screening tools adequately predicted fall risk among community-dwelling older adults. Six screening tools covered most of the components of the WHO-ICF, and three screening tools omitted the environmental factors. The modified 18-item Stay Independent Brochure demonstrated most of the predictive values in predicting fall risk. All tools are brief and easy to use in community or outpatient settings. CONCLUSION: The review explores the literature evaluating fall risk screening tools for nurses and other healthcare providers to assess fall risk among independent community-dwelling older adults. A fall risk screening tool consisting of risk factors alone might be able to predict fall risk. However, further refinements and validations of the tools before use are recommended.

Fall prevention education to reduce fall risk among community-dwelling older persons: A systematic review.

OBJECTIVES: This review aims to identify types of the existing fall prevention education (FPE) and their effectiveness in promoting fall risk awareness, knowledge and preventive fall behaviour change among community-dwelling older people. BACKGROUND: FPE is a cost-effective and helpful tool for reducing fall occurrences. EVALUATION: This is a systematic review study using electronic searches via EBSCOHost® platform, ScienceDirect, Scopus and Google Scholar in March 2021. The review protocol was registered with PROSPERO (CRD42021232102). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement flow chart guided the search strategy. Articles published from January 2010 to March 2021 were included for quality appraisal using the 'Transparent Reporting of Evaluations with Non-randomised Designs' (TREND) and the 'Consolidated Standards of Reporting Trials' (CONSORT) statement for randomised controlled trial studies. KEY ISSUES: Six FPE studies selected emphasised on personal health status, exercise and environmental risk factors. These studies reported an increase in fall risk awareness or knowledge and a positive change in fall preventive behaviours. Two studies included nurses as educators in FPE. CONCLUSION: FPE evidently improved awareness or knowledge and preventive fall behaviour change among older adults. Nurses are in great potential in planning and providing FPE for older adults in community settings. IMPLICATIONS FOR NURSING MANAGEMENT: Expand nurses' roles in fall prevention programmes in community settings by using high-quality and evidence-based educational tools. Highlight the nurse's role and collaborative management in FPE.

Environment factors associated with adolescents' body mass index, physical activity and physical fitness in Kuching South City, Sarawak: a cross-sectional study.

This study examined the relationship between perceived built environment attributes and physical activity, physical fitness and body weight among adolescents aged 14-16 years in Sarawak. This was a cross-sectional study, using multi-stage sampling. A set of questionnaires consisting of socio-demographic information, a self-administered physical activity checklist and a Neighborhood Environment Walkability Scale-Youth (NEWS-Y) was used. Body mass index (BMI) was measured and physical fitness was tested using a maximal multistage 20 m shuttle run test. Data analysis was done using SPSS version 17.0. A total of 316 respondents participated. The mean BMI for boys was almost equal to the mean BMI for girls. Only 7.9% of the sampled population was found to be overweight or obese. The overall mean duration spent per day on physical activity was 128.4 min (SD 118.43), with mean of 56.1 min (SD 73.94) after school time. Girls reported to spend longer each day taking physical activity before and during school. Boys were found to have significantly higher VO2max of 27.79±5.91 mL/kg/min as compared to girls (t=11.22, p<0.000). Based on comparison with other countries, the NEWS-Y scores indicated a mixture of low and high walkability neighborhoods. Respondents who had lower BMIs reported living in lower residential density areas and less risk of crime, and respondents who had better physical fitness reported less suitable infrastructure for walking. Promotion of exercise at all levels should be continuously encouraged as it would lead to improvement in the well-being of an individual.

Quality of Life Among Malaysian Parents with Autism Spectrum Disorder Child: The Double ABCX Model Approach.

This paper reported the quality of life (QoL) of 260 Malaysian parents with autism spectrum disorder (ASD) and factors which influencing it. About half of these parents reported to having good QoL. The factors identified in the double ABCX model showed that perceived social support and sense of coherence (SOC) were mediated by coping strategies and had a positive direct and indirect effect on parents' QoL. These finding reiterate the importance of social support, coping skills, and strong SOC reflection skills in influencing the QoL of parents with ASD child. We therefore suggest parents to utilize the widely available social and organization supports to gain good QoL, which is also important for the wellbeing of their child.

"Feeling unsafe": a photovoice analysis of factors influencing physical activity behavior among Malaysian adolescents.

Understanding the factors influencing physical activity (PA) in the Asia-Pacific region is critical, given the high prevalence of inactivity in this area. The photovoice technique explores the types of PA and factors influencing PA among adolescents in Kuching, Sarawak. A total of 160 photographs were collected from participants (adolescents, n = 22, mean age = 14.27 ± 0.7 years, and parents, n = 8, mean age = 48 ± 6.8 years). Data analysis used constant comparison methods of a grounded theory. The Analysis Grid for Environments Linked to Obesity was used to categorize PA factors. Study findings were centered on the concept of safety, facilities, parental restriction, friends, cultural traits, media, community cohesiveness, and weather. The central theme was "feeling unsafe" when being outdoors. To promote PA behavior, provision of PA facilities needs to be supported by other programs that build on peer support, crime prevention, and traffic safety, together with other educational campaigns.

Physical Activity Among Adolescents in an East Malaysian Rural Indigenous Community: Exploring the Influence of Neighborhood Environmental Factors.

This study explores the rural environmental factors that influence adolescents' participation in physical activities (PA). Thirty-six indigenous adolescents, aged 13 to 17 years from rural communities of East Malaysia were involved in the photovoice procedures: photo-taking, selecting, contextualizing, and codifying themes. Despite being endowed with natural resources such as river, forest, hills, and so on, the adolescents and the community did not capitalize on these rich resources to promote and engage in PA. Poor maintenance of natural resources, the lack of pedestrian infrastructures and road safety, the lack of PA facilities, and negative perception of ancestors' agricultural activities were among factors that constrained adolescents' PA. Although basic amenities such as play spaces and pedestrian infrastructures are necessary to increase adolescents' PA, any intervention should make the most of the natural resources, which are cheaper, environment friendly, and sustainable.

The Relationship between Media Use and Body Mass Index among Secondary Students in Kuching South City, Sarawak, Malaysia

Background: Overweight and obesity rates among adolescents have increased substantially over the years. This study aimed to determine the body mass index (BMI) of students and parents and the relationship among media use, BMI, socio-demographic profiles, and snacking behaviour during television watching of secondary school students in Kuching South City. Methods: In accordance with the two-stage sampling method, a total of 316 adolescents aged 13–17 years from 7 secondary schools participated. Data were collected using questionnaire and anthropometric measurement. Independent t test, one-way ANOVA, Mann–Whitney U test, and chisquare test were performed. Results: The mean BMI was 20.56 kg/m2 (SD 4.33) for boys and 20.15 kg/m2 (SD 3.91) for girls. No significant difference in terms of z score for BMI-for-age or socio-demographic factors was found. The mean duration of time devoted to media use was 4.69 hours (SD 2.93) on weekdays and 5.69 hours (SD 2.87) on weekends. Boys were found to spend more hours on media use than did the girls (t = 4.293, P < 0.01). Respondents were reported to consume more cereal compared with soft drinks and junk foods. Respondents whose fathers worked in the private sector devoted the fewest hours to media use, whereas those with self-employed fathers devoted the most time to media use. Respondents with mothers who were employed spent more time on media use than did respondents whose mothers were housewives (F = 4.067, P < 0.01). No significant difference was found between BMI and media time or snacking habits. Conclusion: This finding indicated that media time has no effect on body weight, because respondents were found to have normal weight and to consume less unhealthy food.