Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Mobile application is a programmed system that is meant to be used by the target user. The usability of a system refers not only to the extent to which product can be used to achieve the task that it was designed for, but also with effectiveness, efficiency, and satisfaction. System Usability Scale (SUS) is one of the most commonly used questionnaire to assess the usability of a system. The original 10-items version of SUS was developed in English language and thus need to be adapted into local language to be able to assess usability of a mobile application. Objective: This study aims to translate with cross cultural adaptation and validate the English SUS questionnaire into Malay language which is the main speaking language in Malaysia. This translated version aims to be able to assess a mobile application. Methods: Forward and backward translation was performed by groups of Malay native speakers who used English language as their second language. Reconciliation and cross-cultural adaptation was done to derive the final version. The Malay SUS Questionnaire content was validated with regards to mobile application by 10 experts in mobile application development. The face validity was tested among 10 smartphone users and reliability test involved 54 users. Results: The content validity index (CVI) were 0.91 indicating good relevancy of the 10 items in assessing usability of a mobile application. The face validity index (FVI) were 0.94 indicating that the questionnaire was easily understood by users. The reliability test showed a Cronbach’s Alpha value of 0.85 (95% CI: 0.79, 0.91) indicating a reliable tool to assess the usability of mobile application. Conclusions: The Malay SUS questionnaire is valid and reliable to assess the usability of mobile application in Malaysia.

Social media sites, dubbed patient online reviews (POR), have been proposed as new methods for assessing patient satisfaction and monitoring quality of care. However, the unstructured nature of POR data derived from social media creates a number of challenges. The objectives of this research were to identify service quality (SERVQUAL) dimensions automatically from hospital Facebook reviews using a machine learning classifier, and to examine their associations with patient dissatisfaction. From January 2017 to December 2019, empirical research was conducted in which POR were gathered from the official Facebook page of Malaysian public hospitals. To find SERVQUAL dimensions in POR, a machine learning topic classification utilising supervised learning was developed, and this study’s objective was established using logistic regression analysis. It was discovered that 73.5% of patients were satisfied with the public hospital service, whereas 26.5% were dissatisfied. SERVQUAL dimensions identified were 13.2% reviews of tangible, 68.9% of reliability, 6.8% of responsiveness, 19.5% of assurance, and 64.3% of empathy. After controlling for hospital variables, all SERVQUAL dimensions except tangible and assurance were shown to be significantly related with patient dissatisfaction (reliability, p < 0.001; responsiveness, p = 0.016; and empathy, p < 0.001). Rural hospitals had a higher probability of patient dissatisfaction (p < 0.001). Therefore, POR, assisted by machine learning technologies, provided a pragmatic and feasible way for capturing patient perceptions of care quality and supplementing conventional patient satisfaction surveys. The findings offer critical information that will assist healthcare authorities in capitalising on POR by monitoring and evaluating the quality of services in real time.

High blood pressure is a worldwide problem and major global health burden. Whether alone or combined with other metabolic diseases, high blood pressure increases the risk of cardiovascular disease. This study is a secondary data analysis from the National Health and Morbidity Survey 2015, a population-based study that was conducted nationwide in Malaysia using a multi-stage stratified cluster sampling design. A total of 15,738 adults ≥18-years-old were recruited into the study, which reports the prevalence of hypertension stages among adults in Malaysia using the JNC7 criteria and determinants of its severity. The overall prevalence of raised blood pressure was 66.8%, with 45.8% having prehypertension, 15.1% having Stage 1 hypertension, and 5.9% having Stage 2 hypertension. In the multivariate analysis, a higher likelihood of having prehypertension was observed among respondents with advancing age, males (OR = 2.74, 95% CI: 2.41–3.12), Malay ethnicity (OR = 1.21, 95% CI: 1.02–1.44), lower socioeconomic status, and excessive weight. The factors associated with clinical hypertension (Stages 1 and 2) were older age, rural residency (Stage 1 OR = 1.22, Stage 2 OR = 1.28), Malay ethnicity (Stage 2 OR = 1.64), diabetes (Stage 2 OR = 1.47), hypercholesterolemia (Stage 1 OR = 1.34, Stage 2 OR = 1.82), being overweight (Stage 1 OR = 2.86, Stage 2 OR = 3.44), obesity (Stage 1 OR = 9.01, Stage 2 OR = 13.72), and lower socioeconomic status. Almost 70% of Malaysian adults are at a risk of elevated blood pressure. The highest prevalence was in the prehypertension group, which clearly predicts a future incurable burden of the disease. Public health awareness, campaigns through mass and social media, and intervention in the work place should be a priority to control this epidemic.

Objectives: To determine the prevalence of low back pain (LBP) and its associated factors among the nurses working in the public hospitals of Penang, Malaysia. Methods: A cross-sectional study was conducted on nurses, aged 25–60 years, who had been working for at least three months at six public hospitals of Penang. A proportionate stratified random sampling method was applied to select 1292 respondents. The Malay-validated BACKS Tool questionnaire using a 5-point Likert scale was used to obtain data. Simple and multiple logistic regression analyses were performed. Results: A total of 989 (76.5%) nurses suffered from LBP at a point of time. The factors significantly associated with LBP among the nurses included working more than seven hours [adjusted odds ratio (AOR) (95% confidence interval (CI)) 1.48 (1.06, 1.98)], twisting of the body while working [AOR (95% CI) 1.60 (1.13, 2.26)], manual handling of patients in wards [AOR (95% CI) 1.44 (1.08, 2.07)], and fatigue [AOR (95% CI) 2.63 (1.94, 3.58)]. Conclusion: The prevalence of LBP among the nurses in the public hospitals of Penang was relatively high. The factors predicting LBP included working more than seven hours a day, twisting of the body while working, manual handling, and fatigue. The findings from this study may better enable policymakers to devote resources to minimize low back pain among nurses. The nurses should be encouraged to comply with safe working procedures.

Social media is emerging as a new avenue for hospitals and patients to solicit input on the quality of care. However, social media data is unstructured and enormous in volume. Moreover, no empirical research on the use of social media data and perceived hospital quality of care based on patient online reviews has been performed in Malaysia. The purpose of this study was to investigate the determinants of positive sentiment expressed in hospital Facebook reviews in Malaysia, as well as the association between hospital accreditation and sentiments expressed in Facebook reviews. From 2017 to 2019, we retrieved comments from 48 official public hospitals’ Facebook pages. We used machine learning to build a sentiment analyzer and service quality (SERVQUAL) classifier that automatically classifies the sentiment and SERVQUAL dimensions. We utilized logistic regression analysis to determine our goals. We evaluated a total of 1852 reviews and our machine learning sentiment analyzer detected 72.1% of positive reviews and 27.9% of negative reviews. We classified 240 reviews as tangible, 1257 reviews as trustworthy, 125 reviews as responsive, 356 reviews as assurance, and 1174 reviews as empathy using our machine learning SERVQUAL classifier. After adjusting for hospital characteristics, all SERVQUAL dimensions except Tangible were associated with positive sentiment. However, no significant relationship between hospital accreditation and online sentiment was discovered. Facebook reviews powered by machine learning algorithms provide valuable, real-time data that may be missed by traditional hospital quality assessments. Additionally, online patient reviews offer a hitherto untapped indication of quality that may benefit all healthcare stakeholders. Our results confirm prior studies and support the use of Facebook reviews as an adjunct method for assessing the quality of hospital services in Malaysia.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The awareness of colorectal cancer risk and participation in screening is still low among Malaysian despite increasing trend of new cases. As the consequence of that, more than half of new cases were detected in late stage. Improvement of disease knowledge may increase screening participation hence disease can be detected early. Currently, health risk was disseminated to the public via education material in the form of pamphlets in health clinic or health campaign. However, with the advancement of communication technology today, reading through pamphlet has becoming less popular. People nowadays prefer to read from their smartphone using web browser or mobile applications. Despite huge increment in smartphone ownership and availability of mobile apps, little is known about the technology implementation in health promotion and education especially in Malaysia. Objective: The aim of this paper is to document the process of designing and developing a mobile app for community education on colorectal cancer as well as to assess the usability of the application prototype. Methods: The mobile application designing and development includes two part which are the content development using nominal group technique (NGT) and development of the mobile application prototype. NGT was a group of discussion involving experts and target-users to determine the information to be included in the prototype and the features of the prototype that is expected for a user-friendly mobile application. The mobile application prototype has been developed using framework Ionic 1 that is based on the Apache Cordova and Angular JS. After that, it has been published in the Google Play store for the target user to download, tested and assess the usability using validated SKAMA questionnaire. One sample T-test was used to assess the usability score with cut-off value for usable mobile application is 68. Results: The ColorApp (Colorectal Cancer Awareness Application) was successfully developed in local Malay language. The NGT discussion had suggested 6 main menus in the ColorApp prototype which are Introduction, Sign and Symptoms, Risk Factors, Preventive Measures, Colorectal Cancer Screening Program, and iFOBT Kit. Two additional menus were added to allow user-ColorApp interaction and as part of its artificial intelligence properties which are Analyse Your Status and ColorApp Calculator. The prototype has been published in Google Play store. The mean(SD) usability score was 72(11.52) indicates that ColorApp is a usable mobile application for health education and promotion on colorectal cancer. Conclusions: ColorApp mobile application can be used as a tool for community education on colorectal cancer.