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 Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn.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.

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.

Background: At present, the validity and reliability evidence of the Malay version of the Smartphone Addiction Scale (SAS-M) is only available by exploratory factor analysis (EFA). The aim of this study is to validate and determine the psychometric properties of the SAS-M by confirmatory factor analysis (CFA). Methods: A cross-sectional study was conducted among 323 medical students in Universiti Sains Malaysia. The students were given questionnaire forms consisting of socio-demographic information, the SAS-M and the Malay version of the Internet Addiction Test (MVIAT). The CFA was conducted using robust maximum likelihood estimator. The internal consistency reliability was determined by Raykov’s rho coefficient. The concurrent validity was assessed by the Pearson’s correlations between the factor scores of the SAS-M and the MVIAT. Results: The analysis showed the five-factor model of the SAS-M has an acceptable model fit after the inclusion of 12 correlated errors (SRMR = 0.067, RMSEA 0.059 (90% CI: 0.054, 0.065), CFI = 0.895, TLI = 0.882). The factor loadings ranged from 0.320 to 0.875. The internal consistency reliability was good (Raykov’s rho = 0.713 to 0.858) and it showed good concurrent validity with the MVIAT. Conclusions: The CFA showed that the SAS-M is a valid and reliable self-administered questionnaire to measure the level of smartphone addiction among medical students.

The COVID-19 pandemic has affected people in many ways, including mental health status. Depression, anxiety, and stress (DAS) are terms often used to describe mental health status worldwide. The present study describes the prevalence of DAS and its associated factors among healthcare workers (HCWs) in the northwest region of Malaysia, during the early phase of recovery of movement control order (RMCO), where some restrictions were lifted, and cases are reducing in number. This cross-sectional study used HCW’s mental health surveillance data using the DASS-21 questionnaire. A total of 981 data collected between 1 July and 31 August 2020 were randomly sampled. Socio-demographic factors, occupational characteristics, and health backgrounds were extracted and analyzed using multiple logistic regression. The prevalences of DAS are 8.4% (6.7, 10.3), 17.1% (14.8, 19.6), and 6.4% (5.0, 8.1), respectively. Age is significantly associated with depression (Adjusted Odd Ratio (Adj.OR) 0.96 (0.93, 0.99)) and stress (Adj.OR 0.96 (0.93, 0.997)). Working at the hospital is associated with depression (Adj.OR 1.88 (1.19, 2.97)) as well as anxiety (Adj.OR 1.91 (1.36, 2.68). HCWs with a degree or postgraduate education level are more stressed compared to those with lower educational levels (Adj.OR 8.43 (1.95, 36.37)). Mental health surveillance helps to identify those at risk. Those younger in age, working in hospitals, and with more responsibility in management are the most affected. With the easing of COVID-19 pandemic restrictions, which lead to the release of certain movement control, the mental health status of HCWs was less affected. Those working directly with COVID-19 patients and with more responsibility in management are the most affected.

Background: Lack of knowledge and poor attitude are barriers to colorectal cancer screening participation. Printed material, such as pamphlets and posters, have been the main approach in health education on disease prevention in Malaysia. Current information technology advancements have led to an increasing trend of the public reading from websites and mobile apps using their mobile phones. Thus, health information dissemination should also be diverted to websites and mobile apps. Increasing knowledge and awareness could increase screening participation and prevent late detection of diseases such as colorectal cancer. Objective: This study aimed to assess the effectiveness of the ColorApp mobile app in improving the knowledge and attitude on colorectal cancer among users aged 50 years and older, who are the population at risk for the disease in Kedah. Methods: A quasi-experimental study was conducted with 100 participants in Kedah, Malaysia. Participants from five randomly selected community empowerment programs in Kota Setar district were in the intervention group; Kuala Muda district was the control group. Participants were given a self-administered validated questionnaire on knowledge and attitudes toward colorectal cancer. A mobile app, ColorApp (Colorectal Cancer Application), was developed as a new educational tool for colorectal cancer prevention. The intervention group used the app for two weeks. The same questionnaire was redistributed to both groups after two weeks. The mean percentage scores for knowledge and attitude between groups were compared using repeated measure ANCOVA. Results: There was no significant difference in age, sex, highest education level, current occupation, and diabetic status between the two groups. The number of smokers was significantly higher in the intervention group compared with the control group and was controlled for during analysis. The intervention group showed a significantly higher mean knowledge score compared with the control group with regards to time (Huynh-Feldt: F1,95=19.81, P<.001). However, there was no significant difference in mean attitude scores between the intervention and control groups with regards to time (F1,95=0.36, P=.55). Conclusions: The ColorApp mobile app may be an adjunct approach in educating the public on colorectal cancer.

Measles is a disease that has resurfaced as a public health concern in Malaysia. Malaysia has had a Measles Elimination Program in place since 2004, but the incidence of measles in Pahang has not improved significantly. The purpose of this study was to describe the incidence and trend of measles in Pahang, as well as to identify the risk factors. The five-year population-based surveillance data of the entire Pahang state was extracted and analyzed for the trend and incidence of measles from January 2016 to December 2020. Multiple logistic regression was used to examine the relationship between measles and available sociodemographic data. A total of 2844 reported measles cases were investigated. Out of the measles cases reported, 7.41 percent were confirmed. According to the five-year fluctuating trend, the incidence rate ranges from 13.51 to 50.97 per 1,000,000 population. Confirmed measles was significantly associated with an indigenous background (AdjOR = 4.90, 95% CI: 1.74, 13.78), history of contact with measles cases (AdjOR = 14.03, 95% CI: 8.23, 23.90), and incomplete vaccination (AdjOR = 3.38, 95% CI: 2.28, 5.01). In conclusion, the incidence of measles in Pahang remains sporadic, owing to sporadic outbreaks. Vaccination is an important preventive measure that must reach out to the isolated populations such as indigenous people.