RP Knowledge and Attitudes of Healthcare Workers in Public and Private sector Primary care Towards Dengue Management .pptx

dengue

1. Knowledge, Attitudes and Practice of Healthcare Workers in Public and Private sector Primary care in Kelantan Towards Dengue Management Master of Public Health RESEARCH PROPOSAL Name of Candidate : DR MOHD FAIZ BIN MOHD GHAZALI Supervisor : Co-researcher : 1

2. Outline of Presentation Introduction Rationale of Study Objectives Literature Review Conceptual Framework Methodology Flow Chart Expected Result Gantt Chart and Milestone References 2

3. Introduction Dengue fever, also known as break-bone fever, is a viral infection transmitted to humans through mosquito bites, primarily prevalent in tropical and subtropical regions In recent decades, there has been a marked escalation in the worldwide prevalence of dengue fever, as evidenced by the escalation in reported cases to the World Health Organization (WHO) from 505,430 in 2000 to 5.2 million in 2019. A substantial proportion of these cases exhibit either asymptomatic or mild symptoms, typically managed without medical intervention, thereby leading to a considerable underestimation of the true burden of dengue cases. Moreover, the diagnostic challenge persists, with numerous cases erroneously diagnosed as other febrile illness 3

4. Introduction In 2019, there was an increase in dengue fever cases globally, including in Malaysia. A total of 130,101 dengue fever cases were reported, marking the highest number recorded in a span of 10 years (from 2000 to 2021), with an incidence rate of 395.2 per 100,000 population. The highest incidence rate of dengue fever was also recorded four (4) years prior, in 2015, with an incidence of 396.4 per 100,000 population ( Strategik Pencegahan Dan Kawalan Denggi Kebangsaan , 2022). Based on the observed pattern, dengue cases are projected to peak every four to five years, with the next peak expected in 2024 or 2025, following the previous peaks in 2019 and 2020 ( Strategik Pencegahan Dan Kawalan Denggi Kebangsaan , 2022). 4

5. Problem Statement Kelantan state has witnessed a notable increase in dengue cases, with documented figures rising from 223 cases in 2021 to 1,227 in 2022, followed by a substantial surge to 2,790 cases in 2023 (surveillance report Vector Division Jabatan Kesihatan Negeri Kelantan) In Kelantan, an average 71 .2% cases(from 2019 to 2021) were diagnoses within 3 days, despite the target set at more than 85% ( Strategik Pencegahan dan Kawalan Denggi Kebangsaan 2022). Despite control efforts, dengue incidence rates continue to rise, leading to uncontrolled outbreaks that can have significant effects on humans and economic costs A ccurately diagnosing dengue can lead to improved patient outcomes 5

6. Rationale of The Study The study aims to identify disparities in healthcare workers' knowledge and attitudes between public and private sector primary care settings. Comparing knowledge and attitudes across different sectors can inform targeted interventions to address any shortcomings. Understanding factors influencing healthcare workers' knowledge and attitudes towards dengue management can provide insights into potential barriers and facilitators in the implementation of dengue control measures. Improving dengue management practices in primary care settings can lead to better patient outcomes and reduced disease burden. 6

7. Research Questions What are the scores of knowledge,attitudes and practise in public and private primary care setting in Kelantan? What are the predictors of knowledge, attitude and practise score of public and private primary care setting in Kelantan ? 7

8. Objectives: General Objective To study the knowledge, attitude and practice score of public and private primary care towards dengue management and its predictors among public and private primary care setting in Kelantan 8

9. Objectives: Specific Objectives To evaluate the knowledge level of healthcare workers regarding dengue epidemiology, transmission, clinical features, and management protocols in public and private primary care settings in Kelantan. To evaluate the attitudes of healthcare workers towards the importance of dengue prevention, early detection, and effective management strategies in public and private primary care settings in Kelantan. To examine the practices of healthcare workers in implementing dengue prevention measures, diagnosing suspected cases, and managing confirmed cases in public and private primary care settings in Kelantan. To identify predictors, such as years of experience, level of education, training in dengue management, availability of resources, and organizational support, that may influence the knowledge, attitudes, and practices of healthcare workers towards dengue management in public and private primary care settings in Kelantan. To explore the relationships between identified predictors and the knowledge, attitudes, and practices of healthcare workers towards dengue management, aiming to understand their impact on dengue control efforts in public and private primary care settings in Kelantan. 9

10. Research Hypothesis There are significant predictors (working experience and professional background) in the implementation of effective practices in dengue management 10

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12. Literature Review (Objective 1) Dengue is likely under-recognized and under-reported in Africa due to low awareness of healthcare provider, other prevalent febrile illness, lack of diagnostic testing and systemic surveillance (Franco et al. , 2010) in Cote d’Ivoire as in many African countries, dengue is likely to be overlooked and underreported because of a low awareness among health care providers, the pervasiveness of other febrile illnesses, and lack of diagnostic testing and systematic surveillance ( Amarasinghe et al., 2011). This fact is conductive to antimalarial drugs misuse, therapeutic failures and subsequent malaria treatment resistance ( Foumane et al., 2015; Shayo et al., 2015; Golassa et al., 2015). Lack of knowledge on the dengue transmission and its preventive methods can increase the chance of spreading dengue fever (Wong, AbuBakar and Chinna , 2014) Effective treatment of dengue fever has largely depended on appropriate and early medical care by experienced clinicians to avoid complications and reduce the fatality rate (WHO) Early diagnosis and treatment can reduce the fatality rate of DF patients from 20% to 1% or less (Stephenson, 2005) There a lack of consensus regarding whether clinical features can effectively differentiate dengue infection from other febrile illness. The identification of dengue patients heavily relies on the vigilance of frontline healthcare provider. (Ho et al. , 2013) 12

13. Literature Review (Objective 1) Dengue is likely under-recognized and under-reported in Africa due to low awareness of healthcare provider, other prevalent febrile illness, lack of diagnostic testing and systemic surveillance (Franco et al. , 2010) in Cote d’Ivoire as in many African countries, dengue is likely to be overlooked and underreported because of a low awareness among health care providers, the pervasiveness of other febrile illnesses, and lack of diagnostic testing and systematic surveillance ( Amarasinghe et al., 2011). This fact is conductive to antimalarial drugs misuse, therapeutic failures and subsequent malaria treatment resistance ( Foumane et al., 2015; Shayo et al., 2015; Golassa et al., 2015). Lack of knowledge on the dengue transmission and its preventive methods can increase the chance of spreading dengue fever (Wong, AbuBakar and Chinna , 2014) Effective treatment of dengue fever has largely depended on appropriate and early medical care by experienced clinicians to avoid complications and reduce the fatality rate (WHO) Early diagnosis and treatment can reduce the fatality rate of DF patients from 20% to 1% or less (Stephenson, 2005) There a lack of consensus regarding whether clinical features can effectively differentiate dengue infection from other febrile illness. The identification of dengue patients heavily relies on the vigilance of frontline healthcare provider. (Ho et al. , 2013) 13

14. Literature Review (Objective 1) 14

15. Literature review (objective 2) Findings Study location Authors More experienced nurses expressed more favorable views and perceptions of the handoff, as they expressed greater attention to patient safety Japan (Gu et al. , 2012) Nurses’ perception were significantly more positive among nurses that had formal training regarding how the handoff worked Japan (Gu et al. , 2012) The longer the duration of handoff , the greater the good perception as they able to communicate well and good conveyance of information Chitwan, Nepal (Koirala et al. , 2019) 15

16. Literature review (objective 2) Findings Study location Authors Most nurses experienced errors in handoff and most nurses had no guidelines and checklist in the ward Handoff evaluation differed significantly according to the level of education , duration of hospital employment , handoff method , degree of satisfaction with the current handoff method and handoff guidelines Korea (Kim et al., 2020) Teamwork and job satisfaction are positively related to the good perception China (Wang et al. , 2022) 16

17. Conceptual Framework Patient handoff among nurses Sociodemographic Factors Age Gender Educational level Marital status Patient’s Factors Type of patient care * Health Service Factors Understaffing* Workload* Lack of standardization* Stress and fatigue* Perception Score * Factors not included in the study Working Characteristics Working experience Department/ward unit Years in the current department Nurse-patient ratio Handoff duration Received in-service formal training on the handoff 17 Healthcare Provider Factors Knowledge* Attitude* Communication* Teamwork* 17

18. Methodology Research design A cross-sectional study Study area The study location will be conducted at three tertiary hospitals in Kelantan: Hospital Raja Perempuan Zainab II (HRPZ II), Kota Bharu Hospital Sultan Ismail Petra (HSIP), Kuala Krai Hospital Tanah Merah (HTM), Tanah Merah 18

19. Methodology Study population Reference population The reference population will be registered nurses that stay in Kelantan Source population The source population for the study will be registered nurses working at tertiary hospitals Sampling population The sampling population for the study will be registered nurses who fulfilled the study criteria . The study only involves the perception of nurses in their daily activities on a handoff 19

20. Methodology Subject criteria Registered nurses that fulfilled the study criteria Inclusion criteria: Malaysian citizen Working at public tertiary hospitals regardless of their shifts Has six months of working experience Exclusion criteria: Nurses with the administrative post ( eg Matrons, Sisters) Those who are not available within the duration of the study 20

21. Methodology Sample size estimation The sample size calculation based on the study objectives as follows: Sample Size Calculation (Objective 1) The sample size calculation to determine the perception score on handoff among nurses at tertiary hospitals in Kelantan was done by using a single mean formula 21

22. Methodology σ = Population’s standard deviation (from previous study) α = Type 1 error d = Margin of error estimating mean T able 1: Sample Size Calculation (Objective 1) The standard deviation (SD) for the perception of patient handoffs among nurses from Chong et al. , 2020 was 0.56 Hence, the number of subjects needed is n= 400 22 Variable σ d n n+20% anticipate dropout Literature review Perception 0.56 0.06 334 400 (Chong et al. , 2020)

23. Methodology Sample Size Calculation (Objective 2) For objective 2, G*Power for linear multiple regression was used to estimate the sample size. With the effect size of the study set at 0.25, type 1 error of 5% and power of 80% while the number of tested parameters of 6 with total number of predictors of 11, the estimated number of samples required is 62 participants After allowing for a 20% dropout, the final sample size is 75 people 23

24. Methodology In conclusion, based on the above calculations, the largest sample size which needs to accomplish the objectives of the study was obtained from the calculation in objective 1, which is 334 , with the additional assumption of a 20% dropout rate, the final total number of sample required was 400 The total number of participants required to fulfill all the study objectives is 400 24

25. Methodology Sampling method and subject recruitment Researcher will proportionately divide the number of participants according to the number of nurses in each hospital. Based on the latest available data, the total number of nurses = 2146 Using the formula as follow, the proportionate number of participants will be determined Later, the head of the nursing unit of each hospital will be approached. The aim of the study will be explained in detail. A list of the available nurses from all identified departments like Medical, Paediatric , Orthopaedic , O&G and Surgery will be obtained 25 Hospital Number of nurses Proportion (Estimated sample/Total N)* Number of available nurses in each hospital Sample Size (n) HRPZ II   1324 (400/2146)*1324 247 HSIP   552 (400/2146)* 552  103 HTM   270 (400/2146)* 270  50 Total  N=2146  400

26. Methodology The distribution of participants for each department will be again proportionately purposely distributed for 20% each . The simple random selection will be made by using SPSS software from the identified list of each department With the help of the head nurse, each of chosen nurses will be approached personally and get consent . The researcher will get appointments and assemble them on one specific day and time. The questionnaire will be distributed and checked before the data collection end Token of appreciation will be given 26

27. Methodology Research tool The tool used in the study will be a verified reliability and validity Hospital Patient Handoff Questionnaire from Gu et al. , (2017) with Cronbach’s alpha = 0.83 The permission for using this questionnaire was granted by the author via e-mail The questionnaire consists of 26 items in five domains namely information and responsibility‐related risk, role understanding, communication, handoff environment, and guidelines and process 27

28. Methodology For each item, respondents were asked to indicate their level of agreement on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) and reverse scoring will be applied for negative questions. The higher the total score, the better the perception Duration for answering this self-administered questionnaire is around 8-10 minutes 28

29. Methodology 29

30. Methodology 30

31. Methodology According to the distributed survey response, all cases will be coded with special numbers for data entry. All the information that will be collected is based on the research tools being used The data will be entered into SPSS version 26.0 software for analysis 31

32. Methodology Ethical Consideration Only after ethical approval by Jawatankuasa Etika Penyelidikan Manusia Universiti Sains Malaysia ( JEPeM -USM) and National Medical Research Register (NMRR), the data collection will be started The confidentiality of the data will be strictly maintained. Only the author and supervisor will have the access to the data available There will be no conflict of interest in this study. Later, the reporting and publications will be carried out with no respondents’ names mentioned 32

33. Methodology Statistical Analysis The numerical data will be presented as mean and SD or median and inter-quartile range (depending upon normality of distribution), while categorical data will be presented with frequency and percentage The predictors of the perception score will be determined using multiple linear regression A p -value of <0.05 was considered significant 33

34. Operational definition Patient handoff Handoff is an act of giving control of something or responsibility for something to someone else ( Cambridge Dictionary, 2020) , an occasion when one person gives something to another A hand-off is a transfer and acceptance of patient care responsibility achieved through effective communication . It is a real-time process of passing patient-specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care 34

35. Flow Chart 35

36. Expected Result Variables n %     Table 1: Sociodemographic characteristics of the participants (n= 400) 36

37. Expected Result Variables n %     Table 2: Working characteristic of the participants (n= 400) 37

38. Expected Result No Items Mean (SD) Total perception score 38 Table 3: Perception score of patient handoffs among nurses in tertiary hospitals, Kelantan n=400

39. Expected Result Variables Mean Perception Score (SD) Simple Linear Regression Multiple Linear Regression b a (95% CI) p -value b a (95% CI) p -value p -value 39 Table 4: Predictors of patient handoffs p erception score among nurses in tertiary hospitals, Kelantan n=400

40. Gantt Chart and Milestone Activities 2023 1 2 3 4 5 Data collection and entry           Data analysis and interpretation           Paper writing           Research project submission Gantt chart 40

41. Gantt Chart and Milestone Data collection and entry January - February 2023 Data analysis and interpretation February - March 2023 Paper writing March - April 2023 Research project submission May 2023 Research milestone 41

42. References Aitken, M. & Gorokhovich , L. (2012). Advancing the Responsible Use of Medicines: Applying Levers for Change . Allegranzi , B., Storr , J., Dziekan , G., Leotsakos , A., Donaldson, L. & Pittet , D. (2007). The First Global Patient Safety Challenge "Clean Care is Safer Care": from launch to current progress and achievements. J Hosp Infect, 65 Suppl 2 , 115-123. doi : 10.1016/s0195-6701(07)60027-9 Auraaen , A., Slawomirski , L. & Klazinga , N. (2018). The economics of patient safety in primary and ambulatory care : Flying blind. OECD Health Working Papers, No. 106, OECD Publishing, Paris, , 52. doi : 10.1787/baf425ad-en Australian Commission on Safety and Quality in Health Care. (2011). Implementation toolkit for clinical handover improvement / Australian Commission on Safety and Quality in Health Care . Darlinghurst, N.S.W: Australian Commission on Safety and Quality in Health Care. Aygin , D., Usta , E., Bozdemir , H. & Uçar , N. (2018). Investigation of Preventive Practices for Surgical Fires and Burns in the Operating Rooms of Four Tertiary Hospitals. Florence Nightingale Hemşirelik Dergisi , 169-178. doi : 10.26650/FNJN375358 Chong, D. W. Q., Iqbal, A. R., Kaur Jaj , B., Zainab, A., Nordin , A., Abd Majid, N. D. & Jusoh , A. (2020). Perceptions of nurses on inter-shift handover: A descriptive study in Hospital Kuala Lumpur, Malaysia. Med J Malaysia, 75(6) , 691-697. 42

43. Thank you 43