Background Mobile health (mHealth) apps play an important role in delivering education, providing advice on treatment, and monitoring patients’ health. Good usability of mHealth apps is essential to achieve the objectives of mHealth apps efficiently. To date, there are questionnaires available to assess the general system usability but not explicitly tailored to precisely assess the usability of mHealth apps. Hence, the mHealth App Usability Questionnaire (MAUQ) was developed with 4 versions according to the type of app (interactive or standalone) and according to the target user (patient or provider). Standalone MAUQ for patients comprises 3 subscales, which are ease of use, interface and satisfaction, and usefulness. Objective This study aimed to translate and validate the English version of MAUQ (standalone for patients) into a Malay version of MAUQ (M-MAUQ) for mHealth app research and usage in future in Malaysia. Methods Forward and backward translation and harmonization of M-MAUQ were conducted by Malay native speakers who also spoke English as their second language. The process began with a forward translation by 2 independent translators followed by harmonization to produce an initial translated version of M-MAUQ. Next, the forward translation was continued by another 2 translators who had never seen the original MAUQ. Lastly, harmonization was conducted among the committee members to resolve any ambiguity and inconsistency in the words and sentences of the items derived with the prefinal adapted questionnaire. Subsequently, content and face validations were performed with 10 experts and 10 target users, respectively. Modified kappa statistic was used to determine the interrater agreement among the raters. The reliability of the M-MAUQ was assessed by 51 healthy young adult mobile phone users. Participants needed to install the MyFitnessPal app and use it for 2 days for familiarization before completing the designated task and answer the M-MAUQ. The MyFitnessPal app was selected because it is one among the most popular installed mHealth apps globally available for iPhone and Android users and represents a standalone mHealth app. Results The content validity index for the relevancy and clarity of M-MAUQ were determined to be 0.983 and 0.944, respectively, which indicated good relevancy and clarity. The face validity index for understandability was 0.961, which indicated that users understood the M-MAUQ. The kappa statistic for every item in M-MAUQ indicated excellent agreement between the raters (κ ranging from 0.76 to 1.09). The Cronbach α for 18 items was .946, which also indicated good reliability in assessing the usability of the mHealth app. Conclusions The M-MAUQ fulfilled the validation criteria as it revealed good reliability and validity similar to the original version. M-MAUQ can be used to assess the usability of mHealth apps in Malay in the future.
Breakfast frequency is associated with cardiovascular disease (CVD) risk in Western populations, possibly via the types of food eaten or the timing of food consumption, but associations in Malaysian adolescents are unknown. While the timing of breakfast is similar, the type of food consumed at breakfast in Malaysia differs from Western diets, which allows novel insight into the mechanisms underlying breakfast–CVD risk associations. We investigated foods eaten for breakfast and associations between breakfast frequency and CVD risk factors in the Malaysian Health and Adolescents Longitudinal Research Team study (MyHeARTs). Breakfast (frequency of any food/drink reported as breakfast in 7-day diet history interviews) and CVD risk factors (body mass index (BMI), waist circumference, fasting blood glucose, triacylglycerol, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and systolic and diastolic blood pressure) were cross-sectionally associated using linear regression adjusting for potential confounders (n = 795, age 13 years). Twelve percent of adolescents never ate breakfast and 50% ate breakfast daily, containing mean (SD) 400 (±127) kilocalories. Commonly consumed breakfast foods were cereal-based dishes (primarily rice), confectionery (primarily sugar), hot/powdered drinks (primarily Milo), and high-fat milk (primarily sweetened condensed milk). After adjustment, each extra day of breakfast consumption per week was associated with a lower BMI (−0.34 kg/m2, 95% confidence interval (CI) −0.02, −0.66), and serum total (−0.07 mmol/L 95% CI −0.02, −0.13) and LDL (−0.07 mmol/L 95% CI −0.02, −0.12) cholesterol concentrations. Eating daily breakfast in Malaysia was associated with slightly lower BMI and total and LDL cholesterol concentrations among adolescents. Longitudinal studies and randomized trials could further establish causality.
Early childhood caries (ECC) is one of the most prevalent dental diseases among children and is related to their early feeding practices. This multi-factorial disease involves susceptible tooth and host, fermentable carbohydrates in the diet, cariogenic micro-organisms and time (American Academy of Pediatric Dentistry, 2008). Thus, this study aimed to identify the associations between bottle-feeding and weaning practices, and ECC formation. By using convenience sampling, 201 children were recruited from the IIUM Outpatient Dental Clinic and ten kindergartens around the area of Kuantan, in the state of Pahang (Malaysia). Examination for caries was conducted visually to determine caries status (with or without caries). The caregivers were requested to fill in a questionnaire regarding feeding practices of their children. The findings of the study indicated that 67% of the children identified with caries practiced bottle-feeding in bed either sometimes or always (every night/day) (p=0.005). The prevalence of ECC was also significantly (p<0.001) the highest (48.5%) among children who had been bottle-feeding for the longest duration (>4 years) among the study population. In addition, the mean intake of sweetened drinks among children with ECC was significantly higher than those with no ECC (5.4 vs. 3.1 servings/week, p=0.001). The results of this research indicated that the increased frequency and prolonged duration of bottle-feeding practices, as well as high consumption of sweet drinks during weaning, could be associated with the formation of ECC. In conclusion, these findings would increase the awareness particularly among parents regarding bottle-feeding practices and weaning diet contents and its potential implication on their children's oral health.
Sedentary lifestyle due to physical inactivity and increased screen-viewing (SV) duration is one of the risk factors for childhood obesity. Thus, this study aimed to assess body mass index (BMI), SV and physical activity (PA) durations among children aged four-to-six years (N=284) attending kindergartens in urban and rural areas of Kuantan, Pahang. The SV and PA durations were estimated via a questionnaire completed by their parents. The preschoolers’ height and weight were measured using a stadiometer and a digital weighing scale, respectively. The BMI-for-age status was interpreted using the CDC growth charts and cut-off points. A total of 37.8% of respondents were underweight, 16.7% overweight/obese, while the rest had normal BMI. Almost 90% of the children were using electronic gadgets. In addition, 89.8% of them recorded >two hours/day of total SV duration, exceeding the international recommendation of <two hours/day of screen time and the Malaysian Dietary Guideline’s recommendation of <two hours/day of sedentary activity. Only 49.8% (on weekdays) and 75.4% (on weekends) of the children met the recommended one hour/day of moderate PA by the WHO. There were no significant differences of BMI, SV and PA durations between urban and rural respondents. The preschoolers in Kuantan were largely found to exceed the recommended SV duration and only half of them met the recommended PA duration on most days. This suggests that intervention is needed to curb these obesity-inducing sedentary behaviours due to long SV duration and physical inactivity among preschoolers across urban and rural areas of the Pahang capital district.
BACKGROUND Mobile health (mHealth) apps play an important role in delivering education, providing advice on treatment, and monitoring patients’ health. Good usability of mHealth apps is essential to achieve the objectives of mHealth apps efficiently. To date, there are questionnaires available to assess the general system usability but not explicitly tailored to precisely assess the usability of mHealth apps. Hence, the mHealth App Usability Questionnaire (MAUQ) was developed with 4 versions according to the type of app (interactive or standalone) and according to the target user (patient or provider). Standalone MAUQ for patients comprises 3 subscales, which are ease of use, interface and satisfaction, and usefulness. OBJECTIVE This study aimed to translate and validate the English version of MAUQ (standalone for patients) into a Malay version of MAUQ (M-MAUQ) for mHealth app research and usage in future in Malaysia. METHODS Forward and backward translation and harmonization of M-MAUQ were conducted by Malay native speakers who also spoke English as their second language. The process began with a forward translation by 2 independent translators followed by harmonization to produce an initial translated version of M-MAUQ. Next, the forward translation was continued by another 2 translators who had never seen the original MAUQ. Lastly, harmonization was conducted among the committee members to resolve any ambiguity and inconsistency in the words and sentences of the items derived with the prefinal adapted questionnaire. Subsequently, content and face validations were performed with 10 experts and 10 target users, respectively. Modified kappa statistic was used to determine the interrater agreement among the raters. The reliability of the M-MAUQ was assessed by 51 healthy young adult mobile phone users. Participants needed to install the MyFitnessPal app and use it for 2 days for familiarization before completing the designated task and answer the M-MAUQ. The MyFitnessPal app was selected because it is one among the most popular installed mHealth apps globally available for iPhone and Android users and represents a standalone mHealth app. RESULTS The content validity index for the relevancy and clarity of M-MAUQ were determined to be 0.983 and 0.944, respectively, which indicated good relevancy and clarity. The face validity index for understandability was 0.961, which indicated that users understood the M-MAUQ. The kappa statistic for every item in M-MAUQ indicated excellent agreement between the raters (κ ranging from 0.76 to 1.09). The Cronbach α for 18 items was .946, which also indicated good reliability in assessing the usability of the mHealth app. CONCLUSIONS The M-MAUQ fulfilled the validation criteria as it revealed good reliability and validity similar to the original version. M-MAUQ can be used to assess the usability of mHealth apps in Malay in the future.
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