Health service use and associated factors among old Khmer people: a cross-sectional survey in Tri Ton District, An Giang Province

Original Research

Abstract

Background: The health status of ethnic minorities of all ages lags far behind that of the general population, particularly in the old. The old minor ethnic population is more likely to have chronic diseases but less likely to access health services. This study assesses the rate of health services use and associated factors in the old Khmer population.

Method: A cross-sectional study was conducted on 400 Khmer people aged 60+ year-old from March to May 2020. Eligible participants were randomly recruited from households of five clusters out of nine communes of Tri Ton District, An Giang province, Vietnam. A structured questionnaire was designed to collect data on socio-demography, health status, health service use and accessibility to health services and quality of life. Quality of life was measured using EQ-5D-5L. All eligible participants were face-to-face interviewed by a bilingual researcher.

Result: The rate of health services use was 63.3%. The EQ-5D-5L utility index mean score was 0.46 (SD=0.28) and EQ-VAS mean score was 49.01 (SD=16.19). The odds of using health services were higher in those reported to have problems in mobility (OR=2.56, 95%CI 1.43-4.61, p<0.01), self-care (OR=2.05, 95%CI 1.30-3.24, p<0.01), activity (OR=2.35, 95%CI 1.44-3.82, p<0.01), pain/discomfort (OR=2.63, 95%CI 1.22-5.67, p=0.01), and anxiety/depression (OR=2.07, 95%CI 1.00-4.29, p=0.05) in univariate but not in multivariable analysis. The multivariable logistic regression showed that the odds of using health services were lower in those who were currently working (aOR=0.48, 95%CI 0.30-0.79, p<0.01), accessible to health information (aOR=0.47, 95%CI 0.27-0.80, p<0.01), but higher in those using health insurance (aOR=5.09, 95%CI 3.19-8.14, p<0.01), and in health facilities used Khmer language (aOR=2.04, 95%CI 1.15-3.62, p=0.01).

Conclusion: This study suggested that Khmer people should be involved in all stages of planning and implementing health programs and services for Khmer communities to improve the accessibility and health equity. 

Graphical abstract

Psychometric properties of Body Mass Index in screening malnutrition of COPD inpatients admitted at Nguyen Tri Phuong Hospital, Vietnam: a cross-sectional study

Original Research

Abstract

Introduction: This study assessed the validation of Body Mass Index (BMI) against Subjective Global Assessment (SGA), and identify the prevalence of malnutrition and its associated factors in Chronic Obstructive Pulmonary Disease (COPD) inpatients at Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam.

Methods: A cross-sectional study was conducted to consecutively select COPD inpatients based on medical records and consultancy with doctors. A structured questionnaire was designed to collect socio-demographic characteristics, health status and comorbidities, nutritional status, and handgrip strength. Nutritional status was assessed using SGA and BMI. Handgrip strength was measured using a hand dynamometer. Health status was collected from medical records.

Results: The mean age of 83 COPD inpatients recruited in this study was 67 (SD=10.4) years. Most of the sample population was ≥60 years old (75%), male (86%), Kinh ethnic (89%), married (72%), not currently working (70%), and less than junior high school (81%). Nearly 68% had at least one comorbidity and 27% were active smokers. The mean handgrip strength was 21.6 kg (SD=8.7), and mean weight was 53.9 kg (SD=10.0). The mean BMI was 20.4 kg/m2 (SD=3.4) with 58% having BMI <21 kg/m2. SGA provided the prevalence of malnutrition of 65%. Age-group, BMI and handgrip strength were associated with malnutrition. A BMI cut-off point of <21 kg/m2 provided the highest ROC area of 84% (95%CI: 76%-92%).

Conclusion: Malnutrition is common in COPD inpatients. This study confirms findings of previous studies that a BMI cut-off point of <21 kg/m2 was sensitive and specific for screening malnutritional risk at bedside.

Graphical abstract

Quality of Life in Patients Receiving Percutaneous Coronary Intervention and Optimal Medical Therapy in Ho Chi Minh City, Vietnam

Original Research

Abstract

Introduction: This study assessed Health-Related Quality of Life (HRQOL) of patients with Acute Coronary Syndrome (ACS) 6 to 12 months after receiving Percutaneous Coronary Intervention (PCI) and/or Optimal Medical Therapy (OMT) at a hospital in Ho Chi Minh City, Vietnam.

Methods: A cross-sectional study was conducted on 113 patients. Data on demographic, lifestyle behaviours, and HRQOL were collected using a structured questionnaire through face-to-face interviews. HRQOL was measured using EQ-5D-5L and EQ-VAS. Data on co-morbidity and other clinical characteristics were extracted from hospital records. Bivariate and multivariable linear regression models were run to test the differences in EQ-5D-5L utility index and EQ-VAS scores between PCI/OMT and OMT alone groups.

Results: EQ-5D-5L utility index and EQ-VAS scores were lower in PCI/OMT compared to OMT groups, although the differences were not clinically meaningful. Weight status, smoking, and physical activity were associated with EQ-5D-5L utility index score, whereas only physical activity was associated with EQ-VAS score.

Conclusion: The findings suggested that improving sufficient physical activity levels and stopping smoking after PCI or/and OMT may help increase HRQOL among ACS patients.

Graphical abstract

Validity and Reliability of the Comfort Behavior Scale in Children Undergoing Wound Dressing Replacement in Vietnam

Original Research

Abstract

Background: This study translated and culturally adapted the Comfort Behavior Scale (Comfort-B) into Vietnamese using a standard protocol guided by the World Health Organization.

Methods: The Comfort-B was translated into Vietnamese and then English back-translated by independent translators. These versions were reviewed and assessed by a Vietnamese expert’s panel and an English expert’s panel. Thirty-four nurses of the Nhi Dong 1 Hospital were invited to use the Vietnamese Comfort-B to assess pain while watching five videos recorded before, during and after wound dressing replacement. The eight characteristics of the Vietnamese Comfort-B were assessed by 34 nurses. Fifteen nurses agreed to do the second assessment two weeks from the first assessment. The content validity index was used to assess the relevance and clarity of all items and the whole scale. Agreements between raters were explored using Kappa statistics. Intraclass correlation coefficients (ICC) were used to assess intra-rater and inter-rater reliability. Multi-level linear regression was used to assess changes in the Vietnamese Comfort-B before, during and after wound dressing replacement between two assessments.

Results: The Vietnamese Comfort-B was accredited by the Vietnamese expert’s panel. The English-back translated version was approved by the English expert’s panel. The nurses agreed that the Vietnamese Comfort-B can be used in clinical practice and research. Kappas of all items were ≥0.96 indicating excellent agreement between raters. Alpha coefficients of two assessments were ≥0.97 indicating excellent internal consistency. All ICCs ≥ 0.79 indicated good intra-rater and inter-rater reliability.

Conclusions: The study suggested that the Vietnamese Comfort-B can be used for future studies assessing children’s pain in the local hospital context.

Graphical abstract

Validity and Reliability of Neonatal Infant Pain Scale (NIPS) in Neonatal Intensive Care Unit in Vietnam

Original Research

Abstract

Background: The study aimed to culturally adapt and validate Neonatal Infant Pain Scale (NIPS) for use in Vietnamese settings.

Methods: The original NIPS was translated into Vietnamese using a standard protocol. Registered nurses of Neonatal Intensive Care Unit (NICU), Tien Giang General Hospital, Vietnam used the Vietnamese NIPS for assessing neonatal pain and then provided feedback on acceptability of the scale. Five registered nurses of NICU were randomly selected and used NIPS for assessing neonatal pain while watching thirty videos at two times, two weeks apart from each other. Pulse rates per minute and oxygen saturation (SpO2) were also recorded for validity evaluation. Intraclass correlation coefficients (ICC) with two-way random effects were applied to assess intra-rater and inter-rater reliability. Multilevel linear regression was applied to assess the association between NIPS score with pulse rates and SpO2 adjusting for raters, three periods and two assessments.

Results: The Vietnamese NIPS was accepted and valued by nurses at the NICU. ICCs between the first and second assessments were from 0.53 to 1.00 for five raters before, during and after clinical procedures showing moderate to excellent intra-rater reliability. ICCs among five raters were moderate to good before and after, but poor (ICC<0.4) during clinical procedures. NIPS score was not associated with SpO2, but with pulse rates per minute.

Conclusions: The preliminary results showed that the Vietnamese version of NIPS is reliable and should be used. However, it is recommended that further research should be conducted to confirm its reliability and validity.

Graphical abstract

Online training needs of Methadone Maintenance Treatment clinics in southern Vietnam

Original Research

Abstract

Introduction: Continuing Medical Education (CME) significantly improves the competency of healthcare workers in Methadone Maintenance Treatment (MMT) clinics. However, CME courses are very costly, and a few participants fully attended a course. Online training is an alternative approach to efficiently improve training outcomes. The study assessed needs and possibility of online training courses of MMT clinics in southern Vietnam.

Methods: A google form was designed to collect characteristics, man-powers, facilities, online activities and training needs of MMT clinics. E-mails were sent to all MMT clinics in southern Vietnam to ask for their participants. A representative of MMT clinics who satisfied the inclusion invited to complete the form.

Result: 93 MMT clinics completed the survey. The response rate was 62% (93/150). One MMT clinic had 3 doctors/assistant doctors, 3 pharmacists/drug dispensers, 2 consultants and 3 other professionals on average. The number of clients visiting the clinic in the last month was 150. About 94% (93/95) of MMT clinics provide other additional services. On average, 385 clients came to MMT for other services. All clinics had adequate devices for online and blended training.

Conclusion: MMT clinics had high training needs and were willing to attend online and blended training courses. Online and blended training were possible in MMT clinics.

Graphical abstract

Translation and cross-cultural adaptation of the Vietnamese version of the Diabetes Distress Scale

Original Research

Abstract

Background: The Diabetes Distress Scale (DDS) is a valid instrument to measure diabetes distress included in American Diabetes Association and Canadian Diabetes Association guidelines but not available in Vietnamese. This study translated and culturally adapted the DDS to assess diabetes distress of Vietnamese type 2 diabetics and evaluated its internal consistency, face and content validity.

Methods: The translation process followed standard guidelines for adaptation of an instrument: forward translation, back translation, synthesis, evaluation by an expert panel and pretest. The expert panel included three English specialists as linguistic experts and six content experts in multidisciplinary areas relevant to the study. The pretest was conducted on a sample of 31 type 2 diabetics in the Endocrinology outpatient clinic at Trung Vuong hospital. Content validity was determined based on experts’ concurrence using content validity index for items (I-CVI). Face validity is assessed by participants in pretest. Internal consistency was measured using Cronbach’s alpha.

Results: Final version was equivalent with the original English version and easy to understand. I-CVI of 17 items were 1.00 in linguistic experts and greater than 0.83 in content experts. All 31 participants involved in the pretest commented that the items were very clear and acceptable regarding their socioeconomic background. Cronbach’s alpha coefficient was 0.76 – 0.93 for each subscale and 0.94 for the overall.

Conclusion: Vietnamese version of the DDS was reliable, face and content-valid to assess diabetes distress in type 2 diabetics among Vietnamese.

Graphical abstract

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