62 CHAPTER FOUR RESULTS 4.1 Introduction This chapter discusses the results of socio-demographic characteristics of the hospital shift workers, physical activity, eating habits, and their psychosocial well-being status. The data collection was done from February 2020 until August 2021 during the COVID- 19 pandemic. Of 413 respondents, 123 responded to the printed questionnaires and 290 answered the online surveys. The IBM Statistical Package for Social Science (SPSS) version 26.0 (SPSS Inc., Chicago, IL, USA) software was utilised for statistical analyses. The data from the printed questionnaires were entered into the Excel software and merged in the same format together with the data from the online questionnaires. The data was then transferred into the IBM SPSS Statistics software Version 26 to be analysed statistically. The descriptive results primarily focus on respondents’ socio- demographic characteristics, physical activities, eating habits and sleep quality. Meanwhile, the inferential statistic results highlight the observed associations between various independent variables with the psychosocial well-being status of hospital shift workers. 63 4.2 Socio-Demography of Hospital Shift Workers Table 4.1 describes the socio-demographic characteristics of the respondents. A total of 413 respondents who met the inclusion and exclusion criteria were included in this study. The respondents’ age ranged from 23 to 54 years old. The mean (SD) age of the respondents was 31.7 (5.9) years. Out of 413 respondents participated in this study, 81.1% were women (n = 335) and 18.9% were men (n = 78). The majority of them were Malays (81.6%), followed by Indians (11.4%), others such as Sikh, Punjabi and Bidayuh (4.1%) and Chinese (2.9%). A total of 90.6% had tertiary education, which consisted of diploma holder (55.9%), bachelor’s degree (34.5%) and postgraduate (0.2%). The rest of the respondents had Malaysian Certificate of Education (SPM) (6.5%), and Malaysian Higher School Certificate (STPM) (2.9%). Two-third of respondents were married (66.6%), while nearly a third were single (32.7%), and 0.7% were either divorced, separated or widowed. 64 Table 4.1: Background of Respondents, n = 413 n % Age 20-29 30-39 40-49 50-59 190 178 35 8 46.0 43.1 9.0 1.9 Gender Men Women 78 335 18.9 81.1 Ethnicity Malay Indian Chinese Others 337 47 12 17 81.6 11.4 2.9 4.1 Religion Islam Hinduism Christian Buddhism Others 347 37 15 12 2 84.0 9.0 3.6 2.9 0.5 Educational Status SPM STPM Tertiary education Diploma Bachelor Postgraduate 27 12 374 231 142 1 6.5 2.9 90.6 55.9 34.5 0.2 Marital status Married Single Divorced/separated/widowed 275 135 3 66.6 32.7 0.7 Household income* < RM4,850 RM4,850 – RM10,959 ≥ RM10,960 192 207 14 46.5 50.1 3.4 65 Work place (Hospital) Ampang Shah Alam Banting Klang Kajang Others 117 76 70 65 41 44 28.3 18.4 16.9 15.7 10.0 10.7 Work Department Emergency & Trauma Medical-based departments Surgical-based departments 175 125 113 42.4 30.3 27.3 Healthcare Position Staff nurses Medical officers House officers Paramedics 251 91 47 24 60.8 22.0 11.4 5.8 Part-Time Job Involvement No Yes 369 44 89.3 10.7 Comorbidity No Yes 353 60 85.5 14.5 Smoking/Vaping Status No Yes 390 23 94.4 5.6 Alcohol Consumption No Yes 399 14 96.6 3.4 *Based on the Department of Statistics Malaysia official portal classification Based on the categories by the Department of Statistics Malaysia Official Portal (Department of Statistics 2019), most of the respondents were from the middle-class socio-economic status with the percentage of 50.1% that accounted the household income of RM4,850 – RM10,959, followed by 46.5% from the household income of 66 less than RM4,850 of the lower-class socio-economic status and 3.4% from the upper- class socio-economic status of household income more than RM10,960. Figure 4.1 illustrates the percentage of respondents working at hospitals in Klang Valley. The majority of the respondents served in Ampang Hospital (28.3%), followed by Shah Alam Hospital (18.4%), Banting Hospital (16.9%), Klang Hospital (15.7%), other hospitals (10.7%) and Kajang Hospital (10.0%). Other hospital referred to other hospitals in Klang Valley, included Serdang Hospital, University of Malaya Medical Centre, Kuala Lumpur Hospital and Selayang Hospital. Figure 4.1: Percentage of Respondents’ Working Hospitals, n = 413 117 (28.3) 76 (18.4) 70 (16.9) 65 (15.7) 41 (10.0) 44 (10.7) Ampang Hospital Shah Alam Hospital Banting Hospital Klang Hospital Kajang Hospital Others n (%) 67 Figure 4.2 shows the departments where the respondents were working in the hospitals. Out of 413 respondents, 42.4% of them worked in the department of Emergency, 30.3% of them in medical-based departments and 27.3% in surgical-based departments. The medical-based departments included the departments of Medical, Anaesthetic & Intensive Care, Psychiatry, and Paediatrics. Meanwhile, the surgical- based departments represented the Surgical, Orthopaedics, and Obstetrics & Gynaecology departments. Figure 4.2: Percentage of Respondents’ Department, n = 413 Meanwhile, Figure 4.3 portrays the healthcare position of the respondents. There were 60.8% of respondents working as staff nurses, 22.0% of them as medical officers, 11.4% as house officers and 5.8% of them as paramedics. Medical officers and house officers are doctors who work in the hospitals. Part-time job involvement included respondents participated in other part-time-work beyond their working hours. There were 10.7% involving in the part-time job, and 89.3% who did not involve in the part- time job. 251 (60.8) 91 (22.0) 47 (11.4) 24 (5.8) Staff nurses Medical officers House officers Paramedics n (%) 68 Figure 4.3: Percentage of Respondents’ Healthcare Position, n = 413 Regarding the comorbidity of the respondents, the majority of them did not have any illness (85.5%), and 14.5% suffered from various diseases that include hypertension (20.3%), diabetes mellitus (8.7%), arthritis (8.7%), asthma (8.7%), anaemia (8.7%), dyslipidaemia (4.3%) and others (40.6%). Other diseases included migraine, gastritis, acute rhinitis and back pain. Some of the respondents had multiple comorbidities. A small percentage of 5.6% of them were smokers or vapers, and 3.4% of them were alcohol consumers. 175 (42.4) 125 (30.3) 113 (27.3) Emergency & Trauma Medical-based departments Surgical-based departments n (%) 69 4.3 Body Mass Index (BMI) of Hospital Shift Workers The mean (SD) height of the respondents was 1.60 (0.08) metres, and the mean (SD) weight was 63.76 (15.07) kilograms. The body mass index (BMI) of the respondents was computed and classified accordingly based on the WHO classification. The mean (SD) BMI of the respondents was 24.86 (4.99) kg/m2. Almost half of them (48.9%) were classified as normal BMI group (18.5 – 24.9 kg/m2), 25.9% was overweight (25.0 – 29.9 kg/m2), 17.9% was obese (≥ 30.0 kg/m2) and 7.3% was underweight (< 18.5 kg/m2). Figure 4.4 presents the percentage of the body mass index of the respondents. Note: Body mass index (BMI) of the respondents based on the WHO classification; underweight (<18.5 kg/m2); normal (18.5–24.9 kg/m2); overweight (25.0–29.9 kg/m2), obese (≥30.0 kg/m2). Figure 4.4: Percentage of Respondents’ Body Mass Index, n = 413 30 (7.3) 202 (48.9) 107 (25.9) 74 (17.9) 0 10 20 30 40 50 60 Underweight Normal Overweight Obese B M I BMI classification Underweight Normal Overweight Obese n (%) 70 4.4 Physical Activity Level and Eating Habits of Hospital Shift Workers in Klang Valley This section caters Study Objective 1 which is to determine the physical activity level and eating habits of hospital shift workers in Klang Valley. This is important to assess the balance between habits that influence energy uptake and energy expenditure. 4.4.1 Physical Activity Level of Hospital Shift Workers In this study, the physical activities of the respondents were evaluated by using the International Physical Activity Questionnaires-Short Form Malay (IPAQ-M). IPAQ-M assessed the specific types of physical activity that include walking, moderate-intensity activities, vigorous-intensity activities and sitting; the frequency measured was based on days per week; and duration measured was based on time per day. The amount of energy used during physical activity was measured in MET minutes. There was no international consensus on the best way to describe physical activity levels derived from self-report surveys or questionnaires (Forde 2018). Therefore, the reporting of this study was based on previous literatures from Lim et al. (2019) and Babiolakis et al. (2015). Table 4.2 reports the median MET-minutes per week of the respondents’ activities of walking, moderate-intensity, and vigorous-intensity activities. Median MET-minutes/week and interquartile ranges (IQR) were reported since the data were not normally distributed. In addition, the median for sitting time was 240 minutes (IQR: 225 minutes). 71 Table 4.2: Physical Activity MET-Minutes/Week Scores, n = 413 Physical Activity MET-minutes/week Median (IQR) Walking Moderate intensity activity 594 (2170) 240 (480) Vigorous intensity activity Total scores 240 (720) 1571 (4172) The respondents’ physical activity in this study were further categorised into three levels; inactive, minimally active, and health–enhancing physically active (HEPA) according to the criteria mentioned in the guidelines and algorithms of IPAQ- M. As shown in Figure 4.5, majority of the respondents were either inactive (31.7%) or minimally active (43.6%), and only 24.5% of them were HEPA active. Figure 4.5: Percentage of Respondents’ Level of Physical Activity based on IPAQ-M, n = 413 131 (31.7) 180 (43.6) 101 (24.5) 0 5 10 15 20 25 30 35 40 45 50 Inactive Minimally active HEPA active P er ce n ta g e (% ) Level of physical activity n (%)Inactive Minimally active HEPA active 72 Respondents were also asked about intentional exercise, which referred to exercise that were performed at least 3 times per week for 20 minutes during their free time. Figure 4.6 shows the percentage of intentional exercise that were carried out by the respondents, with the proportion of 61.3% (n = 253) did not perform intentional exercise as defined above and 38.7% (n = 160) intentionally exercise during their free time. Figure 4.6: Percentage of Intentional Exercise among Respondents, n = 413 4.4.2 Eating Habits of Hospital Shift Workers The tool of the Dutch Eating Behavior Questionnaire (DEBQ) was used to evaluate the eating habits of the respondents in this study. This questionnaire assessed eating behaviour in three domains; emotional eating, external eating and restrained eating. Table 4.3 highlights the eating habits of the respondents according to the three different domains. The mean (SD) of emotional eating was 2.48 (0.80). The majority of the respondents had good emotional eating habit (low scores) (86.9%) and others (13.1%) 253 (61.3) 160 (38.7) 0 10 20 30 40 50 60 70 No Yes Percentage (%) In te n ti o n al e x er ci se n (%)No Yes 73 had poor emotional eating habit (high scores) with the cut-off point of 3.25. Meanwhile, the mean (SD) of external eating was 2.96 (0.60), and the mean (SD) of restrained eating was 2.78 (0.80). There were 78.0% and 63.4% of the respondents had poor eating habits (high scores) for external eating and restrained eating respectively with cut-off point of 2.5. Table 4.3: Eating Habits of Respondents based on DEBQ Scores, n = 413 DEBQ Domains n (%) Emotional Eating (Question 1, 3, 5, 8, 10, 13, 16, 20, 23, 25, 28, 30, 32) Low High External Eating (Question 2, 6, 9, 12, 15, 18, 21, 24, 27, 33) Low High 359 (86.9) 54 (13.1) 91 (22.0) 322 (78.0) Restrained Eating (Question 4, 7, 11, 14, 17, 19, 22, 26, 29, 31) Low High 151 (36.6) 262 (63.4) 4.5 Psychosocial Well-Being Status of Hospital Shift Workers in Klang Valley This section caters the Study Objective 2, which is to determine the psychosocial well- being status of hospital shift workers in Klang Valley in the aspects of mental health (depression, anxiety and stress level), quality of life, work engagement and sleep quality. 74 This is imperative to elucidate the main concern of the respondents’ psychosocial well- being status. 4.5.1 Mental Health of Hospital Shift Workers The questionnaire of Malay Depression, Anxiety, Stress Scale-21 Items (Malay-DASS- 21) was utilised in this study for the assessment of mental health. Malay-DASS-21 measured the psychological distress along the constructs of depression, anxiety and stress. Results on mental health status based on Malay-DASS-21 were described in Table 4.4. Overall, there was 60.0% (n = 248) of the respondents with normal mental health without any symptoms of depression, anxiety and stress, whilst 40.0% (n = 164) of them had one or more symptoms of mental health problems of either depression, anxiety or stress at different levels. Table 4.4 illustrates in details the respondents’ mental health status. There were 27.4% of the respondents had symptoms of depression ranging from the severity of either mild, moderate, severe, or/and extremely severe. Besides, 34.6% of them had the anxiety symptoms, whilst 11.6% of them had symptoms of stress. Figure 4.7 portrays the mental health status of the respondents with regard to depression, anxiety and stress. Presentation of results is based on recently published study by Juliana et al. (2022) on the mental health of healthcare shift workers. 75 Table 4.4: Malay-DASS-21 Subscales of Self-Perceived Depression, Anxiety and Stress, n = 413 Malay-DASS-21 Domains n (%) Mean ± SD Depression (Question 3, 5, 10, 13, 16, 17, 21) Normal (0-9) Mild (10-13) Moderate (14-20) Severe (21-27) Extremely severe (28+) 299 (72.4) 33 (8.0) 64 (15.5) 6 (1.5) 10 (2.4) 15.61 ± 5.70 Anxiety (Question 2, 4, 7, 9, 15, 19, 20) Normal (0-7) Mild (8-9) Moderate (10-14) Severe (15-19) Extremely severe (20+) 269 (65.1) 24 (5.8) 85 (20.6) 12 (2.9) 22 (5.3) 13.89 ± 5.50 Stress (Question 1, 6, 8, 11, 12, 14, 18) Normal (0-14) Mild (15-18) Moderate (19-25) Severe (26-33) Extremely severe (34+) 364 (88.1) 23 (5.6) 16 (3.9) 8 (1.9) 1 (0.2) 21.04 ± 5.30 76 Note: Respondents may have more than one symptom of mental health problems. *The total bar represents the cumulative percentage of those who had mild, moderate, severe and extremely severe mental health problems. Figure 4.7: Mental Health Status of Respondents, n = 413 4.5.2 Quality of Life of Hospital Shift Workers In this study, the quality of life of the respondents was determined via the 5-Item World Health Organisation Well-Being Index Malay (WHO-5-Malay) and the Malay 36-Item Short Form Survey (Malay-SF-36). WHO-5-Malay focused on subjective psychological well-being. The Malay-SF-36 questionnaire assessed health-related quality of life, measuring on the dimensions of physical health and mental health. Table 4.5 shows the results of the WHO-5-Malay scores, 55.4% of them had good well-being and 44.6% of them had poor well-being. Meanwhile, for the Malay- SF-36 scores, highlighting that most of the respondents had a good quality of life, with a percentage of 91.8% having good quality of life for the total score, 90.3% having a 27.4 34.6 11.6 8.0 5.8 5.6 15.5 20.6 3.9 1.5 2.9 1.92.4 5.3 0.2 0 5 10 15 20 25 30 35 40 Depression Anxiety Stress P er ce n ta g e (% ) Mental health problems Total* Mild Moderate Severe Extremely severe 77 good quality of life for the domain of physical health and 89.3% having a good quality of life for the mental health domain. Table 4.5: Quality of Life based on WHO-5-Malay and Malay-SF-36 Scores, n = 413 Domains n (%) Mean ± SD WHO-5-Malay Score Good well-being Poor well-being 229 (55.4) 184 (44.6) 53.64 ± 19.90 Malay-SF-36 Total Score Good quality of life Poor quality of life 379 (91.8) 34 (8.2) 73.28 ± 15.00 Malay-SF-36 Physical Health Good quality of life Poor quality of life 373 (90.3) 40 (9.7) 72.12 ± 15.20 Malay-SF-36 Mental Health Good quality of life Poor quality of life 369 (89.3) 44 (10.7) 70.67 ± 14.70 4.5.3 Work Engagement of Hospital Shift Workers The work engagement component utilised the questionnaire of Utrecht Work Engagement Scale Malay (UWES-M). UWES-M consisted of three factors that include vigour, dedication and absorption. Each domain was classified accordingly based on the category of low, average and high scores. Table 4.6 illustrates the work engagement of the respondents referring to the domains in the UWES-M scores. Based on the total score, majority of the respondents 78 (61.0%) had an average score of work engagement. For the domain of vigour, most of them (42.6%) fall in the category of low score. Meanwhile, both domain of dedication and absorption showed that most of the respondents had average scores of dedication (61.5%) and absorption (52.5%). Table 4.6: Work Engagement based on UWES-M Scores, n = 413 UWES-M Domains n (%) Mean ± SD Total Score Low (≤ 2.88) Average (2.89 – 4.66) High (≥ 4.67) 59 (14.3) 252 (61.0) 102 (24.7) 3.81 ± 1.20 Vigour (Question 1, 2, 5) Low (≤ 3.25) Average (3.26 – 4.80) High (≥ 4.81) 176 (42.6) 163 (39.5) 74 (17.9) 3.61 ± 1.20 Dedication (Question 3, 4, 7) Low (≤ 2.90) Average (2.91 – 4.70) High (≥ 4.71) 64 (15.5) 254 (61.5) 95 (23.0) 3.83 ± 1.20 Absorption (Question 6, 8, 9) Low (≤ 2.33) Average (2.34 – 4.20) High (≥ 4.21) 40 (9.7) 217 (52.5) 156 (37.8) 3.98 ± 1.20 79 4.5.4 Sleep Quality of Hospital Shift Workers The quality of sleep of the respondents was examined by using the Pittsburgh Sleep Quality Index Malay (PSQI-M) questionnaire. The items from PSQI-M represent the subscales of subjective sleep efficiency, sleep latency, sleep duration, sleep quality, sleep disturbance, sleep medication use, and daytime dysfunction due to sleepiness. The mean (SD) of the global score of PSQI-M in this study was 6.49 (3.10), suggesting poor sleep quality of the respondents. Figure 4.8 shows the histogram of the PSQI-M global score. Based on PSQI-M, the majority of the respondents had poor sleep quality with the percentage of 58.1% (n = 240), and 41.6% of them (n = 172) were having good quality of sleep, as portrayed in Figure 4.9. Figure 4.8: Histogram of PSQI-M Global Score of the Respondents, n = 413 PSQI-M Global Score F re q u en cy 80 Figure 4.9: Sleep Quality Categories of the Respondents based on PSQI-M, n = 413 4.6 Associated Factors (Socio-Demographic Factors, Physical Activity, and Eating Habits) with Psychosocial Well-Being of Hospital Shift Workers in Klang Valley This caters the Study Objective 3; which is to determine the factors (socio-demographic factors, physical activity, and eating habits) that are associated with the psychosocial well-being of hospital shift workers in Klang Valley. These predictors are important to be tackled to preserve the psychosocial well-being of the shift workers. Further analysis was done to determine the association of independent variables with the psychosocial well-being of the hospital shift workers. Chi-square test was performed and subsequently followed by logistic regression for those variables with significant associations (p < 0.05). 172 (41.6) 240 (58.1) Good sleep quality Poor sleep quality n (%) 81 4.6.1 Associated Factors with Mental Health Status Table 4.7 shows the association between variables affecting depression among the respondents. The respondents were grouped into two groups and the association was made between those without depression and those with depression (combination of mild to extremely severe). The Chi-square test proved that there was significant association between age group, ethnicity, religion, marital status, healthcare position, hospital, physical activity and sleep quality with depression based on Malay-DASS-21 scores, p < 0.05. Other variables had no significant associations with the mental health status of depression among the respondents; p > 0.05 (Table 4.7). 82 Table 4.7: Association of Factors Affecting Depression based on Malay-DASS-21 Scores, n = 413 Group Normal (n = 299) n (%) Depression (n = 113) n (%) X2 df p value Age Group < 40 years old ≥ 40 years old 260 (70.8) 37 (86.0) 107 (29.2) 6 (14.0) 4.455 1 0.035* Gender Men Women 57 (73.1) 242 (72.5) 21 (26.9) 92 (27.5) 0.012 1 0.912 Ethnicity Malay Non-Malay 251 (74.7) 48 (63.2) 85 (25.3) 28 (36.8) 4.150 1 0.042* Religion Muslim Non-Muslim 258 (74.6) 41 (62.1) 88 (25.4) 25 (37.9) 4.313 1 0.038* Marital Status Single/divorced/separated/widowed Married 90 (65.2) 209 (76.3) 48 (34.8) 65 (23.7) 5.640 1 0.018* Educational Status SPM and STPM Tertiary education 30 (76.9) 269 (72.1) 9 (23.1) 104 (27.9) 0.410 1 0.522 Household Income < RM 4,850 RM 4,850 – RM 10,959 ≥ RM 10,960 140 (73.3) 146 (70.5) 13 (92.9) 51 (26.7) 61 (29.5) 1 (7.1) 3.378 2 0.185 Healthcare Position Doctors Staff nurses and paramedics 86 (62.3) 213 (77.7) 52 (37.7) 61 (22.3) 10.961 1 0.001* 83 Hospital Ampang Klang Shah Alam Banting Kajang Others 94 (81.0) 43 (66.2) 42 (55.3) 53 (75.7) 34 (82.9) 33 (75.0) 22 (19.0) 22 (33.8) 34 (44.7) 17 (24.3) 7 (17.1) 11 (25.0) 19.644 5 0.001* Department Emergency & Trauma Medical-based Surgical-based 119 (68.0) 96 (77.4) 84 (74.3) 56 (32.0) 28 (22.6) 29 (25.7) 3.478 2 0.176 Part-Time Job No Yes 269 (73.1) 30 (68.2) 99 (26.9) 14 (31.8) 0.477 1 0.490 Comorbidity No Yes 254 (72.2) 45 (75.0) 98 (27.8) 15 (25.0) 0.208 1 0.648 Body Mass Index (BMI) Underweight Normal Overweight Obese 20 (66.7) 151 (74.8) 80 (75.5) 48 (64.9) 10 (33.3) 51 (25.2) 26 (24.5) 26 (35.1) 3.664 3 0.300 Smoking/Vaping No Yes 283 (72.8) 16 (69.6) 106 (27.2) 7 (30.4) 0.111 1 0.739 Alcohol Consumption No Yes 289 (72.6) 10 (71.4) 109 (27.4) 4 (28.6) 1.000¥ 84 Intentional Exercise No Yes 182 (72.2) 117 (73.1) 70 (27.8) 43 (26.9) 0.040 1 0.841 Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 81 (61.8) 137 (76.5) 80 (79.2) 50 (38.2) 42 (23.5) 21 (20.8) 11.221 2 0.004* Emotional Eating Habit (DEBQ) Low High 265 (74.0) 34 (63.0) 93 (26.0) 20 (37.0) 2.883 1 0.090 External Eating Habit (DEBQ) Low High 72 (79.1) 227 (70.7) 19 (20.9) 94 (29.3) 2.516 1 0.113 Restrained Eating Habit (DEBQ) Low High 106 (70.2) 193 (73.9) 45 (29.8) 68 (26.1) 0.675 1 0.411 Sleep Quality (PSQI-M) Good Poor 141 (82.5) 157 (65.4) 30 (17.5) 83 (34.6) 14.543 1 < 0.001* *Significant to p value = < 0.05, using Chi-square test ¥Fischer’s exact test was utilised since more than 20% of the expected counts are less than 5. 85 In Table 4.8, those who were in the age group of less than 40 years old recorded the higher odds of having perceived symptoms of depression (OR = 2.54; 95% CI: 1.1 – 6.2). Non-Malay and Non-Muslim were more likely to develop depression (OR = 1.72; 95% CI: 1.1 – 2.9); (OR = 1.79; 95% CI: 1.1 – 3.1). As for the marital status, those who were either single, divorced, separated or widowed was demonstrated to have higher odds of depression symptoms (OR = 1.72; 95% CI: 1.1 – 2.7). Furthermore, doctors were having higher chances of getting depression compared to staff nurses and paramedics (OR = 2.13; 95% CI: 1.4 – 3.3). The respondents who worked in Klang Hospital and Shah Alam Hospital had greater odds to have depression with the reference of Ampang Hospital (OR = 2.19; 95% CI: 1.1 – 4.4); (OR = 3.46; 95% CI: 1.8 – 6.6). Physical activity level was also one of the strong associated factors for depression among the shift workers, in which as compared to the group of HEPA active, those who were inactive had the odds of two times to be having depression (AOR = 1.96; 95% CI: 1.1 – 3.7). Apart from that, the respondents with poor sleep quality were also two times higher to suffer from depression (AOR = 2.44; 95% CI: 1.5 – 4.0). 86 Table 4.8: Significant Factors Affecting Depression based on Malay-DASS-21 Scores, n = 413 Factors Malay-DASS-21 Depression Normal (n = 299) n (%) Depression (n = 113) n (%) Crude OR (95% CI) p value Adjusted OR (95% CI) p value Age Group < 40 years old ≥ 40 years old 260 (70.8) 37 (86.0) 107 (29.2) 6 (14.0) 2.54 (1.1 – 6.2) Ref p = 0.041* 1.66 (0.6 – 4.3) Ref p = 0.295 Ethnicity Malay Non-Malay 251 (74.7) 48 (63.2) 85 (25.3) 28 (36.8) Ref 1.72 (1.1 – 2.9) p = 0.043* Ref 1.08 (0.2 – 4.7) p = 0.917 Religion Muslim Non-Muslim 258 (74.6) 41 (62.1) 88 (25.4) 25 (37.9) Ref 1.79 (1.1 – 3.1) p = 0.040* Ref 1.11 (0.2 – 5.3) p = 0.898 Marital Status Single/divorced/separated Married 90 (65.2) 209 (76.3) 48 (34.8) 65 (23.7) 1.72 (1.1 – 2.7) Ref p = 0.018* 1.48 (0.9 – 2.5) Ref p = 0.155 Healthcare Position Doctors Staff nurses and paramedics 86 (62.3) 213 (77.7) 52 (37.7) 61 (22.3) Ref 0.47 (0.3 – 0.7) p = 0.001* Ref 0.69 (0.4 – 1.2) p = 0.208 Hospital Ampang Klang Shah Alam Banting Kajang Others 94 (81.0) 43 (66.2) 42 (55.3) 53 (75.7) 34 (82.9) 33 (75.0) 22 (19.0) 22 (33.8) 34 (44.7) 17 (24.3) 7 (17.1) 11 (25.0) Ref 2.19 (1.1 – 4.4) 3.46 (1.8 – 6.6) 1.37 (0.7 – 2.8) 0.88 (0.3 – 2.2) 1.42 (0.6 – 3.3) p = 0.027* p = < 0.001* p = 0.389 p = 0.788 p = 0.401 Ref 2.02 (1.1 – 4.2) 2.36 (1.2 – 4.9) 1.54 (0.7 – 3.4) 0.81 (0.3 – 2.2) 0.72 (0.3 – 1.8) p = 0.059 p = 0.019* p = 0.288 p = 0.672 p = 0.478 87 Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 81 (61.8) 137 (76.5) 80 (79.2) 50 (38.2) 42 (23.5) 21 (20.8) 2.35 (1.3 – 4.3) 1.17 (0.6 – 2.1) Ref p = 0.005* p = 0.607 1.96 (1.1 – 3.7) 1.24 (0.7 – 2.3) Ref p = 0.039* p = 0.502 Sleep Quality (PSQI-M) Good Poor 141 (82.5) 157 (65.4) 30 (17.5) 83 (34.6) Ref 2.49 (1.5 – 4.0) p = < 0.001* Ref 2.44 (1.5 – 4.0) p = 0.001* *Significant to p value = < 0.05, using logistic regression Adjusted OR = Results are adjusted for age, ethnicity, religion, marital status, healthcare position, hospital, category of physical activity and sleep quality 88 The associated factors influencing anxiety based on Malay-DASS-21 scores among the respondents were presented in Table 4.9. The association was made between those without anxiety and those with anxiety (combination of mild to extremely severe). The findings recorded that the age group, gender, body mass index (BMI), emotional eating habit, external eating habit and sleep quality were significantly associated with anxiety; p < 0.05. Other variables had no significant associations with the mental health status of anxiety among the respondents; p > 0.05 (Table 4.9). 89 Table 4.9: Association of Factors Affecting Anxiety based on Malay-DASS-21 Scores, n = 413 Group Normal (n = 269) n (%) Anxiety (n = 143) n (%) X2 df p value Age Group < 40 years old ≥ 40 years old 230 (62.7) 37 (86.0) 137 (37.3) 6 (14.0) 9.260 1 0.002* Gender Men Women 59 (75.6) 210 (62.9) 19 (24.4) 124 (37.1) 4.548 1 0.033* Ethnicity Malay Non-Malay 225 (67.0) 44 (57.9) 111 (33.0) 32 (42.1) 2.250 1 0.134 Religion Muslim Non-Muslim 228 (65.9) 41 (62.1) 118 (34.1) 25 (37.9) 0.349 1 0.555 Marital Status Single/divorced/separated/widowed Married 83 (60.1) 186 (67.9) 55 (39.9) 88 (32.1) 2.425 1 0.119 Educational Status SPM and STPM Tertiary education 23 (59.0) 246 (66.0) 16 (41.0) 127 (34.0) 0.759 1 0.384 Household Income < RM 4,850 RM 4,850 – RM 10,959 ≥ RM 10,960 121 (63.4) 137 (66.2) 11 (78.6) 70 (36.6) 70 (33.8) 3 (21.4) 1.480 2 0.477 Healthcare Position Doctors Staff nurses and paramedics 87 (63.0) 182 (66.4) 51 (37.0) 92 (33.6) 0.463 1 0.496 Hospital Ampang Klang Shah Alam Banting Kajang Others 75 (64.7) 38 (58.5) 44 (57.9) 48 (68.6) 30 (73.2) 34 (77.3) 41 (35.3) 27 (41.5) 32 (42.1) 22 (31.4) 11 (26.8) 10 (22.7) 7.436 5 0.190 90 Department Emergency & Trauma Medical-based Surgical-based 118 (67.4) 82 (66.1) 69 (61.1) 57 (32.6) 42 (33.9) 44 (38.9) 1.283 2 0.526 Part-Time Job No Yes 241 (65.5) 28 (63.6) 127 (34.5) 16 (36.4) 0.060 1 0.807 Comorbidity No Yes 228 (64.8) 41 (68.3) 124 (35.2) 19 (31.7) 0.287 1 0.592 Body Mass Index (BMI) Underweight Normal Overweight Obese 16 (53.3) 128 (63.4) 81 (76.4) 44 (59.5) 14 (46.7) 74 (36.6) 25 (23.6) 30 (40.5) 9.122 3 0.028* Smoking/Vaping No Yes 254 (65.3) 15 (65.2) 135 (34.7) 8 (34.8) 0.000 1 0.994 Alcohol Consumption No Yes 258 (64.8) 11 (78.6) 140 (35.2) 3 (21.4) 0.396¥ Intentional Exercise No Yes 156 (61.9) 113 (70.6) 96 (38.1) 47 (29.4) 3.284 1 0.070 Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 79 (60.3) 115 (64.2) 74 (73.3) 52 (39.7) 64 (35.8) 27 (26.7) 4.352 2 0.113 Emotional Eating Habit (DEBQ) Low High 242 (67.6) 27 (50.0) 116 (32.4) 27 (50.0) 6.412 1 0.011* 91 External Eating Habit (DEBQ) Low High 68 (74.7) 201 (62.6) 23 (25.3) 120 (37.4) 4.587 1 0.032* Restrained Eating Habit (DEBQ) Low High 97 (64.2) 172 (65.9) 54 (35.8) 89 (34.1) 0.117 1 0.733 Sleep Quality (PSQI-M) Good Poor 127 (74.3) 141 (58.8) 44 (25.7) 99 (41.3) 10.600 1 0.001* *Significant to p value = < 0.05, using Chi-square test ¥Fischer’s exact test was utilised since more than 20% of the expected counts are less than 5. 92 Further analysis of logistic regression was done, and it was shown that age group, gender, body mass index (BMI), emotional eating habit, external eating habit and sleep quality were the strong predictors of anxiety. Those who aged less than 40 years old were three times greater to be having anxiety (AOR = 3.43; 95% CI: 1.4 – 8.6). Women had double chances of developing anxiety than men (AOR = 2.13; 95% CI: 1.2 – 3.9) (Table 4.10). On the other hand, with reference to normal body mass index (BMI), those who were overweight were less likely to suffer from anxiety (OR = 0.53; 95% CI: 0.3 – 0.9). Referring to the eating habits of the respondents, emotional eating habit and external eating habit were among the strong predictors of anxiety. Those with poor eating habits of emotional eating habit and external eating habit (high scores) had higher chances to have anxiety (OR = 2.09; 95% CI: 1.2 – 3.7); (OR = 1.77; 95% CI: 1.1 – 3.0). The odds of developing anxiety were two times greater for those with poor sleep quality (AOR = 2.23; 95% CI: 1.4 – 3.5) (Table 4.10). 93 Table 4.10: Significant Factors Affecting Anxiety based on Malay-DASS-21 Scores, n = 413 Factors Malay-DASS-21 Anxiety Normal (n = 269) n (%) Anxiety (n = 143) n (%) Crude OR (95% CI) p value Adjusted OR (95% CI) p value Age Group < 40 years old ≥ 40 years old 230 (62.7) 37 (86.0) 137 (37.3) 6 (14.0) 3.67 (1.5 – 8.9) Ref p = 0.004* 3.43 (1.4 – 8.6) Ref p = 0.009* Gender Men Women 59 (75.6) 210 (62.9) 19 (24.4) 124 (37.1) Ref 1.83 (1.1 – 3.2) p = 0.035* Ref 2.13 (1.2 – 3.9) p = 0.013* Body Mass Index (BMI) Underweight Overweight Obese Normal 16 (53.3) 81 (76.4) 44 (59.5) 128 (63.4) 14 (46.7) 25 (23.6) 30 (40.5) 74 (36.6) 1.51 (0.7 – 3.3) 0.53 (0.3 – 0.9) 1.18 (0.7 – 2.0) Ref p = 0.293 p = 0.021* p = 0.553 1.47 (0.6 – 3.3) 0.59 (0.3 – 0.9) 1.36 (0.8 – 2.4) Ref p = 0.358 p = 0.062 p = 0.302 Emotional Eating Habit (DEBQ) Low High 242 (67.6) 27 (50.0) 116 (32.4) 27 (50.0) Ref 2.09 (1.2 – 3.7) p = 0.013* Ref 1.70 (0.9 – 3.2) p = 0.093 External Eating Habit (DEBQ) Low High 68 (74.7) 201 (62.6) 23 (25.3) 120 (37.4) Ref 1.77 (1.1 – 3.0) p = 0.034* Ref 1.5 (0.8 – 2.6) p = 0.174 Sleep Quality (PSQI-M) Good Poor 127 (74.3) 141 (58.8) 44 (25.7) 99 (41.3) Ref 2.03 (1.3 – 3.1) p = 0.001* Ref 2.23 (1.4 – 3.5) p = < 0.001* *Significant to p value = < 0.05, using logistic regression Adjusted OR = Results are adjusted for age, gender, BMI, emotional eating habit, external eating habit and sleep quality 94 The association was made between those without stress and those with stress (combination of mild to extremely severe). According to Table 4.11, there were significant associations between marital status, healthcare position, physical activity, restrained eating habit and sleep quality with stress among the respondents. Other variables had no significant associations with the mental health status of stress among the respondents; p > 0.05 (Table 4.11). 95 Table 4.11: Association of Factors Affecting Stress based on Malay-DASS-21 Scores, n = 413 Group Normal (n = 364) n (%) Stress (n = 48) n (%) X2 df p value Age Group < 40 years old ≥ 40 years old 321 (87.5) 41 (95.3) 46 (12.5) 2 (4.7) 2.314 1 0.128 Gender Men Women 67 (85.9) 297 (88.9) 11 (14.1) 37 (11.1) 0.562 1 0.453 Ethnicity Malay Non-Malay 300 (89.3) 64 (84.2) 36 (10.7) 12 (15.8) 1.551 1 0.213 Religion Muslim Non-Muslim 310 (89.6) 54 (81.8) 36 (10.4) 12 (18.2) 3.257 1 0.071 Marital Status Single/divorced/separated/widowed Married 112 (81.2) 252 (92.0) 26 (18.8) 22 (8.0) 10.422 1 0.001* Educational Status SPM and STPM Tertiary education 36 (92.3) 328 (87.9) 3 (7.7) 45 (12.1) 0.601¥ Household Income < RM 4,850 RM 4,850 – RM 10,959 ≥ RM 10,960 168 (88.0) 183 (88.4) 13 (92.9) 23 (12.0) 24 (11.6) 1 (7.1) 0.305 2 0.858 Healthcare Position Doctors Staff nurses and paramedics 113 (81.9) 251 (91.6) 25 (18.1) 23 (8.4) 8.427 1 0.004* Hospital Ampang Klang Shah Alam Banting Kajang Others 105 (90.5) 60 (92.3) 60 (78.9) 65 (92.9) 37 (90.2) 37 (84.1) 11 (9.5) 5 (7.7) 16 (21.1) 5 (7.1) 4 (9.8) 7 (15.9) 10.346 5 0.066 96 Department Emergency & Trauma Medical-based Surgical-based 151 (86.3) 111 (89.5) 102 (90.3) 24 (13.7) 13 (10.5) 11 (9.7) 1.291 2 0.524 Part-Time Job No Yes 327 (88.9) 37 (84.1) 41 (11.1) 7 (15.9) 0.868 1 0.352 Comorbidity No Yes 311 (88.4) 53 (88.3) 41 (11.6) 7 (11.7) 0.000 1 0.997 Body Mass Index (BMI) Underweight Normal Overweight Obese 25 (83.3) 180 (89.1) 95 (89.6) 64 (86.5) 5 (16.7) 22 (10.9) 11 (10.4) 10 (13.5) 1.263 3 0.738 Smoking/Vaping No Yes 344 (88.4) 20 (87.0) 45 (11.6) 3 (13.0) 0.741¥ Alcohol Consumption No Yes 352 (88.4) 12 (85.7) 46 (11.6) 2 (14.3) 0.672¥ Intentional Exercise No Yes 222 (88.1) 142 (88.8) 30 (11.9) 18 (11.3) 0.041 1 0.840 Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 108 (82.4) 165 (92.2) 90 (89.1) 23 (17.6) 14 (7.8) 11 (10.9) 7.032 2 0.030* Emotional Eating Habit (DEBQ) Low High 318 (88.8) 46 (85.2) 40 (11.2) 8 (14.8) 0.605 1 0.437 97 External Eating Habit (DEBQ) Low High 82 (90.1) 282 (87.9) 9 (9.9) 39 (12.1) 0.352 1 0.553 Restrained Eating Habit (DEBQ) Low High 124 (82.1) 240 (92.0) 27 (17.9) 21 (8.0) 8.989 1 0.003* Sleep Quality (PSQI-M) Good Poor 163 (95.3) 200 (83.3) 8 (4.7) 40 (16.7) 13.913 1 < 0.001* *Significant to p value = < 0.05, using Chi-square test ¥Fischer’s exact test was utilised since more than 20% of the expected counts are less than 5. 98 Strong predictors of stress among the respondents were recorded in Table 4.12. As for marital status, those who were either single, divorced, separated or widowed had higher odds of being stressed (OR = 2.66; 95% CI: 1.4 – 4.9) as compared to those who were married. Besides, healthcare position was also significantly associated to stress. Those who worked as doctors were found to have higher stress than the staff nurses and paramedics (OR = 2.44; 95% CI: 1.3 – 5.0). Physical activity level was not one of the significant predictors for stress according to the logistic regression analysis in Table 4.12. The respondents who had good restrained eating habit (low scores) were having higher chances of getting stress (AOR = 2.27; 95% CI: 1.3 – 5.0). Furthermore, those who had poor sleep quality highlighted the odds of being stressed nearly four times than those who had good sleep quality (AOR = 3.66; 95% CI: 1.6 – 8.2). 99 Table 4.12: Significant Factors Affecting Stress based on Malay-DASS-21 Scores, n = 413 Factors Malay-DASS-21 Stress Normal (n = 364) n (%) Stress (n = 48) n (%) Crude OR (95%CI) p value Adjusted OR (95% CI) p value Marital Status Single/divorced/separated/widowed Married 112 (81.2) 252 (92.0) 26 (18.8) 22 (8.0) 2.66 (1.4 – 4.9) Ref p = 0.002* 1.96 (1.0 – 3.8) Ref p = 0.050 Healthcare Position Doctors Staff nurses and paramedics 113 (81.9) 251 (91.6) 25 (18.1) 23 (8.4) Ref 0.41 (0.2 – 0.8) p = 0.005* Ref 0.58 (0.3 – 1.1) p = 0.114 Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 108 (82.4) 165 (92.2) 90 (89.1) 23 (17.6) 14 (7.8) 11 (10.9) 1.74 (0.8 – 3.8) 0.69 (0.3 – 1.6) Ref p = 0.158 p = 0.389 1.30 (0.6 – 3.0) 0.65 (0.3 – 1.6) Ref p = 0.529 p = 0.330 Restrained Eating Habit (DEBQ) Low High 124 (82.1) 240 (92.0) 27 (17.9) 21 (8.0) Ref 0.40 (0.2 – 0.7) p = 0.003* Ref 0.44 (0.2 – 0.8) p = 0.011* Sleep Quality (PSQI-M) Good Poor 163 (95.3) 200 (83.3) 8 (4.7) 40 (16.7) Ref 4.08 (1.9 – 9.0) p = < 0.001* Ref 3.66 (1.6 – 8.2) p = 0.002* *Significant to p value = < 0.05, using logistic regression Adjusted OR = Results are adjusted for marital status, healthcare position, category of physical activity, restrained eating habit and sleep quality 100 There was 60.0% (n = 248) of the respondents with normal mental health without any symptoms of depression, anxiety or stress, while 36 respondents had all the symptoms of depression, anxiety and stress (triple DAS symptoms). Meanwhile, there was 128 of them who had either one or two symptoms of depression, anxiety or stress. Chi-square test was performed, and it was shown that there were significant associations between age, gender, marital status, healthcare position, venue of the hospital, physical activity, emotional eating habit, external eating habit, restrained eating habit and sleep quality with DAS symptoms; p < 0.05 (Table 4.13). 101 Table 4.13: Association of Factors Affecting All Depression, Anxiety and Stress based on Malay-DASS-21 Scores, n = 413 Group Normal (n = 248) n (%) One or two DAS symptoms (n = 128) n (%) Triple DAS symptoms (n = 36) n (%) X2 df p value Age Group < 40 years old ≥ 40 years old 211 (57.5) 35 (81.4) 122 (33.2) 6 (14.0) 34 (9.3) 2 (4.7) 9.185 2 0.010* Gender Men Women 54 (69.2) 194 (58.1) 14 (17.9) 114 (34.1) 10 (12.8) 26 (7.8) 8.471 2 0.014* Ethnicity Malay Non-Malay 208 (61.9) 40 (52.6) 101 (30.1) 27 (35.5) 27 (8.0) 9 (11.8) 2.509 2 0.285 Religion Muslim Non-Muslim 211 (61.0) 37 (56.1) 108 (31.2) 20 (30.3) 27 (7.8) 9 (13.6) 2.396 2 0.302 Marital Status Single/divorced/separated/widowed Married 74 (53.6) 174 (63.5) 44 (31.9) 84 (30.7) 20 (14.5) 16 (5.8) 9.398 2 0.009* Educational Status SPM and STPM Tertiary education 22 (56.4) 226 (60.6) 16 (41.0) 112 (30.0) 1 (2.6) 35 (9.4) 3.356 2 0.187 Household Income < RM 4,850 RM 4,850 – RM 10,959 ≥ RM 10,960 114 (59.7) 124 (59.9) 10 (71.4) 61 (31.9) 63 (30.4) 4 (28.6) 16 (8.4) 20 (9.7) 0 (0.0) 1.860 4 0.762 Healthcare Position Doctors Staff nurses and paramedics 71 (51.4) 177 (64.6) 47 (34.1) 81 (29.6) 20 (14.5) 16 (5.8) 11.098 2 0.004* 102 Hospital Ampang Klang Shah Alam Banting Kajang Others 70 (60.3) 36 (55.4) 36 (47.4) 47 (67.1) 28 (68.3) 31 (70.5) 40 (34.5) 25 (38.5) 26 (34.2) 18 (25.7) 12 (29.3) 7 (15.9) 6 (5.2) 4 (6.2) 14 (18.4) 5 (7.1) 1 (2.4) 6 (13.6) 23.482 10 0.009* Department Emergency & Trauma Medical-based Surgical-based 103 (58.9) 81 (65.3) 64 (56.6) 53 (30.3) 32 (25.8) 43 (38.1) 19 (10.9) 11 (8.9) 6 (5.3) 6.167 4 0.187 Part-Time Job No Yes 221 (60.1) 27 (61.4) 117 (31.8) 11 (25.0) 30 (8.2) 6 (13.6) 1.948 2 0.378 Comorbidity No Yes 209 (59.4) 39 (65.0) 112 (31.8) 16 (26.7) 31 (8.8) 5 (8.3) 0.720 2 0.698 Body Mass Index (BMI) Underweight Normal Overweight Obese 16 (53.3) 119 (58.9) 74 (69.8) 39 (52.7) 9 (30.0) 67 (33.2) 24 (22.6) 28 (37.8) 5 (16.7) 16 (7.9) 8 (7.5) 7 (9.5) 8.949 6 0.176 Smoking/Vaping No Yes 234 (60.2) 14 (60.9) 122 (31.4) 6 (26.1) 33 (8.5) 3 (13.0) 0.713 2 0.700 Alcohol Consumption No Yes 238 (59.8) 10 (71.4) 126 (31.7) 2 (14.3) 34 (8.5) 2 (14.3) 2.128 2 0.345 Intentional Exercise No Yes 144 (57.1) 104 (65.0) 86 (34.1) 42 (26.3) 22 (8.7) 14 (8.8) 2.958 2 0.228 103 Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 68 (51.9) 110 (61.5) 69 (68.3) 45 (34.4) 59 (33.0) 24 (23.8) 18 (13.7) 10 (5.6) 8 (7.9) 10.890 4 0.028* Emotional Eating Habit (DEBQ) Low High 226 (63.1) 22 (40.7) 102 (28.5) 26 (48.1) 30 (8.4) 6 (11.1) 10.143 2 0.006* External Eating Habit (DEBQ) Low High 65 (71.4) 183 (57.0) 17 (18.7) 111 (34.6) 9 (9.9) 27 (8.4) 8.394 2 0.015* Restrained Eating Habit (DEBQ) Low High 91 (60.3) 157 (60.2) 36 (23.8) 92 (35.2) 24 (15.9) 12 (4.6) 17.977 2 < 0.001* Sleep Quality (PSQI-M) Good Poor 120 (70.2) 127 (52.9) 47 (27.5) 81 (33.8) 4 (2.3) 32 (13.3) 19.987 2 < 0.001* *Significant to p value = < 0.05, using Chi-square test. 104 Further analysis of multinomial logistic regression is reported in Table 4.14. Those who were less than 40 years old had triple the odds of having one or two DAS symptoms than the older age group (AOR = 2.93; 95% CI: 1.1 – 7.6). Women were three times more likely to have one or two DAS symptoms (AOR = 2.83; 95% CI: 1.4 – 5.9). With the reference of Ampang Hospital, the respondents who worked in others hospital were less likely to have one or two DAS symptoms (AOR = 0.23; 95% CI: 0.1 – 0.6). Those who were inactive had double odds of having one or two DAS symptoms (AOR = 2.19; 95% CI: 1.1 – 4.2). The respondents with poor emotional and external eating habits (high scores) had more chances to get one or two DAS symptoms (AOR = 2.25; 95% CI: 1.1 – 4.4; OR = 2.32; 95% CI: 1.3 – 4.2). Besides, the respondents with poor sleep quality recorded double odds of having one or two DAS symptoms (AOR = 2.00; 95% CI: 1.2 – 3.3). Zooming on the triple DAS symptoms, those who were in the group of single, divorced, separated or widowed was demonstrated to have higher odds of having triple DAS symptoms (OR = 2.94; 95% CI: 1.4 – 6.0). Staff nurses and paramedics had the odds of three times to be having triple DAS symptoms as compared to doctors (OR = 3.12; 95% CI: 1.5 – 6.4). In addition, those who worked in Shah Alam Hospital were more having higher chances of getting triple DAS symptoms than those who worked in Ampang Hospital (OR = 4.54; 95% CI: 1.6 – 12.8). Those with good restrained eating habit (low scores) had more chances to get triple DAS symptoms (AOR = 3.85; 95% CI: 1.7 – 10.0). The respondents with poor sleep quality had greater odds of having triple DAS symptoms (AOR = 7.60; 95% CI: 2.4 – 23.9). . 105 Table 4.14: Significant Factors Affecting All Depression, Anxiety and Stress based on Malay-DASS-21 Scores, n = 413 Factors One or two DAS symptoms Triple DAS symptoms Crude OR (95% CI) p value Adjusted OR (95% CI) p value Crude OR (95% CI) p value Adjusted OR (95% CI) p value Age < 40 years old ≥ 40 years old 3.37 (1.4 – 8.2) Ref p = 0.008* 2.93 (1.1 – 7.6) Ref p = 0.027* 2.82 (0.6 – 12.3) Ref p = 0.167 0.74 (0.1 – 3.9) Ref p = 0.726 Gender Men Women Ref 2.27 (1.2 – 4.3) p = 0.011* Ref 2.83 (1.4 – 5.9) p = 0.006* Ref 0.72 (0.3 – 1.6) p = 0.422 Ref 1.54 (0.6 – 3.9) p = 0.369 Marital Status Single/divorced/separated Married 1.23 (0.8 – 1.9) Ref p = 0.369 1.08 (0.6 – 1.9) Ref p = 0.785 2.94 (1.4 – 6.0) Ref p = 0.003* 2.18 (0.9 – 5.1) Ref p = 0.074 Healthcare Position Doctors Staff nurses and paramedics Ref 1.45 (0.9 – 2.3) p = 0.110 Ref 1.63 (0.9 – 3.0) p = 0.124 Ref 3.12 (1.5 – 6.4) p = 0.002* Ref 2.19 (0.8 – 5.7) p = 0.112 Hospital Ampang Klang Shah Alam Banting Kajang Others Ref 1.22 (0.6 – 2.3) 1.26 (0.7 – 2.4) 0.67 (0.3 – 1.3) 0.75 (0.3 – 1.6) 0.40 (0.2 – 0.9) p = 0.551 p = 0.471 p = 0.240 p = 0.470 p = 0.045* Ref 1.04 (0.5 – 2.1) 1.14 (0.5 – 2.4) 0.65 (0.3 – 1.4) 0.80 (0.3 – 1.9) 0.23 (0.1 – 0.6) p = 0.901 p = 0.724 p = 0.271 p = 0.599 p = 0.004* Ref 1.30 (0.3 – 4.9) 4.54 (1.6 – 12.8) 1.24 (0.4 – 4.3) 0.42 (0.1 – 3.6) 2.26 (0.7 – 7.6) p = 0.702 p = 0.004* p = 0.733 p = 0.427 p = 0.186 Ref 0.76 (0.2 – 3.2) 2.37 (0.7 – 8.0) 1.20 (0.3 – 5.0) 0.28 (0.1 – 2.7) 0.87 (0.2 – 3.5) p = 0.711 p = 0.164 p = 0.806 p = 0.267 p = 0.848 Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 1.90 (1.1 – 3.5) 1.54 (0.9 – 2.7) Ref p = 0.035* p = 0.131 2.19 (1.1 – 4.2) 1.68 (0.9 – 3.1) Ref p = 0.020* p = 0.101 2.28 (0.9 – 5.6) 0.78 (0.3 – 2.1) Ref p = 0.071 p = 0.626 1.47 (0.5 – 4.1) 0.73 (0.2 – 2.2) Ref p = 0.471 p = 0.581 106 Eating Habits (DEBQ) Emotional eating Low High External Eating Low High Ref 2.62 (1.4 – 4.8) Ref 2.32 (1.3 – 4.2) p = 0.002* p = 0.005* Ref 2.25 (1.1 – 4.4) Ref 1.88 (1.1 – 3.6) p = 0.018* p = 0.061 Ref 2.06 (0.8 – 5.5) Ref 1.07 (0.5 – 2.4) p = 0.150 p = 0.877 Ref 2.63 (0.8 – 8.1) Ref 1.54 (0.6 – 4.2) p = 0.094 p = 0.401 Restrained Eating Low High Ref 1.48 (0.9 – 2.4) p = 0.097 Ref 1.30 (0.8 – 2.2) p = 0.332 Ref 0.29 (0.1 – 0.6) p = 0.001* Ref 0.26 (0.1 – 0.6) p = 0.002* Sleep Quality (PSQI-M) Good Poor Ref 1.63 (1.1 – 2.5) p = 0.029* Ref 2.00 (1.2 – 3.3) p = 0.005* Ref 7.56 (2.6 – 22.0) p = < 0.001* Ref 7.60 (2.4 – 23.9) p = 0.001* The reference category for factors affecting all depression, anxiety and stress is Normal. *Significant to p value = < 0.05, using multinomial logistic regression Adjusted OR = Results are adjusted for age, gender, marital status, healthcare position, hospital, category of physical activity, eating habits of emotional, external and restrained, and sleep quality. 107 4.6.2 Associated Factors with Quality of Life The respondents’ WHO-5-Malay quality of life scores is illustrated in Table 4.15. Healthcare position, hospital, department, external eating habit, restrained eating habit and sleep quality were the significant predictors that were associated with the quality of life of the respondents according to WHO-5-Malay scores; p < 0.05. Other variables had no significant associations with the quality of life of the respondents; p > 0.05 (Table 4.15). 108 Table 4.15: Association of Factors Affecting Quality of Life based on WHO-5-Malay Scores, n = 413 Group Good quality of life (n = 229) n (%) Poor quality of life (n = 184) n (%) X2 df p value Age Group < 40 years old ≥ 40 years old 200 (54.3) 27 (62.8) 168 (45.7) 16 (37.2) 1.110 1 0.292 Gender Men Women 41 (52.6) 188 (56.1) 37 (47.4) 147 (43.9) 0.324 1 0.569 Ethnicity Malay Non-Malay 194 (57.6) 35 (46.1) 143 (42.4) 41 (53.9) 3.328 1 0.068 Religion Muslim Non-Muslim 197 (56.8) 32 (48.5) 150 (43.2) 34 (51.5) 1.542 1 0.214 Marital Status Single/divorced/separated/widowed Married 69 (50.0) 160 (58.2) 69 (50.0) 115 (41.8) 2.490 1 0.115 Educational Status SPM and STPM Tertiary education 26 (66.7) 203 (54.3) 13 (33.3) 171 (45.7) 2.194 1 0.139 Household Income < RM 4,850 RM 4,850 – RM 10,959 ≥ RM 10,960 101 (52.6) 120 (58.0) 8 (57.1) 91 (47.4) 87 (42.0) 6 (42.9) 1.178 2 0.555 Healthcare Position Doctors Staff nurses and paramedics 64 (46.4) 165 (60.0) 74 (53.6) 110 (40.0) 6.903 1 0.009* 109 Hospital Ampang Klang Shah Alam Banting Kajang Others 76 (65.0) 42 (64.6) 26 (34.2) 38 (54.3) 20 (48.8) 27 (61.4) 41 (35.0) 23 (35.4) 50 (65.8) 32 (45.7) 21 (51.2) 17 (38.6) 21.770 5 0.001* Department Emergency & Trauma Medical-based Surgical-based 85 (48.6) 67 (53.6) 77 (68.1) 90 (51.4) 58 (46.4) 36 (31.9) 10.893 2 0.004* Part-Time Job No Yes 202 (54.7) 27 (61.4) 167 (45.3) 17 (38.6) 0.698 1 0.404 Comorbidity No Yes 198 (56.1) 31 (51.7) 155 (43.9) 29 (48.3) 0.406 1 0.524 Body Mass Index (BMI) Underweight Normal Overweight Obese 16 (53.3) 114 (56.4) 57 (53.3) 42 (56.8) 14 (46.7) 88 (43.6) 50 (46.7) 32 (43.2) 0.391 3 0.942 Smoking/Vaping No Yes 217 (55.6) 12 (52.2) 173 (44.4) 11 (47.8) 0.106 1 0.745 Alcohol Consumption No Yes 220 (55.1) 9 (64.3) 179 (44.9) 5 (35.7) 0.458 1 0.498 Intentional Exercise No Yes 132 (52.2) 97 (60.6) 121 (47.8) 63 (39.4) 2.834 1 0.092 110 Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 66 (50.4) 103 (57.2) 60 (59.4) 65 (49.6) 77 (42.8) 41 (40.6) 2.229 2 0.328 Emotional Eating Habit (DEBQ) Low High 196 (54.6) 33 (61.1) 163 (45.4) 21 (38.9) 0.807 1 0.369 External Eating Habit (DEBQ) Low High 39 (42.9) 190 (59.0) 52 (57.1) 132 (41.0) 7.490 1 0.006* Restrained Eating Habit (DEBQ) Low High 73 (48.3) 156 (59.5) 78 (51.7) 106 (40.5) 4.862 1 0.027* Sleep Quality (PSQI-M) Good Poor 111 (64.5) 118 (49.2) 61 (35.5) 122 (50.8) 9.585 1 0.002* *Significant to p value = < 0.05, using Chi-square test 111 According to the logistic regression analysis, Table 4.16 describes the strong factors associated with quality of life based on WHO-5-Malay. Based on nature of work positions, doctors have the odds of poorer quality of life as compared to the staff nurses and paramedics (AOR = 2.00; 95% CI: 1.1 – 3.3). With the reference of Ampang Hospital, the respondents who worked in Shah Alam Hospital were three times higher to have poor quality of life (AOR = 2.81; 95% CI: 1.4 – 5.5). The respondents in department of emergency and trauma had poorer quality of life in comparison with those who were in the surgical-based department (OR = 2.27; 95% CI: 1.4 – 3.3). On top of that, eating habits based on DEBQ scores also contributed to the strong predictors of quality of life among the respondents. Those who had good external eating habit (low scores) and good restrained eating habit (low scores) were two times likely to have poor quality of life (OR = 1.92; 95% CI: 1.3 – 3.3); (OR = 1.56; 95% CI: 1.1 – 2.5). Besides, the respondents with poor sleep quality were also two times higher to have poor quality of life (AOR = 1.69; 95% CI: 1.1 – 2.6). 112 Table 4.16: Significant Factors Affecting Quality of Life based on WHO-5-Malay Scores, n = 413 Factors WHO-5-Malay Good Quality of Life (n = 229) n (%) Poor Quality of Life (n = 184) n (%) Crude OR (95% CI) p value Adjusted OR (95% CI) p value Healthcare Position Doctors Staff nurses and paramedics 64 (46.4) 165 (60.0) 74 (53.6) 110 (40.0) Ref 0.58 (0.4 – 0.9) p = 0.009* Ref 0.50 (0.3 – 0.9) p = 0.020* Hospital Ampang Klang Shah Alam Banting Kajang Others 76 (65.0) 42 (64.6) 26 (34.2) 38 (54.3) 20 (48.8) 27 (61.4) 41 (35.0) 23 (35.4) 50 (65.8) 32 (45.7) 21 (51.2) 17 (38.6) Ref 1.02 (0.5 – 1.9) 3.57 (1.9 – 6.5) 1.56 (0.9 – 2.9) 1.95 (0.9 – 4.0) 1.17 (0.6 – 2.4) p = 0.963 p = < 0.001* p = 0.149 p = 0.070 p = 0.672 Ref 0.79 (0.4 – 1.6) 2.81 (1.4 – 5.5) 1.34 (0.7 – 2.6) 1.92 (0.8 – 4.3) 0.78 (0.4 – 1.7) p = 0.507 p = 0.003* p = 0.398 p = 0.120 p = 0.518 Department Emergency & Trauma Medical-based Surgical-based 85 (48.6) 67 (53.6) 77 (68.1) 90 (51.4) 58 (46.4) 36 (31.9) Ref 0.82 (0.5 – 1.3) 0.44 (0.3 – 0.7) p = 0.391 p = 0.001* Ref 1.69 (0.9 – 3.2) 0.78 (0.4 – 1.4) p = 0.105 p = 0.418 Eating Habits (DEBQ) External Eating Low High Restrained Eating Low High 39 (42.9) 190 (59.0) 73 (48.3) 156 (59.5) 52 (57.1) 132 (41.0) 78 (51.7) 106 (40.5) Ref 0.52 (0.3 – 0.8) Ref 0.64 (0.4 – 0.9) p = 0.007* p = 0.028* Ref 0.60 (0.4 – 1.0) Ref 0.81 (0.5 – 1.3) p = 0.056 p = 0.350 Sleep Quality (PSQI-M) Good Poor 111 (64.5) 118 (49.2) 61 (35.5) 122 (50.8) Ref 1.88 (1.3 – 2.8) p = 0.002* Ref 1.69 (1.1 – 2.6) p = 0.016* *Significant to p value = < 0.05, using logistic regression Adjusted OR = Results are adjusted for healthcare position, hospital, department, external eating habit, restrained eating habit and sleep quality 113 Table 4.17 illustrates the association of factors affecting the quality of life of respondents referring to the Malay-SF-36 scores of physical domains. In general, there was a significant association between comorbidity and sleep quality with the quality of life of the respondents in the aspect of physical domain of Malay-SF-36 scores; p < 0.05. Other variables had no significant associations with the quality of life of the respondents physically; p > 0.05. According to Table 4.18, the respondents with comorbidity were 3 times higher to have a poor quality of life physically. Besides, it was also shown that those with poor sleep quality were 5 times more likely to have a poor quality of life in the physical domain. 114 Table 4.17: Association of Factors Affecting Quality of Life based on Malay-SF-36 Physical Domain, n = 413 Group Good quality of life (n = 373) n (%) Poor quality of life (n = 40) n (%) X2 df p value Age Group < 40 years old ≥ 40 years old 332 (90.2) 39 (90.7) 36 (9.8) 4 (9.3) 1.000¥ Gender Men Women 72 (92.3) 301 (89.9) 6 (7.7) 34 (10.1) 0.437 1 0.509 Ethnicity Malay Non-Malay 308 (91.4) 65 (85.5) 29 (8.6) 11 (14.5) 2.441 1 0.118 Religion Muslim Non-Muslim 315 (90.8) 58 (87.9) 32 (9.2) 8 (12.1) 0.533 1 0.465 Marital Status Single/divorced/separated/widowed Married 124 (89.9) 249 (90.5) 14 (10.1) 26 (9.5) 0.050 1 0.823 Educational Status SPM and STPM Tertiary education 35 (89.7) 338 (90.4) 4 (10.3) 36 (9.6) 0.781¥ Household Income < RM 4,850 RM 4,850 – RM 10,959 ≥ RM 10,960 169 (88.0) 190 (91.8) 14 (100.0) 23 (12.0) 17 (8.2) 0 (0.0) 3.170 2 0.205 Healthcare Position Doctors Staff nurses and paramedics 130 (94.2) 243 (88.4) 8 (5.8) 32 (11.6) 3.582 1 0.058 115 Hospital Ampang Klang Shah Alam Banting Kajang Others 110 (94.0) 54 (83.1) 66 (86.8) 63 (90.0) 37 (90.2) 43 (97.7) 7 (6.0) 11 (16.9) 10 (13.2) 7 (10.0) 4 (9.8) 1 (2.3) 9.546 5 0.089 Department Emergency & Trauma Medical-based Surgical-based 155 (88.6) 115 (92.0) 103 (91.2) 20 (11.4) 10 (8.0) 10 (8.8) 1.104 2 0.576 Part-Time Job No Yes 335 (90.8) 38 (86.4) 34 (9.2) 6 (13.6) 0.414¥ Comorbidity No Yes 326 (92.4) 47 (78.3) 27 (7.6) 13 (21.7) 11.521 1 0.001* Body Mass Index (BMI) Underweight Normal Overweight Obese 26 (86.7) 188 (93.1) 98 (91.6) 61 (82.4) 4 (13.3) 14 (6.9) 9 (8.4) 13 (17.6) 7.663 3 0.054 Smoking/Vaping No Yes 354 (90.8) 19 (82.6) 36 (9.2) 4 (17.4) 0.262¥ Alcohol Consumption No Yes 360 (90.2) 13 (92.9) 39 (9.8) 1 (7.1) 1.000¥ Intentional Exercise No Yes 225 (88.9) 148 (92.5) 28 (11.1) 12 (7.5) 1.426 1 0.232 116 Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 116 (88.5) 164 (91.1) 92 (91.1) 15 (11.5) 16 (8.9) 9 (8.9) 0.665 2 0.717 Emotional Eating Habit (DEBQ) Low High 324 (90.3) 49 (90.7) 35 (9.7) 5 (9.3) 0.013 1 0.910 External Eating Habit (DEBQ) Low High 80 (87.9) 293 (91.0) 11 (12.1) 29 (9.0) 0.770 1 0.380 Restrained Eating Habit (DEBQ) Low High 133 (88.1) 240 (91.6) 18 (11.9) 22 (8.4) 1.360 1 0.244 Sleep Quality (PSQI-M) Good Poor 167 (97.1) 205 (85.4) 5 (2.9) 35 (14.6) 15.583 1 < 0.001* *Significant to p value = < 0.05, using Chi-square test ¥Fischer’s exact test was utilised since more than 20% of the expected counts are less than 5. 117 Table 4.18: Significant Factors Affecting Quality of Life based on Malay-SF-36 Physical Domain, n = 413 Factors Malay-SF-36 Physical Domain Good quality of life (n = 373) n (%) Poor quality of life (n = 40) n (%) Crude OR (95% CI) p value Adjusted OR (95% CI) p value Comorbidity No Yes 326 (92.4) 47 (78.3) 27 (7.6) 13 (21.7) Ref 3.34 (1.6 – 6.9) p = 0.001* Ref 3.01 (1.4 – 6.4) p = 0.004* Sleep Quality (PSQI-M) Good Poor 167 (97.1) 205 (85.4) 5 (2.9) 35 (14.6) Ref 5.70 (2.2 – 14.9) p = < 0.001* Ref 5.37 (2.0 – 14.1) p = 0.001* *Significant to p value = < 0.05, using logistic regression Adjusted OR = Results are adjusted for comorbidity and sleep quality 118 Meanwhile, referring to the mental domain of Malay-SF-36 scores, restrained eating habit and sleep quality were found significantly associated with the quality of life of the respondents; p < 0.05. Other variables had no significant associations with the particular domain of Malay-SF-36 (Table 4.19). Analysis of logistic regression highlighted in Table 4.20 found that respondents with poor sleep quality were 11 times more likely to have poor quality of life specifically in mental domain. On the other hand, the factor of restrained eating habit did not have significant association with the quality of life of the respondents based on Malay-SF-36 scores of mental domain. 119 Table 4.19: Association of Factors Affecting Quality of Life based on Malay-SF-36 Mental Domain, n = 413 Group Good quality of life (n = 369) n (%) Poor quality of life (n = 44) n (%) X2 df p value Age Group < 40 years old ≥ 40 years old 325 (88.3) 42 (97.7) 43 (11.7) 1 (2.3) 0.067¥ Gender Men Women 72 (92.3) 297 (88.7) 6 (7.7) 38 (11.3) 0.886 1 0.347 Ethnicity Malay Non-Malay 305 (90.5) 64 (84.2) 32 (9.5) 12 (15.8) 2.581 1 0.108 Religion Muslim Non-Muslim 314 (90.5) 55 (83.3) 33 (9.5) 11 (16.7) 2.984 1 0.084 Marital Status Single/divorced/separated/widowed Married 118 (85.5) 251 (91.3) 20 (14.5) 24 (8.7) 3.209 1 0.073 Educational Status SPM and STPM Tertiary education 33 (84.6) 336 (89.8) 6 (15.4) 38 (10.2) 0.284¥ Household Income < RM 4,850 RM 4,850 – RM 10,959 ≥ RM 10,960 171 (89.1) 184 (88.9) 14 (100.0) 21 (10.9) 23 (11.1) 0 (0.0) 1.731 2 0.421 Healthcare Position Doctors Staff nurses and paramedics 121 (87.7) 248 (90.2) 17 (12.3) 27 (9.8) 0.604 1 0.437 Hospital Ampang Klang Shah Alam Banting Kajang 108 (92.3) 59 (90.8) 61 (80.3) 64 (91.4) 35 (85.4) 9 (7.7) 6 (9.2) 15 (19.7) 6 (8.6) 6 (14.6) 10.529 5 0.062 120 Others 42 (95.5) 2 (4.5) Department Emergency & Trauma Medical-based Surgical-based 153 (87.4) 116 (92.8) 100 (88.5) 22 (12.6) 9 (7.2) 13 (11.5) 2.328 2 0.312 Part-Time Job No Yes 332 (90.0) 37 (84.1) 37 (10.0) 7 (15.9) 0.296¥ Comorbidity No Yes 317 (89.8) 52 (86.7) 36 (10.2) 8 (13.3) 0.530 1 0.467 Body Mass Index (BMI) Underweight Normal Overweight Obese 26 (86.7) 181 (89.6) 99 (92.5) 63 (85.1) 4 (13.3) 21 (10.4) 8 (7.5) 11 (14.9) 2.754 3 0.431 Smoking/Vaping No Yes 348 (89.2) 21 (91.3) 42 (10.8) 2 (8.7) 1.000¥ Alcohol Consumption No Yes 355 (89.0) 14 (100.0) 44 (11.0) 0 (0.0) 0.380¥ Intentional Exercise No Yes 221 (87.4) 148 (92.5) 32 (12.6) 12 (7.5) 2.729 1 0.099 Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 112 (85.5) 164 (91.1) 92 (91.1) 19 (14.5) 16 (8.9) 9 (8.9) 2.945 2 0.229 Emotional Eating Habit (DEBQ) Low High 322 (89.7) 47 (87.0) 37 (10.3) 7 (13.0) 0.348 1 0.555 121 External Eating Habit (DEBQ) Low High 78 (85.7) 291 (90.4) 13 (14.3) 31 (9.6) 1.617 1 0.203 Restrained Eating Habit (DEBQ) Low High 129 (85.4) 240 (91.6) 22 (14.6) 22 (8.4) 3.834 1 0.049* Sleep Quality (PSQI-M) Good Poor 169 (98.3) 199 (82.9) 3 (1.7) 41 (17.1) 24.714 1 < 0.001* *Significant to p value = < 0.05, using Chi-square test ¥Fischer’s exact test was utilised since more than 20% of the expected counts are less than 5. Table 4.20: Significant Factors Affecting Quality of Life based on Malay-SF-36 Mental Domain, n = 413 Factors Malay-SF-36 Mental Domain Good quality of life (n = 369) n (%) Poor quality of life (n = 44) n (%) Crude OR (95% CI) p value Adjusted OR (95% CI) p value Restrained Eating (DEBQ) Low High 129 (85.4) 240 (91.6) 22 (14.6) 22 (8.4) Ref 0.54 (0.3 – 0.9) p = 0.053 Ref 0.61 (0.3 – 1.2) p = 0.133 Sleep Quality (PSQI-M) Good Poor 169 (98.3) 199 (82.9) 3 (1.7) 41 (17.1) Ref 11.61 (3.5 – 38.2) p = < 0.001* Ref 11.18 (3.4 – 36.8) p = < 0.001* *Significant to p value = < 0.05, using logistic regression Adjusted OR = Results are adjusted for restrained eating habit and sleep quality 122 4.6.3 Associated Factors with Work Engagement Table 4.21 shows the association between variables affecting work engagement based on total scores of UWES-M among the respondents. The Chi-square test proved that there was significant association between age group, educational status, healthcare position, intentional exercise, physical activity, eating habits of external and restrained, and sleep quality with work engagement based on total scores of UWES-M, p < 0.05. Other variables had no significant associations with the parameter of work engagement among the respondents; p > 0.05 (Table 4.21) 123 Table 4.21: Association of Factors Affecting Total Score of UWES-M, n = 413 Group Low Total Score (n = 59) n (%) Average (n = 252) n (%) High Total Score (n = 102) n (%) X2 df p value Age Group < 40 years old ≥ 40 years old 56 (15.2) 3 (7.0) 228 (62.0) 23 (53.5) 84 (22.8) 17 (39.5) 6.647 2 p = 0.036* Gender Men Women 10 (12.8) 49 (14.6) 47 (60.3) 205 (61.2) 21 (26.9) 81 (24.2) 0.347 2 p = 0.841 Ethnicity Malay Non-Malay 43 (12.8) 16 (21.1) 209 (62.0) 43 (56.6) 85 (25.2) 17 (22.4) 3.491 2 p = 0.175 Religion Muslim Non-Muslim 48 (13.8) 11 (16.7) 213 (61.4) 39 (59.1) 86 (24.8) 16 (24.2) 0.366 2 p = 0.833 Marital Status Single/divorced/separated/widowed Married 20 (14.5) 39 (14.2) 90 (65.2) 162 (58.9) 28 (20.3) 74 (26.9) 2.236 2 p = 0.327 Educational Status SPM and STPM Tertiary education 7 (17.9) 52 (13.9) 12 (30.8) 240 (64.2) 20 (51.3) 82 (21.9) 19.186 2 p = < 0.001* Household Income < RM 4,850 RM 4,850 – RM 10,959 ≥ RM 10,960 32 (16.7) 27 (13.0) 0 (0.0) 112 (58.3) 130 (62.8) 10 (71.4) 48 (25.0) 50 (24.2) 4 (28.6) 3.686 4 p = 0.450 Healthcare Position Doctors Staff nurses and paramedics 22 (15.9) 37 (13.5) 93 (67.4) 159 (57.8) 23 (16.7) 79 (28.7) 7.190 2 p = 0.027* 124 Hospital Ampang Klang Shah Alam Banting Kajang Others 10 (8.5) 12 (18.5) 14 (18.4) 13 (18.6) 7 (17.1) 3 (6.8) 69 (59.0) 39 (60.0) 48 (63.2) 39 (55.7) 27 (65.9) 30 (68.2) 38 (32.5) 14 (21.5) 14 (18.4) 18 (25.7) 7 (17.1) 11 (25.0) 13.578 10 p = 0.193 Department Emergency & Trauma Medical-based Surgical-based 32 (18.3) 12 (9.6) 15 (13.3) 108 (61.7) 80 (64.0) 64 (56.6) 35 (20.0) 33 (26.4) 34 (30.1) 7.554 4 p = 0.109 Part-Time Job No Yes 50 (13.6) 9 (20.5) 227 (61.5) 25 (56.8) 92 (24.9) 10 (22.7) 1.532 2 p = 0.465 Comorbidity No Yes 52 (14.7) 7 (11.7) 217 (61.5) 35 (58.3) 84 (23.8) 18 (30.0) 1.219 2 p = 0.544 Body Mass Index (BMI) Underweight Normal Overweight Obese 6 (20.0) 25 (12.4) 15 (14.0) 13 (17.6) 18 (60.0) 128 (63.4) 67 (62.6) 39 (52.7) 6 (20.0) 49 (24.3) 25 (23.4) 22 (29.7) 3.955 6 p = 0.683 Smoking/Vaping No Yes 55 (14.1) 4 (17.4) 239 (61.3) 13 (56.5) 96 (24.6) 6 (26.1) 0.264 2 p = 0.876 Alcohol Consumption No Yes 58 (14.5) 1 (7.1) 242 (60.7) 10 (71.4) 99 (24.8) 3 (21.4) 0.838 2 p = 0.658 Intentional Exercise No Yes 37 (14.6) 22 (13.8) 167 (66.0) 85 (53.1) 49 (19.4) 53 (33.1) 10.230 2 p = 0.006* 125 Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 28 (21.4) 23 (12.8) 8 (7.9) 69 (52.7) 113 (62.8) 69 (68.3) 34 (26.0) 44 (24.4) 24 (23.8) 10.334 4 p = 0.035* Emotional Eating Habit (DEBQ) Low High 53 (14.8) 6 (11.1) 214 (59.6) 38 (70.4) 92 (25.6) 10 (18.5) 2.289 2 p = 0.318 External Eating Habit (DEBQ) Low High 22 (24.2) 37 (11.5) 44 (48.4) 208 (64.6) 25 (27.5) 77 (23.9) 11.424 2 p = 0.003* Restrained Eating Habit (DEBQ) Low High 36 (23.8) 23 (8.8) 82 (54.3) 170 (64.9) 33 (21.9) 69 (26.3) 17.750 2 p = < 0.001* Sleep Quality (PSQI-M) Good Poor 10 (5.8) 49 (20.4) 108 (62.8) 143 (59.6) 54 (31.4) 48 (20.0) 20.344 2 p = < 0.001* *Significant to p value = < 0.05, using Chi-square test. 126 Based on the multinomial logistic regression for the total scores of UWES-M, the variables of age group, educational status, healthcare position, intentional exercise, physical activity, eating habits of external and restrained, and sleep quality were significantly associated to work engagement, meanwhile other variables were non- significant (Table 4.22). As for the poor work engagement (low scores), those with the educational status until SPM and STPM were more likely to have poor work engagement than those with tertiary education (AOR = 3.28; 95% CI: 1.1 – 9.5). The respondents who were inactive had triple odds of having poor work engagement as compared to those who were HEPA active (AOR = 3.17; 95% CI: 1.3 – 8.0). Besides, the respondents with good external and restrained eating habits (low scores) had greater odds of getting poor work engagement (AOR = 2.08; 95% CI: 1.1 – 5.0; AOR = 2.38; 95% CI: 1.3 – 5.0). Those who had poor sleep quality were also three times higher to have poor work engagement (AOR = 3.18; 95% CI: 1.5 – 6.7). Meanwhile, referring to the good work engagement (high scores) among the respondents, those who were in the age group of more than 40 years old recorded double odds of having good work engagement (OR = 2.00; 95% CI: 1.1 – 3.3). As for the educational status, those who were educated until SPM and STPM were more likely to have good work engagement than those with tertiary education (AOR = 4.89; 95% CI: 2.2 – 10.9). In addition, staff nurses and paramedics were shown to have better work engagement as compared to doctors (OR = 2.01; 95% CI: 1.2 – 3.4). The respondents who practiced intentional exercise recorded the higher odds of having good work 127 engagement (AOR = 2.27; 95% CI: 1.4 – 3.3). Those who were inactive had double odds of having good work engagement than those who were HEPA active (AOR = 2.02; 95% CI: 1.1 – 4.0). 128 Table 4.22: Significant Factors Affecting Work Engagement for Total Score of UWES-M, n = 413 Factors Low Total Score High Total Score Crude OR (95% CI) p value Adjusted OR (95% CI) p value Crude OR (95% CI) p value Adjusted OR (95% CI) p value Age < 40 years old ≥ 40 years old 1.88 (0.5 – 6.5) Ref p = 0.316 1.79 (0.5 – 6.7) Ref p = 0.389 0.50 (0.3 – 0.9) Ref p = 0.043* 0.61 (0.3 – 1.3) Ref p = 0.182 Educational Status SPM and STPM Tertiary education 2.69 (1.1 – 7.2) Ref p = 0.047* 3.28 (1.1 – 9.5) Ref p = 0.028* 4.88 (2.3 – 10.4) Ref p = < 0.001* 4.89 (2.2 – 10.9) Ref p = < 0.001* Healthcare Position Doctors Staff nurses and paramedics Ref 0.98 (0.5 – 1.8) p = 0.956 Ref 1.05 (0.5 – 2.0) p = 0.882 Ref 2.01 (1.2 – 3.4) p = 0.010* Ref 1.40 (0.8 – 2.5) p = 0.272 Intentional Exercise No Yes 0.86 (0.5 – 1.5) Ref p = 0.605 0.71 (0.4 – 1.4) Ref p = 0.306 0.47 (0.3 – 0.8) Ref p = 0.002* 0.44 (0.3 – 0.7) Ref p = 0.002* Category of Physical Activity Inactive Minimally active HEPA active 3.50 (1.5 – 8.2) 1.76 (0.7 – 4.1) Ref p = 0.004* p = 0.199 3.17 (1.3 – 8.0) 1.64 (0.7 – 4.0) Ref p = 0.014* p = 0.284 1.42 (0.8 – 2.6) 1.12 (0.6 – 2.0) Ref p = 0.271 p = 0.703 2.02 (1.1 – 4.0) 1.22 (0.7 – 2.3) Ref p = 0.043* p = 0.538 External Eating (DEBQ) Low High Restrained Eating (DEBQ) Low High Ref 0.36 (0.2 – 0.7) Ref 0.31 (0.2 – 0.6) p = 0.001* p = < 0.001* Ref 0.48 (0.2 – 0.9) Ref 0.42 (0.2 – 0.8) p = 0.042* p = 0.010* Ref 0.65 (0.4 – 1.1) Ref 1.01 (0.6 – 1.6) p = 0.131 p = 0.973 Ref 0.65 (0.4 – 1.2) Ref 1.02 (0.6 – 1.8) p = 0.171 p = 0.951 Sleep Quality (PSQI-M) Good Poor Ref 3.70 (1.8 – 7.6) p = < 0.001* Ref 3.18 (1.5 – 6.7) p = 0.002* Ref 0.67 (0.4 – 1.1) p = 0.091 Ref 0.66 (0.4 – 1.1) p = 0.102 The reference category for total score of UWES-M is Average. *Significant to p value = < 0.05, using multinomial logistic regression Adjusted OR = Results are adjusted for age, educational status, healthcare position, intentional exercise, category of physical activity, eating habits of external and restrained, and sleep quality. 129 Table 4.23 illustrates the association between variables affecting work engagement based on the domain of vigour among the respondents. There were significant associations between age group, marital status, educational status, healthcare position, intentional exercise, and sleep quality with work engagement referring to vigour domain of UWES-M, p < 0.05 based on Chi-square test. Other variables had no significant associations with the domain of vigour of work engagement among the respondents; p > 0.05. 130 Table 4.23: Association of Factors Affecting Vigour Domain of UWES-M, n = 413 Group Low Vigour (n = 176) n (%) Average (n = 161) n (%) High Vigour (n = 74) n (%) X2 df p value Age Group < 40 years old ≥ 40 years old 167 (45.4) 9 (20.9) 140 (38.0) 21 (48.8) 61 (16.6) 13 (30.2) 10.508 2 p = 0.005* Gender Men Women 30 (38.5) 146 (43.6) 30 (38.5) 133 (39.7) 18 (23.1) 56 (16.7) 1.842 2 p = 0.398 Ethnicity Malay Non-Malay 136 (40.4) 40 (52.6) 141 (41.8) 22 (28.9) 60 (17.8) 14 (18.4) 4.818 2 p = 0.090 Religion Muslim Non-Muslim 144 (41.5) 32 (48.5) 142 (40.9) 21 (31.8) 61 (17.6) 13 (19.7) 1.938 2 p = 0.379 Marital Status Single/divorced/separated/widowed Married 73 (52.9) 103 (37.5) 49 (35.5) 114 (41.5) 16 (11.6) 58 (21.1) 10.592 2 p = 0.005* Educational Status SPM and STPM Tertiary education 13 (33.3) 163 (43.6) 13 (33.3) 150 (40.1) 13 (33.3) 61 (16.3) 6.993 2 p = 0.030* Household Income < RM 4,850 RM 4,850 – RM 10,959 ≥ RM 10,960 84 (43.8) 88 (42.5) 4 (28.6) 78 (40.6) 78 (37.7) 7 (50.0) 30 (15.6) 41 (19.8) 3 (21.4) 2.404 4 p = 0.662 Healthcare Position Doctors Staff nurses and paramedics 76 (55.1) 100 (36.4) 47 (34.1) 116 (42.2) 15 (10.9) 59 (21.5) 14.830 2 p = 0.001* Hospital Ampang Klang Shah Alam Banting Kajang 47 (40.2) 29 (44.6) 41 (53.9) 23 (32.9) 19 (46.3) 42 (35.9) 25 (38.5) 25 (32.9) 31 (44.3) 18 (43.9) 28 (23.9) 11 (16.9) 10 (13.2) 16 (22.9) 4 (9.8) 14.346 10 p = 0.158 131 Others 17 (38.6) 22 (50.0) 5 (11.4) Department Emergency & Trauma Medical-based Surgical-based 85 (48.6) 48 (38.4) 43 (38.1) 66 (37.7) 55 (44.0) 42 (37.2) 24 (13.7) 22 (17.6) 28 (24.8) 8.170 4 p = 0.086 Part-Time Job No Yes 157 (42.5) 19 (43.2) 147 (39.8) 16 (36.4) 65 (17.6) 9 (20.5) 0.301 2 p = 0.860 Comorbidity No Yes 155 (43.9) 21 (35.0) 136 (38.5) 27 (45.0) 62 (17.6) 12 (20.0) 1.670 2 p = 0.434 Body Mass Index (BMI) Underweight Normal Overweight Obese 17 (56.7) 85 (42.1) 49 (45.8) 25 (33.8) 9 (30.0) 82 (40.6) 38 (35.5) 34 (45.9) 4 (13.3) 35 (17.3) 20 (18.7) 15 (20.3) 5.624 2 p = 0.467 Smoking/Vaping No Yes 165 (42.3) 11 (47.8) 156 (40.0) 7 (30.4) 69 (17.7) 5 (21.7) 0.857 2 p = 0.651 Alcohol Consumption No Yes 173 (43.4) 3 (21.4) 155 (38.8) 8 (57.1) 71 (17.8) 3 (21.4) 2.773 2 p = 0.250 Intentional Exercise No Yes 112 (44.3) 64 (40.0) 106 (41.9) 57 (35.6) 35 (13.8) 39 (24.4) 7.474 2 p = 0.024* Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 60 (45.8) 77 (42.8) 38 (37.6) 47 (35.9) 72 (40.0) 44 (43.6) 24 (18.3) 31 (17.2) 19 (18.8) 1.877 4 p = 0.758 Emotional Eating Habit (DEBQ) Low High 152 (42.3) 24 (44.4) 141 (39.3) 22 (40.7) 66 (18.4) 8 (14.8) 0.408 2 p = 0.815 132 External Eating Habit (DEBQ) Low High 38 (41.8) 138 (42.9) 32 (35.2) 131 (40.7) 21 (23.1) 53 (16.5) 2.301 2 p = 0.316 Restrained Eating Habit (DEBQ) Low High 71 (47.0) 105 (40.1) 55 (36.4) 108 (41.2) 25 (16.6) 49 (18.7) 1.889 2 p = 0.389 Sleep Quality (PSQI-M) Good Poor 57 (33.1) 118 (49.2) 75 (43.6) 88 (36.7) 40 (23.3) 34 (14.2) 11.887 2 p = 0.003* *Significant to p value = < 0.05, using Chi-square test 133 Based on the results of multinomial logistic regression, it was shown that age group, marital status, educational status, healthcare position, intentional exercise, and sleep quality were the significant predictors that affecting the vigour domain of work engagement of the respondents. Other variables were non-significant (Table 4.24). Zooming on the poor work engagement of vigour domain (low scores), the respondents who were less than 40 years old had higher odds of having poor work engagement (OR = 2.78; 95% CI: 1.2 – 6.3). Those who were single, divorced, separated or widowed were more likely to have poor work engagement than the married group (OR = 1.65; 95% CI: 1.1 – 2.6). Moreover, healthcare position was also one of the significant factors associated with work engagement. Doctors were found to have higher chances of getting poor work engagement as compared to staff nurses and paramedics (OR = 1.89; 95% CI: 1.3 – 3.3). Those who had poor sleep quality highlighted the odds of having poor work engagement nearly two times than those with good sleep quality (AOR = 1.69; 95% CI: 1.1 – 2.6). In addition, the significant factors associated with good work engagement of vigour domain (high scores) were educational status and intentional exercise. Those with the educational status until SPM and STPM were found to have good work engagement as compared to those who had tertiary education (OR = 2.46; 95% CI: 1.1 – 5.6). The odds of having good work engagement were two times greater for those who practiced intentional exercise (AOR = 2.08; 95% CI: 1.1 – 3.3). 134 Table 4.24: Significant Factors Affecting Work Engagement for Vigour Domain of UWES-M, n = 413 Factors Low Vigour High Vigour Crude OR (95% CI) p value Adjusted OR (95% CI) p value Crude OR (95% CI) p value Adjusted OR (95% CI) p value Age < 40 years old ≥ 40 years old 2.78 (1.2 – 6.3) Ref p = 0.014* 2.03 (0.9 – 4.7) Ref p = 0.101 0.70 (0.3 – 1.5) Ref p = 0.361 0.79 (0.4 – 1.8) Ref p = 0.570 Marital Status Single/divorced/separated/widowed Married 1.65 (1.1 – 2.6) Ref p = 0.029* 1.28 (0.8 – 2.1) Ref p = 0.336 0.64 (0.3 – 1.2) Ref p = 0.179 0.66 (0.3 – 1.3) Ref p = 0.247 Educational Status SPM and STPM Tertiary education 0.92 (0.4 – 2.0) Ref p = 0.839 1.09 (0.5 – 2.5) Ref p = 0.840 2.46 (1.1 – 5.6) Ref p = 0.032* 2.34 (1.1 – 5.5) Ref p = 0.052 Healthcare Position Doctors Staff nurse and paramedics Ref 0.53 (0.3 – 0.8) p = 0.006* Ref 0.61 (0.4 – 1.1) p = 0.055 Ref 1.59 (0.8 – 3.1) p = 0.167 Ref 0.96 (0.5 – 2.0) p = 0.903 Intentional Exercise No Yes 0.94 (0.6 – 1.5) Ref p = 0.789 0.89 (0.6 – 1.4) Ref p = 0.609 0.48 (0.3 – 0.8) Ref p = 0.011* 0.48 (0.3 – 0.9) Ref p = 0.013* Sleep Quality (PSQI-M) Good Poor Ref 1.76 (1.1 – 2.7) p = 0.012* Ref 1.69 (1.1 – 2.6) p = 0.023* Ref 0.72 (0.4 – 1.3) p = 0.252 Ref 0.75 (0.4 – 1.3) p = 0.311 The reference category for vigour domain of UWES-M is Average. *Significant to p value = < 0.05, using multinomial logistic regression Adjusted OR = Results are adjusted for age, marital status, educational status, healthcare position, intentional exercise, and sleep quality. 135 Besides, Table 4.25 presents the significant predictors for the domain of dedication of UWES-M, p < 0.05 based on Chi-square test. These include educational status, healthcare position, intentional exercise, physical activity, external eating habit, restrained eating habit, and sleep quality. Other variables were non-significant; p > 0.05. 136 Table 4.25: Association of Factors Affecting Dedication Domain of UWES-M, n = 413 Group Low Dedication (n = 64) n (%) Average (n = 254) n (%) High Dedication (n = 95) n (%) X2 df p value Age Group < 40 years old ≥ 40 years old 61 (16.6) 3 (7.0) 228 (62.0) 25 (58.1) 79 (21.5) 15 (34.9) 5.400 2 p = 0.067 Gender Men Women 12 (15.4) 52 (15.5) 44 (56.4) 210 (62.7) 22 (28.2) 73 (21.8) 1.538 2 p = 0.464 Ethnicity Malay Non-Malay 48 (14.2) 16 (21.1) 211 (62.6) 43 (56.6) 78 (23.1) 17 (22.4) 2.239 2 p = 0.326 Religion Muslim Non-Muslim 53 (15.3) 11 (16.7) 215 (62.0) 39 (59.1) 79 (22.8) 16 (24.2) 0.196 2 p = 0.907 Marital Status Single/divorced/separated/widowed Married 22 (15.9) 42 (15.3) 89 (64.5) 165 (60.0) 27 (19.6) 68 (24.7) 1.393 2 p = 0.498 Educational Status SPM and STPM Tertiary education 8 (20.5) 56 (15.0) 13 (33.3) 241 (64.4) 18 (46.2) 77 (20.6) 16.291 2 p = < 0.001* Household Income < RM 4,850 RM 4,850 – RM 10,959 ≥ RM 10,960 33 (17.2) 29 (14.0) 2 (14.3) 113 (58.9) 133 (64.3) 8 (57.1) 46 (24.0) 45 (21.7) 4 (28.6) 1.588 4 p = 0.811 Healthcare Position Doctors Staff nurses and paramedics 27 (19.6) 37 (13.5) 90 (65.2) 164 (59.6) 21 (15.2) 74 (26.9) 8.140 2 p = 0.017* 137 Hospital Ampang Klang Shah Alam Banting Kajang Others 14 (12.0) 11 (16.9) 17 (22.4) 10 (14.3) 9 (22.0) 3 (6.8) 71 (60.7) 40 (61.5) 44 (57.9) 44 (62.9) 25 (61.0) 30 (68.2) 32 (27.4) 14 (21.5) 15 (19.7) 16 (22.9) 7 (17.1) 11 (25.0) 9.243 10 p = 0.509 Department Emergency & Trauma Medical-based Surgical-based 35 (20.0) 10 (8.0) 19 (16.8) 105 (60.0) 84 (67.2) 65 (57.5) 35 (20.0) 31 (24.8) 29 (25.7) 9.175 4 p = 0.057 Part-Time Job No Yes 54 (14.6) 10 (22.7) 229 (62.1) 25 (56.8) 86 (23.3) 9 (20.5) 1.976 2 p = 0.372 Comorbidity No Yes 58 (16.4) 6 (10.0) 216 (61.2) 38 (63.3) 79 (22.4) 16 (26.7) 1.817 2 p = 0.403 Body Mass Index (BMI) Underweight Normal Overweight Obese 7 (23.3) 29 (14.4) 16 (15.0) 12 (16.2) 18 (60.0) 130 (64.4) 66 (61.7) 40 (54.1) 5 (16.7) 43 (21.3) 25 (23.4) 22 (29.7) 4.594 6 p = 0.597 Smoking/Vaping No Yes 60 (15.4) 4 (17.4) 241 (61.8) 13 (56.5) 89 (22.8) 6 (26.1) 0.255 2 p = 0.880 Alcohol Consumption No Yes 63 (15.8) 1 (7.1) 244 (61.2) 10 (71.4) 92 (23.1) 3 (21.4) 0.900 2 p = 0.638 Intentional Exercise No Yes 41 (16.2) 23 (14.4) 166 (65.6) 88 (55.0) 46 (18.2) 49 (30.6) 8.604 2 p = 0.014* 138 Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 30 (22.9) 23 (12.8) 11 (10.9) 68 (51.9) 115 (63.9) 70 (69.3) 33 (25.2) 42 (23.3) 20 (19.8) 10.719 4 p = 0.030* Emotional Eating Habit (DEBQ) Low High 59 (16.4) 5 (9.3) 213 (59.3) 41 (75.9) 87 (24.2) 8 (14.8) 5.472 2 p = 0.065 External Eating Habit (DEBQ) Low High 20 (22.0) 44 (13.7) 46 (50.5) 208 (64.6) 25 (27.5) 70 (21.7) 6.454 2 p = 0.040* Restrained Eating Habit (DEBQ) Low High 38 (25.2) 26 (9.9) 80 (53.0) 174 (66.4) 33 (21.9) 62 (23.7) 17.307 2 p = < 0.001* Sleep Quality (PSQI-M) Good Poor 15 (8.7) 49 (20.4) 110 (64.0) 143 (59.6) 47 (27.3) 48 (20.0) 11.466 2 p = 0.003* *Significant to p value = < 0.05, using Chi-square test 139 On top of that, the multinomial logistic regression further proved the significant associations of the age group, marital status, educational status, healthcare position, intentional exercise, and sleep quality with the dedication domain of work engagement of the respondents. Other variables were non-significant (Table 4.26). The poor work engagement (low scores) based on the dedication domain showed significant associated factors that include educational status, physical activity, external eating habit, restrained eating habit and sleep quality. Those who had the educational status until SPM and STPM were found to have poor work engagement as compared to those who had tertiary education (AOR = 3.58; 95% CI: 1.3 – 9.7). The respondents who were inactive had higher odds of having poor work engagement than those who were HEPA active (AOR = 2.63; 95% CI: 1.1 – 6.0). Besides, the respondents who had good external and restrained eating habits (low scores) were more likely to have poor work engagement (OR = 2.04; 95% CI: 1.1 – 3.3; AOR = 2.78; 95% CI: 1.4 – 5.0). Those who had poor sleep quality were demonstrated to have greater odds of having poor work engagement (AOR = 2.13; 95% CI: 1.1 – 4.1). Apart from that, the significant factors associated with good work engagement of dedication domain (high scores) include educational status, healthcare position, intentional exercise and physical activity. The respondents who had the educational status until SPM and STPM had higher chances to have good work engagement than those who had tertiary education (AOR = 4.20; 95% CI: 1.9 – 9.3). Staff nurses and paramedics were shown to have double odds of having good work engagement as compared to doctors (OR = 1.93; 95% CI: 1.1 – 3.3). Those who practiced intentional 140 exercise were more likely to have good work engagement (AOR = 2.13; 95% CI: 1.3 – 3.3). The respondents who were inactive were two times higher to have good work engagement than those who were HEPA active (AOR = 2.48; 95% CI: 1.2 – 5.0). 141 Table 4.26: Significant Factors Affecting Work Engagement for Dedication Domain of UWES-M, n = 413 Factors Low Dedication High Dedication Crude OR (95% CI) p value Adjusted OR (95% CI) p value Crude OR (95% CI) p value Adjusted OR (95% CI) p value Educational Status SPM and STPM Tertiary education 2.65 (1.1 – 6.7) Ref p = 0.040* 3.58 (1.3 – 9.7) Ref p = 0.012* 4.33 (2.0 – 9.2) Ref p = < 0.001* 4.20 (1.9 – 9.3) Ref p = < 0.001* Healthcare Position Doctors Staff nurses and paramedics Ref 0.75 (0.4 – 1.3) p = 0.317 Ref 0.73 (0.4 – 1.4) p = 0.321 Ref 1.93 (1.1 – 3.3) p = 0.018* Ref 1.51 (0.8 – 2.7) p = 0.171 Intentional Exercise No Yes 0.95 (0.5 – 1.7) Ref p = 0.846 0.73 (0.4 – 1.4) Ref p = 0.330 0.50 (0.3 – 0.8) Ref p = 0.004* 0.47 (0.3 – 0.8) Ref p = 0.004* Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 2.81 (1.3 – 6.0) 1.27 (0.6 – 2.8) Ref p = 0.008* p = 0.543 2.63 (1.1 – 6.0) 1.22 (0.5 – 2.8) Ref p = 0.022* p = 0.627 1.70 (0.9 – 3.2) 1.28 (0.7 – 2.4) Ref p = 0.109 p = 0.430 2.48 (1.2 – 5.0) 1.42 (0.7 – 2.7) Ref p = 0.011* p = 0.288 Eating Habits (DEBQ) External Eating Low High Restrained Eating Low High Ref 0.49 (0.3 – 0.9) Ref 0.32 (0.2 – 0.6) p = 0.022* p = < 0.001* Ref 0.71 (0.4 – 1.4) Ref 0.36 (0.2 – 0.7) p = 0.327 p = 0.001* Ref 0.62 (0.4 – 1.1) Ref 0.86 (0.5 – 1.4) p = 0.092 p = 0.565 Ref 0.64 (0.3 – 1.2) Ref 0.91 (0.5 – 1.6) p = 0.149 p = 0.744 Sleep Quality (PSQI-M) Good Poor Ref 2.51 (1.3 – 4.7) p = 0.004* Ref 2.13 (1.1 – 4.1) p = 0.023* Ref 0.79 (0.5 – 1.3) p = 0.317 Ref 0.77 (0.5 – 1.3) p = 0.303 The reference category for dedication domain of UWES-M is Average. *Significant to p value = < 0.05, using multinomial logistic regression Adjusted OR = Results are adjusted for educational status, healthcare position, intentional exercise, category of physical activity, eating habits of external and restrained, and sleep quality. 142 Table 4.27 and 4.28 show the findings of Chi-square test and multinomial logistic regression for the domain of absorption of UWES-M. Gender, ethnicity, department, external eating habit, and sleep quality were the strong associated factors that influence the work engagement of the domain of absorption among the respondents. Other variables were non-significant. Zooming on the poor work engagement of absorption domain (low scores), the respondents who were non-Malay had double odds of having poor work engagement (AOR = 2.42; 95% CI: 1.1 – 5.5). Besides, those who worked in emergency and trauma department had greater odds to have poor work engagement with reference to medical- based departments (AOR = 4.00; 95% CI: 1.4 – 10.0). The respondents who had good external eating habit (low scores) had higher chances to have poor work engagement (AOR = 2.27; 95% CI: 1.1 – 5.0). Those with poor sleep quality were nearly four times to have poor work engagement as compared to those with good sleep quality (AOR = 3.70; 95% CI: 1.5 – 9.0). Meanwhile, the odds of having good work engagement of absorption domain (high scores) were two times higher for men (AOR = 2.04; 95% CI: 1.1 – 3.3). 143 Table 4.27: Association of Factors Affecting Absorption Domain of UWES-M, n = 413 Group Low Absorption (n = 40) n (%) Average (n = 217) n (%) High Absorption (n = 156) n (%) X2 df p value Age Group < 40 years old ≥ 40 years old 38 (10.3) 2 (4.7) 199 (54.1) 18 (41.9) 131 (35.6) 23 (53.5) 5.651 2 p = 0.059 Gender Men Women 7 (9.0) 33 (9.9) 32 (41.0) 185 (55.2) 39 (50.0) 117 (34.9) 6.284 2 p = 0.043* Ethnicity Malay Non-Malay 27 (8.0) 13 (17.1) 185 (54.9) 32 (42.1) 125 (37.1) 31 (40.8) 7.450 2 p = 0.024* Religion Muslim Non-Muslim 31 (8.9) 9 (13.6) 189 (54.5) 28 (42.4) 127 (36.6) 29 (43.9) 3.588 2 p = 0.166 Marital Status Single/divorced/separated/widowed Married 11 (8.0) 29 (10.5) 83 (60.1) 134 (48.7) 44 (31.9) 112 (40.7) 4.811 2 p = 0.090 Educational Status SPM and STPM Tertiary education 6 (15.4) 34 (9.1) 15 (38.5) 202 (54.0) 18 (46.2) 138 (36.9) 3.870 2 p = 0.144 Household Income < RM 4,850 RM 4,850 – RM 10,959 ≥ RM 10,960 20 (10.4) 20 (9.7) 0 (0.0) 106 (55.2) 104 (50.2) 7 (50.0) 66 (34.4) 83 (40.1) 7 (50.0) 3.385 4 p = 0.496 Healthcare Position Doctors Staff nurses and paramedics 17 (12.3) 23 (8.4) 76 (55.1) 141 (51.3) 45 (32.6) 111 (40.4) 3.200 2 p = 0.202 144 Hospital Ampang Klang Shah Alam Banting Kajang Others 4 (3.4) 9 (13.8) 10 (13.2) 9 (12.9) 5 (12.2) 3 (6.8) 66 (56.4) 35 (53.8) 37 (48.7) 34 (48.6) 21 (51.2) 24 (54.5) 47 (40.2) 21 (32.3) 29 (38.2) 27 (38.6) 15 (36.6) 17 (38.6) 9.777 10 p = 0.460 Department Emergency & Trauma Medical-based Surgical-based 23 (13.1) 5 (4.0) 12 (10.6) 86 (49.1) 77 (61.6) 54 (47.8) 66 (37.7) 43 (34.4) 47 (41.6) 10.070 4 p = 0.039* Part-Time Job No Yes 34 (9.2) 6 (13.6) 196 (53.1) 21 (47.7) 139 (37.7) 17 (38.6) 1.021 2 p = 0.600 Comorbidity No Yes 38 (10.8) 2 (3.3) 185 (52.4) 32 (53.3) 130 (36.8) 26 (43.3) 3.507 2 p = 0.173 Body Mass Index (BMI) Underweight Normal Overweight Obese 3 (10.0) 17 (8.4) 10 (9.3) 10 (13.5) 19 (63.3) 108 (53.5) 61 (57.0) 29 (39.2) 8 (26.7) 77 (38.1) 36 (33.6) 35 (47.3) 8.333 6 p = 0.215 Smoking/Vaping No Yes 38 (9.7) 2 (8.7) 210 (53.8) 7 (30.4) 142 (36.4) 14 (60.9) 5.730 2 p = 0.057 Alcohol Consumption No Yes 39 (9.8) 1 (7.1) 211 (52.9) 6 (42.9) 149 (37.3) 7 (50.0) 0.929 2 p = 0.628 Intentional Exercise No Yes 26 (10.3) 14 (8.8) 138 (54.5) 79 (49.4) 89 (35.2) 67 (41.9) 1.898 2 p = 0.387 145 Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 19 (14.5) 17 (9.4) 4 (4.0) 60 (45.8) 97 (53.9) 59 (58.4) 52 (39.7) 66 (36.7) 38 (37.6) 8.600 4 p = 0.072 Emotional Eating Habit (DEBQ) Low High 38 (10.6) 2 (3.7) 184 (51.3) 33 (61.1) 137 (38.2) 19 (35.2) 3.273 2 p = 0.195 External Eating Habit (DEBQ) Low High 15 (16.5) 25 (7.8) 44 (48.4) 173 (53.7) 32 (35.2) 124 (38.5) 6.170 2 p = 0.046* Restrained Eating Habit (DEBQ) Low High 21 (13.9) 19 (7.3) 72 (47.7) 145 (55.3) 58 (38.4) 98 (37.4) 5.477 2 p = 0.065 Sleep Quality (PSQI-M) Good Poor 7 (4.1) 33 (13.8) 90 (52.3) 126 (52.5) 75 (43.6) 81 (33.8) 12.241 2 p = 0.002* *Significant to p value = < 0.05, using Chi-square test 146 Table 4.28: Significant Factors Affecting Work Engagement for Absorption Domain of UWES-M, n = 413 Factors Low Absorption High Absorption Crude OR (95% CI) p value Adjusted OR (95% CI) p value Crude OR (95% CI) p value Adjusted OR (95% CI) p value Gender Men Women Ref 0.82 (0.3 – 2.0) p = 0.656 Ref 1.80 (0.7 – 4.8) p = 0.243 Ref 0.52 (0.3 – 0.9) p = 0.014* Ref 0.49 (0.3 – 0.9) p = 0.018* Ethnicity Malay Non-Malay Ref 2.78 (1.3 – 6.0) p = 0.008* Ref 2.42 (1.1 – 5.5) p = 0.036* Ref 1.43 (0.8 – 2.5) p = 0.194 Ref 1.31 (0.7 – 2.3) p = 0.353 Department Emergency & Trauma Medical-based Surgical-based Ref 0.24 (0.1 – 0.7) 0.83 (0.4 – 1.8) p = 0.006* p = 0.640 Ref 0.25 (0.1 – 0.7) 1.10 (0.4 – 2.3) p = 0.011* p = 0.989 Ref 0.73 (0.4 – 1.2) 1.13 (0.7 – 1.9) p = 0.205 p = 0.626 Ref 0.98 (0.6 -1.7) 1.37 (0.8 – 2.4) p = 0.927 p = 0.256 Eating Habit (DEBQ) External eating Low High Ref 0.42 (0.2 – 0.9) p = 0.020* Ref 0.44 (0.2 – 0.9) p = 0.035* Ref 0.99 (0.6 – 1.6) p = 0.955 Ref 1.07 (0.6 – 1.8) p = 0.794 Sleep Quality (PSQI-M) Good Poor Ref 3.37 (1.4 – 8.0) p = 0.006* Ref 3.70 (1.5 – 9.0) p = 0.004* Ref 0.77 (0.5 – 1.2) p = 0.220 Ref 0.73 (0.5 – 1.1) p = 0.145 The reference category for absorption domain of UWES-M is Average. *Significant to p value = < 0.05, using multinomial logistic regression Adjusted OR = Results are adjusted for gender, ethnicity, department, eating habit of external, and sleep quality. 147 4.6.4 Associated Factors with Sleep Quality Table 4.29 describes factors that affect sleep quality of respondents according to the PSQI-M scores. Besides analysing sleep quality as the dependent variable being affected by multiple factors below, previous sections have taken into account of the sleep quality as a factor that is able to affect other psychosocial well-being parameters. There were significant associations between gender, healthcare position, working hospital and smoking/vaping status with the quality of sleep of respondents; p < 0.05. Other variables had no significant associations with the quality of sleep; p > 0.05. 148 Table 4.29: Association of Factors Affecting Sleep Quality based on PSQI-M, n = 413 Group Good Quality of Sleep (n = 172) n (%) Poor Quality of Sleep (n = 240) n (%) X2 df p value Age Group < 40 years old ≥ 40 years old 149 (40.6) 23 (53.5) 218 (59.4) 20 (46.5) 2.626 1 0.105 Gender Men Women 23 (29.5) 149 (44.6) 55 (70.5) 185 (55.4) 5.947 1 0.015* Ethnicity Malay Non-Malay 140 (41.7) 32 (42.1) 196 (58.3) 44 (57.9) 0.005 1 0.944 Religion Muslim Non-Muslim 144 (41.6) 28 (42.4) 202 (58.4) 38 (57.6) 0.015 1 0.903 Marital Status Single/divorced/separated/widowed Married 49 (35.8) 123 (44.7) 88 (64.2) 152 (55.3) 3.019 1 0.082 Educational Status SPM and STPM Tertiary education 18 (46.2) 154 (41.3) 21 (53.8) 219 (58.7) 0.344 1 0.558 Household Income < RM 4,850 RM 4,850 – RM 10,959 ≥ RM 10,960 85 (44.5) 79 (38.2) 8 (57.1) 106 (55.5) 128 (61.8) 6 (42.9) 3.054 2 0.217 Healthcare Position Doctors Staff nurses and paramedics 48 (34.8) 124 (45.3) 90 (65.2) 150 (54.7) 4.139 1 0.042* 149 Hospital Ampang Klang Shah Alam Banting Kajang Others 60 (51.7) 34 (52.3) 28 (36.8) 28 (40.0) 11 (26.8) 11 (25.0) 56 (48.3) 31 (47.7) 48 (63.2) 42 (60.0) 30 (73.2) 33 (75.0) 17.395 5 0.004* Department Emergency & Trauma Medical-based Surgical-based 64 (36.6) 55 (44.4) 53 (46.9) 111 (63.4) 69 (55.6) 60 (53.1) 3.509 2 0.173 Part-Time Job No Yes 153 (41.6) 19 (43.2) 215 (58.4) 25 (56.8) 0.042 1 0.838 Comorbidity No Yes 153 (43.5) 19 (31.7) 199 (56.5) 41 (68.3) 2.935 1 0.087 Body Mass Index (BMI) Underweight Normal Overweight Obese 12 (41.4) 82 (40.6) 47 (43.9) 31 (41.9) 17 (58.6) 120 (59.4) 60 (56.1) 43 (58.1) 0.321 3 0.956 Smoking/Vaping No Yes 170 (43.7) 2 (8.7) 219 (56.3) 21 (91.3) 10.943 1 0.001* Alcohol Consumption No Yes 164 (41.2) 8 (57.1) 234 (58.8) 6 (42.9) 1.412 1 0.235 Intentional Exercise No Yes 108 (42.7) 64 (40.3) 145 (57.3) 95 (59.7) 0.238 1 0.625 150 Category of Physical Activity (IPAQ-M) Inactive Minimally active HEPA active 47 (35.9) 76 (42.2) 49 (48.5) 84 (64.1) 104 (57.8) 52 (51.5) 3.775 2 0.151 Emotional Eating Habit (DEBQ) Low High 149 (41.6) 23 (42.6) 209 (58.4) 31 (57.4) 0.018 1 0.893 External Eating Habit (DEBQ) Low High 37 (40.7) 135 (42.1) 54 (59.3) 186 (57.9) 0.057 1 0.812 Restrained Eating Habit (DEBQ) Low High 54 (35.8) 118 (45.2) 97 (64.2) 143 (54.8) 3.512 1 0.061 *Significant to p value = < 0.05, using Chi-square test 151 Furthermore, the analysis of logistic regression was highlighted in Table 4.30 showing that men had double the odds of having poor sleep quality than women (OR = 1.92; 95% CI: 1.1 – 3.3). Doctors had poorer sleep quality as compared to staff nurses and paramedics (OR = 1.54; 95% CI: 1.1 – 2.5). Besides that, workplace was also a significantly associated to the sleep quality. Those who worked in Shah Alam Hospital, Banting Hospital, Kajang Hospital and other hospitals were more likely to have poor sleep quality compared to Ampang Hospital (OR = 1.84; 95% CI: 1.1 – 3.3; AOR = 2.02; 95% CI: 1.1 – 3.8; AOR = 3.15; 95% CI: 1.4 – 7.0); AOR = 2.88; 95% CI: 1.3 – 6.5). The respondents who were smoking/vaping were having higher chances of getting poor sleep quality (AOR = 8.69; 95% CI: 1.8 – 42.2). 152 Table 4.30: Significant Factors Affecting Quality of Sleep based on PSQI-M Scores, n = 413 *Significant to p value = < 0.05, using logistic regression Adjusted OR = Results are adjusted for gender, healthcare position, hospital and smoking/vaping status Factors PSQI-M Good Quality of Sleep (n = 172) n (%) Poor Quality of Sleep (n = 240) n (%) Crude OR (95% CI) p value Adjusted OR (95% CI) p value Gender Men Women 23 (29.5) 149 (44.6) 55 (70.5) 185 (55.4) Ref 0.52 (0.3 – 0.9) p = 0.016* Ref 1.04 (0.5 – 2.0) p = 0.907 Healthcare Position Doctors Staff nurses and paramedics 48 (34.8) 124 (45.3) 90 (65.2) 150 (54.7) Ref 0.65 (0.4 – 0.9) p = 0.043* Ref 0.68 (0.4 – 1.1) p = 0.141 Hospital Ampang Klang Shah Alam Banting Kajang Others 60 (51.7) 34 (52.3) 28 (36.8) 28 (40.0) 11 (26.8) 11 (25.0) 56 (48.3) 31 (47.7) 48 (63.2) 42 (60.0) 30 (73.2) 33 (75.0) Ref 0.98 (0.5 – 1.8) 1.84 (1.1 – 3.3) 1.61 (0.9 – 2.9) 2.92 (1.3 – 6.4) 3.21 (1.5 – 7.0) p = 0.940 p = 0.044* p = 0.122 p = 0.007* p = 0.003* Ref 0.99 (0.5 – 1.9) 1.72 (0.9 – 3.2) 2.02 (1.1 – 3.8) 3.15 (1.4 – 7.0) 2.88 (1.3 – 6.5) p = 0.994 p = 0.091 p = 0.028* p = 0.005* p = 0.012* Smoking/Vaping No Yes 170 (43.7) 2 (8.7) 219 (56.3) 21 (91.3) Ref 8.15 (1.9 – 35.2) p = 0.005* Ref 8.69 (1.8 – 42.2) p = 0.007* 153 4.7 Validation of SHiFT Module This caters the Study Objective 4 which is to develop a module on psychosocial well- being maintenance for hospital shift workers in Klang Valley and assess its content and face validity. The results of this study demonstrated that the factors of sleep quality, inactivity and eating habits were significantly associated with the psychosocial well-being of the hospital shift workers. In fact, the main concern of psychosocial well-being among the hospital shift workers in this study was sleep quality. The factor of sleep quality was strongly associated with mental health, quality of life and work engagement of the hospital shift workers. As a result, the findings of this study contributed to the development of SHiFT module that primarily focused on improving sleep quality of the hospital shift workers by modification of few associated factors that are modifiable. Hence, this module was developed with the intention to enhance the sleep quality of shift workers and subsequently giving beneficial impact on their psychosocial well-being. 154 4.7.1 Content Validity of SHiFT Module The process of content validation was conducted after the development of SHiFT module. The objective was to make sure that the content of the module particularly in improving the sleep quality among the shift workers was easily understood by the respondents. In addition, the comments received were used for the improvement of the module. The assessment of the content validity of SHiFT module involved the participation of nine panel experts who volunteered to evaluate and answer questionnaires regarding the module (Refer to Appendix 7). Table 4.31 demonstrates the socio-demographic background of the respondents for the content validity of SHiFT module. The respondents age ranged from 29 to 51 years old with median (IQR) age of 34.00 (7.50) years. Majority of the respondents (n = 7) were women and married. Out of the 9, there were 8 of them with Malay ethnicity and Islam in religion. Most of them (n = 8) had the educational background of either Master degrees or Doctor of Philosophy (PhD). Referring to the respondents’ job’s title, 4 of them were academicians, 3 were physiotherapists and 2 were dietitians or nutritionists. More than half of them had the experience of at least 5 years involving in the field (n = 6). 155 Table 4.31: Socio-Demographic Information of the Panel Experts for Content Validity of SHiFT Module, n = 9 n % Age < 40 years old ≥ 40 years old 7 2 77.8 22.2 Gender Men Women 2 7 22.2 77.8 Ethnicity Malay 8 88.9 Chinese 1 11.1 Religion Islam Buddhism 8 1 88.9 11.1 Educational Status Bachelor Postgraduate (Master, PhD) 1 8 11.1 88.9 Marital Status Single Married 2 7 22.2 77.8 Job’s Title Lecturer/academician Physiotherapist Dietitian/nutritionist 4 3 2 44.4 33.3 22.2 Years Involved in the Field < 5 years ≥ 5 years 3 6 33.3 66.7 Monthly Household Income < RM4,850 RM4,850 – RM10,959 ≥ RM10,960 3 2 4 33.3 22.2 44.4 156 Table 4.32 presents the percentage of the content validity items of SHiFT module among the expert panels based on the Likert scales. Further analysis was made and illustrated in Table 4.33. Based on the formula and calculation of CVI indices, the I-CVI was 0.89 – 1.00, S-CVI/Ave was 0.978, and the S-CVI/UA was 0.80. The values of I-CVI ≥ 0.78, S-CVI/Ave ≥ 0.90, and S-CVI/UA ≥ 0.80 were considered as excellent content validity (Rahmad & Teng 2020). Therefore, it was concluded that I-CVI, S- CVI/Ave and S-CVI/UA met satisfactory level. As a result, the scale of content validity questionnaire for the SHiFT module achieved the satisfactory level of content validity. 157 Table 4.32: Analysis of Content Validity of SHiFT Module among the Expert Panels, n = 9 Subtopics n (%) Totally Disagree Partially Agree Agree Totally Agree Pengenalan 1. Contents are in agreement with the current knowledge 2. Recommendations are necessary and are correctly approached 3. Objectives are evident 4. Recommendation about the desired behaviour is satisfactory 5. There is no unnecessary information 6. Important points are reviewed 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (11.1) 1 (11.1) 0 (0) 1 (11.1) 0 (0) 0 (0) 5 (55.6) 3 (33.3) 7 (77.8) 6 (66.7) 3 (33.3) 6 (66.7) 3 (33.3) 5 (55.6) 2 (22.2) 2 (22.2) 6 (66.7) 3 (33.3) Panduan 1: 10-Minit Senaman Khas Ringkas 1. Contents are in agreement with the current knowledge 2. Recommendations are necessary and are correctly approached 3. Objectives are evident 4. Recommendation about the desired behaviour is satisfactory 5. There is no unnecessary information 6. Important points are reviewed 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 6 (66.7) 6 (66.7) 6 (66.7) 5 (55.6) 3 (33.3) 4 (44.4) 3 (33.3) 3 (33.3) 3 (33.3) 4 (44.4) 6 (66.7) 5 (55.6) Panduan 2: Senaman Pernafasan 1. Contents are in agreement with the current knowledge 2. Recommendations are necessary and are correctly approached 3. Objectives are evident 4. Recommendation about the desired behaviour is satisfactory 5. There is no unnecessary information 6. Important points are reviewed 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 6 (66.7) 4 (44.4) 5 (55.6) 4 (44.4) 3 (33.3) 5 (55.6) 3 (33.3) 5 (55.6) 4 (44.4) 5 (55.6) 6 (66.7) 4 (44.4) Panduan 3: Tidur Nyenyak 1. Contents are in agreement with the current knowledge 2. Recommendations are necessary and are correctly approached 3. Objectives are evident 4. Recommendation about the desired behaviour is satisfactory 5. There is no unnecessary information 6. Important points are reviewed 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (11.1) 0 (0) 1 (11.1) 0 (0) 0 (0) 7 (77.8) 4 (44.4) 4 (44.4) 3 (33.3) 3 (33.3) 6 (66.7) 2 (22.2) 4 (44.4) 5 (55.6) 5 (55.6) 6 (66.7) 3 (33.3) 158 Panduan 4: Pemakanan Sihat 1. Contents are in agreement with the current knowledge 2. Recommendations are necessary and are correctly approached 3. Objectives are evident 4. Recommendation about the desired behaviour is satisfactory 5. There is no unnecessary information 6. Important points are reviewed 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (11.1) 0 (0) 0 (0) 5 (55.6) 4 (44.4) 5 (55.6) 3 (33.3) 5 (55.6) 5 (55.6) 4 (44.4) 5 (55.6) 4 (44.4) 5 (55.6) 4 (44.4) 4 (44.4) 159 Table 4.33: Analysis of Content Validity of SHiFT Module among the Expert Panels, n = 9 Expert 1 Expert 2 Expert 3 Expert 4 Expert 5 Expert 6 Expert 7 Expert 8 Expert 9 Experts In Agreement I-CVI UA Item Q1 1 1 1 1 1 0 1 1 1 8 0.89 0 Q2 1 1 1 1 1 0 1 1 1 8 0.89 0 Q3 1 1 1 1 1 1 1 1 1 9 1 1 Q4 1 1 1 1 1 0 1 1 1 8 0.89 0 Q5 1 1 1 1 1 1 1 1 1 9 1 1 Q6 1 1 1 1 1 1 1 1 1 9 1 1 Q7 1 1 1 1 1 1 1 1 1 9 1 1 Q8 1 1 1 1 1 1 1 1 1 9 1 1 Q9 1 1 1 1 1 1 1 1 1 9 1 1 Q10 1 1 1 1 1 1 1 1 1 9 1 1 Q11 1 1 1 1 1 1 1 1 1 9 1 1 Q12 1 1 1 1 1 1 1 1 1 9 1 1 Q13 1 1 1 1 1 1 1 1 1 9 1 1 Q14 1 1 1 1 1 1 1 1 1 9 1 1 Q15 1 1 1 1 1 1 1 1 1 9 1 1 Q16 1 1 1 1 1 1 1 1 1 9 1 1 Q17 1 1 1 1 1 1 1 1 1 9 1 1 Q18 1 1 1 1 1 1 1 1 1 9 1 1 Q19 1 1 1 1 1 1 1 1 1 9 1 1 Q20 1 1 1 1 1 0 1 1 1 8 0.89 0 Q21 1 1 1 1 1 1 1 1 1 9 1 1 Q22 1 1 1 1 1 0 1 1 1 8 0.89 0 Q23 1 1 1 1 1 1 1 1 1 9 1 1 Q24 1 1 1 1 1 1 1 1 1 9 1 1 Q25 1 1 1 1 1 1 1 1 1 9 1 1 Q26 1 1 1 1 1 1 1 1 1 9 1 1 Q27 1 1 1 1 1 1 1 1 1 9 1 1 Q28 1 1 1 1 1 1 1 0 1 8 0.89 0 160 Q29 1 1 1 1 1 1 1 1 1 9 1 1 Q30 1 1 1 1 1 1 1 1 1 9 1 1 S-CVI/Ave 0.978 Proportion relevance 1.00 1.00 1.00 1.00 1.00 0.83 1.00 0.97 1.00 S-CVI/UA 0.80 Average proportion of items judged as relevance across nine experts 0.978 161 In addition, there were six open-ended questions provided in the questionnaires for the improvement of the module: 1. Do you have any suggestions regarding the definition of the topics or medical terms? 2. Do the subtopics appear to cover the full range of content on the booklet module? 3. Are the sentences clearly worded and easy to understand? 4. Are the sentences on the booklet module appropriate for a shift worker? Do you have any suggestions for improving the booklet module? (Please feel free to provide comments directly on the sentences regarding rewording and/or removing the words.). 5. Do you have any comments regarding the appearance or literacy presentation of the booklet module? 6. Do you have anything that you would like to add? Please feel free to comment. The open-ended questions were given to get feedback from the experts in order for them to pinpoint the lacking parts of the module by providing comments and suggestions to revise it. The SHiFT module was then amended based on the comments from the expert panels. Most of the expert panels reported that the terminology, sentence structure and the definition of the topics were very clear, simple, concise and easy to be understood for everyone. They also indicated that the module was appropriate for shift workers. The figures and illustrations were great, however, they suggested for standardisation of 162 fonts and theme colour for each subtopic in the module. Other suggestions given by the expert panels were to include more examples of the recommended local food that can be easily obtained by the shift workers and provide variety of choices for better understanding. All the comments and suggestions from the expert panels were taken into consideration and amended accordingly for improvement of the module. 4.7.2 Face Validity of SHiFT Module The face validity was carried out after revising the SHiFT module according to the comments and suggestions from the expert panels. The evaluation of the revised version of SHiFT module (Refer to Appendix 8) for the face validity was done on 10 respondents with health sciences related background and 10 hospital shift workers in Klang Valley. The face validity was evaluated based on their understanding and acceptance of all information provided in the module. Table 4.34 displays the socio-demographic profile of the respondents. It involved 20 respondents aged 25 to 51 years with mean (SD) age of 32.60 (5.60) years, with 70% women and 30% men. Majority of them were Malay and Islam (85%). Out of the 20, 45% were having the education of postgraduate (Masters or PhD), 30% with bachelor holder and 25% with diploma holder. Most of them were married (70%). Referring to the job’s title, 20% of them were lecturer or academician, 15% were physiotherapist, 15% were dietitian or nutritionist, 10% were house officer, 10% were medical officer, 15% were staff nurse, and 15% were paramedics, with 60% of them were having at least five years’ experience in the respective field. 163 Majority of the respondents had the monthly household income of less than RM 4,850 (45%), followed by 30% of them having income of more than RM10,960 and 25% of them having income ranged of RM4,850 to RM10,959. Table 4.34: Socio-Demography of Respondents for the Face Validity of SHiFT Module, n = 20 n % Gender Men Women 6 14 30.0 70.0 Ethnicity Malay 17 85.0 Chinese Indian 1 2 5.0 10.0 Religion Islam Buddhism Hinduism 17 1 2 85.0 5.0 10.0 Educational Status Diploma Bachelor Postgraduate (Master, PhD) 5 6 9 25.0 30.0 45.0 Marital Status Single Married 6 14 30.0 70.0 Job’s Title Lecturer/academician Physiotherapist Dietitian/nutritionist House officer Medical officer Staff nurse Paramedics 4 3 3 2 2 3 3 20.0 15.0 15.0 10.0 10.0 15.0 15.0 Years Involved in the Field < 5 years ≥ 5 years 8 12 40.0 60.0 Monthly Household Income < RM4,850 RM4,850 – RM10,959 ≥ RM10,960 9 5 6 45.0 25.0 30.0 164 The analysis of face validity towards the SHiFT module was described in Table 4.35. The results indicated that all respondents understood the information provided in the module. Majority of them (95.0%) reported that the terminology was easily understood, sentences clear and easily understood, figures clear, suitable and attractive and suitable to be recommended to the shift workers. In addition, 90% of them agreed with the suitability of the figures and illustrations, and also 90% of them responded that the combination of colours were attractive. It was found that most of the respondents (95%) claimed that the font size was easy to be read. The consideration of index of less than 80% was regarded as unacceptable and decided for elimination or modified accordingly (Teng et al. 2019). Thus, it was concluded that the percentages for all items in the analysis of face validity was more than 80%, in which met the satisfactory level. As a result, the scale of face validity questionnaire for the SHiFT module achieved the satisfactory level of face validity. 165 Table 4.35: Analysis of Face Validation of SHiFT Module among the Respondents with Health Sciences Related Background and Hospital Shift Workers [Presented as n (%)] Assessment Parameters Respondents with Health Sciences Related Background, n = 10 n (%) Hospital Shift Workers, n = 10 n (%) Total, n = 20 n (%) Understanding of Information Yes No 10 (100.0) 0 (0.0) 10 (100.0) 0 (0.0) 20 (100.0) 0 (0.0) Items Facilitate Comprehension* Terminology easily understood Sentences clear and easily understood Figures clear, suitable and attractive Suitability of recommendation to shift workers 10 (100.0) 10 (100.0) 9 (90.0) 10 (100.0) 9 (90.0) 9 (90.0) 10 (100.0) 9 (90.0) 19 (95.0) 19 (95.0) 19 (95.0) 19 (95.0) Suitability of Figures/Illustrations Yes No 9 (90.0) 1 (10.0) 9 (90.0) 1 (10.0) 18 (90.0) 2 (10.0) Combination of Colours Attractive Not attractive 10 (100.0) 0 (0.0) 8 (80.0) 2 (20.0) 18 (90.0) 2 (10.0) Font Size Easy to read Difficult to read 10 (100.0) 0 (0.0) 9 (90.0) 1 (10.0) 19 (95.0) 1 (5.0) *The cumulative percentages more than 100% as respondents may have multiple answers.