Research funding impact and priority setting - advancing universal access and quality healthcare research in Malaysia

Evidence Synthesis for the Development of National Nursing-Sensitive Indicators in Malaysia: A Literature Review and Stakeholder Engagement Approach

Introduction

Nursing-sensitive indicators measure and evaluate nursing care quality and its contribution to patient care. The identification of indicators that demonstrate nursing care contribution and the quality of care delivered locally is of paramount importance, and national indicators that demonstrate this are essential. This paper aims to provide an evidence base of nursing-sensitive indicators that can facilitate the conceptualization of local nursing national indicators.

Method

A multifaceted and iterative approach incorporating literature review, and stakeholder engagements was utilized in evidence synthesis. A review of indicators present internationally complemented by the inclusion of context-specific local NSIs through stakeholder engagements was performed. Secondary data analysis of documents from an environmental scan was also included to highlight areas of concern for nursing-sensitive indicator prioritization from the viewpoint of nurses.

Results

A total of 64 articles were reviewed and indicators were coded according to the Nursing Care Performance Framework subsystems, dimensions, and variables. All papers reviewed had documented outcome indicators. From our secondary data analysis, nurses identified areas of concern such as nursing staff supply, staff maintenance, nursing processes and risk outcomes, and safety to be prioritized for developing quality indicators.

Conclusion

This paper provides a list of NSIs coded systematically with definitions to aid stakeholders in prioritizing indicators for national indicator development. The inclusion of areas of concern provides insight into NSIs that nurse practitioners find relevant to the local context. To our knowledge, this is the first paper that includes evidence available in the literature and incorporates stakeholders' perspectives in synthesizing evidence needed to guide the development of national nursing indicators. This iterative approach is crucial because it enhances the likelihood of knowledge translation.

Ageing well with tech: Exploring the determinants of e-healthcare services adoption in an emerging economy

The adoption of e-healthcare services is critical for improving healthcare accessibility and efficiency, particularly in regions with diverse populations, such as Malaysia. Although e-healthcare services offer numerous advantages, their adoption is considerably low and requires a thorough understanding of the key factors that influence their use. This study investigated the determinants and dynamics of e-healthcare adoption among adults over 40 years by extending the unified theory of acceptance and use of technology. We employed a quantitative research approach, specifically a cross-sectional design. Data were collected from 393 Malaysian respondents through a structured survey questionnaire, using convenience sampling. They were analyzed using partial least-squares-structural equation modeling. The findings revealed that performance expectancy, effort expectancy, social influence, and perceived product value significantly influenced individuals' intentions to use e-healthcare services. Meanwhile, perceived risk had an insignificant negative effect. Facilitating conditions significantly influenced individuals' intentions and actual usage of e-healthcare services. Furthermore, individuals' intentions to use e-healthcare services significantly affected their actual use of these services. Additionally, the intention to use e-healthcare services mediated the relationship between the factors and usage of e-healthcare services, except for perceived risk. Surprisingly, perceived service accuracy had no significant moderating effect on the relationship between individuals' intention to use and their actual use of e-healthcare services. This study offers valuable insights for educators, practitioners, and policymakers, enriching the scholarly discourse in this field. For education, integrating e-healthcare topics into curricula can enhance digital health literacy. In practice, healthcare providers should focus on improving user experience and addressing barriers to technology adoption. For policy making, developing supportive policies, and infrastructure to facilitate e-healthcare adoption is crucial to enhancing public health outcomes.

The Malaysian HEalth and WellBeing AssessmenT (MyHEBAT) Study Protocol: An Initiation of a National Registry for Extended Cardiovascular Risk Evaluation in the Community

Cardiovascular disease (CVD) has been a burden to many developing countries for decades, including Malaysia. Although various steps have been taken to prevent and manage CVD, it remains the leading cause of morbidity and mortality. The rising prevalence of CVD risk factors such as hypertension, hypercholesterolaemia, diabetes, overweight and obesity is the main driving force behind the CVD epidemic. Therefore, a nationwide health study coined as the Malaysian Health and Wellbeing Assessment (MyHEBAT) was designed. It aimed to investigate the prevalence of CVD and the associated risk factors in the community across Malaysia. The MyHEBAT study recruited participants (18-75 years old) through community health screening programmes from 11 states in Malaysia. The MyHEBAT study was further divided into two sub-studies, namely, the Cardiovascular Risk Epidemiological Study (MyHEBAT-CRES) and the MyHEBAT Familial Hypercholesterolaemia Study (MyHEBAT-FH). These studies assessed the prevalence of CVD risk factors and the prevalence of FH in the community, respectively. The data garnered from the MyHEBAT study will provide information for healthcare providers to devise better prevention and clinical practice guidelines for managing CVD in Malaysia.

What funders are doing to assess the impact of their investments in health and biomedical research

As pressures to maximize research funding grow, biomedical research funders are increasingly tasked with demonstrating the long-term and real-world impacts of their funded research investments. Over the past three decades, research impact assessments (RIA) have emerged as an important tool for analysing the impacts of research by incorporating logic models, frameworks and indicators to track measures of knowledge production, capacity-building, development of research products, adoption of research into clinical guidelines and policies, and the realization of health, economic and social benefits. While there are currently several models for RIA within the literature, less attention has been paid to how funders can practically select and implement a RIA model to demonstrate the impacts of their own research portfolios. In this paper, a literature review was performed to understand (1) which research funders have performed RIAs of their research portfolios to date; (2) how funders have designed their assessments, including the models and tools they have used; (3) what challenges to and facilitators of success have funders found when adopting the RIA model to their own portfolio; and (4) who participates in the assessments. Forty-four papers from both published and grey literature were found to meet the review criteria and were examined in detail. There is a growing culture of RIA among funders, and included papers spanned a diverse set of funders from 10 countries or regions. Over half of funders (59.1%) used a framework to conduct their assessment, and a variety of methods for collecting impact data were reported. Issues of methodological rigour were observed across studies in the review, and this was related to numerous challenges funders faced in designing timely RIAs with quality impact data. Over a third of articles (36.4%) included input from stakeholders, yet only one article reported surveying patients and members of the public as part of the assessment. To advance RIA among funders, we offer several recommendations for increasing the methodological rigour of RIAs and suggestions for future research, and call for a careful reflection of the voices needed in an impact assessment to ensure that RIAs are having a meaningful impact on patients and the public.

Methods for Identifying Health Research Gaps, Needs, and Priorities: a Scoping Review

BACKGROUND

Well-defined, systematic, and transparent processes to identify health research gaps, needs, and priorities are vital to ensuring that available funds target areas with the greatest potential for impact.

OBJECTIVE

The purpose of this review is to characterize methods conducted or supported by research funding organizations to identify health research gaps, needs, or priorities.

METHOD

We searched MEDLINE, PsycINFO, and the Web of Science up to September 2019. Eligible studies reported on methods to identify health research gaps, needs, and priorities that had been conducted or supported by research funding organizations. Using a published protocol, we extracted data on the method, criteria, involvement of stakeholders, evaluations, and whether the method had been replicated (i.e., used in other studies).

RESULTS

Among 10,832 citations, 167 studies were eligible for full data extraction. More than half of the studies employed methods to identify both needs and priorities, whereas about a quarter of studies focused singularly on identifying gaps (7%), needs (6%), or priorities (14%) only. The most frequently used methods were the convening of workshops or meetings (37%), quantitative methods (32%), and the James Lind Alliance approach, a multi-stakeholder research needs and priority setting process (28%). The most widely applied criteria were importance to stakeholders (72%), potential value (29%), and feasibility (18%). Stakeholder involvement was most prominent among clinicians (69%), researchers (66%), and patients and the public (59%). Stakeholders were identified through stakeholder organizations (51%) and purposive (26%) and convenience sampling (11%). Only 4% of studies evaluated the effectiveness of the methods and 37% employed methods that were reproducible and used in other studies.

DISCUSSION

To ensure optimal targeting of funds to meet the greatest areas of need and maximize outcomes, a much more robust evidence base is needed to ascertain the effectiveness of methods used to identify research gaps, needs, and priorities.