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I
J
P
H
S)
Vo
l.
14
,
No
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3
,
Sep
tem
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er
20
25
,
p
p
.
1
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8
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~
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n
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sy
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h
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ial
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e
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l
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tra
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l,
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m
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it
y
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a
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d
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c
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fa
c
to
rs)
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n
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th
e
ir
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a
n
d
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t
e
ffe
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t
o
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o
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l
fa
c
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o
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m
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ise
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se
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g
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e
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iate
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y
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it
u
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e
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a
s
n
o
t
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e
e
n
in
v
e
stig
a
te
d
.
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u
s,
t
h
is
stu
d
y
a
i
m
e
d
to
in
v
e
sti
g
a
te
th
e
ro
le
o
f
a
t
ti
tu
d
e
a
s
a
m
e
d
iato
r
b
e
twe
e
n
so
c
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o
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e
c
o
lo
g
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l
fa
c
to
rs
a
n
d
n
o
n
-
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o
m
m
u
n
ica
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l
e
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ise
a
se
m
a
n
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m
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t
a
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g
su
p
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t
sta
ff
in
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y
a
,
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a
lay
sia
.
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c
ro
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se
c
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o
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a
l
stu
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y
u
sin
g
c
lu
ste
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ra
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sa
m
p
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g
will
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e
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o
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d
u
c
ted
a
t
se
lec
ted
M
in
istri
e
s,
in
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u
traja
y
a
M
a
lay
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.
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e
q
u
e
stio
n
n
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ire wil
l
a
ss
e
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re
s
p
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n
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ts’
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a
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o
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ise
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m
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c
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b
le
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ise
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se
a
n
d
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h
ro
n
ic
il
l
n
e
ss
re
so
u
rc
e
s
su
rv
e
y
(CIRS
)
to
m
e
a
su
re
so
c
io
-
e
c
o
lo
g
ica
l
fa
c
to
rs.
De
sc
rip
ti
v
e
a
n
d
in
fe
re
n
ti
a
l
sta
ti
stics
will
b
e
u
se
d
in
d
a
ta
a
n
a
l
y
sis
u
sin
g
S
P
S
S
a
n
d
S
EM
wit
h
AMOS
so
ftwa
re
.
Th
e
fin
d
in
g
s
will
p
r
o
v
i
d
e
a
th
e
o
re
ti
c
a
l
m
o
d
e
l
f
o
r
u
n
d
e
rsta
n
d
i
n
g
t
h
e
v
a
ri
o
u
s
fa
c
to
rs
th
a
t
d
e
term
in
e
t
o
wa
rd
s
n
o
n
-
c
o
m
m
u
n
ica
b
le
d
ise
a
se
m
a
n
a
g
e
m
e
n
t
th
ro
u
g
h
m
e
d
iatio
n
o
f
a
tt
i
tu
d
e
.
K
ey
w
o
r
d
s
:
Attitu
d
e
Me
d
iatio
n
No
n
-
co
m
m
u
n
icab
le
d
is
ea
s
e
Ma
n
ag
em
en
t
So
cio
-
ec
o
lo
g
ical
f
ac
t
o
r
s
Su
p
p
o
r
t staf
f
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
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nd
ing
A
uth
o
r
:
Haliza
Ab
d
u
l Rah
m
an
Dep
ar
tm
en
t o
f
E
n
v
ir
o
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m
e
n
tal
an
d
Occ
u
p
atio
n
al
Hea
lth
,
Fac
u
lty
o
f
Me
d
ici
n
e
an
d
Hea
lth
Scien
ce
s
Un
iv
er
s
iti Pu
tr
a
Ma
lay
s
ia
Ser
d
an
g
-
4
3
4
0
0
,
Selan
g
o
r
,
Ma
l
ay
s
ia
E
m
ail:
d
r
.
h
aliza
@
u
p
m
.
ed
u
.
m
y
1.
I
NT
RO
D
UCT
I
O
N
No
n
-
co
m
m
u
n
icab
le
d
is
ea
s
es
(
NC
Ds)
ar
e
d
an
g
er
o
u
s
to
h
u
m
an
d
u
e
to
th
eir
p
o
ten
tial
ca
u
s
es
o
f
m
o
r
b
id
ity
an
d
m
o
r
tality
.
I
t
ac
co
u
n
ts
f
o
r
7
4
%
o
f
all
d
ea
th
s
wo
r
ld
wid
e
[
1
]
.
Ma
lay
s
ia
is
a
m
o
n
g
t
h
e
co
u
n
tr
ies
ex
p
er
ien
cin
g
ep
id
em
io
lo
g
ical
tr
an
s
itio
n
,
r
ap
id
ec
o
n
o
m
ic
d
ev
el
o
p
m
en
t,
p
o
p
u
latio
n
ag
in
g
,
an
d
life
s
ty
l
e
ch
an
g
es
r
esu
ltin
g
in
a
n
in
cr
e
ased
r
ate
o
f
NC
D
[
1
]
.
I
t
h
as
b
ec
o
m
e
th
e
lead
in
g
ca
u
s
e
o
f
6
7
%
o
f
d
ea
th
s
f
o
r
p
eo
p
le
in
Ma
lay
s
ia
b
e
f
o
r
e
'
p
r
em
atu
r
e
d
ea
th
s
’
(
3
0
-
7
0
y
e
ar
s
)
[
2
]
.
Acc
o
r
d
in
g
to
th
e
Natio
n
al
Hea
lth
an
d
Mo
r
b
id
ity
S
u
r
v
e
y
(
NHM
S),
o
v
er
7
0
%
o
f
a
d
u
lt
Ma
lay
s
ian
s
ar
e
liv
in
g
with
h
ea
r
t
d
is
ea
s
e,
d
iab
etes,
an
d
ca
n
ce
r
an
d
ac
co
u
n
t
f
o
r
7
3
%
o
f
d
ea
th
s
in
Ma
lay
s
ia
[
2
]
,
[
3
]
.
L
ik
ewise,
an
esti
m
ated
2
4
0
m
illi
o
n
p
eo
p
le
liv
in
g
with
NC
D
an
d
4
.
9
m
illi
o
n
d
ea
th
s
d
u
e
to
NC
D
[
4
]
.
T
h
u
s
,
th
is
h
ig
h
lig
h
ts
th
e
g
lo
b
al
b
u
r
d
en
o
f
NC
Ds
as
o
n
e
o
f
th
e
ch
allen
g
es in
p
r
o
v
id
in
g
h
ea
lth
tr
ea
tm
en
t sy
s
tem
,
ca
r
e,
an
d
s
u
p
p
o
r
t [
5
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
3
8
7
-
1
3
9
3
1388
I
n
Ma
lay
s
ia,
th
e
p
r
ev
alen
ce
o
f
NC
D
k
ee
p
s
r
is
in
g
,
esp
ec
ially
am
o
n
g
lo
w
-
in
c
o
m
e
g
r
o
u
p
s
co
m
p
ar
ed
to
o
th
er
in
c
o
m
e
g
r
o
u
p
s
[
6
]
.
T
h
e
p
r
ev
alen
ce
o
f
h
y
p
er
ten
s
io
n
a
n
d
d
iab
etes
ar
e
m
o
r
e
p
r
e
v
alen
t
am
o
n
g
th
e
b
o
tto
m
(
B
4
0
)
th
an
o
th
er
in
c
o
m
e
g
r
o
u
p
s
as
r
ep
o
r
ted
b
y
NHM
S
2
0
1
9
[
7
]
.
NHM
S
2
0
1
5
also
s
h
o
w
ed
s
im
ilar
f
in
d
in
g
s
,
with
th
e
p
r
ev
alen
ce
o
f
r
aised
h
y
p
er
ten
s
io
n
an
d
d
iab
ete
s
am
o
n
g
lo
w
-
in
co
m
e
g
r
o
u
p
[
2
]
.
T
h
e
s
tatis
tics
illu
s
tr
ated
th
at
th
e
p
r
ev
ale
n
ce
o
f
NC
D
am
o
n
g
lo
w
-
in
c
o
m
e
wo
r
k
e
r
s
h
as
n
o
w
r
ea
c
h
ed
an
alar
m
in
g
lev
el
i
n
Ma
lay
s
ia.
T
h
e
r
is
e
in
p
r
ev
a
len
ce
o
f
NC
D
am
o
n
g
lo
w
-
i
n
co
m
e
g
r
o
u
p
s
will
in
cr
ea
s
e
th
e
r
is
k
o
f
h
ea
lth
p
r
o
b
lem
s
,
an
d
it
m
ay
b
e
at
h
i
g
h
er
r
is
k
o
f
m
o
r
t
ality
,
m
o
r
b
id
ity
,
an
d
d
is
ab
ilit
y
.
T
h
is
s
itu
at
io
n
h
as
a
n
eg
ativ
e
ef
f
ec
t
o
n
th
e
q
u
ality
o
f
life
,
p
r
o
d
u
ctiv
ity
lev
el,
d
ec
r
ea
s
es
in
i
n
d
iv
id
u
al
f
am
ily
-
r
elate
d
q
u
ality
o
f
life
,
i
n
cr
ea
s
ed
m
ed
ical
ex
p
en
d
itu
r
e,
a
n
d
cr
iti
ca
lly
in
cr
ea
s
ed
th
e
co
u
n
tr
y
’
s
ec
o
n
o
m
ic
b
u
r
d
e
n
[
8
]
,
[
9
]
.
Pre
v
io
u
s
s
tu
d
ies
h
av
e
f
o
u
n
d
t
h
at
p
eo
p
le
o
f
lo
w
s
o
cio
ec
o
n
o
m
ic
s
tatu
s
f
ac
e
lim
ited
ac
ce
s
s
to
p
o
licies,
leg
is
latio
n
,
r
eg
u
latio
n
s
,
an
d
h
ea
lth
ca
r
e
s
er
v
ices,
wh
er
eb
y
ex
p
o
s
u
r
e
to
NC
D
is
p
r
ev
alen
t
[
1
0
]
.
I
n
d
ee
d
,
th
e
in
cr
ea
s
e
in
h
ea
lth
ca
r
e
co
s
ts
r
e
d
u
ce
s
th
e
ab
ilit
y
t
o
p
ay
f
o
r
m
ed
ical
ex
p
e
n
s
es,
wh
ich
in
cr
ea
s
es
th
e
r
is
k
o
f
NC
D
[
1
1
]
.
B
esid
es
th
at,
it
was
r
ep
o
r
ted
th
at
lo
wer
s
o
cio
ec
o
n
o
m
ic
s
tatu
s
is
o
f
ten
ass
o
ciate
d
wit
h
h
a
v
in
g
h
ig
h
r
ates
o
f
ch
r
o
n
ic
d
is
ea
s
e,
h
ig
h
m
o
r
b
id
ity
an
d
m
o
r
tality
,
an
d
lo
wer
life
ex
p
ec
ta
n
cy
c
o
m
p
a
r
ed
to
h
ig
h
-
in
co
m
e
g
r
o
u
p
s
d
u
e
to
a
lack
o
f
ac
ce
s
s
to
g
o
o
d
h
ea
lth
ca
r
e
an
d
th
e
n
ee
d
f
o
r
s
o
cial
p
r
o
tectio
n
[
1
0
]
,
[
1
2
]
.
A
p
ar
t
f
r
o
m
th
at,
th
ey
o
f
ten
d
o
n
o
t
h
av
e
e
n
o
u
g
h
f
ac
ilit
ies
(
i.e
.
liv
in
g
co
n
d
itio
n
s
,
p
h
y
s
ical
s
af
ety
,
an
d
h
ea
lth
y
f
o
o
d
)
wh
ich
p
lay
a
n
ess
en
tial
r
o
le
in
d
ev
elo
p
i
n
g
N
C
D
[
1
3
]
-
[1
5
]
.
Me
an
wh
ile,
th
e
u
r
b
a
n
p
o
o
r
ar
e
at
r
is
k
an
d
m
o
r
e
ex
p
o
s
ed
to
th
e
d
an
g
er
o
f
NC
D
co
m
p
ar
ed
t
o
o
th
er
p
eo
p
le
liv
in
g
in
t
h
e
city
as
th
ey
h
av
e
a
lack
o
f
k
n
o
wled
g
e,
lim
itatio
n
s
in
h
ea
lth
in
f
o
r
m
atio
n
,
f
ewe
r
r
es
o
u
r
ce
s
f
o
r
t
r
ea
tm
en
t
a
n
d
h
ea
lt
h
ca
r
e
as
well
as
lim
ited
s
o
u
r
ce
s
o
f
in
co
m
e.
T
h
is
ex
p
o
s
u
r
e
lead
s
th
em
t
o
ad
o
p
t
an
u
r
b
a
n
life
s
ty
le
an
d
tu
r
n
p
u
t
s
th
em
at
a
h
ig
h
er
r
is
k
o
f
g
etti
n
g
NC
D
as
well
a
s
wo
r
s
en
s
th
eir
co
n
d
itio
n
[
1
6
]
.
Mo
r
eo
v
e
r
,
p
o
v
er
ty
a
n
d
th
e
lev
el
o
f
d
e
v
elo
p
m
e
n
t,
esp
ec
i
ally
in
an
ar
ea
o
r
co
u
n
tr
y
wh
er
e
u
r
b
an
izatio
n
is
co
n
tr
ib
u
tin
g
to
th
e
in
cr
ea
s
e
i
n
ch
r
o
n
ic
d
is
ea
s
es
[
1
7
]
.
Fu
r
th
er
m
o
r
e,
p
r
o
lo
n
g
ed
ex
p
o
s
u
r
e
to
h
ea
lth
-
r
is
k
b
e
h
av
io
r
s
s
u
ch
as
u
r
b
an
izatio
n
,
p
o
v
er
ty
,
lack
o
f
ac
ce
s
s
to
h
ea
lth
c
ar
e
f
ac
ilit
ies,
r
is
k
y
b
eh
av
io
r
s
,
u
s
e
o
f
to
b
ac
co
p
r
o
d
u
cts,
u
n
h
ea
lth
y
ea
tin
g
,
p
h
y
s
ical
in
ac
tiv
ity
,
an
d
b
ein
g
o
v
er
weig
h
t
o
r
o
b
ese
ca
n
af
f
ec
t
th
eir
h
ea
lth
an
d
am
p
lify
th
e
r
is
k
o
f
ch
r
o
n
ic
d
is
ea
s
e
[
1
8
]
.
Per
h
ap
s
n
o
t
s
u
r
p
r
is
in
g
ly
,
lo
w
-
in
co
m
e
wo
r
k
er
s
also
ex
p
o
s
ed
to
p
h
y
s
ical
an
d
p
s
y
ch
o
s
o
cial
r
is
k
s
at
th
e
wo
r
k
p
lace
wh
ich
h
as
co
n
tr
i
b
u
ted
t
o
a
h
ig
h
e
r
in
cid
en
ce
o
f
ch
r
o
n
ic
d
is
ea
s
es
[
1
8
]
,
[
19
]
.
Ultim
ately
,
lo
w
-
in
co
m
e
g
r
o
u
p
s
ten
d
to
f
ac
e
v
a
r
io
u
s
f
ac
t
o
r
s
s
u
ch
as
s
o
cial,
wo
r
k
p
lace
,
co
m
m
u
n
ity
,
an
d
en
v
ir
o
n
m
en
t
d
u
e
to
t
h
e
lack
o
f
s
u
f
f
icien
t
r
eso
u
r
ce
s
in
d
ea
lin
g
with
h
ea
lth
p
r
o
b
lem
s
an
d
n
o
n
-
co
m
m
u
n
ica
b
le
d
is
ea
s
es [
1
8
]
,
[
2
0
].
I
n
th
is
r
eg
ar
d
,
n
o
n
-
co
m
m
u
n
i
ca
b
le
d
is
ea
s
e
m
an
ag
em
en
t
p
lay
s
a
v
ital
r
o
le
in
d
ea
lin
g
with
th
ese
d
is
ea
s
es
to
im
p
r
o
v
e
h
ea
lth
o
u
tco
m
es.
Un
d
er
s
tan
d
i
n
g
f
ac
to
r
s
th
at
co
n
tr
ib
u
te
to
im
p
r
o
v
in
g
th
e
ca
r
e
a
n
d
m
an
ag
em
en
t
o
f
NC
D
i
s
im
p
o
r
tan
t,
as
lo
wer
-
in
co
m
e
h
o
u
s
e
h
o
ld
s
ar
e
m
o
s
t
v
u
ln
er
ab
le
to
NC
D.
Nev
er
th
eless
,
litt
le
is
k
n
o
wn
ab
o
u
t
t
h
e
m
an
ag
em
en
t
o
f
n
o
n
-
c
o
m
m
u
n
icab
le
d
is
ea
s
es
am
o
n
g
lo
w
-
in
co
m
e
wo
r
k
er
s
.
Fu
r
th
er
m
o
r
e
,
o
n
ly
a
f
ew
s
tu
d
ies
h
av
e
ex
am
in
ed
th
e
r
o
le
o
f
co
n
tex
tu
al
f
ac
to
r
s
in
ch
r
o
n
ic
d
is
ea
s
e
m
an
ag
em
en
t
[2
1
]
.
Pre
v
io
u
s
s
tu
d
ies
h
av
e
f
o
u
n
d
a
n
ass
o
ciatio
n
b
etwe
en
s
elf
-
m
an
ag
em
en
t
o
f
n
o
n
-
co
m
m
u
n
icab
le
d
is
ea
s
es
with
ag
e
[
2
2
]
g
en
d
er
[
2
2
]
ed
u
ca
tio
n
lev
el
[
2
3
]
,
lo
w
s
o
cio
-
e
co
n
o
m
ic
s
tatu
s
[
2
4
]
,
d
ep
r
ess
io
n
an
d
an
x
iety
[
2
2
]
,
[2
5
],
[2
6
]
,
m
u
lti
-
m
o
r
b
i
d
ity
[
2
2
]
,
d
is
ea
s
e
ch
ar
ac
ter
is
tics
[
2
3
]
,
d
is
ea
s
e
d
u
r
atio
n
,
d
is
ea
s
e
s
ev
er
ity
[
2
2
]
,
illn
ess
p
er
ce
p
tio
n
[
2
6
]
,
h
ea
lth
liter
ac
y
[
2
4
]
an
d
s
o
cial
s
u
p
p
o
r
t
[
2
7
]
.
Ho
wev
er
,
th
e
r
e
ar
e
s
till
lim
ited
s
tu
d
ies
ex
p
lo
r
in
g
n
ee
d
s
b
e
y
o
n
d
in
d
iv
id
u
al
f
ac
to
r
s
th
at
p
r
ed
ict
n
o
n
-
co
m
m
u
n
icab
le
d
is
ea
s
e
m
a
n
ag
em
en
t
u
s
in
g
th
e
s
o
cio
-
ec
o
lo
g
ical
m
o
d
el
th
at
h
av
e
n
o
t
b
ee
n
clea
r
ly
r
ev
ea
led
.
Ap
a
r
t
f
r
o
m
th
at,
th
er
e
is
a
lim
ited
h
o
lis
tic
m
o
d
el
o
r
m
u
ltil
ev
el
ap
p
r
o
ac
h
with
in
th
e
h
ea
lth
p
r
o
m
o
tio
n
f
ield
[
2
8
]
.
Fu
r
t
h
er
m
o
r
e
,
th
e
r
o
le
o
f
attitu
d
e
as
a
m
ed
iato
r
was
lim
ited
in
s
tu
d
y
in
g
th
e
m
ed
iatin
g
ef
f
ec
t
o
f
attitu
d
e
in
a
g
iv
en
r
elatio
n
s
h
ip
to
war
d
p
r
e
v
en
tiv
e
h
ea
lth
p
r
o
m
o
tio
n
b
eh
av
io
r
[
29
]
,
[
3
0
]
.
Attitu
d
e
is
cr
u
cial
in
m
o
tiv
atin
g
in
d
i
v
id
u
als
to
b
e
m
o
r
e
lik
ely
to
ac
t
o
r
b
eh
av
io
r
al.
I
t
is
th
e
ab
ilit
y
to
en
co
u
r
a
g
e
a
r
esp
o
n
s
ib
le
m
o
ti
v
atio
n
f
o
r
ac
tio
n
.
A
p
o
s
itiv
e
attitu
d
e
ca
n
im
p
ac
t
m
o
tiv
atio
n
to
f
o
llo
w
th
e
m
an
ag
em
en
t
o
f
th
e
d
is
ea
s
e.
T
h
is
p
o
s
itiv
e
attitu
d
e
also
en
h
an
ce
s
th
eir
m
o
tiv
atio
n
to
m
an
ag
e
h
ea
lth
e
f
f
ec
tiv
ely
.
C
o
n
v
er
s
ely
,
n
e
g
ativ
e
attitu
d
es
ca
n
b
e
b
ar
r
ier
s
th
at
d
ec
r
ea
s
e
th
e
ab
ilit
y
to
p
r
o
d
u
ce
m
o
tiv
atio
n
o
r
g
o
o
d
r
esu
lts
in
th
e
m
an
ag
em
e
n
t
o
f
n
o
n
-
c
o
m
m
u
n
icab
le
d
is
ea
s
es.
T
h
er
ef
o
r
e,
an
attitu
d
e
ca
n
im
p
r
o
v
e
o
r
d
ec
r
ea
s
e
m
o
tiv
atio
n
b
y
i
n
f
lu
en
ci
n
g
in
d
i
v
id
u
als
to
war
d
s
th
e
m
an
ag
e
m
en
t
o
f
n
o
n
-
c
o
m
m
u
n
icab
le
d
is
ea
s
es
o
r
v
ice
v
er
s
a.
L
ik
ewise,
attitu
d
es
ca
n
b
e
u
s
ed
as
a
m
ed
iato
r
i
n
c
o
n
tr
o
llin
g
th
e
r
el
atio
n
s
h
ip
b
etwe
en
th
e
two
v
ar
iab
les.
T
h
is
s
tu
d
y
aim
s
to
d
eter
m
in
e
th
e
r
o
le
o
f
attitu
d
es
as
a
m
ed
iato
r
b
etwe
en
s
o
cio
-
ec
o
lo
g
ical
f
ac
to
r
s
an
d
n
o
n
-
co
m
m
u
n
icab
l
e
d
is
ea
s
e
m
an
ag
em
en
t a
m
o
n
g
lo
w
-
in
co
m
e
wo
r
k
er
s
in
Ma
lay
s
ia.
2.
M
E
T
H
O
D
2
.
1
.
Study
lo
c
a
t
io
n
T
h
is
s
tu
d
y
will
b
e
ca
r
r
ied
o
u
t
at
th
e
Min
is
tr
ies
in
Pu
tr
ajay
a
,
Ma
lay
s
ia.
Pu
tr
ajay
a
h
as
2
3
m
in
is
tr
ies
,
an
d
th
e
lo
ca
tio
n
was
ch
o
s
en
b
ec
au
s
e
it
is
th
e
f
ed
er
al
g
o
v
er
n
m
en
t'
s
ad
m
in
is
tr
ativ
e
ce
n
te
r
,
r
ep
r
esen
tin
g
th
e
lar
g
est
n
u
m
b
er
o
f
ci
v
il
s
er
v
an
t
s
in
Ma
lay
s
ia.
T
h
e
NM
HS
r
ev
ea
led
th
at
civ
il
s
er
v
an
ts
in
Pu
tr
ajay
a
ex
p
er
ien
ce
d
an
in
cr
ea
s
e
in
o
b
esit
y
f
r
o
m
2
0
1
5
to
2
0
1
9
,
f
r
o
m
4
0
.
3
%
to
4
1
.
4
%
[
2
]
,
[
7
]
.
Hen
ce
,
it
h
as
p
u
t
alm
o
s
t
h
alf
o
f
th
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
A
ttit
u
d
e
a
s
a
med
ia
to
r
b
etw
ee
n
s
o
cio
-
ec
o
lo
g
ica
l fa
cto
r
s
a
n
d
n
o
n
-
c
o
mmu
n
ica
b
le
…
(
A
z
r
in
S
h
a
h
A
b
u
B
a
ka
r
)
1389
ad
u
lt
p
o
p
u
latio
n
in
Pu
tr
ajay
a
wh
ich
c
o
n
s
is
ts
o
f
g
o
v
er
n
m
e
n
t
em
p
lo
y
ee
s
,
in
th
e
o
v
er
wei
g
h
t
o
r
o
b
ese.
Sin
ce
m
o
s
t
o
f
th
e
p
o
p
u
latio
n
co
n
s
is
ts
o
f
wo
r
k
in
g
ad
u
lts
,
th
is
in
cr
ea
s
e
in
o
b
esit
y
is
an
ea
r
ly
war
n
in
g
r
is
k
f
ac
to
r
f
o
r
NC
Ds [
3
1
].
2
.
2
.
Study
des
ig
n a
nd
s
t
ud
y
po
pu
la
t
io
n
T
h
is
s
tu
d
y
em
p
lo
y
s
a
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
th
at
aim
s
to
d
eter
m
in
e
th
e
m
ed
iatin
g
r
o
le
o
f
attitu
d
e
in
th
e
r
elatio
n
s
h
ip
s
b
etwe
en
s
o
cio
-
ec
o
lo
g
ical
f
ac
to
r
s
a
n
d
n
o
n
-
co
m
m
u
n
icab
le
d
is
ea
s
e
m
an
ag
em
en
t
am
o
n
g
s
u
p
p
o
r
t
s
taf
f
in
P
u
tr
ajay
a,
Ma
lay
s
ia.
T
h
e
tar
g
et
p
o
p
u
latio
n
i
s
s
u
p
p
o
r
t
s
taf
f
m
em
b
er
s
.
T
h
e
r
esp
o
n
d
en
ts
will
b
e
ch
o
s
en
u
s
in
g
clu
s
ter
r
an
d
o
m
s
am
p
lin
g
wh
er
e
eig
h
t
o
u
t
o
f
2
3
m
in
is
tr
ies
in
Pu
tr
ajay
a
wer
e
r
an
d
o
m
ly
s
elec
ted
u
s
in
g
a
tab
le
o
f
r
an
d
o
m
n
u
m
b
er
.
T
h
e
in
clu
s
io
n
cr
iter
ia
ar
e
p
er
m
an
en
t
s
taf
f
ag
ed
1
8
y
ea
r
s
o
ld
an
d
ab
o
v
e.
T
h
e
ex
clu
s
io
n
cr
iter
io
n
is
co
n
tr
ac
t
o
r
p
ar
t
-
tim
e
s
taf
f
.
All
s
u
p
p
o
r
t
s
taf
f
wh
o
m
ee
t
th
e
in
clu
s
io
n
cr
iter
ia
will
b
e
ap
p
r
o
ac
h
ed
f
o
r
p
a
r
ticip
atio
n
i
n
th
is
s
tu
d
y
.
2
.
3
.
Da
t
a
c
o
llect
io
n pro
ce
du
re
B
ef
o
r
e
d
is
tr
ib
u
tin
g
th
e
q
u
esti
o
n
n
air
e,
th
o
s
e
wh
o
f
u
l
f
illed
th
e
in
clu
s
io
n
cr
iter
ia
will
b
e
in
f
o
r
m
e
d
ab
o
u
t
th
e
r
esear
ch
p
r
o
ce
d
u
r
e
.
T
h
en
th
e
q
u
esti
o
n
n
air
e
,
an
d
c
o
n
s
en
t
f
o
r
m
will
b
e
d
is
tr
ib
u
ted
to
th
e
r
esp
o
n
d
en
ts
an
d
ad
m
i
n
is
ter
ed
v
ia
an
o
f
f
ice
in
ch
ar
g
e
o
r
r
ep
r
esen
tativ
es
f
r
o
m
s
elec
ted
m
in
is
tr
ies
th
r
o
u
g
h
em
ail
a
n
d
W
h
atsAp
p
wh
ich
will th
en
b
e
s
en
t w
ee
k
ly
as r
em
in
d
er
s
to
t
h
e
r
esp
o
n
d
e
n
ts
.
2
.
4
.
Sa
m
ple size
T
h
e
m
in
im
u
m
s
am
p
le
s
ize
r
eq
u
ir
ed
f
o
r
th
is
s
tu
d
y
was
ca
lc
u
lated
u
s
in
g
an
o
n
lin
e
ca
lcu
la
to
r
[
3
2
]
b
y
s
ettin
g
th
e
an
ticip
ated
ef
f
ec
t
s
ize
f
2
=
0
.
3
,
th
e
d
esire
d
p
-
v
al
u
e
was
at
0
.
0
5
,
th
e
d
esire
d
s
tatis
tical
p
o
wer
lev
e
l
at
8
0
%,
th
e
n
u
m
b
er
o
f
o
b
s
er
v
ed
v
ar
iab
les
was
9
4
an
d
t
h
e
n
u
m
b
er
o
f
laten
t
v
ar
iab
les
was
1
2
is
2
0
0
,
a
n
d
th
e
f
in
al
s
am
p
le
s
ize
af
ter
ac
co
u
n
t
in
g
f
o
r
a
n
o
n
-
r
esp
o
n
s
e
r
ate
8
0
% is
3
6
0
.
2
.
5
.
Study
ins
t
rum
ent
s
T
h
is
s
tu
d
y
i
n
s
tr
u
m
en
t
c
o
m
p
r
is
es
f
o
u
r
s
ec
tio
n
s
wh
ich
i
n
clu
d
e
s
o
cio
-
d
em
o
g
r
ap
h
ic
in
f
o
r
m
atio
n
,
k
n
o
wled
g
e
o
f
n
o
n
-
co
m
m
u
n
ica
b
le
d
is
ea
s
es,
attitu
d
es
to
war
d
s
p
r
ev
e
n
tin
g
n
o
n
-
c
o
m
m
u
n
icab
l
e
d
is
ea
s
es,
an
d
th
e
ch
r
o
n
ic
illn
ess
r
eso
u
r
ce
s
s
u
r
v
ey
(
C
I
R
S).
T
h
e
q
u
esti
o
n
n
air
e
will
b
e
m
o
d
if
ied
an
d
ad
ap
te
d
f
r
o
m
[
3
3
]
,
[
3
4
]
.
Sectio
n
A
co
n
s
is
ts
o
f
s
o
cio
-
d
em
o
g
r
ap
h
ic
in
f
o
r
m
atio
n
in
clu
d
in
g
ag
e
,
g
e
n
d
er
,
r
ac
e,
m
a
r
ital
s
tatu
s
,
ed
u
ca
tio
n
al
lev
el,
an
d
m
o
n
th
ly
h
o
u
s
eh
o
ld
in
co
m
e.
Sectio
n
B
ass
ess
es
t
h
e
r
esp
o
n
d
e
n
ts
'
k
n
o
wled
g
e
o
f
n
o
n
-
c
o
m
m
u
n
icab
le
d
is
ea
s
es,
th
e
k
n
o
wled
g
e
q
u
e
s
tio
n
s
co
v
er
th
e
u
n
d
er
s
tan
d
i
n
g
o
f
n
o
n
-
c
o
m
m
u
n
icab
le
d
is
ea
s
es
in
clu
d
in
g
th
e
m
ajo
r
n
o
n
-
co
m
m
u
n
icab
le
d
is
ea
s
es
wh
ich
ar
e
ca
r
d
io
v
ascu
lar
d
is
ea
s
e,
s
tr
o
k
e
an
d
h
y
p
er
ten
s
io
n
,
d
iab
etes
m
ellitu
s
,
an
d
ch
r
o
n
ic
o
b
s
tr
u
ctiv
e
p
u
lm
o
n
a
r
y
d
is
ea
s
e
as
well
as
r
is
k
f
ac
to
r
s
,
co
m
p
licatio
n
s
an
d
d
is
ea
s
e
m
an
ag
em
en
t.
R
esp
o
n
d
en
t
will
b
e
in
s
tr
u
cted
to
g
iv
e
a
‘
y
es’,
‘
n
o
t’
an
d
‘
d
o
n
o
t
k
n
o
w’
.
T
h
e
lev
el
o
f
k
n
o
wled
g
e
will
b
e
ca
teg
o
r
ize
d
as
h
av
in
g
g
o
o
d
k
n
o
wled
g
e,
m
o
d
er
ate
k
n
o
wled
g
e
an
d
p
o
o
r
k
n
o
wled
g
e.
I
t
h
ad
e
x
ce
llen
t
in
ter
n
al
co
n
s
is
ten
cy
r
eliab
ilit
y
(
C
r
o
n
b
ac
h
’
s
α
=
0
.
9
6
1
)
.
Sectio
n
C
co
n
s
is
ts
o
f
1
5
item
s
f
o
r
th
e
attitu
d
e
to
war
d
s
p
r
ev
en
tin
g
n
o
n
-
c
o
m
m
u
n
icab
l
e
d
is
ea
s
es,
wh
ich
in
clu
d
i
n
g
b
alan
ce
d
d
iet,
p
h
y
s
ic
al
ac
ti
v
ity
,
s
m
o
k
i
n
g
,
s
alt
in
tak
e,
m
ed
icatio
n
in
tak
e,
an
d
tr
ea
tm
en
t
ch
ec
k
s
.
T
h
e
q
u
es
tio
n
s
ar
e
ev
alu
ated
u
s
in
g
a
5
-
p
o
in
t
L
ik
er
t
s
ca
le
r
an
g
in
g
f
r
o
m
‘
Stro
n
g
ly
d
is
ag
r
ee
’
,
‘
d
is
ag
r
ee
’
,
‘
ag
r
ee
’
an
d
‘
s
tr
o
n
g
ly
a
g
r
ee
’
.
All
r
esu
lts
will
b
e
d
is
cu
s
s
ed
b
y
d
escr
ip
tiv
e
d
a
ta
an
aly
s
is
.
I
n
th
is
s
tu
d
y
,
th
e
s
u
r
v
ey
s
h
o
wed
g
o
o
d
in
ter
n
al
co
n
s
is
ten
cy
r
eliab
ilit
y
(
C
r
o
n
b
ac
h
’
s
α
=
0
.
8
9
8
)
.
Sectio
n
D
will
b
e
th
e
f
in
al
s
ec
tio
n
o
f
th
e
q
u
esti
o
n
n
air
e
c
o
n
tain
in
g
6
5
item
s
f
o
r
c
h
r
o
n
ic
illn
ess
r
eso
u
r
ce
s
s
u
r
v
e
y
(
C
I
R
S)
to
a
s
s
es
s
th
e
s
o
cio
-
ec
o
l
o
g
i
ca
l
f
ac
to
r
s
,
d
iv
id
ed
i
n
to
f
iv
e
s
u
b
-
s
c
ales
th
at
m
ea
s
u
r
es
in
ter
p
er
s
o
n
al,
o
r
g
an
izatio
n
al,
co
m
m
u
n
ity
,
s
o
cieta
l,
s
elf
-
m
a
n
ag
em
en
t
o
f
d
is
ea
s
e.
T
h
e
q
u
esti
o
n
n
air
e
is
b
ased
o
n
a
5
-
p
o
in
t
L
ik
e
r
t
s
ca
le
as
ei
th
er
‘
No
t
at
all’
,
‘
A
litt
le’
,
‘
M
o
d
er
ate’
,
‘
Q
u
ite
a
lo
t’
an
d
‘
A
g
r
ea
t
d
ea
l’
.
I
n
th
is
s
tu
d
y
,
th
e
C
I
R
S sh
o
wed
g
o
o
d
in
ter
n
al
co
n
s
is
ten
cy
r
eliab
ilit
y
(
C
r
o
n
b
ac
h
’
s
α
=
0
.
9
0
)
.
2.
6
.
Da
t
a
a
na
ly
s
is
Data
will
b
e
an
al
y
ze
d
u
s
in
g
th
e
s
tatis
tical
p
ac
k
ag
e
f
o
r
s
o
ci
al
s
cien
ce
(
SP
SS
)
an
d
s
tr
u
ctu
r
al
eq
u
atio
n
m
o
d
el
(
SEM
)
u
s
in
g
AM
OS.
De
s
cr
ip
tiv
e
an
aly
s
is
will
b
e
p
er
f
o
r
m
e
d
to
m
ea
s
u
r
e
all
v
a
r
iab
les.
SEM
will
b
e
ap
p
lied
in
th
e
in
f
er
en
tial
m
et
h
o
d
t
o
test
th
e
h
y
p
o
t
h
esized
m
o
d
el
an
d
co
n
f
ir
m
th
e
r
elatio
n
s
h
ip
m
o
d
elin
g
with
th
r
ee
s
tag
es,
wh
ich
ar
e
co
n
f
ir
m
ato
r
y
f
ac
to
r
an
al
y
s
is
(
CF
A)
,
m
ea
s
u
r
em
en
t
m
o
d
el,
an
d
s
tr
u
ctu
r
e
m
o
d
el.
T
h
e
n
,
b
o
o
ts
tr
ap
p
in
g
an
aly
s
is
will b
e
u
s
ed
to
test
th
e
m
ed
iatio
n
e
f
f
e
ct.
T
h
e
s
ig
n
if
ican
ce
le
v
el
will b
e
s
et
at
p
<0
.
0
5
.
3.
DIS
CU
SS
I
O
N
T
h
is
s
tu
d
y
will
e
x
am
in
e
th
e
r
elatio
n
s
h
ip
b
etwe
en
s
o
cio
-
ec
o
lo
g
ical
f
ac
to
r
s
an
d
m
an
ag
em
e
n
t
o
f
n
o
n
-
co
m
m
u
n
ica
b
le
d
is
ea
s
e
as
wel
l
as
u
n
d
er
s
tan
d
in
g
th
e
m
ed
iat
in
g
r
o
le
o
f
attitu
d
es.
T
h
e
f
in
d
in
g
will
in
v
esti
g
ate
wh
eth
er
s
o
cio
-
ec
o
lo
g
ical
f
ac
t
o
r
s
(
i.e
.
,
in
t
r
ap
er
s
o
n
al,
in
ter
p
er
s
o
n
al,
o
r
g
an
izatio
n
al,
co
m
m
u
n
ity
,
a
n
d
s
o
cieta
l
f
ac
to
r
s
)
h
elp
to
in
f
lu
e
n
ce
n
o
n
-
co
m
m
u
n
icab
le
d
is
ea
s
e
m
an
ag
em
en
t
th
r
o
u
g
h
attitu
d
e
as
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e
m
ed
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r
.
I
n
o
th
e
r
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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:
2
2
5
2
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8
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6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
3
8
7
-
1
3
9
3
1390
wo
r
d
s
,
s
o
cio
-
ec
o
lo
g
ical
f
ac
to
r
s
wh
eth
er
th
e
d
ir
ec
t
an
d
in
d
ir
ec
t
in
f
lu
en
ce
o
n
n
o
n
-
co
m
m
u
n
icab
le
d
is
ea
s
e
in
p
r
esen
ce
o
f
attitu
d
es
as
a
m
ed
iatin
g
v
ar
iab
le.
T
h
is
ev
id
e
n
ce
is
n
e
ce
s
s
ar
y
to
d
eter
m
in
e
wh
eth
er
attitu
d
e
m
ed
iates th
e
r
elatio
n
s
h
ip
b
etw
ee
n
s
o
cio
-
ec
o
lo
g
ical
f
ac
to
r
s
a
n
d
n
o
n
-
co
m
m
u
n
ica
b
le
d
is
ea
s
e
m
an
ag
em
e
n
t.
A
s
tu
d
y
co
n
d
u
cted
lo
ca
lly
a
m
o
n
g
p
u
b
lic
s
er
v
ice
em
p
lo
y
ee
s
in
Pu
tr
ajay
a,
Ma
lay
s
ia
f
o
u
n
d
t
h
at
7
7
.
8
%
wer
e
o
b
esit
y
an
d
4
4
.
7
%
h
a
d
h
ig
h
b
lo
o
d
p
r
ess
u
r
e
am
o
n
g
th
e
im
p
lem
en
ter
g
r
o
u
p
co
m
p
ar
ed
to
th
e
p
r
o
f
ess
io
n
al
an
d
m
a
n
ag
em
en
t
g
r
o
u
p
[
3
5
]
.
T
h
is
s
h
o
ws
th
at
lo
w
-
in
co
m
e
wo
r
k
er
s
ar
e
m
o
r
e
lik
ely
t
o
s
u
f
f
er
ch
r
o
n
ic
d
is
ea
s
es
as
co
m
p
ar
e
d
to
h
ig
h
-
in
co
m
e
g
r
o
u
p
[
3
6
]
.
T
h
e
r
ef
o
r
e,
n
o
n
-
co
m
m
u
n
icab
le
di
s
ea
s
e
m
an
ag
e
m
en
t
is
in
cr
ea
s
in
g
l
y
r
ec
o
g
n
ized
as
im
p
o
r
tan
t
f
o
r
th
e
wo
r
k
in
g
ag
e
g
r
o
u
p
,
th
e
p
r
ev
alen
ce
o
f
ch
r
o
n
ic
co
n
d
itio
n
s
,
an
d
th
e
im
p
o
r
ta
n
ce
o
f
m
ain
tain
in
g
p
r
o
d
u
ctiv
e
an
d
co
m
p
etitiv
e
em
p
lo
y
ee
s
[
3
7
]
.
Ap
p
ly
in
g
th
e
m
an
a
g
em
en
t
o
f
ch
r
o
n
ic
d
is
ea
s
e
in
d
aily
life
p
lay
s
a
p
iv
o
tal
r
o
le
in
d
ea
lin
g
with
th
e
d
is
ea
s
es,
im
p
r
o
v
in
g
h
ea
lth
,
an
d
q
u
ality
o
f
life
[
3
8
]
.
T
h
is
s
tu
d
y
em
p
h
asizes
th
e
im
p
o
r
t
an
ce
o
f
n
o
n
-
co
m
m
u
n
ica
b
le
d
is
ea
s
e
m
an
ag
em
en
t
to
p
r
ev
e
n
t
an
d
r
ed
u
ce
NC
D
am
o
n
g
l
o
w
-
in
co
m
e
w
o
r
k
er
s
.
No
n
-
co
m
m
u
n
i
ca
b
le
d
i
s
e
a
s
e
m
an
ag
em
en
t
am
o
n
g
lo
w
-
in
c
o
m
e
wo
r
k
e
r
s
in
Ma
la
y
s
ia
h
as
b
ee
n
lim
i
ted
.
Al
s
o
,
u
n
d
e
r
s
tan
d
in
g
th
e
i
s
s
u
e
s
r
e
la
t
in
g
to
n
o
n
-
co
m
m
u
n
i
ca
b
le
d
i
s
ea
s
e
m
an
ag
em
en
t
a
n
d
s
o
c
io
e
co
l
o
g
i
ca
l
f
r
am
ewo
r
k
a
p
p
li
ca
tio
n
s
wi
th
in
th
e
h
e
al
th
p
r
o
m
o
t
io
n
f
i
eld
i
s
s
ti
ll
lim
i
te
d
[
2
8
]
.
T
o
ac
h
iev
e
th
is
g
o
al,
d
ir
ec
t
a
n
d
in
d
ir
ec
t
ef
f
ec
t
o
f
i
n
tr
ap
er
s
o
n
al,
in
ter
p
er
s
o
n
al,
o
r
g
an
izatio
n
al,
co
m
m
u
n
ity
,
a
n
d
s
o
cieta
l
f
ac
to
r
s
o
n
n
o
n
-
c
o
m
m
u
n
icab
l
e
d
is
ea
s
e
m
an
ag
e
m
en
t
t
h
r
o
u
g
h
attitu
d
es
will
b
e
m
ea
s
u
r
ed
u
s
in
g
s
tr
u
ctu
r
al
eq
u
atio
n
m
o
d
elin
g
t
o
co
n
f
ir
m
th
e
r
elatio
n
s
h
ip
m
o
d
elin
g
.
SE
M
b
y
Mc
L
er
o
y
et
a
l.
[
39
]
is
u
s
ed
as
a
th
eo
r
etica
l
f
r
am
ewo
r
k
to
e
x
p
lain
th
e
in
f
l
u
en
tial
f
ac
to
r
s
to
war
d
s
n
o
n
-
c
o
m
m
u
n
ica
b
le
d
is
ea
s
e
m
an
ag
em
en
t.
Prio
r
r
esear
c
h
h
as
u
s
ed
SEM
m
o
d
el
t
o
in
v
esti
g
ate
th
e
p
o
ten
tial
d
eter
m
i
n
an
ts
o
f
h
ea
lth
[
4
0
]
.
A
c
o
m
p
ar
is
o
n
o
f
s
ev
er
al
th
eo
r
ies
an
d
m
o
d
els
th
at
ex
p
lain
h
ea
lth
b
eh
av
i
o
r
s
u
ch
as
h
ea
lth
b
elief
m
o
d
el
(
HB
M)
,
th
eo
r
y
o
f
r
ea
s
o
n
ed
ac
tio
n
(
T
R
A)
,
an
ex
ten
s
io
n
o
f
th
e
t
h
eo
r
y
o
f
p
lan
n
e
d
b
eh
av
i
o
r
(
T
PB
)
,
an
d
s
o
cial
c
o
g
n
itiv
e
th
eo
r
y
(
SC
T
)
h
as
f
o
cu
s
ed
o
n
in
d
iv
i
d
u
a
l
(
in
tr
a
p
e
r
s
o
n
al)
an
d
p
er
s
o
n
al,
b
eh
av
i
o
r
an
d
en
v
ir
o
n
m
en
tal
(
in
ter
p
er
s
o
n
al)
f
ac
to
r
s
r
ath
er
th
an
tak
in
g
in
to
ac
co
u
n
t
a
b
r
o
ad
er
o
r
h
o
lis
tic
p
er
s
p
ec
tiv
e
[
4
1
]
.
R
esear
ch
er
s
claim
th
at
t
h
ese
p
s
y
ch
o
lo
g
ical
th
eo
r
ies
em
p
h
asize
th
e
in
d
iv
id
u
al
b
y
n
o
t
e
x
am
in
in
g
th
e
wid
er
h
ea
lth
b
e
h
av
io
r
en
v
ir
o
n
m
en
t
[
4
2
]
,
[
4
3
]
.
Acc
o
r
d
in
g
to
Flay
et
a
l.
[4
4
]
,
th
e
th
eo
r
ies
ab
o
v
e
ar
e
m
o
r
e
s
u
itab
le
f
o
r
in
v
esti
g
atin
g
s
in
g
l
e
in
f
lu
en
tial
f
ac
to
r
s
in
v
o
lv
in
g
p
r
o
x
im
al
an
d
d
is
tal
f
ac
to
r
s
,
b
u
t
n
o
t
co
m
b
i
n
in
g
t
wo
o
r
th
r
ee
f
ac
to
r
s
.
Hen
ce
,
t
h
is
SEM
m
o
d
el
wa
s
ch
o
s
en
b
ec
a
u
s
e
it
is
a
co
m
p
r
eh
en
s
iv
e
m
o
d
el
th
at
in
te
g
r
ate
s
m
u
ltip
le
lev
els
o
f
i
n
f
lu
en
ce
th
at
in
ter
ac
t
in
a
b
o
u
n
d
ed
m
a
n
n
er
(
d
y
n
am
ic
t
r
an
s
ac
tio
n
s
)
with
in
th
e
s
co
p
e
o
f
h
u
m
an
life
in
th
e
en
v
i
r
o
n
m
en
t
h
elp
in
g
to
d
eter
m
in
e
a
p
e
r
s
o
n
'
s
h
ea
lth
b
e
h
av
io
r
.
T
h
e
b
u
lk
o
f
th
e
liter
atu
r
e
s
u
g
g
ested
th
at
th
e
SEM
m
o
d
el
al
lo
ws
f
o
r
th
e
u
n
d
er
s
tan
d
in
g
o
f
in
f
lu
en
ce
s
th
at
ca
n
im
p
ac
t
h
ea
lth
o
u
tco
m
es,
r
ed
u
cin
g
d
is
ea
s
e
r
is
k
s
,
p
ar
ticu
lar
ly
am
o
n
g
v
u
ln
er
a
b
l
e
p
o
p
u
latio
n
g
r
o
u
p
s
[4
5
]
,
[
4
6
]
.
I
n
ad
d
itio
n
,
th
is
SE
M
m
o
d
el
ca
n
p
r
o
v
id
e
a
g
o
o
d
u
n
d
er
s
tan
d
i
n
g
o
f
th
e
in
f
lu
en
ce
o
f
h
ea
lth
b
eh
a
v
io
r
to
r
ed
u
ce
h
ea
lth
in
eq
u
alities
am
o
n
g
lo
w
-
in
co
m
e
wo
r
k
er
s
[
1
8
]
.
A
s
tu
d
y
b
y
W
atts
et
a
l.
[4
7
]
h
as
u
s
ed
th
e
SEM
m
o
d
el
to
p
r
o
m
o
te
h
ea
lth
in
t
h
e
wo
r
k
p
lace
.
Ho
wev
e
r
,
it
w
as
f
o
u
n
d
th
at
th
er
e
is
s
till
a
lim
ited
n
u
m
b
e
r
o
f
s
tu
d
ies
th
at
co
m
b
in
es
v
ar
io
u
s
f
ac
to
r
s
f
o
r
th
e
s
tu
d
y
o
f
em
p
lo
y
ee
b
eh
a
v
io
r
in
th
e
n
atio
n
al
c
o
n
tex
t
in
Ma
lay
s
ia.
T
h
u
s
,
th
is
s
tu
d
y
p
r
o
p
o
s
es
th
at
s
o
cio
-
ec
o
lo
g
ical
f
ac
t
o
r
s
m
a
y
h
elp
in
m
an
ag
i
n
g
n
o
n
-
c
o
m
m
u
n
icab
le
d
is
ea
s
e.
T
h
e
p
r
io
r
itizatio
n
o
f
th
e
s
o
c
io
-
ec
o
lo
g
ical
f
ac
to
r
s
is
cr
u
ci
al
f
o
r
e
n
s
u
r
in
g
t
h
ese
f
ac
to
r
s
co
n
tr
ib
u
te
to
th
e
m
an
ag
em
en
t
o
f
n
o
n
-
co
m
m
u
n
i
ca
b
le
d
is
ea
s
e.
Un
d
er
s
tan
d
in
g
th
ese
f
ac
to
r
s
a
f
f
ec
tin
g
th
e
m
a
n
ag
em
en
t
o
f
n
o
n
-
co
m
m
u
n
ica
b
le
d
is
ea
s
es
wo
u
ld
also
o
f
f
er
o
r
p
la
n
u
s
ef
u
l
o
p
p
o
r
tu
n
ities
in
d
ev
elo
p
in
g
a
p
p
r
o
p
r
iate
in
ter
v
en
tio
n
s
tu
d
ies
b
ased
o
n
co
n
s
id
er
in
g
th
ese
f
ac
to
r
s
to
in
clu
d
e
a
m
o
r
e
h
o
lis
tic
p
r
o
g
r
am
to
im
p
r
o
v
e
th
e
p
r
ev
e
n
tiv
e
b
eh
av
io
r
to
war
d
s
n
o
n
-
co
m
m
u
n
icab
le
d
is
ea
s
e
m
an
ag
em
en
t
am
o
n
g
lo
w
-
in
co
m
e
w
o
r
k
er
s
i
n
Ma
lay
s
ia.
Hen
ce
,
th
e
SEM
m
o
d
el
wo
u
ld
s
ee
m
to
b
e
s
u
ited
t
o
th
is
s
tu
d
y
a
s
th
e
b
asis
o
f
th
e
b
eh
av
i
o
r
m
o
d
el
n
ee
d
ed
f
o
r
ap
p
licatio
n
s
f
o
r
r
esear
ch
an
d
i
n
ter
v
en
tio
n
.
T
h
is
s
tu
d
y
f
u
r
t
h
er
h
ig
h
lig
h
ts
th
e
p
o
ten
tial
f
in
d
in
g
s
th
at
ca
n
b
e
u
s
ef
u
l
t
o
r
elev
a
n
t
s
tak
eh
o
ld
er
s
in
clu
d
in
g
th
e
g
o
v
er
n
m
en
t,
p
o
licy
m
ak
er
s
,
an
d
h
ea
lth
p
r
o
f
es
s
io
n
als
in
u
n
d
er
s
tan
d
in
g
th
e
p
r
o
b
lem
,
s
o
lv
in
g
it,
an
d
d
e
v
elo
p
in
g
p
lan
s
,
s
tr
ateg
i
es,
an
d
p
o
licies
th
at
f
o
cu
s
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[4
7
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-
[
49
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.
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.
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