IMPROVING THE PERCENTAGE OF STUDENTS RECEIVING THEIR PSYCHOLOGY STATUS EARLY
Haymalatha R, Norhayati I, Nurul Ain MB, Ross Aniza R, Azmil I
Institut Latihan Kementerian Kesihatan Malaysia (ILKKM) Sultan Azlan Shah, Perak.
TABLE OF CONTENTS
INTRODUCTION
The current practice in the ILKKM setting is that only students referred to the counselling unit are being assessed manually for mental state periodically by the counsellor, which is time-consuming, burdensome, and delayed in producing results—causing delay in students getting their slots for therapy.
According to Fauzi et al. (2021), the prevalence of anxiety, stress and depression among health science students is 66 to 74 %.
Timely detection and management of mental health disorders among students are essential to safeguard public health.
1. SELECTION OF OPPORTUNITIES FOR IMPROVEMENT
Delay in providing service for the needy students based on their psychological status
Effectiveness
A low percentage of compiling student’s psychological level using the manual DASS-21 early
Long-waiting time (32 days) for psychological status causing
uncertainty among students
Possibility of
students feeling
unsafe because of their unknown
mental health
status.
A high percentage
of students received their psychological status late.
Method
5W1H
Who is affected?
Students of Allied Health Science
5 W
1 W
2 W
4 W
1 H
3 W
Why does the problem happen?
Lack of manpower,
do not have simplified
method to assess student
When does it happen?
During academic phase
Where does it occur?
Institut Latihan Kementerian Kesihatan Malaysia, SAS
What is the actual problem?
Notification of psychological
assessment of 484 students delayed to 32 days.
How does it happen?
The task to assess all student in a short period of time
BRIEF DESCRIPTION OF CONTEXT
Training can become stressful because student’s first
experience with a patient, thus require a continuous
assessment of mental health throughout their training period
(Beiter et al., 2015).
Problem chosen based on S.M.A.R.T. approach
Table 1: Problem chosen based on S.M.A.R.T approach
108
Problem analysis chart
Causes of delay in Delivering the psychological status | Frequency, n | Percentage | Cumulative frequency | Cumulative Percentage |
Usage of manual questionnaire | 230 | 46% | 230 | 46% |
Time constraint | 170 | 34% | 400 | 80% |
Access problem for students | 70 | 14% | 470 | 94% |
Shortage of human resource | 30 | 6% | 500 | 100% |
Figure 1 : Pareto Chart –
Causes of delay in delivering
the psychological status
Causes of delay in Delivering the psychological status | Frequency, n | Percentage | Cumulative frequency | Cumulative Percentage |
Manual calculation | 130 | 26% | 130 | 26% |
Longer delivery time | 120 | 24% | 250 | 50% |
High cost - paper | 90 | 18% | 340 | 68% |
High cost - photostat | 80 | 16% | 420 | 84% |
Missing data | 60 | 12% | 480 | 96% |
Student attitude | 10 | 2% | 490 | 98% |
Staff issue | 10 | 2% | 500 | 100% |
Figure 2 : Pareto Chart –
Causes of delay in delivering the psychological status
Problem statement
A manual psychological assessment
consists of 3 sub-scale-depression,
anxiety & stress, conducted from
ILKKMSAS) revealed 96.8% of
Students received their psychological assessment done >3 working days
Problem
Multiple factors including manpower,
information system collaboration, attitude
and current working culture may contribute
to this problem.
The intervention delay will affect student’s
therapy plan, deterioration of student’s
psychological status, affecting academic
performance from the study.
Effects
This study aims to improve the percentage
of students receiving the psychological
assessment early by the counsellor.
The aim of the study
Cause
General objective
The main objective is to improve the percentage of
students receiving the psychological assessment early
Specific objective
1. To verify the percentage of students who receives their psychological status more than three working days.
Specific objective
of students receiving their psychological
assessment results.
Specific objective
Specific objective
4. To evaluate the effectiveness of the transformation in assessing student’s psychological status early.
Blue
Definition of terms
Students
The students enroll for a 3-year programme at the College of Allied Health Sciences Sultan Azlan Shah.
The basic programmes are
Diploma of nursing,
Diploma of Medical Assistant,
Diploma of Pharmacy and
Certificate of Public Health.
Receiving their psychological status
Psychological status comprising depression, anxiety and stress in a
3-piece assessment. The DASS-21 is adapted from Lovibond & Lovibond (1995)
Early –
1 working day
Background – Evidence to support choice of the measures
Evaluation of the psychometric properties in Bahasa Malaysia DASS-21 among non-Malaysia in Malaysia revealed good reliability and validity, implying the scales can be used in a multi-ethnic population in Malaysia.
(Ramli et al., 2012; Musa & Maskat, 2020).
A cross-sectional study - UiTM Puncak Alam, Malaysia, 478 (Medical Lab Sciences, Medical Imaging, Nursing) Self-administered DASS-21 questionnaires - students to be filled up within 20 minutes
(Fauzi et al., 2021)
2. KEY MEASURES FOR IMPROVEMENT
2. Comprehensiveness
Good indicators required for the improvement for Web-based DASS-21
1. Specificity
-Screen based questionnaire
-auto-generated results in
3 mins
3. Reliability
4. Validity
5. Feasible to get data
6. Acceptable
students & staff
Manual DASS-21
16 students = 1 working day
500 students = 32 working days
1 working day
More than 1 working day
INDICATOR AND STANDARD
3. PROCESS OF GATHERING INFORMATION
01
- Cross-sectional
Study design
Study setting
Population
Sample size & technique
Time Frame
Instrument
Inclusion & exclusion criteria
02
500 students
Universal sampling
03
5 months
(Mac – July 2021)
04
05
Inclusion: All basic students (4 courses) registered
Exclusion: Unwell during study period
4. ANALYSIS AND INTERPRETATION
Finding: Comparison between percentage of students who receives their psychological status using Manual and Web-based DASS-21 results
4. ANALYSIS AND INTERPRETATION
The contributing factors to the delay of students receiving their psychological assessment results.
32 working days
4. ANALYSIS AND INTERPRETATION
The Quality Assurance
project team managed to
create a web-based DASS-21
The implementation of transformation approach obtaining students’s psychological status early.
4. ANALYSIS AND INTERPRETATION
The effectiveness of the transformation is assessing student’s psychological status early.
The effectiveness of the transformation is assessing student’s psychological status early.
Cost in RM
Cost in RM
Cost in RM
Cost in RM
Differences in cost of Electricity
Differences in cost
of Utility
Differences in staff wages
Differences in cost of Photostat
Findings
i. Time taken to obtain a result from the Manual DASS-21 is 32 days.
ii. The problem does not immediately address the issues of students suffering from stress, anxiety and depression.
iii. Web-based DASS-21 – result in 1 working day.
iv. The counselor could plan the therapy for the students within 3 working days and fulfill the key performance index.
v. Save operational cost for 500 student = RM3250.20 period of 5 years
5. STRATEGY FOR CHANGE
Figure 5.1: Psychological status assessment Figure 5.2: Psychological status assessment
flowchart – Manual DASS-21 flowchart – Web-based DASS-21
5. STRATEGY FOR CHANGE
Quality Assurance
Project Team ILKKMSAS
Psychology Officer
(Counselling)
Assistant Information
Technology Officer
Allied Health
Science Tutors
1
4
1
Facilitator
1
Director
Of
ILKKMSAS
6. EFFECTS OF CHANGE
Figure 6 : Illustrates effects of change on ABNA
The changes or innovation lead to improvement.
Percentage increased from 3.2% in phase 1, improved to 100% in phase 2
Achievable benefit not achieved (ABNA) was improved from 86.8% to 100% finally.
- Reduced the time duration from 32 working days to 1 working day & maintain the higher percentage of student’s psychological assessment
6. EFFECTS OF CHANGE
6. EFFECTS OF CHANGE
Save Time:
From 32 working
days) to 1 working day with an
auto-generated
results by the
web-based system
Shorten time for analyse & delivery of Dass-21 results to respondents
32 working days
MODEL OF GOOD CARE
Process | Criteria | Standard |
| Cycle 1 Pre- Remedial | Cycle 2 Post Remedial | ||
% | Time | % | Time | % | Time | ||
Staff make sure Screening tools available | Psychology officer/Course-coordinators must inform students to respond DASS-21 | 100% | ≤ 1 hour | 100% | 30 min | 100% | 2 seconds |
Psychology officer / Course –coordinators identify the respondents | Ensure the students for psychological assessment were selected and are informed. | 100% | 15 seconds | 100% | 10 min | 100% | 13 seconds |
Psychology officer / Course-coordinators prepare DASS-21 | Psychology officer / Course-coordinators explain the rules & regulations of using DASS-21 | 100% | 30 seconds | 100% | 280 min
| 100% | 30 second
|
Students to fill up DASS form | Psychology officer / Course-coordinators gives gentle reminder | 100% | 30 minutes | 100% | 40 minutes | 100% | 13 minutes
|
Psychology officer receive the DASS form | Psychology officer checks the result | 100% | ≤ 3 working days | 3.2%
96.8% | 1 working day
32 working days | 100% | 1 working day
|
Year | Manual DASS-21 (RM) | Web-based DASS-21 (RM) | Saving (RM) |
Year-1 | 56,200.00 | 10,549.00 | 44,650.20 |
Year-2 | 110,400.00 | 2.40 | 110,397.60 |
Year-3 | 165,600.00 | 4.80 | 165,595.20 |
Year-4 | 220,800.00 | 14.40 | 220,785.60 |
Year-5 | 276,000.00 | 24.00 | 275,976.00 |
Year-1 Year-2 Year-3 Year-4 Year-5
Saving operational cost for analyse & delivery of Dass-21 results to respondents
Table 1: Saving of operational cost-the differences between Manual DASS-21 and Web-based
DASS-21 for 5 years
6. EFFECTS OF CHANGE
6. EFFECTS OF CHANGE
Psychology officer and students’
satisfaction on change.
Pie Chart on cause effect on delay result of psychological status
Before getting appointment
Fearful
289 (60%)
Worrisome 168 (35%)
Poor Focus
32 (5%)
6. EFFECTS OF CHANGE
Web-based DASS-21 innovation clearly shows improvement in standard of student counseling.
Mental health issues are a serious problem that needs to be apprehended early by the Training Management Division, MOH.
Ensure the wellness of the students are in good condition that required to be in a healthy state of mind – health care service in future.
Achievement
Learning
EFFECTS OF
Change
01
02
03
04
05
06
Students’ preferred confidentiality
Analyze & ranging the severity of psychological status in 3 minutes
Students received their psychological assessment in 3 minutes
Counselor can plan early counselling / therapy & referral
Web-based cater for large group of students
Reduce cost – wages, paper, photostat, electricity
6. EFFECTS OF CHANGE
7. THE NEXT STEP
The Web-based DASS-21 will be
implemented throughout ILKKM in Malaysia
All students enrolled in ILKKM will have to undergo mental state assessment throughout their study period.
The study was presented to the Committee of Quality in Training Management Division in August 2022.
8. VISION, MISSION, OBJECTIVES
REFERENCES
Amir Hamzah, N.S.; Nik Farid, N.D.; Yahya, A.; Chin, C.; Su, T.T.; Lekhraj Rampal, S.R.; Dahlul, M. (2019). The prevalence and associated factors of depression, anxiety and stress of first year undergraduate students in a public higher learning institution in Malaysia. Journal of Child and Family Study, 28, 3545–3557. Retrieved from https://link.springer.com/article/10.1007/s10826-019-01537-y
Fauzi, M. F., Anuar, T. S., Teh, L. K., Lim, W. F., James, R. J., Ahmad, R., … Salleh, M. Z. (2021). Stress, anxiety and depression among a cohort of health sciences undergraduate students: The prevalence and risk factors. International Journal of Environmental Research and Public Health, 18(6), 1–14. https://doi.org/10.3390/ijerph18063269
Kementerian Kesihatan Malaysia. (2020). Kursus Pra Perkhidmatan Anggota Sains Kesihatan Bersekutu (Separa Perubatan) Kementerian Kesihatan Malaysia: Retrieved from: https://www.moh.gov.my/moh/resources/kerjaya/DIPLOMA_KEJURURAWATAN.pdf [September 9, 2021]
Lovibond, P.F.; Lovibond, S.H.(1995).The structure of negative emotional stress: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and AnxietyInventories. Behaviour. Res. Therapy. 33, 335–343. Retrieved from https://pubmed.ncbi.nlm.nih.gov/7726811/
Ramli, M.; Mohd Ariff, F.; Nora, M.; Rosnani, S.; Aidil Faszrul, A.; Musa, R. (2012). Psychometric properties of Bahasa Malaysia version of the Depressive Anxiety and Stress Scales 42-item (DASS-42), 19, 21–22. Retrieved from http://www2.psy.unsw.edu.au/Groups/Dass/Malaysian/Ramli_DASS42_MJP.pdf
Regmi, P. R., Waithaka, E., Paudyal, A., Simkhada, P., & van Teijlingen, E. (2016). Guide to the design and application of online questionnaire surveys. Nepal journal of epidemiology, 6(4), 640–644. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506389/
Acknowledgement
Gantt chart
Checklist
Checklist
Checklist
Checklist