Abstract
Background: Ibadah Friendly Hospital (IFH) program was officially introduced by the Ministry of Health
Malaysia (MOH) in 2014. The program is a paradigm shift from a secular paradigm into a tauhidic paradigm in which a holistic approach in treating Muslim patients is applied. The IFH program in Al-Islam Specialist Hospital was officially launched in 2006. It has been more than 15 years since the hospital has implemented this program. Therefore, the objective of the study was to assess level of knowledge, attitude, and practices(KAP) towards Ibadah Friendly Hospital (IFH) program among healthcare practitioners at Al-Islam Specialist Hospital.
Methods: A cross-sectional study was conducted among healthcare practitioners to assess knowledge, attitude and practices towards IFH program. Data was collected through self-developed questionnaries from middle of January to middle of March 2023 and was analyzed by using Microsoft Excel and SPSS version 19. Scalar scoring method was employed to analyze the collected data and then Bloom’s cut-off point was used to categorize the scores as high, moderate or low for knowledge, positive, neutral or negative for attitude, and good, moderate or low for practices associated with IFH program.
Results: A total of 44 healthcare practitioners participated in the study with 67 % response rate. The findings revealed that 100% of the healthcare practitioners at the Al-Islam Specialist Hospital are having high-level of knowledge and positive attitude towards Ibadah Friendly hospital (IFH) program. 97.7% of th respondents showing good practices and only 2.3% showing moderate practices associated with IFH program.
Conclusion: The results highlight majority of the healthcare practitioners were having high level of knowledge, positive attitude and good practices associated with IFH program. Nevertheless, there is one area regarding the knowledge, attitude and practices associated with IFH program has to be improved among Al-Islam Specialist Hospital’s healthcare practitioners. Based on the results of this study, to maintain high level of knowledge, attitude and practices among the healthcare practitioners, continuous mandatory trainings and courses on IFH programs as well as other appropriate interventions shall be conducted by the Academy of IFH. Further study shall be conducted among the non-clinical employees at this hospital so as to identify the overall level of KAP of the hospital’s employees towards IFH program.
Introduction
The healthcare sector in Malaysia continues as one of the
crucial domains in the country today. Its healthcare
system is divided into two highly developed sectors: a
government-led and tax-funded public sector, and a
thriving private sector. The Islamization of Malaysia
healthcare services as a form of ibadah and
institutionalization of Islamic values in medical field
began in the early 1980’s (Sinanović, 2012). The initial
effort in instilling Islamic values was on female awrah
which refers to any body part of women body that is
prohibited from being revealed to other man or woman. It
then followed by integration of Islamic values in the
medical curriculum. This innovative step to islamize the
medical curriculum consists of two separate but closely
related components that is Islamization and legal
medicine (Kasule, 2009). These efforts were further
expanded with the introduction of Ibadah Friendly
Hospital (IFH) program by the Ministry of Health
Malaysia (MOH) in 2014. This initiative stemmed from
the Islamic Hospital of Jordan (Ishak et al, 2021″)
Nevertheless, the term “IFH” was first use by Hospital
UniversitiSains Malaysia (HUSM), a government
teaching hospital in Penang in 2004 in its effort to
integrate Islamic values in the hospital operation
(Ministry of Health Malaysia, 2020). New Straits Times
(2016) reported that there are many major hospitals
nationwide both public and private hospitals have been
recognized as IFH for providing facilities and guidance
for patients to perform their ibadah while receiving
treatments. Hospital Tengku Ampuan Afzan in Pahang,
Hospital Banting in Selangor, Hospital Tawau in Sabah,
and Hospital Jasin in Melaka to name a few are among
the public hospitals that are recognized by MOH and
JabatanKemajuan Islam Malaysia (JAKIM) as the IFH.
Among private hospitals that rendered their services
under IFH are Al-Islam Specialist Hospital, Hospital
PUSRAWI, Pusat Rawatan Islam Ar-Ridzuan and
Hospital Az-Zahrah.
IFH program is a concept used in hospital management to
achieve excellence and self-identity among hospital
employees as well as focusing on the well-being of
patients through the application and appreciation during
and after treatment. The aim of IFH program is to
provide awareness through patient and family education
to be closer to Allah SWT. The program is a paradigm
shift from a secular paradigm into a Tauhidic paradigm
which a holistic approach in treating Muslim patients is
applied which encompasses of physical, psychological,
mental and spiritual aspects. The IFH concept and
program are guided by Al-Quran and Sunnah, Maqasid al-Sharī`ah, Qawaid al-Fiqhiyaah, and concepts of
rukhsah and dharurat. Practicing medicine is a
profession and also a social obligation towards seeking
the pleasure of Allah are the thrust of IFH program
(Rahman, Zailani& Musa, 2018). In summary, the
objectives of IFH are: (1) towards achieving
Mardhatillah (acceptance of Allah SWT); (2) aiming for
success in this world and hereafter; (3) treating and
managing patients using a holistic approach; (4) assisting
employees, patients and relatives to be closer to Allah
SWT; (5) helping and guiding patients, employees and
their family to perform ibadah especially salat (prayer)
(6) providing the best services to the ummah (society);
(7) application of work as ibadah and amal; and (8)
hospital as a platform for dakwah
Al-Islam Specialist Hospital, Kuala Lumpur was
established in 1996 with total conviction to become an
excellent Islamic hospital and as a dakwah center. Its
establishment was directly related to the impressive
achievement and performance of Islamic Hospital in
Jordan in term of their facilities, clinical achievement,
and implementation of Islamic values in the hospital
management. The IFH program was officially launched
by Al-Islam Specialist Hospital in 2006. The
implementation of IFH program in Al-Islam Hospital is
more inclusive and comprehensive in which it is not
limited to provision of facilities, assistance, and guidance
for patients to perform their ibadah but also extended to
the manner in which the hospital is managed.
The IFH program provides a platform to strive for
mardhatillah by the Al-Islam Specialist Hospital’s
healthcare practitioners, patients, and visitors. Hence, as
part of the Dakwahbil Hal, the hospital management has
taken a proactive role to assimilate and instill the IFH
concept at every opportunity and level available. Every
Al-Islam Specialist Hospital employee was given the
awareness of their responsibilities not only as a Muslim
employee who perform his/her duties but also as a “daei
whose role is to disseminate knowledge and preaching in
his/her respective areas of work and considers his/her
work as ibadah. In line with these aspirations, various
programs and activities were initiated and organized
internally such as Islamic Social Responsibility (ISR),
Usrah, Tazkirah, daily Quranic reading, and Key
Performance Index (KPI). Externally, Al-Islam Specialist
Hospital has initiated and shared the IFH concept
programs with many hospitals locally and abroad, both
private and public hospitals since 2006. The awareness
campaign on IFH program consisted of many seminars
and workshops. Since then, many hospitals affiliated to
the Federation of Islamic Association Members (FIMA) especially those in Pakistan and Nigeria have adopted
IFH as their core program and some have refined the
program further (Ishak et al, 2021 a).
The implementation of IFH program in Al-Islam
Specialist Hospital covers nine (9) elements that have
become the Standards in IFH as mentioned below:
Hospital Policy of Implementing IFH:
The policy of the hospital is based on IFH and good
values are integrated and assimilated in the hospital
administration. Next, the vision and mission of the
hospital must take into consideration the IFH program
towards achieving excellent hospital services. All
stakeholders must ensure IFH becomes an integral part of
the hospital’s policy.
Organization Structure:
The establishment of an IFH Committee with specific job
scope and organizational chart shall reflect IFH
aspiration. Hospital Director and senior members of the
hospital management are directly involved in the IFH
Committee. It is important to establish a spiritual
Department or a Chaplaincy Department in ensuring the
successful implementation of IFH program. The IFH
Committee has to conduct regular meetings at least four
times a year and report must be submitted to the hospital
management.
Culture in IFH:
In general, the culture in IFH is comprised of good values
namely itqan, ikhlas and ihsan. Specific culture such as
culture of smiling and salam are practices not only
towards patients but also among the employees.
Recitation of Bismillah/Alhamdulillah/Insha’ Allah by all
employees at appropriate time such as before or during or
post procedure become a norm. As part of awareness and
promotion efforts about the IFH culture, campaign,
poster and banner are made available at designated areas
in the hospital. Continuous monitoring on the practices
and assimilation of this culture is conducted periodically.
Human Resource Management:
Basic training focuses on the awareness about IFH
program is implemented for all employees. Other
relevant programs and basic trainings on IFH are also
conducted for them. On top of that, manual for basic training in IFH is also
prepared. In ensuring sustainability of the program
regular monitoring is made available.
Facilities for IFH:
Ibadah facilitation is further strengthened through the
provision of ibadah facilities such as qiblah direction
clean area, booklet on ibadah guidelines for patients,
bottle spray, tayammum powder, and audio visual for
prayer reminder. Furthermore, patients’ attire during
delivery or procedure and surgery as well as in ward shall
cover the awrah. Separate rooms or wards for different
gender are also provided.
Standard Operating Procedures(SOP) in IFH
There are general SOPs on the assimilation of good
values at all levels that reflects good character or akhlaq
SOPs in all clinical settings including orientation for new
admission, pre and post procedures are to be followed in
day-to-day running of the hospital. In addition, there
shall be a chaperone for patient who seek treatment from
medical employee of the opposite gender. SOPs in
guiding and assisting patients to perform ibadah are also
made available.
Dignity of Patients and Employees
Dignity of patients and employees is cared for such as in
the case of ECG and catheter are to be performed by
same gender. In addition, awrah of patients in the
operation theatre or delivery room must follow the
Sharī`ah guidelines.
KhusnulKhatimah:
Chaplain services is established which comprised of
talqin services and spiritual support for patients and
relatives. Besides that, it also offers assistance in
preparing a will (wasiat) for the family as well as
assistance for the funeral arrangement.
Quality Management:
The implementation of IFH is monitored by the Quality
Committee. In the effort to ensure quality of the IFH
program is the priority, there is also internal and external
audit exercises. On top of that, patient’s feedback
regarding the IFH program in the hospital is obtained
through provision of QR code that has been made
available at many areas in the hospital. Scheduled
monitoring of the programs is developed to ensure the
smooth running of the program and to identify loopholes
in its implementation.
Problem Statement
In the Malaysian context, much of the research published
on the IFH program and its implementation are either
conceptual papers or literature review or review papers.
Hammad et al (2018) published a literature review on the implementation of IFH in Malaysian Islamic Hospital
Consortium (KHIM) meanwhile Ishak et al (2021) and
Ishak et al (2021)b published conceptual papers on IFH
and Islamization of health services through IFH. A paper
presented at the Conference Proceeding such as by Mohd
Ariff et al (2021) was centred on the framework of an
IFH. Other related study on IFH was focusing on service
quality in Muslim Friendly Private hospitals (Azman et
al, 2021). Norwina et al (2012) conducted a qualitative
approach of literature reviews on what makes a hospital
with a “soul” or Ibadah Friendly. Mohammad Aizat,
Betania, MohdAnuar, and Muhammad Hadi (2019)
carried out a study on the concept and framework of
Muslim Friendly hospital in Malaysia pertaining to
Shariah compliance meanwhile NurHidayah, Zurina, and
Zainal, (2019) conducted a case study on the adoption of
Shariah-based and Muslim friendly practices at the
selected medical tourism hospitals in Malaysia. On the
other spectrum, Shaharom& Abdul Rahman (2016)
Majdah& Khadijah (2017) and Shaharom, Shahimi, and
Roslan (2019) were focusing on the Shariah compliant
healthcare services in Malaysia. In addition, there are
qualitative research related to IFH that is on the
implementation of spiritual guidance, for example a
study by Muhammad Faisal, MohdZainuddin, and
SitiJamiah (2020) and Muhammad Faisal, SitiJamiah and
Norhisham (2020) as well as a conceptual paper on
Muslim Chaplaincy in IFH by Surina, MohdZulkifli,
NurulAisyah, Izzati, and Ishak (2021).
There is limited empirical research and scientific data on
the level of knowledge, attitude, and practices (KAP)
related to comprehensive implementation of the IFH
program. Most research conducted on KAP in IFH was
mainly focused on performing salat (prayers) among
Muslim patients in public hospitals. For instance, Abdul
Hadi et al (2013) conducted a KAP study among in-ward
patients in selected public hospitals such as Queen
Elizabeth Hospital, Sabah, SultanahNurZahirah,
Terengganu, and BatuPahat Hospital, Johor. Muhammad
Shamsir et al (2015) also conducted a KAP study on
performing salat (prayers) among Muslim patients in a
public hospital in Langkawi, Kedah. There is however
quantitative research conducted on the effectiveness of
the IFH course among the hospital staff which include
doctors, nurses, assistant health officers, medical
assistants as well as non-clinical employees. The two
research were also carried out in the selected public
hospitals in Pahang with the focus also on prayers (salat)
for sick patients (Kow et al, 2019; Kow et al, 2020).
As per the above discussion, there is a dearth of research
on KAP towards Ibadah Friendly Hospital (IFH)
program among healthcare practitioners at the private hospital. Thus far, Noor Azizah (2019) conducted an
empirical study on KAP towards the comprehensive
implementation ofIFH program among selected
employees at the public and private hospital in Malaysia.
Furthermore, in the case of Al-Islam Specialist Hospital
the IFH program is not new among its employees. It has
been more than 15 years since the hospital has
implemented this program. Therefore, it is deemed
necessary to examine the knowledge, attitude, and
practices towards IFH program among its healthcare
practitioners. Hence, this study was conducted to gain
some insights and current situation with relation to IFH
program at this hospital. Identifying existing knowledge,
attitude, and practices (KAP) towards among healthcare
practitioners at Al-Islam Specialist Hospital is a first key
step to further refine a successful IFH program
implementation. The findings will be able to assist
hospital administration to strategize and design specific
intervention with regards to the possible areas for
improving the practices of the program. The information
and understanding on this matter would not only the benefits
the Al-Islam Specialist Hospital but would also benefit
and be replicated by other Ibadah Friendly Hospitals in
Malaysia.
METHODOLOGY
Study setting and design
This study design was quantitative and cross-sectional
conducted from the middle of January to the middle of
March 2023 among Al-Islam Specialist Hospital’s
healthcare practitioners.
The study population of this study were 66 healthcare
practitioners consisted of medical specialists, medical
officers, nurses, medical assistants and caregivers whose
job responsibility is directly involved with patient care
and/or provide treatment to patients.
Only those who were under the category of healthcare
practitioners and agreed to participate were involved in
this study.
Questionnaire Design
The study was conducted using a self-developed
questionnaire through an extensive literature review and
a face-to-face interview with the experts of the IFH
program at the hospital.
The questionnaire was designed to capture the knowledge
(K), attitude (A), and practices (P) towards the IFH
program among the healthcare practitioners. The content,
rationality and validity of the questionnaire were assessed
and validated using the opinions of experts of the IFH
program at the Al-Islam Specialist Hospital. The
reliability of the questionnaire was calculated using
Cronbach Alpha value of 0.836. The questionnaire was
designed in Bahasa Malaysia, a national language where
all respondents were well-versed.
The questionnaire consists of four (4) sections. Section A
of the questionnaire comprised of five (5) questions
about demographic profile of the respondents namely
gender, age, education levels, current position and
duration working at Al-Islam Specialist Hospital. The
remaining sections consists of (a) questions related to the
knowledge level of the healthcare practitioners towards
the IFH program (Section B), (b) questions related to the
attitude towards IFH program (Section C) and (c)
questions that evaluate the practices associated with IFH
programs (Section D).
Data Collection method
Questionnaires were distributed to healthcare
practitioners at the Al-Islam Specialist Hospital at
various wards and departments in order to obtain
responses from a wide range of healthcare practitioners at
the hospital. Questionnaires were uploaded through
Google Surveys and disseminated by forwarding web
page link through social media outlet such WhatsApp
and also through staff emails. Participation was voluntary
and all respondents were kept anonymous. In addition,
follow-up was done twice to ensure good response rate.
Data analysis and interpretation
Collected data was compiled and keyed-in into the excel
sheet after it was thoroughly checked, cleaned and coded
before it was entered into SPSS version 19. The study
findings are explained in words, tables, and other
statistical summary techniques.
In the knowledge and practices sections (Section B and
D), respondents were asked to choose “yes” or “no”
options. In the attitude section (Section C), respondents
were also given two (2) choices of answer based on 2
Likert scale from 0 to 1 (agree and disagree).
The analysis of these sections was done on the basis of a
scalar-scoring method. 1 point was given for correct
response and 0 point is given for wrong response. The
scores for knowledge, attitude and practices were
calculated as percentage scores by dividing the total
correct answers by the respondents with the maximum
scores multiplied by 100.
Bloom’s cut off point was then used to categorise as high
level of knowledge if the sum score was between 80% to
100%, moderate level of knowledge if the sum score was
between 60% and 79%, and low level of knowledge if the
sum score was less than 60%. In the attitude section
(Section C), sum score between 80% to100% was
categorized as positive attitude, sum score between 60%
and 79% was categorized as neutral attitude and sum
score less than 60% was categorized as negative
attitude.Similarly, for practices, sum score between 80%
to 100% was categorized as good practices, sum score
between 60% to 79% was categorized as moderate
practices and sum score less than 60% was categorized as
low practices.
Ethical consideration
This study was conducted after approval from the Al
Islam Specialist Hospital’s administration was granted.
Data was kept confidential and consent to participate in
the study was obtained from the respondents after
permission to conduct the study was given by the hospital
administration.
RESULTS
Demographic characteristics of healthcare
practitioners:
A total of 47 questionnaires were received, however only
44 were usable for this study yielding a 67% response rate
rate. Table 1 reveals demographic characteristics of the
respondents. Out of 44 respondents, 39 were female (88.6%)
%) and 5 were males (11.4 %). The majority of the
respondents were between the ages 20 – 30 years (15,
34.1%).
Thirteen (29.4%) respondents were 31-40 years , 9
(20.5%) respondents were aged between 41 – 50 years.
4(9.1%) respondents were 51-50 years and 3 (6.9%) of
the respondents were aged 60 years and above.
Most respondents were diploma holders 30 (68.2%), while 6(13.6%) were Bachelor degree and Malaysian
Certificate of Education holders and only 2(4.6%) of the respondents were Master degree holders. Among the
included respondents, 25(56.8%) were nurses, 9(20.5%) were medical assistants, 3(6.8%) were medical
officers, and 1(2.3%) was a medical specialist. The remaining included 1(2.3%) dietician and 5(11.3%) others.
The highest number of the respondents have been working at Al-Islam Specialist Hospital for 1-5 years (27.3%), followed by 9 for less than a year (20.5%), 8 for 11-15 years (18.1%) and 6 for 5-10 years (13.6%)
Five respondents have been working for 15-20 years (11.4%) and 4 (9.1%) have been working for more than 20 years in the hospital.
Knowledge on IFH program among healthcare practitioners: The frequency distribution of respondents’
knowledge towards IFH program is presented in Table 2a.
The total score for this section is 15 and the mean score for knowledge among 44 healthcare practitioners is 14.52
(±0.567). 61.4% (27/44) of the respondents are above mean score. The lowest score value for among the respondents
are on the official introduction of Ibadah Friendly Hospital (IFH) program by Ministry of Health Malaysia in 2014
(88.6%, 39/44) and provision of facilities for HusnulKhatimah is part of the Ibadah Friendly Hospital (IFH) program
(86.4%, 38/44). Based on Bloom’s cut off point as shown in Table 2b, all of the respondents (44, 100%) were having
high level of knowledge on IFH program.
Attitude on IFH program among healthcare practitioners: Findings regarding the frequency distribution of
respondents’ attitude on IFH program are presented in Table 3a.
The total score for this section is 15 and the mean score for attitude among 44 healthcare practitioners is 14.43
(±0.837). 63.6% (28/44) of the respondents are above mean score. The lowest score value among the respondents is
opinion on whether patients who do not follow doctors and/or nurses’ instruction shall be advised (81.8%, 36/44).
Based on Bloom’s cut off point as depicted in Table 3b, all of the respondents (100%, 44) were having positive
attitude towards IFH program.
Practices associated with IFH program among healthcare practitioners:Table 4a shows the frequency distribution
of respondents’ practices associated with IFH program. The total score for this section is 15. The mean score for
practices among 44 healthcare practitioners is 14.61 (±0.859). 77.3% (34/4) ) of the respondents are above the mean score. The lowest score value among the respondents is on giving advice to patients who do not follow doctors and/or
nurses’ instruction (86.4%, 38/44).
Based on Bloom’s cut off point as presented in Table 4b, 97.7% (43) were having high practices associated with
program and only 2.3% (1) was having moderate practices associated with IFH program.
DISCUSSION
This preliminary study offers information on the
knowledge, attitude and practices associated with IFH
program among the healthcare practitioners at Al-Islam
Specialist Hospital. In this study, the overall response
rate of 67% is considered high with respect to online
surveys and at an individual level of analysis. This is
supported by a meta-analysis on response rates of online
surveys in published research by Wu, Zhao and Fils
Aime (2022) found that the average online survey
response rate is 44.1%. A study by Holtom et al. (2022)
also found that response rates for journals that focus
primarily on the individual level of analysis was almost
universally near or above 70%. A higher response rate
for this study was also contributed to by a clearly defined
and refined population and using phone calls as
reminders to participants.
Generally, knowledge, attitude and practices are key
components of behavioral change models. According to
the theory of KAP (knowledge, attitude and practices),
knowledge refers to understanding and using of
information of any given topic, attitude refers to feeling
or reaction towards that given topic (Ajzen&Fishbein,
2000), and practices refer to the ways in which the
knowledge and attitude are demonstrated
(Kaliyaperumal, 2004; Bano et al., 2013). Previous
studies have identified interconnections between
knowledge, attitude and practices (e.g., Hungerford &
Volk,1990; Valente, Paredes & Poppe,1998; Muhammad
Shamsir et al (2015); Soyam et al., 2017; Monje et al.,
2020; Lee, Kang & You, 2021; Sagar et al., 2022).
In this study, estimating the level of respondents
knowledge on IFH program was divided into three levels namely high level of knowledge, moderate level of
knowledge and low level of knowledge. The results of
the current study showed that 100% (44) of the
respondents had high level of knowledge on IFH
program. This is due to adequate information sharing and
trainings related to IFH program were provided by the
organization.
In this study, the respondents’ attitude towards IFH
program was assessed as having a positive attitude a
neutral attitude and a negative attitude. All 44 of the
respondents (100%,) showed a positive attitude towards
the IFH program. Continuous training and a supportive
working environment towards the program have nurtured
a positive attitude among the healthcare practiotiners.
In this study, the level of practices associated with IFH
program was measured as having good practices,
moderate practices and low practices. The current study
demonstrated that a significant number of respondents 43
(97.7%) having good practices associated with IFH
program and only 1 (2.3%) of the respondents having
moderate practices associated with IFH program. This
could be explained by the fact that some of the
respondents are working less than a year and have not
been confirmed in their job position.
Based on the results of this study, to maintain high level
of knowledge, attitude and practices among the
healthcare practitioners, continuous mandatory trainings
and courses on IFH programs for all healthcare
practitioners are to be conducted by the Academy of IFH.
Annual lectures, seminars, webinars and workshops on
IFH for all its healthcare employees can also be
organized by the Academy of IFH.
In addition, attention should also be paid to one of the
aspects of attitudes and practices of the healthcare
practitioners that were found to be deficient including
giving advises to patients who do not follow doctors
and/or nurses’ instruction. Trainings and courses on IFH
should include interpersonal communication skills in the
effort to develop effective communication with patients.
The main limitations of this study are threefold. The first
limitation is that knowledge questions were based on
certain important areas of knowledge and do not
represent the overall knowledge about IFH programs
Secondly, this study only relied on a self-administered
questionnaire which may contribute to response bias.
Finally, due to time-constraints, most of the respondents
especially medical specialists were unable to participate
in the current study.
CONCLUSION
In conclusion, good knowledge, attitude and practices
towards IFH programs are important factors in
determining the success of IFH program at IFH hospitals.
The findings suggest that the majority of the healthcare
practitioners at Al-Islam Specialist Hospital have a high
level of knowledge, positive attitude and good practices
associated with IFH program. However, one aspect of
attitudes and practices of the healthcare practitioners
were found to be deficient. Therefore, continuous
training and other effective interventions are required to
maintain desirable level of KAP among the healthcare
practitioners towards IFH programs. Further studies
should focus on level of KAP among non-clinical
employees in order to understand the overall KAP among
Al-Islam Specialist Hospital’s employees.
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