Scale of adherence to post–sharps injury follow-up services among healthcare workers is uncommon compared to medication adherence scale. To develop a novel and culturally adapted scale, stakeholders should be consulted to specify dimensions by deducing it from the existing framework. This study was to demonstrate how health stakeholders were consulted to specify the dimensions.

This study employed two sessions of Nominal Group Technique. Each session consisted of 12 purposive-sampled mixed participants i.e., healthcare managers and providers. A four-step sequential protocol was used for collecting participants’ key ideas on what adherence factors in post–sharps injury follow-up services: silent idea generation, round-robin collection, idea clarification, and ranking. Similar ideas were clustered and coded with an appropriate group theme and categorized it into subdimensions. Results: A total of 116 key ideas, yielding 13 and 10 themes in session 1 and 2, respectively. Those themes were coded into 16 sub-dimensions affecting adherence. They were distributed under five emerged dimensions in decreasing order of relative importance: (a) healthcare team and system-related factors; (b) patient-related factors; (c) therapy-related factors; and (d) condition-related factors. These findings guide researchers in developing culturally adapted items for measuring the level of adherence to post–sharps injury follow-up services.


nominal group technique, qualitative research, healthcare workers, dimensions affecting adherence, sharps injury

Author Bio(s)

The first author, Abdullah Aliff Abdul Wahab, is a Doctor of Public Health, gazette as a Public Health Medicine Specialist. She was directly involved in developing the NGT protocol, guided by a previously published protocol. She moderated the NGT sessions and collected all input using NGT. She had received about 50 hours training in qualitative research in health care from the third author, a Professor of the Department of Social and Development Sciences, Faculty of Human Ecology, Universiti Putra Malaysia (UPM). She relates more to protecting HCWs against all hazards, especially biological hazards, at work. She was a Medical and Health Officer for the first 8 years of her career, subsequently working as a medical lecturer and active researcher for understanding workers’ personalities and work environment interactions, and regularly developed occupational health mitigation plans to ensure worker safety, health, and welfare. Espousing the academic and practitioner perspectives, she has about 12 years of experience in occupational health risk assessment and management, in both healthcare and non-healthcare settings. She also has considerable experience in community development work: managing and coordinating occupational health programs for institution and capacity-building, and health promotion and incident command system-related simulations through participatory processes and integrated approaches. These experiences have shaped her reflexivity on the research objective.

The second and corresponding author, Rosnah Ismail, is a medical doctor, a Doctor of Public Health (DrPH) candidate. He acted as a facilitator. He was motivated to perform this research after analyzing a state data in central region of Malaysia. His job scope in investigating and managing HCWs post–sharps injury made him realize that it is vital to specify the adherence factors to the follow-up services. Subconsciously, he began to explore how he could manage HCWs so that they would opt to adhere to the post-sharp injury follow-up services as per national guidelines. He wishes to be able to employ the existing interacting dimensions affect adherence framework and has focused on it to satisfy his curiosity. Please direct correspondence to drrose@ppukm.ukm.edu.my.

The third author, Asnarulkhadi Abu Samah, is a Professor at the Department of Social and Development Sciences, Faculty of Human Ecology, Universiti Putra Malaysia, and past Director at the Institute for Social Science Studies, Universiti Putra Malaysia. He has over 20 years of experience in the field of community development and community work and has been actively involved in community development research, particularly in climate change and human adaptability, and community empowerment. Besides, he is also engaged in education and training on the community work modules for community-based organizations, non-governmental organizations, government agencies, and specializing in qualitative research methodology.

The fourth author, Noor Dalila Inche Zainal Abidin, is a Medical and Health Officer since 2014, also a Doctor of Public Health (DrPH) candidate. She acted as a facilitator. Throughout her journey as Medical and Health Officer, she realized that a worker’s health is a vital pillar in a successful organization. The aim of protecting and promoting health at the workplace made her a critical thinker by providing and communicating evidence for action and practice in workers’ health. This has shaped her as a researcher and future Public Health Medicine Specialist, forming her reflexivity.

The fifth author, Nurul Asyikin Mustaffa, is a female medical doctor who worked in Occupational Safety & Health Unit, Melaka Hospital, Malaysia. Her experience was basically as an investigator and management of the sharps injury incident besides involved in the National Sharps Injury Surveillance at the workplace. She acts as a liaison officer and ensure relationship between researcher and participant was established prior and during the study commencement.

The sixth author, Halim Ismail, is a Public Health Medicine Specialist with special interest in occupational health. Previously, he worked with Ministry of Health, Malaysia and join Universiti Kebangsaan Malaysia as a lecturer. He was involved in qualitative and quantitative research throughout my work with the university.


We thank the gatekeeper of district health office, Mohamad Fairuz Rahmat, and gatekeeper of hospital to make this research possible. Thank you to Director General of Health Malaysia for the permission to publish this article. We also thank all participants of both NGT sessions for their feedback and their precious time for contributing significantly to this research. This work was ethically approved and supported by Universiti Kebangsaan Malaysia [FF-2019-078].

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