Version No: Version 1

Version Date: 3 March 2020

Study Title: Knowledge, Attitude and Belief towards Electronic Cigarettes Use among

Nurses and Patients with Cardiopulmonary Diseases.

Study Duration: 1/5/2020-1/2/2021

Researcher: Hanim Farhana Binti Shahibon

Nur Syafiqah Wani Binti Abu Supian

Research Supervisor: Dr Lee Wan Ling

Background of Study

The emerging of tobacco products are thriving in the industry with a new version of

devices introduced to the public with a new marketing strategy used to attract people using it.

Recently, the use of electronic cigarette (e-cigarette) had gained their popularity especially

among youth. An electronic cigarette is also known as vape, that are used as an alternative in

tobacco smoke. It is a battery powered device used to consume nicotine rather than inhaling

or exhaling tobacco smoke. It contains liquid that typically contain of solvent such as

propylene glycol or glycerol, nicotine and variety of flavours added to satisfy the users,

which then will be heated and generate into aerosol. The e-cigarette user usually referring

themselves as vapers meanwhile the talk of e-cigarette known as vaping rather than smoking.

The e-cigarette was patented by Herbert A. Gillbert from Beaver Falls, Pennsylvania in

19967. Unfortunately, he could not convince any companies to bring it into the market,

instead in 2004, Hon Link known as the Chinese Pharmacist was the first generation who

used electronic cigarette and introduce it into the Chinese market. In a meanwhile, the

electronic cigarette had become a big hit in Malaysia around 2015 and started to gain it

popularity once more nowadays among the youth. Malaysia also could be the number one

among the neighbouring countries in regulating the vape industry.

 A study by House of Commons Research Library (2019), stated that there is

approximately over 41 million of vapers around the world, where the majority of them are an

people who want to stop smoking. Prior report had stated that electronic cigarette has mostly

been used as a smoking cessation tool and is assumed to be less harmful compared to

traditional tobacco product but there is lacking in evidence to support the data and a conflict

arises either to advocate electronic cigarette for smoking cessation or reduction (Vanessa Y.

Hiratsuka, 2015). In addition, World Health Organization (WHO) classified electronic

cigarette in the same category as a smokeless tobacco and consider electronic cigarette use as

a public health issue.

Other than that, recently The Stars had reported a case of 12 deaths and 805 cases of

illness linked to electronic cigarette used which make the United States against in using

electronic cigarette. Despite of the emerging on the electronic cigarette use, the specific

clinical practice guidelines has not yet been established to address this issue including public

health issue.

Healthcare provider play an important role in advising their patient in behavioural

changes especially in smoking cessation and smoker often said that the best motivation in

quitting smoking are from their healthcare providers. However, most of the Tobacco

Dependence Guidelines focus exclusively on the traditional tobacco products. Thus, there is

no counselling guidelines for the healthcare provider to refer in addressing patient using

electronic cigarette (Ta Misha S. Bascombe, 2016).

Thus, the purpose of this study is to examine the knowledge, attitude and belief towards

electronic cigarette use among nurses and patients with cardiopulmonary disease to help in

determining and implementing the clinical preventive screening services for the electronic

cigarette use and smoking cessation treatment while increase the awareness towards the

danger of electronic cigarette among the patients and public.

Objectives

a) General Objective

To assess the knowledge, attitude and belief towards electronic cigarette use among

nurses and patients with cardiopulmonary disease.

b) Specific Objectives

i. To determine sociodemographic factors associated with the level of

knowledge, attitude and belief towards electronic cigarette use among nurses

and patients with cardiopulmonary disease.

ii. To examine the relation between knowledge, attitude and belief towards

electronic cigarette use.

iii. To compare the knowledge, attitude and belief towards electronic cigarette

between nurses and patients.

Significance of the Study

a) Patient Care

The benefits of the study towards the patient are the main concern in our

study. A better understanding on the patients use of electronic cigarette and their

perceptions can help to determine the best intervention in helping them to quit vaping.

The nurses also play an important role in the behavioural changes by educating them

and encouraging them to quit vaping. This will help the patient in increasing their

quality of life and prevent them from developing a serious and chronic diseases. Thus,

by increasing the level of knowledge, beliefs and attitudes towards electronic cigarette

can help in promoting a better quality of life to the patient and implementing good

practices to the nurses.

b) Nursing Practice

This study will help to identify and evaluate the nurse’s level of knowledge

towards the electronic cigarette and their beliefs and attitude in using the electronic

cigarette. Throughout this study, we can determine either there is misconception in the

use of electronic cigarette among nurses and help to identify either the nurses play

their role in preventing and educating patients who using electronic cigarette. Lack in

knowledge or misconception of the use of electronic cigarette will result in poor

practices in treating patients using e-cigarette. This will lead to increase in number of

people using electronic cigarette in the future and poor outcome of the treatment

provided.

c) Organization

In order to overcome the problem an organization such as Public Health

Malaysia or an organization or club from every university, institution or school

around Malaysia, must held a campaign in increasing awareness towards electronic

cigarette use among the public especially youth and teenagers. It can help to relay

information to public on the danger of electronic cigarettes and either the benefits or

impact of it to their health. Thus, this knowledge and information provided can help to

prevent people from begin to use electronic cigarette and become addicted to it.

d) Nursing Policy

The nurse organization must be informed on the nurses’ knowledge on

electronic cigarette and their practice in treating patient who using it. So that, they can

prepare a set of guidelines to be followed by the nurses. A program also must be

conducted for all the nurses and other healthcare providers to increase their awareness

towards electronic cigarette and provide the evidence-based guideline in helping them

to advice their patients enquiring with the electronic cigarette. This will help in
 improving the patient's quality of life, in addition help the nurses to meet the standard

of care in their profession.

Methodology

This study focused on the knowledge, attitude and belief towards electronic cigarettes

use among nurses and patients with cardiopulmonary diseases. The research approach for this

study is non-experimental, quantitative and cross-sectional. The data is collected using the

questionnaire. The total population size is 72,000, 5% acceptable margin of error, confident

level of 95% and 50% of response distribution, the minimum recommended size of the study

is 150 of nurses and 150 of patients with cardiorespiratory disease in cardiac and respiratory

wards (12U, 4U/CCU, 4S,13U and ICW) at UMMC. In order to prevent from non-

responsive respondents and missing value, additional 10% of the minimum sample size (15

nurses and 15 patients) will be tested to reduce the drop off rate. Thus, researcher decided to

distribute 300 sets of questionnaires.

Study Design & Subject Requirement

This study is using the cross-sectional study design. The survey questionnaire will use

as study instruments to determine the level of knowledge, attitude and belief towards

electronic cigarettes use among nurses and patients with cardiopulmonary diseases. The

questionnaire will be kept in an individual envelope and distributed to 150 of nurses and 150

of patients with cardiopulmonary disease in cardiac and respiratory wards (12U, 4U/CCU,

4S,13 and ICW) at UMMC.

Inclusion & Exclusion Criteria

The inclusion criteria for this study is all the registered nurses that was working in

cardiac and respiratory wards in UMMC and patient with cardiopulmonary diseases in

UMMC. The criteria included both male and female nurses and patients. Meanwhile for

patient, they must be adult above 18 years old and treat under cardiac or respiratory diseases

or both.

The exclusion criteria for this study is the nurses from wards other than cardiac and

respiratory wards such as Gynaecology ward, Paediatrics ward and others. It is because we

want to assess the nurses’ level of knowledge, beliefs and their attitude in treating patient

with cardiopulmonary problem. We want to determine what is the guidelines they have been

using to encourage or advocate their patient to stop smoking or vaping. Thus, we need a

healthcare provider that work under the study setting for a valid and accurate outcome.

Meanwhile for patient, the unconscious and cognitively impaired patient will be

excluded in our study as we will distribute a questionnaire for the participant to be answered

and get a valid response from them. In addition, patient that are not treat under cardiac or

respiratory problem also will be excluded, because most of the smoker or vaper will have

cardiac or respiratory complication. Thus, by assessing and understanding why those patient

smoking or vaping can help the nurses to developed or planned for a better intervention in

advocating the patient to stop smoking or vaping.

Instrumentation

Self-administered questionnaire will be use in this research and will be distributed to

all the sample population in cardiac and respiratory ward (12U, 4U/CCU, 4S,13U and ICW),

UMMC. The questionnaire will be kept in an individual envelope before distributing to the

respondent.

The research instrument use on this study is questionnaire. The questionnaire is

consisting of a series of questions and required the respondents to answer all the questions.

The questionnaire was modified from the previous study done by “E-cigarette knowledge,

Belief and Attitude Questionnaire by Ibrahim Dwedar, Dina Ruby and Aya Mostafa (2019)”

after obtained the approval from the authors/researchers. This self-administered questionnaire

also was adapted from 3 previous relevant literature Quinta Mbe, Olabode Ayodele and

Darleesa Doss (2017), Geletko K, Myers K, and Brownstein N, et al (2016) and North Carol

by Kandra K, Ranney L, Lee JG & Goldstein A (2013).

The questionnaire will be divided into 5 parts which are Part A, Part B, Part C, Part D

and Part E. This set of questionnaires is requiring respondents about 15 to 20 minutes to

answer it. Copies of questionnaires will be in English and Malay version. Part A of

questionnaire is the knowledge on electronic cigarettes from “Health professionals in

Flanders perceive the potential health risks of vaping as lower than those of smoking but do

not recommend using e-cigarettes to their smoking patients” by Van Gucht & Baeyens(2016).

Part B of questionnaire is about the perception on policy for electronic cigarettes from

“Support for e-cigarette regulations among Australian young adults” by Jongenelis et al.,

(2019). Part C of the questionnaire is about the perception on electronic cigarettes use in

smoking cessation from “Prevalence and associated factors of ever use of electronic
cigarettes: Findings from a hospitals and health clinics study based in Malaysia” by

Perialathan et al., (2018).

Part D of questionnaire consists of the fagerstrom test for nicotine dependence. The

Fagerstrom Test for Nicotine Dependency (FTND) only applied to active smokers. This is a

standard instrument for assessing the intensity of physical addiction to nicotine. The test was

designed to provide an ordinal measure of nicotine dependence related to cigarettes smoking.

It contains six items that evaluate the quantity of cigarette consumption, the compulsion to

use and dependence. In scoring the Fagerstrom test for nicotine dependence, yes/no items are

scored from 0 to 1 and multiple-choice items are scored from 0 to 3. The items are summed

to yield a total score of 0-10. The higher the total Fagerstrom score, the more intense the

patient’s physical dependence on nicotine. In the clinic, the Fagerstrom test may be used by

the physician to document indications for prescribing medication for nicotine withdrawal.

The Fagerstrom Tolerance Questionnaire was developed by Karl-Oloy Fagerstrom. This

instrument was modified to the Fagerstrom Test for Nicotine Dependence by Todd

Heatherton, et al. in 1991. The FTND is copyrighted by Taylor and Francis Ltd., but may be

reproduced without permission, as available from the source reference (Heatherton, et al.,

1991). Lastly the Part E is about the demographic background of patients and nurses.
 KNOWLEDGE AND PERCEPTIONS OF E-CIGARETTES QUESTIONNAIRE

The following questions are about electronic cigarette (often called as e-cigarette or
vape). Note: E-cigarettes are battery-powered devices that illuminate or glow at the end
and provide vapour containing nicotine or flavourings. The act of using e-cigarette is also
known as vaping and a person who using it known as vaper.
Soalan berikut adalah tentang rokok elektronik (biasanya dipanggil e-rokok atau vape).
Nota: E-rokok adalah rokok yang berbentuk tiub yang berkuasa bateri yang menyala atau
bersinar di hujung dan memberikan wap yang mengandungi nikotin atau perasa.
Penggunaan e-rokok juga dikenali sebagai vaping dan seseorang yang menggunakannya
dikenali sebagai pengguna vape.

PART A: KNOWLEDGE ON ELECTRONIC CIGARETTES

(1.1) Have you ever heard of e-cigarettes?
Pernahkah anda mendengar e-rokok?

 Yes
Ya

 No
Tidak

(1.2) Where have you learn about e-cigarettes? (Tick any that apply to you.)
Dari manakah anda belajar tentang e-rokok? (Tandakan mana-mana berkenaan
dengan anda.)

 Media advertisement
Iklan media

 Newspapers
Akhbar

 Magazines
Majalah

 Roadside poster/billboards
Poster pinggir jalan/papan iklan

 Doctors
Doktor

 Nurses
Jururawat

 Internet website
 Laman web internet

 Peers/Friends
Rakan sebaya/Kawan-kawan

Social media: (Please specify:  Facebook  Twitter  Instagram Others:

Media sosial: (Sila nyatakan:  Facebook Twitter Instagram Lain-lain:

(1.3) How much do you know about e-cigarettes?

Berapa banyakkah anda tahu tentang e-rokok?

 Nothing at all
1  2 A little  A moderate  Know everything
3 4

Tidak tahu langsung Sedikit Sederhana Tahu semua

(2) Which of the following statement best describes your opinion on e-cigarettes compared
to conventional cigarettes? (Tick any that apply to you.)
Antara pernyataan berikut yang manakah paling sesuai menggambarkan pendapat
anda tentang e-rokok berbanding rokok tembakau. (Tandakan mana-mana yang
berkenaan dengan anda).

 E-cigarette are less harmful than conventional cigarettes

E-rokok kurang berbahaya daripada rokok tembakau.

 E-cigarette and conventional cigarette are equally harmful

E-rokok dan rokok tembakau adalah sama berbahaya.

 E-cigarette are more harmful than conventional cigarettes

E-rokok lebih berbahaya daripada rokok tembakau.

 Don’t know
Tidak tahu

(3) Please give your answer (Yes/No/Don’t know) for each question below:
Sila berikan jawapan anda (Ya/Tidak/Tidak tahu) untuk setiap soalan di bawah:
Knowledge on E-cig (Source: Van Gucht & Baeyens,2016; DOI 10.1186/s12954-016-0111-4)

3.1 E-cigarette is harmful to the vaper.  Yes  No  Don’t know

E-rokok adalah berbahaya kepada Ya Tidak Tidak tahu
pengguna vape

3.2 E-cigarette is harmful to people around  Yes  No  Don’t know

them. Ya Tidak Tidak tahu
E-rokok berbahaya kepada orang-orang di
sekitarnya.
 3.3 E-cigarette is healthier than  Yes  No  Don’t know
conventional cigarette. Ya Tidak Tidak tahu
E-rokok lebih sihat daripada rokok
konvensional

3.4 E-cigarette can cause cancer.  Yes  No  Don’t know

E-rokok boleh menyebabkan kanser. Ya Tidak Tidak tahu

3.5 Risk of cancer is lower for the e-  Yes  No  Don’t know

cigarette user compared to Ya Tidak Tidak tahu
conventional cigarette user.
Risiko kanser e-rokok lebih rendah
berbanding dengan pengguna rokok
konvensional.

3.6 E-cigarette increase the risk of heart  Yes  No  Don’t know

attack. Ya Tidak Tidak tahu
E-rokok meningkatkan risiko serangan
jantung.

3.7 E-cigarette increase the risk of stroke.  Yes  No  Don’t know

E-rokok meningkatkan risiko strok. Ya Tidak Tidak tahu

3.8 Risk of getting heart related diseases  Yes  No  Don’t know

such as heart attack or stroke is lower Ya Tidak Tidak tahu
for the e-cigarette user compared to
conventional cigarette.
Risiko mendapat penyakit berkait
dengan jantung seperti serangan
jantung atau strok lebih rendah untuk
pengguna e-rokok berbanding kepada
rokok konvensional.

3.9 E-cigarette increases the risk of lung  Yes  No  Don’t know

injury (vaping associated lung injury). Ya Tidak Tidak tahu
E-rokok meningkatkan risiko
kecederaan paru-paru (vaping
dikaitkan kecederaan paru-paru).

3.10 Risk of chronic lung diseases is lower  Yes  No  Don’t know

for e-cigarette user compared to Ya Tidak Tidak tahu
conventional cigarette.
Risiko penyakit paru-paru kronik
adalah lebih rendah untuk pengguna e-
rokok berbanding rokok konvensional.
3.11 Nicotine is harmful component of e-  Yes  No  Don’t know
cigarette. Ya Tidak Tidak tahu
Nikotin adalah komponen berbahaya e-
rokok.

3.12 E-cigarette with nicotine has an  Yes  No  Don’t know

addictive effect. Ya Tidak Tidak tahu
Nikotin e-rokok memberi kesan
ketagihan.

3.13 E-cigarette user can be addicted to the  Yes  No  Don’t know

e-cigarette without nicotine. Ya Tidak Tidak tahu
Pengguna e-rokok boleh menjadi
ketagih terhadap e-rokok tanpa
nikotin.

PART B: PERCEPTION ON POLICY FOR ELECTRONIC CIGARETTES

(4) Please choose how much do you agree or disagree with the statements below:
Sila pilih berapa banyak anda bersetuju dan tidak bersetuju dengan penyataan di bawah:
Perception on policy for E-cig (Source: Jongenelis et al., 2019 doi:10.1186/s12889-019-6410-4

4.1 E-cigarette can be prescribed  Strongly

1  Disagree
2  Agree
3  Strongly
4

as medicine to quit smoking. disagree Tidak Bersetuju agree

E-rokok boleh dipreskripsi Sangat tidak bersetuju Sangat
seperti ubatan untuk berhenti bersetuju bersetuju
merokok.

4.2 E-cigarette should be treated  Strongly

1  Disagree
2  Agree
3  Strongly
4

as if they are conventional disagree Tidak Bersetuju agree

cigarette. Sangat tidak bersetuju Sangat
E-rokok adalah sama seperti bersetuju bersetuju
rokok tembakau.

4.3 E-cigarette should only be  Strongly

1  Disagree
2  Agree
3  Strongly
4

sold in pharmacies like other disagree Tidak Bersetuju agree

nicotine replacement Sangat tidak bersetuju Sangat
therapy. (eg. bersetuju bersetuju
patches,gums,lozenges)
E-rokok hanya boleh dijual di
farmasi seperti terapi
penggantian nikotin. ( Contoh,
tampalan,gula-gula
getah,lozen)
4.4 E-cigarette should be made  Strongly
1  Disagree
2  Agree
3  Strongly
4

readily available as an over disagree Tidak Bersetuju agree

the counter purchases at Sangat tidak bersetuju Sangat
regular shops. bersetuju bersetuju
E-rokok harus boleh didapatkan
di pembelian kaunter di kedai-
kedai biasa.

4.5 The supply of e-cigarettes  Strongly

1  Disagree
2  Agree
3  Strongly
4

that contain nicotine should disagree Tidak Bersetuju agree

be prohibited. Sangat tidak bersetuju Sangat
Pembekalan e-rokok yang bersetuju bersetuju
mengandungi nikotin perlu
dilarang.

4.6 E-cigarette should be  Strongly

1  Disagree
2  Agree
3  Strongly
4

prohibited to minors. (Below disagree Tidak Bersetuju agree

18 years old). Sangat tidak bersetuju Sangat
E-rokok harus dilarang kepada bersetuju bersetuju
yang di bawah umur (18
tahun).
(Source: Van Gucht & Baeyens, 2016; DOI 10.1186/s12954-
0160111-4)

4.7 E-cigarette should be banned 1 Strongly  Disagree

2  Agree
3  Strongly
4

in Malaysia. disagree Tidak Bersetuju agree

E-rokok perlu diharamkan di Sangat tidak bersetuju Sangat
Malaysia. bersetuju bersetuju
(Source: Perialathan et al., 2018;doi:10.18332/tid/99258)

4.8 E-cigarette should be used at  Strongly

1  Disagree
2  Agree
3  Strongly
4

a non-smoking area. disagree Tidak Bersetuju agree

E-rokok sepatutnya digunakan Sangat tidak bersetuju Sangat
di kawasan larangan merokok. bersetuju bersetuju
(Source: Perialathan et al., 2018;doi:10.18332/tid/99258)
PART C: PERCEPTION ON ELECTRONIC CIGARETTES USE IN SMOKING CESSATION
(5) Please choose how much do you agree or disagree with the statements below:
Sila pilih berapa banyak anda bersetuju dan tidak bersetuju dengan penyataan di bawah:
Perceptions on E-cig use in smoking cessation (Source :Perialathan et al., 2018; doi:10.18332/tid/99258)

5.1 I am confident about my  Strongly

1  Disagree
2  Agree
3  Strongly
4

ability to answer questions disagree Tidak Bersetuju agree

about e-cigarettes. Sangat tidak bersetuju Sangat
Saya yakin dengan kebolehan bersetuju bersetuju
saya untuk menjawab soalan
tentang e-rokok.
5.2 Family members should  Strongly
1  Disagree
2  Agree
3  Strongly
4

encourage smokers to switch disagree Tidak Bersetuju agree

to e-cigarette instead as it is Sangat tidak bersetuju Sangat
safer. bersetuju bersetuju
Ahli keluarga perlu
menggalakkan perokok
bertukar kepada e-rokok kerana
ia lebih selamat.

5.3 Smokers are encouraged to  Strongly

1  Disagree
2  Agree
3  Strongly
4

use e-cigarette to aid in disagree Tidak Bersetuju agree

quitting smoking. Sangat tidak bersetuju Sangat
Perokok digalakkan bersetuju bersetuju
menggunakan rokok elektronik
untuk membantu berhenti
merokok.

5.4 E-cigarette is the main choice 1 Strongly  Disagree

2  Agree
3  Strongly
4

for effective quit smoking disagree Tidak Bersetuju agree

method. Sangat tidak bersetuju Sangat
Rokok elektronik adalah pilihan bersetuju bersetuju
utama kaedah berhenti
merokok yang berkesan.

5.5 E-cigarette is more effective  Strongly

1  Disagree
2  Agree
3  Strongly
4

than normal medication disagree Tidak Bersetuju agree

therapy to quit smoking. Sangat tidak bersetuju Sangat
Rokok elektronik lebih berkesan bersetuju bersetuju
berbanding daripada ubat
terapi biasa untuk berhenti
merokok.

5.6 E-cigarette doesn’t cause any 1 Strongly  Disagree

2  Agree
3  Strongly
4

harmful effects to patient disagree Tidak Bersetuju agree

with diabetes. Sangat tidak bersetuju Sangat
E-rokok tidak menyebabkan bersetuju bersetuju
sebarang kesan berbahaya
terhadap pesakit diabetik.
 5.7 E-cigarette doesn’t cause any 1 Strongly  Disagree
2  Agree
3  Strongly
4

harmful effects to patient disagree Tidak Bersetuju agree

with hypertension. Sangat tidak bersetuju Sangat
E-rokok tidak menyebabkan bersetuju bersetuju
sebarang kesan berbahaya
terhadap pesakit darah
tinggi(hipertensi).

5.8 E-cigarette doesn’t cause any 1 Strongly  Disagree

2  Agree
3  Strongly
4

harmful effects to patient disagree Tidak Bersetuju agree

with heart problem. Sangat tidak bersetuju Sangat
E-rokok tidak menyebabkan bersetuju bersetuju
sebarang kesan berbahaya
terhadap pesakit bermasalah
jantung.

5.9 Vapours from e-cigarette are  Strongly

1  Disagree
2  Agree
3  Strongly
4

not harmful to others. disagree Tidak Bersetuju agree

Wap daripada e-rokok tidak Sangat tidak bersetuju Sangat
membahayakan orang lain. bersetuju bersetuju

5.10 Sharing of e-cigarette  Strongly

1  Disagree
2  Agree
3  Strongly
4

devices can cause disagree Tidak Bersetuju agree

transmission of infectious Sangat tidak bersetuju Sangat
diseases (Example: bersetuju bersetuju
Tuberculosis (TB), Influenza)
Berkongsi alat e-rokok boleh
menyebabkan penyebaran
penyakit berjangkit (Contoh:
Tuberkulosis(TB), Influenza)

5.11 E-cigarette could cause dual  Strongly

1  Disagree
2  Agree
3  Strongly
4

use of e-cigarette and disagree Tidak Bersetuju agree

conventional cigarette. Sangat tidak bersetuju Sangat
E-rokok telah boleh bersetuju bersetuju
menyebabkan penggunaan
kedua-dua e-rokok dan rokok
konvensional.
(Source: Feng et al, 2019; doi:10.3390/ijerph16173175)

5.12 E-cigarette is highly  Strongly

1  Disagree
2  Agree
3  Strongly
4

addictive. disagree Tidak Bersetuju agree

E-rokok boleh menyebabkan Sangat tidak bersetuju Sangat
ketagihan yang sangat tinggi. bersetuju bersetuju
(Source: Feng et al, 2019; doi:10.3390/ijerph16173175)

5.13 E-cigarette can cause a  Strongly

1  Disagree
2  Agree
3  Strongly
4

person to start smoking. disagree Bersetuju agree

 E-rokok boleh menyebabkan Sangat tidak Tidak Sangat
seseorang itu untuk mula bersetuju bersetuju bersetuju
merokok.
(Source: Van Gucht & Baeyens, 2016; DOI 10.1186/s12954-
0160111-4)

5.14 I think e-cigarette will cause  Strongly

1  Disagree
2  Agree
3  Strongly
4

society to treat smoking as a disagree Tidak Bersetuju agree

norm. Sangat tidak bersetuju Sangat
Saya fikir e-rokok akan bersetuju bersetuju
menyebabkan masyarakat
menganggap merokok
sebagai kebiasaan.
(Source: Van Gucht & Baeyens, 2016; DOI 10.1186/s12954-
0160111-4)

5.15 It is important to discuss the 1 Strongly  Disagree

2  Agree
3  Strongly
4

effect of e-cigarette with any disagree Tidak Bersetuju agree

person who smokes. Sangat tidak bersetuju Sangat
Ia adalah penting untuk bersetuju bersetuju
membincangkan kesan e-
rokok bersama dengan orang
merokok.

5.16 I support person who want 1 Strongly  Disagree

2  Agree
3  Strongly
4

to start using e-cigarette. disagree Tidak Bersetuju agree

Saya menyokong seseorang Sangat tidak bersetuju Sangat
itu untuk mula menggunakan bersetuju bersetuju
e-rokok.
(Source: Van Gucht & Baeyens, 2016; DOI 10.1186/s12954-
0160111-4)

5.17 I will recommend e-cigarette  Strongly

1  Disagree
2  Agree
3  Strongly
4

to person who smokes. disagree Tidak Bersetuju agree

Saya akan mencadangkan e- Sangat tidak bersetuju Sangat
rokok kepada orang yang bersetuju bersetuju
merokok.
(Source: Van Gucht & Baeyens, 2016; DOI 10.1186/s12954-
0160111-4)

(
5.18 E-cigarette gives the  Strongly
1  Disagree  Agree
2 3  Strongly 
4 Don’t
5

same satisfaction as disagree Tidak Bersetuju agree know

conventional Sangat tidak bersetuju Sangat Tidak tahu
cigarette. bersetuju bersetuju
E-rokok memberi
kepuasan yang sama
seperti rokok
konvensional.

5.19 E-cigarette is the  Strongly

1  Disagree  Agree
2 3  Strongly 
4 Don’t
5

choice because it is disagree Tidak Bersetuju agree know

cheaper. Sangat tidak bersetuju Sangat Tidak tahu
E-rokok menjadi bersetuju bersetuju
pilihan kerana kosnya
menjimatkan.
PART D: FAGERSTROM TEST FOR NICOTINE DEPENDCE
(6) Do you currently smoke cigarettes?
Adakah anda merokok pada masa ini?

 Yes
Ya

 No
Tidak

If ‘Yes’, read each question below. For each question, enter the answer choice which best
describes your response.
Jika, ‘Ya’, baca setiap soalan di bawah. Untuk setiap soalan, masukkan pilihan jawapan yang
paling sesuai yang menyatakan respon anda.
The Fagerström Test for Nicotine Dependence. (Source: Heatherton et al.,1991. Br J Addiction. 86(9):1119-1127).

PLEASE TICK (✓ ) ONE BOX FOR EACH QEUSTION

6.1 How soon after waking do you smoke 3 Within 5 minutes
your first cigarette? Dalam masa 5 minit
Berapa lama selepas bangun dari tidur,
anda menghisap rokok pertama anda?  6-30 minutes
2

6-30minit

 31-60 minutes
1

31-60minit

 0 After 60 minutes
Selepas 60minit

6.2 Do you find it difficult to refrain from  Yes 1

smoking in places where it is Ya

forbidden?
(e.g. at worship places, at library, in  No 0

cinema). Tidak
Adakah anda berasa sukar untuk menahan
diri daripada merokok di tempat-tempat
larangan (contoh, di tempat ibadat, di
perpustakaan, di pawagam)?

6.3 Which cigarette would you hate most  The first in the morning
1

to give up? Pada pertama pagi

Rokok yang mana yang paling sukar untuk
dilepaskan?  Any other
0

Lain-lain

6.4 How many cigarettes per day do you  10 or less

0

smoke? 10 atau kurang

 Berapa banyak rokok anda hisap dalam
sehari  11-20
1

11-20
*Exception for vape user
*Pengecualian bagi pengguna vape  21-30
2

21-30

 31 or more
3

31 atau lebih

6.5 Do you smoke more frequently during the  Yes

1
first hours after waking that during the Ya
rest of the day?
Adakah anda merokok lebih kerap selepas
bangun dari tidur atau pada lain-lain
 No
0

masa? Tidak

6.6 Do you smoke when you are so ill that you  Yes
1
are in bed most of the day? Ya
Adakah anda merokok apabila anda sakit
sehingga anda berada di tempat tidur
sepanjang hari?
 No
0

Tidak
PART E: DEMOGRAPHIC BACKGROUND (PATIENT)

(1) What is your gender?

Apakah jantina anda?

 Male
1

Lelaki
2 Female
Perempuan

(2) What is your age?

Berapakah umur anda?

(3) What is your ethnicity?

Apakah etnik anda?

 Malay
1

Melayu
2 Chinese
Cina
3 Indian
India
4 Any others:
Lain-lain:

(4) What is your level of education?

Apakah tahap pendidikan anda?

 Primary school
1

Sekolah primer
2 Secondary School
Sekolah sekunder
3 Tertiary
Tertiari
4 Any others:
Lain-lain:

(5) If you are a nurse answer questions below:

Jika anda adalah seorang jururawat jawab soalan di bawah:

(5.1) Years of nursing:

Tahun dalam bidang kejuruwatan:
(5.2) Ward:
Wad:

(5.3) Training School:

Sekolah latihan:
 Data Analysis

The data will be analysed using the SPSS version 23. Descriptive statistics will be

used to measure the distribution, frequency and central tendency in order to summarize the

findings.

Gantt Chart

Research 2020 2021

Activity Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar. Apr.
Ethical
application/
Submission

Validation
of
questionnaire
(Face
validation)
Pilot study

Data
collection
Data analysis

Report
writing
Completion
of thesis and
submission