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  1. Masngut N, Mohamad E
    J Med Internet Res, 2021 08 04;23(8):e28074.
    PMID: 34156967 DOI: 10.2196/28074
    BACKGROUND: The COVID-19 health crisis has posed an unprecedented challenge for governments worldwide to manage and communicate about the pandemic effectively, while maintaining public trust. Good leadership image in times of a health emergency is paramount to ensure public confidence in governments' abilities to manage the crisis.

    OBJECTIVE: The aim of this study was to identify types of image repair strategies utilized by the Malaysian government in their communication about COVID-19 in the media and analyze public responses to these messages on social media.

    METHODS: Content analysis was employed to analyze 120 media statements and 382 comments retrieved from Facebook pages of 2 mainstream newspapers-Berita Harian and The Star. These media statements and comments were collected within a span of 6 weeks prior to and during the first implementation of Movement Control Order by the Malaysian Government. The media statements were analyzed according to Image Repair Theory to categorize strategies employed in government communications related to COVID-19 crisis. Public opinion responses were measured using modified lexicon-based sentiment analysis to categorize positive, negative, and neutral statements.

    RESULTS: The Malaysian government employed all 5 Image Repair Theory strategies in their communications in both newspapers. The strategy most utilized was reducing offensiveness (75/120, 62.5%), followed by corrective action (30/120, 25.0%), evading responsibilities (10/120, 8.3%), denial (4/120, 3.3%), and mortification (1/120, 0.8%). This study also found multiple substrategies in government media statements including denial, shifting blame, provocation, defeasibility, accident, good intention, bolstering, minimization, differentiation, transcendence, attacking accuser, resolve problem, prevent recurrence, admit wrongdoing, and apologize. This study also found that 64.7% of public opinion was positive in response to media statements made by the Malaysian government and also revealed a significant positive association (P=.04) between image repair strategies utilized by the Malaysian government and public opinion.

    CONCLUSIONS: Communication in the media may assist the government in fostering positive support from the public. Suitable image repair strategies could garner positive public responses and help build trust in times of crisis.

  2. Ishak A, Mohamad E, Hambali A, Johari NL
    Water Sci Technol, 2022 Nov;86(9):2233-2247.
    PMID: 36378177 DOI: 10.2166/wst.2022.360
    This paper presents the promising method of synchronizing the Six Sigma and reliability analyses at 15 sewage treatment plants (STPs) operating in Melaka, Malaysia. Five different suspended growth treatment technologies in various capacities were investigated. The sequential batch reactor (SBR) and extended aeration activated sludge (EAAS) processes, conventional activated sludge (CAS), aerated lagoon (AL), and oxidation pond (OP) were compared using innovative Niku's treatment reliability and Six Sigma process capability method for biological oxygen demand (BOD5), chemical oxygen demand (COD), total suspended solids (TSS), oil and grease (O&G), and ammoniacal nitrogen (NH3-N) effluent parameters and justified the importance of understanding the lognormal behavior of the effluent parameters in interpreting the performance monitoring results and discharge compliance. The results showed that the SBR and EAAS systems relatively fulfilled the highest performance (>95%) compared to conventional systems to ensure the high quality of effluent discharge. Although the whole system is incapable of removing nutrients efficiently, ranging between 42.31% and 90.48%, may lead to eutrophication issues. Process modification and treatment control should become a critical priority in order to reduce variability, improve stability, and increase the efficiency of nutrient removal. These initiatives promote global sustainable development goals (SDGs) 2030 and the domestic water sector transformation (WST) 2040 by treatment cost reduction, improving environmental sustainability and guaranteeing social and health benefits.
  3. Tri Sakti AM, Mohamad E, Azlan AA
    J Med Internet Res, 2021 08 09;23(8):e28249.
    PMID: 34280116 DOI: 10.2196/28249
    BACKGROUND: One of the successful measures to curb COVID-19 spread in large populations is the implementation of a movement restriction order. Globally, it was observed that countries implementing strict movement control were more successful in controlling the spread of the virus as compared with those with less stringent measures. Society's adherence to the movement control order has helped expedite the process to flatten the pandemic curve as seen in countries such as China and Malaysia. At the same time, there are countries facing challenges with society's nonconformity toward movement restriction orders due to various claims such as human rights violations as well as sociocultural and economic issues. In Indonesia, society's adherence to its large-scale social restrictions (LSSRs) order is also a challenge to achieve. Indonesia is regarded as among the worst in Southeast Asian countries in terms of managing the spread of COVID-19. It is proven by the increased number of daily confirmed cases and the total number of deaths, which was more than 6.21% (1351/21,745) of total active cases as of May 2020.

    OBJECTIVE: The aim of this study was to explore public sentiments and emotions toward the LSSR and identify issues, fear, and reluctance to observe this restriction among the Indonesian public.

    METHODS: This study adopts a sentiment analysis method with a supervised machine learning approach on COVID-19-related posts on selected media platforms (Twitter, Facebook, Instagram, and YouTube). The analysis was also performed on COVID-19-related news contained in more than 500 online news platforms recognized by the Indonesian Press Council. Social media posts and news originating from Indonesian online media between March 31 and May 31, 2020, were analyzed. Emotion analysis on Twitter platform was also performed to identify collective public emotions toward the LSSR.

    RESULTS: The study found that positive sentiment surpasses other sentiment categories by 51.84% (n=1,002,947) of the total data (N=1,934,596) collected via the search engine. Negative sentiment was recorded at 35.51% (686,892/1,934,596) and neutral sentiment at 12.65% (244,757/1,934,596). The analysis of Twitter posts also showed that the majority of public have the emotion of "trust" toward the LSSR.

    CONCLUSIONS: Public sentiment toward the LSSR appeared to be positive despite doubts on government consistency in executing the LSSR. The emotion analysis also concluded that the majority of people believe in LSSR as the best method to break the chain of COVID-19 transmission. Overall, Indonesians showed trust and expressed hope toward the government's ability to manage this current global health crisis and win against COVID-19.

  4. Ju W, Sannusi SN, Mohamad E
    PMID: 36834039 DOI: 10.3390/ijerph20043347
    BACKGROUND: Stigma relating to health can result in a broad range of vulnerabilities and risks for patients and healthcare providers. The media play a role in people's understanding of health, and stigma is socially constructed through many communication channels, including media framing. Recent health issues affected by stigma include monkeypox and COVID-19.

    OBJECTIVES: This research aimed to examine how The Washington Post (WP) framed the stigma around monkeypox and COVID-19. Guided by framing theory and stigma theory, online news coverage of monkeypox and COVID-19 was analyzed to understand the construction of social stigma through media frames.

    METHODS: This research used qualitative content analysis to compare news framings in The Washington Post's online news coverage of monkeypox and COVID-19.

    RESULTS: Using endemic, reassurance, and sexual-transmission frames, The Washington Post predominantly defined Africa as the source of monkeypox outbreaks, indirectly labeled gays as a specific group more likely to be infected with monkeypox, and emphasized that there was no need to worry about the spread of the monkeypox virus. In its COVID-19 coverage, The Washington Post adopted endemic and panic frames to describe China as the source of the coronavirus and to construct an image of panic regarding the spread of the virus.

    CONCLUSIONS: These stigma discourses are essentially manifestations of racism, xenophobia, and sexism in public health issues. This research confirms that the media reinforces the stigma phenomenon in relation to health through framing and provides suggestions for the media to mitigate this issue from a framing perspective.

  5. Mohamad E, Tham JS, Ayub SH, Hamzah MR, Hashim H, Azlan AA
    J Med Internet Res, 2020 11 12;22(11):e23922.
    PMID: 33151897 DOI: 10.2196/23922
    BACKGROUND: There are multiple media platforms and various resources available for information on COVID-19. Identifying people's preferences is key to building public confidence and planning for successful national health intervention strategies.

    OBJECTIVE: This study examines the sources of information for COVID-19 used by the Malaysian public and identifies those that are associated with building public confidence and positive perceptions toward the Malaysian government.

    METHODS: A cross-sectional online survey of 4850 Malaysian residents was conducted. Participant demographics, media use, information sources, and attitudes surrounding COVID-19 were assessed. Descriptive statistics and multiple logistic regression analyses were conducted to gauge the relationship between demographics, information sources, and attitudes toward COVID-19.

    RESULTS: Malaysians primarily used television and internet news portals to access information on COVID-19. The Malaysian Ministry of Health was the most preferred source of COVID-19 information. Respondents who referred to the Ministry of Health, television, and the Malaysian National Security Council for information were more likely to believe that the country could win the battle against COVID-19 and that the government was handling the health crisis well compared to those who referred to other information sources. Those who used the World Health Organization, friends, YouTube, family, and radio as sources of information were less likely to harbor confidence and positive belief toward combating COVID-19.

    CONCLUSIONS: Managing information and sustaining public confidence is important during a pandemic. Health authorities should pay considerable attention to the use of appropriate media channels and sources to allow for more effective dissemination of critical information to the public.

  6. Azlan AA, Hamzah MR, Sern TJ, Ayub SH, Mohamad E
    PLoS One, 2020;15(5):e0233668.
    PMID: 32437434 DOI: 10.1371/journal.pone.0233668
    In an effort to mitigate the outbreak of COVID-19, many countries have imposed drastic lockdown, movement control or shelter in place orders on their residents. The effectiveness of these mitigation measures is highly dependent on cooperation and compliance of all members of society. The knowledge, attitudes and practices people hold toward the disease play an integral role in determining a society's readiness to accept behavioural change measures from health authorities. The aim of this study was to determine the knowledge levels, attitudes and practices toward COVID-19 among the Malaysian public. A cross-sectional online survey of 4,850 Malaysian residents was conducted between 27th March and 3rd April 2020. The survey instrument consisted of demographic characteristics, 13 items on knowledge, 3 items on attitudes and 3 items on practices, modified from a previously published questionnaire on COVID-19. Descriptive statistics, chi-square tests, t-tests and one-way analysis of variance (ANOVA) were conducted. The overall correct rate of the knowledge questionnaire was 80.5%. Most participants held positive attitudes toward the successful control of COVID-19 (83.1%), the ability of Malaysia to conquer the disease (95.9%) and the way the Malaysian government was handling the crisis (89.9%). Most participants were also taking precautions such as avoiding crowds (83.4%) and practising proper hand hygiene (87.8%) in the week before the movement control order started. However, the wearing of face masks was less common (51.2%). This survey is among the first to assess knowledge, attitudes and practice in response to the COVID-19 pandemic in Malaysia. The results highlight the importance of consistent messaging from health authorities and the government as well as the need for tailored health education programs to improve levels of knowledge, attitudes and practices.
  7. Azlan AA, Hamzah MR, Tham JS, Ayub SH, Ahmad AL, Mohamad E
    PMID: 34063294 DOI: 10.3390/ijerph18094860
    Health literacy is progressively seen as an indicator to describe a nation's health status. To improve health literacy, countries need to address health inequalities by examining different social demographic factors across the population. This assessment is crucial to identify and evaluate the strengths and limitations of a country in addressing health issues. By addressing these health inequalities, a country would be better informed to take necessary steps to improve the nation's health literacy. This study examines health literacy levels in Malaysia and analyses socio-demographic factors that are associated with health literacy. A cross-sectional survey was carried out using the HLS-M-Q18 instrument, which was validated for the Malaysian population. Multi-stage random sampling strategy was used in this study, utilising several sampling techniques including quota sampling, cluster sampling, and simple random sampling to allow random data collection. A total of 855 respondents were sampled. Our results showed that there were significant associations between health literacy and age, health status, and health problems. Our findings also suggest that lower health literacy levels were associated with the younger generation. This study's findings have provided baseline data on Malaysians' health literacy and provide evidence showing potential areas of intervention.
  8. Mohamad E, Tham JS, Mohd Ajis SZ, Hamzah MR, Ayub SH, Tri Sakti AM, et al.
    Int J Environ Res Public Health, 2022 Nov 08;19(22).
    PMID: 36429342 DOI: 10.3390/ijerph192214623
    INTRODUCTION: This study explored exposure to misinformation, COVID-19 risk perception, and confidence towards the government as predictors of negative attitudes toward the COVID-19 vaccine.

    METHODS: A cross-sectional survey was carried out from 30 June to 30 August 2021 involving 775 respondents. The survey instrument for the questionnaire was an adaptation from various different studies consisting of five main variables: (1) misinformation about vaccination; (2) risk perception toward COVID-19; (3) attitudes toward the vaccination programme; (4) intention to get vaccinated; and (5) public confidence in the government in executing the vaccination programme.

    RESULTS: The results of this study indicate that higher exposure to misinformation led to higher levels of negative attitudes toward the COVID-19 vaccine. When the perceived risk of COVID-19 infection was high, mistrust of vaccine benefits was low but there were also higher worries about the future effects of the vaccine. Confidence in the government was associated with lower negative attitudes toward the COVID-19 vaccine.

    CONCLUSION: The results of this study may help develop an understanding of negative attitudes toward vaccinations in Malaysia and its contributing factors.

  9. Duong TV, Aringazina A, Baisunova G, Nurjanah, Pham TV, Pham KM, et al.
    J Epidemiol, 2017 Feb;27(2):80-86.
    PMID: 28142016 DOI: 10.1016/j.je.2016.09.005
    BACKGROUND: Health literacy has been increasingly recognized as one of the most important social determinants for health. However, an appropriate and comprehensive assessment tool is not available in many Asian countries. This study validates a comprehensive health literacy survey tool European health literacy questionnaire (HLS-EU-Q47) for the general public in several Asian countries.

    METHODS: A cross-sectional survey based on multistage random sampling in the target countries. A total of 10,024 participants aged ≥15 years were recruited during 2013-2014 in Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, and Vietnam. The questionnaire was translated into local languages to measure general health literacy and its three domains. To evaluate the validity of the tool in these countries, data were analyzed by confirmatory factor analysis, internal consistency analysis, and regression analysis.

    RESULTS: The questionnaire was shown to have good construct validity, satisfactory goodness-of-fit of the data to the hypothetical model in three health literacy domains, high internal consistency (Cronbach's alpha >0.90), satisfactory item-scale convergent validity (item-scale correlation ≥0.40), and no floor/ceiling effects in these countries. General health literacy index score was significantly associated with level of education (P from <0.001 to 0.011) and perceived social status (P from <0.001 to 0.016), with evidence of known-group validity.

    CONCLUSIONS: The HLS-EU-Q47 was a satisfactory and comprehensive health literacy survey tool for use in Asia.

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