Phase 1 will consist of the identification and analysis of the problem. The duration of this phase will be 6 months and will include knowledge development about workplace cyberbullying among TCM practitioners.

The specific objectives of this study include (1) evaluating the overall prevalence rate of workplace cyberbullying and its related psychological impacts (depression, anxiety, and stress) on TCM practitioner; (2) understanding the measures associated with various forms of workplace cyberbullying on age, gender, and frequency; and (3) understanding the measure associated with workplace cyberbullying on perpetrators responsible for workplace cyberbullying. The current research will be a survey-based online cross-sectional prevalence study. TCM practitioners are considered a hard-to-reach population; thus, we will conduct a nonprobability snowball sample of 1023 adults (3% precision, 95% confidence level) according to the number of TCM practitioners, which was approximately 15,000 in 2011 [16]. The Hamilton Depression Scale (HAM-D) [17], the Hamilton Anxiety Scale (HAM-A) [18], and the clinical anger scale [19] will be used to assess the psychological impact on TCM practitioners. The Cyberbullying Questionnaire (CBQ) and a short version of a cyberbullying behavior questionnaire (CBQ-S), adapted from Jönsson et al [20], will be used to identify the prevalence among TCM practitioners; these selected questionnaires were already validated in Sweden and the US adult population [20]. The prevalence will also investigate the association with moderating variables (age and gender). Perpetrators of cyberbullying will also be assessed in the specific identification of the prevalence of workplace cyberbullying using the CBQ and CBQ-S questionnaires. The sampling method to understand perpetrator effects in the prevalence will similarly be addressed. The survey will also include a socioeconomic assessment, including education, income, home characteristics, and commodities. The survey will be conducted online due to the current pandemic situation caused by COVID-19, following the CHERRIES guidelines given by Gunther Eysenbach [21].

The purpose of the exploratory study is to understand the moderating and mediating factors of workplace cyberbullying by using the ERM on TCM practitioners [15]. The specific questions of this study include the following: (1) What are the relationships between emotions, workplace stressors, cyberbullying perpetration, cyberbullying victimization, and control appraisal, reappraisal, and suppression? (2) What effects do demographic factors have on emotions, workplace stressors, cyberbullying perpetration, cyberbullying victimization, and control appraisal, reappraisal, and suppression? The survey will be conducted using a convenience method, with a sample size of 384 (5% precision, 95% confidence level). A structural equation model will be developed, and each construct will be discussed. A snowball sampling method will be used to approach the target population. There will be a lucky draw at the end of the exploratory study on the participants; the 10 winners of the draw will receive an electronic power bank.

This procedure was selected due to a hard-to-reach study population and a study undertaken during the COVID-19 pandemic.

The aim of Stage 2 is to develop the anticyberbullying intervention program. Past approaches have been ineffective because of a lack of consistency within the community. To achieve this objective, a quasi-experiment with a nonequivalent pretest–post-test control group design will be conducted for a duration of 1-1.5 years (Figure 5).

The study design for this stage is quasi-experimental, in which the groups are nonrandomized into intervention and control groups and selected purposively. This study will be conducted in public hospitals and private hospitals located in Malaysia. All hospitals are eligible to participate. The selection of hospitals will be randomized for the implementation of the interventions. The randomization of hospitals will be performed by online statistical computing web programming to generate the randomization schedule [22]. The current methodology will help reduce selection bias in the study.

This intervention study will be conducted on TCM practitioners specifically. A baseline assessment will be done, in the intervention and control hospital, to measure the burden of bullying and its correlates using the CBQ and CBQ-S. This stage will begin after the investigation of prevalence and exploratory research. First, baseline information will be collected within 3 months, and then the intervention will be monitored twice after a regular period of 6 months in order to monitor the consistency of the intervention program.

The intervention program will be designed and finalized after (1) a systematic review of systematic reviews of previously published literature on bullying and the effectiveness of antibullying intervention programs; (2) the conducting of focus group discussions with TCM practitioners, patients, and other health care providers (to explore the perceptions, beliefs, and suggestions regarding bullying prevention programs); and (3) the conducting of a consultation workshop with all the stakeholders. The bullying intervention program (BIP) will pretest among 50 participants, which will include health care providers, TCM practitioners, and patients. The multicomponent hospital-based intervention strategy will be administered at 3 levels: (1) patients, (2) TCM practitioners, and (3) other health care providers. All the data of participants in this study will be password-protected and safe using Microsoft OneDrive. The recruitment of participants will follow the same procedure described for the exploratory study and prevalence study.

An expert from each stakeholder group (TCM practitioners, other health care professionals, patients, and IT experts) will be involved in the interface design, information system design, and prototype testing. The system’s overall performance and satisfaction will be acquired through questionnaires (questionnaires are available upon request). The CBQ and CBQ-S will be used to determine the effectiveness of an intervention program using a prototype (post-test). The compilation of this research will be used to design the Personalized Mobile Mental Health Intervention (PMMH-I). The duration for stage 3 will be 6 months.

There is limited literature available on interventions for workplace cyberbullying among TCM practitioners. Most of the available literature is limited to the identification of exploratory factors, measurement factors, and increasing trends of workplace cyberbullying. Funded by the Massey University Research Fund, D’Souza et al [23] discussed the issue of workplace cyberbullying in New Zealand; the study sample size was limited to 20 participants, but they predict an increase of workplace cyberbullying [23,24]. Vranjes et al [25] developed the inventory of cyberbullying acts at the workplace (ICA-W); the available results are preliminary items and build upon existing knowledge.

Moreover, the results of available literature are often generalized, noncontextual, and lack practical implications [25]. Another online self-report survey on workplace cyberbullying in New Zealand reports an increasing trend in workplace cyberbullying [26]; however, self-reported answers may be exaggerated and lead to an increase in survey bias. The studies of Farley [27], who had worked on the workplace cyberbullying measurement scale, are limited to methodological improvement in the measurement scale; these studies call for further exploratory studies. Other studies on the exploratory factors of workplace cyberbullying [27-29] lack coordination between theoretical and practical applications. The subjects of cyberbullying literature in Malaysia are limited mostly to adolescents and undergraduate students, and the focus is primarily on prevalence, the determination of exploratory factors, and descriptive studies [30-33]. The available studies are limited to examining the exploratory factors of workplace bullying [34].

Our studies will adopt the ERM in hospitals, and will adapt personalized mobile-based IT consumerization of the ERM in workplace cyberbullying among health care professionals as the intervention. A recent study also supports mobile phone– and internet-based interventions for treating depression [35]. Our study will be the first to use a personalized mobile mental health intervention for workplace cyberbullying for TCM practitioners.

The recruitment of participants will follow the same procedure as was described for the exploratory study and prevalence study. The participant will be invited to join through a webinar to complete the questionnaire. Only the participants who completed Phase 2 will be asked to continue. The prototype will be given to them, and a brief training will be provided through a 30-minute webinar. Stage 3 participants will be limited to the Stage 2 completers in order to gauge the effectiveness of the Step 2 intervention program and whether the prototype is capable of reporting cyberbullying effectively. Thematic analysis will be done on the data yielded from the control and intervention groups. All the data of participants in this study will be password-protected and safe using Microsoft OneDrive.