Background: Cyberbullying is becoming prevalent among health care professionals and may cause a variety of mental health issues. Traditional and complementary medicine practitioners remain an important pillar of the health care system in Malaysia.
Objective: This paper presents a study protocol for an online survey (Cyberbullying Among Traditional and Complementary Medicine Practitioner [TCMPs]) that will collect the first nationwide representative data on cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia. The objectives of the survey are to (1) evaluate the cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia, (2) identify sociodemographic and social factors related to cyberbullying, and (3) evaluate the association between cyberbullying behavior, sociodemographic, and social factors.
Methods: A snowball sampling strategy will be applied. Traditional and complementary medicine practitioners who are permanent Malaysian residents will be randomly selected and invited to participate in the survey (N=1023). Cyberbullying behavior will be measured using the Cyberbullying Behavior Questionnaire (CBQ). Data on the following items will be collected: work-related bullying, person-related bullying, aggressively worded messages, distortion of messages, sending offensive photos/videos, hacking computers or sending a virus or rude message, and threatening messages about personal life or family members. We will also collect data on participants’ sociodemographic characteristics, social factors, and substance abuse behavior.
Results: This cross-sectional descriptive study was registered with Research Registry (Unique Identifying Number 6216; November 05, 2020). This research work (substudy) is planned under a phase 1 study approved by the Research Management Centre, Xiamen University Malaysia. This substudy has been approved by the Research Ethics Committee of Xiamen University Malaysia (REC-2011.01). The cross-sectional survey will be conducted from July 01, 2021, to June 30, 2022. Data preparation and statistical analyses are planned from January 2022 onward.
Conclusions: The current research can contribute to identify the prevalence of workplace cyberbullying among Malaysian traditional and complementary medicine practitioners. The results will help government stakeholders, health professionals, and education professionals to understand the psychological well-being of Malaysian traditional and complementary medicine practitioners.
Trial Registration: Research Registry Unique Identifying Number 6216; https://tinyurl.com/3rsmxs7u
International Registered Report Identifier (IRRID): PRR1-10.2196/29582
Adverse consequences of cyberbullying behavior in the workplace are well-documented [, ]. The negative effects of cyberbullying behavior are harmful or aggressive communications [ ], expressing negative emotions [ ], and e-harassment [ ]. Cyberbullying is a severe threat to the workplace that results in job dissatisfaction, mental strain [ ], and perceived organizational injustice, which in turn increases the perceived job stress that eventually results in cyberbullying [ ]. Cyberbullying is defined as a repetitive negative (harmful) behavior by a person (perpetrator) to intentionally hurt an individual (affected party) through technological means, such as SMS text messages or email. In most cases, this involves an imbalance of power between the perpetrator (usually anonymous) and the affected individual. The perpetrator’s action is generally considered more severe in the public domain than in the private domain [ ].
The prevalence of cyberbullying in the workplace has raised some serious global public health concern. A Swedish survey estimated the prevalence of workplace cyberbullying to be 9.7% , based on Leymann’s cut-off criterion [ ]. Gardner et al [ ] performed a study on predictors of workplace bullying and cyberbullying in New Zealand, and found that among the total study participants (N=826), 15% (n=123) experienced bullying and 2.8% (n=23) experienced cyberbullying (2.8%) within the last 6 months. Workplace bullying in different countries among different staff members have been reported in many studies; for example, the prevalence of bullying among hospital employees in Austria was reported to be 26.6% [ ], among university employees in Finland to be 16.9% [ ], and among health and welfare managers in Norway to be 8.6% [ ]. Bullying in workplace is also reported from studies conducted in Ireland (16.9%) [ ] and Portugal (33.5%) [ , ]. By contrast, there is very limited research on workplace cyberbullying.
Cyberbullying behavior has psychological effects on the affected individual, such as social anxiety , emotional distress [ ], and depression [ ]. However, the exact biological mechanism underlying cyberbullying remains unknown. Cabrera et al [ ] reported on the role of cortisol in cyberbullying behavior, with the level of this hormone being higher among affected individuals due to increased activity of the hypothalamic–pituitary–adrenocortical axis, which plays an important in the management of stress.
The World Health Organization has expressed concern with the prevalence of bullying among students and employees globally [- ]. Recently, The United Nations Educational, Scientific, and Cultural Organization and the Government of Ireland, Dublin City University, have developed a partnership to increase institutional capacities on cyberbullying awareness through knowledge sharing and collaborative work [ ]. The International Labour Organization sets benchmarks for defining, preventing, and responding to violence at the workplace and recognizes bullying under “aggressive behavior” [ ].
Using the workplace Cyberbullying Behavior Questionnaire (CBQ), this study aims to provide the first nationally representative data on cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia. Objectives of the CBQ survey are to (1) evaluate the cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia, (2) identify sociodemographic and social factors related to cyberbullying, and (3) evaluate the association between cyberbullying behavior, sociodemographic, and social factors. In the following sections, we discuss the research design and methods and present an overview of methodological challenges, strengths, and limitations related to the study design and sampling strategy.
This is a cross-sectional descriptive study performed using the Cyberbullying Behavior Questionnaire (CBQ and its short version [CBQ-S]), which was administered to traditional and complementary medicine practitioners in Malaysia. The questionnaire includes 32 questions (see) in a closed-ended question format. The standardized checklist for the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations was used to ensure that all the elements recommended were addressed within this section to participate in the study, including a link to the platform where all the information related to the project, its objectives, and expected outcomes can be found [ ]. Traditional and complementary medicine practitioners will receive an online invitation using SurveyMonkey to participate in the study, including a link to the platform where all the information related to the project, its objectives, and expected outcomes can be found [ ]. The online survey will follow the CHERRIES guideline [ ] to maintain the quality of the web-based survey. Malaysia is a highly digitally networked nation, with nearly 90% of households using the internet, mostly through mobile broadband plans on smartphones. The rationale to conduct an online survey is the ease of internet availability in Malaysia [ ].
Individuals were selected for study participation according to the following inclusion criteria: traditional and complementary medicine practitioners working in the public and private sector in Malaysia; and currently practicing in any one of the practice areas recognized by the Ministry of Health Malaysia (Traditional Malay Medicine, Traditional Chinese Medicine, Traditional Indian Medicine, homeopathy, chiropractic, osteopathy, and Traditional Islamic Medicine).
All eligible participants will be contacted through official Facebook pages of the Malaysian Society for Complementary Medicine, Federation of Chinese Physicians and Acupuncturists Associations Malaysia, Malaysian Chinese Medical Association, TCM & Western Naturopathic Malaysia, Traditional Malay Medicine Association, Majlis Perubatan Homeopathy Malaysia, Association of Chiropractic Malaysia, Malaysia Osteopathy Association, and Malaysian Health Qigong Association.
Individuals were excluded from study participation according to the following exclusion criteria: not traditional and complementary medicine practitioners in one of the recognized practice areas and practitioners who did not give consent.
Using traditional sampling strategies to recruit hard-to-reach population faces several hurdles. In this regard, a snowball sampling method is valuable. It is a technique to find research participants with the help of name suggestions from a single participant: initially, 1 participant is identified and then a chain of participants related to the first one is identified. This remains one of the valuable sampling strategies in descriptive studies . We will use snowball sampling on the Facebook pages of official traditional and complementary medicine practitioner associations ( ). A list of well-known associations is mentioned above (see inclusion criteria).
Traditional and complementary medicine practitioners will be selected from both public and private sectors in Malaysia. The total number of traditional and complementary medicine practitioners in Malaysia is approximately 15,000 (data as of 2011) . However, no data are available on how many practitioners are serving in the general and urban population. Because of the COVID-19 pandemic, we cannot directly contact the practitioners. Therefore, we will conduct a nonprobability snowball sampling involving 1023 participants (3% precision and 95% confidence level).
Data Protection and Ethical Approval
All data are stored in a password-protected electronic format on OneDrive cloud (Microsoft). To ensure participant anonymity, the survey will not contain any information that will personally identify the participants. The study results will be used for research purposes only. This study will be conducted according to the Declaration of Helsinki and the guidelines of the National Committee for Clinical Research . The study has been approved by the Research Ethics Committee of Xiamen University Malaysia (REC-2011.01). Data collection is expected to happen between July 01, 2021, and June 30, 2022. Duration of the online survey is 15-20 minutes. All participants will be given a study information sheet. An electronic version of the informed consent form will be made available within the survey (SurveyMonkey [ ]).
Data Collection and Data Handling
Participants will use SurveyMonkey to accept or decline participation. Participants will be invited via Facebook pages of medical associations. There will be a reminder every 2 weeks to follow-up on the status of the questionnaire with participants.presents an overview of the study flow and informed consent procedure.
The items in the questionnaire were chosen according to previous studies by Einarsen et al , Farley [ ], and Forssell [ , ] and aimed for a comprehensive assessment of all aspects of workplace cyberbullying among traditional and complementary medicine practitioners in Malaysia ( ). There will be no public involvement in the design of this study. The results will be presented in scientific meetings worldwide and published in peer-reviewed open-access journals to disseminate the outcomes. The Cronbach α values for CBQ and CBQ-S in the study by Forssell et al [ ] were .76 (Swedish sample) and .95 (American sample). The Negative Acts Questionnaire-Revised (NAQ-R) has a Cronbach α value of .90. Therefore CBQ, CBQ-S, and NAQ-R are reliable and valid instruments for the evaluation of workplace cyberbullying [ , ].
|Topic/parameter and measure||Source||Number of items||Assessing objectivesa|
|Sex, age group, and current relationship status||N/Ab||3||2|
|Level of education||N/A||1||2|
|Substance abuse||Pattern of Substance and Drug Misuse Among Youth in Malaysia ||1||2|
|Working sector, location (city)||N/A||2||2|
|Community participant work, current job level, practice area||Official Portal of Traditional and Complementary Medicine Division ||3||2|
|Cyberbullying Behavior Questionnaire|
|Work-related bullying, person-related bullying||Negative Acts Questionnaire-Revised ||11||1 and 3|
|Aggressively worded messages, distortion of messages||The Measurement and Impact of Workplace Cyberbullying ||2||1 and 3|
|Posted offensive photos/videos, hacking computer or sending virus or rude message, attaching or threatening messages about personal life or family||Forssell Cyberbullying Behavior Questionnaire ||7||1 and 3|
aObjective 1: To evaluate the cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia; objective 2: To identify sociodemographic and social factors related to cyberbullying; and objective 3: To evaluate the association between cyberbullying behavior, sociodemographic, and social factors.
bN/A: not applicable.
Data Management, Data Preparation, and Data Analysis
Descriptive statistics and exploratory structural equation modeling will be used to assess sociodemographic and social factors related to cyberbullying and evaluate the association between cyberbullying behavior, sociodemographic, and social factors. Statistical analysis will be performed using SPSS (version 26) and SPSS AMOS/ADANCO (IBM).
This cross-sectional descriptive study was registered with Research Registry (Unique Identifying Number 6216; November 05, 2020). This research work (substudy) is planned under a phase 1 study approved by the Research Management Centre, Xiamen University Malaysia, whose protocol has already been published . This substudy has been approved by the Research Ethics Committee of Xiamen University Malaysia (REC-2011.01). Data preparation and statistical analyses are planned from January 2022 onward.
This exploratory study will provide the first nationally representative data on workplace cyberbullying for traditional and complementary medicine practitioners in Malaysia. The data collected and analyzed will explore the relationship between workplace cyberbullying and social factors. A significant strength of the study is the use of a validated measurement tool (CBQ and CBQ-S), which is a combination of different instruments validated for different population groups (Swedish and American) . Compared with the Copenhagen Psychosocial Questionnaire (COPSOQ III) [ ], which encompasses a broad range of psychosocial aspects of modern work life, the CBQ possesses an excellent Cronbach α value of .95 when applied in an American population.
CBQ and CBQ-S are specifically administered to evaluate cyberbullying behavior in the workplace. Understanding the prevalence of cyberbullying is the first step in the formulation of evidence-based interventions for promoting the mental health of both perpetrator(s) and affected individual(s). Our sampling strategy has both strengths and limitations. Participants will be conveniently selected from the Facebook pages of various professional associations of traditional and complementary medicine practitioners using the snowball sampling method . The survey will also follow CHERRIES guidelines [ ] for the design, obtaining of informed consent, development, survey administration, response rates evaluation, and analysis. Because of time constraints, it is not feasible to perform a nonresponder bias survey, which could help identify the factors associated with the lack of response [ , ].
The CBQ survey results will provide data to identify the prevalence of workplace cyberbullying among traditional and complementary medicine practitioners, identify a correlation between social factors and cyberbullying behavior, and guide the implementation of related interventions for traditional and complementary medicine practitioners in a Malaysian context. Data from this survey will help improve mental health strategies to promote mental health education among health care professionals.
The authors gratefully acknowledge Xiamen University Malaysia for their support and guidance. This work is supported by the Xiamen University Malaysia Research Fund (Grant No: XMUMRF/2020-C6/ITCM/0005). The funding body had no role in the design and conduct of this study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
YJK, LQ, and MSA conceptualized the study, formulated the methodologies, and are responsible for project administration and funding acquisition. MSA accomplished data curation and original draft preparation. MSA and YJK performed the review and editing of this protocol. All authors have read and agreed to the published version of the manuscript.
Conflicts of Interest
The Cyberbullying Behavior Questionnaire.PDF File (Adobe PDF File), 219 KB
- Muhonen T, Jönsson S, Bäckström M. Consequences of cyberbullying behaviour in working life. IJWHM 2017 Oct 02;10(5):376-390. [CrossRef]
- Cao X, Khan AN, Ali A, Khan NA. Consequences of Cyberbullying and Social Overload while Using SNSs: A Study of Users’ Discontinuous Usage Behavior in SNSs. Inf Syst Front 2019 Jun 17;22(6):1343-1356. [CrossRef]
- Mehdad A, Nezhad A. Relationship between Perceived Organizational Injustice , Perceived Job Stress and Cyber Bullying : A Test of Mediation. Int J Psychol Behav Res 2014;3(5):374-385.
- Farley S, Coyne I, Sprigg C, Axtell C, Subramanian G. Exploring the impact of workplace cyberbullying on trainee doctors. Med Educ 2015 Apr 20;49(4):436-443. [CrossRef] [Medline]
- Piotrowski C. From workplace bullying to cyberbullying: The enigma of e-harassment in modern organizations. Organ Dev J 2012;30(4):44-53 [FREE Full text]
- Coyne I, Farley S, Axtell C, Sprigg C, Best L, Kwok O. Understanding the relationship between experiencing workplace cyberbullying, employee mental strain and job satisfaction: a dysempowerment approach. The International Journal of Human Resource Management 2016 Feb 26;28(7):945-972. [CrossRef]
- Menesini E, Nocentini A, Palladino BE, Frisén A, Berne S, Ortega-Ruiz R, et al. Cyberbullying definition among adolescents: a comparison across six European countries. Cyberpsychol Behav Soc Netw 2012 Sep;15(9):455-463 [FREE Full text] [CrossRef] [Medline]
- Forssell R. Exploring cyberbullying and face-to-face bullying in working life – Prevalence, targets and expressions. Computers in Human Behavior 2016 May;58:454-460. [CrossRef]
- Leymann H. The content and development of mobbing at work. European Journal of Work and Organizational Psychology 1996 Jun;5(2):165-184. [CrossRef]
- Gardner D, O'Driscoll M, Cooper-Thomas H, Roche M, Bentley T, Catley B, et al. Predictors of Workplace Bullying and Cyber-Bullying in New Zealand. Int J Environ Res Public Health 2016 Apr 27;13(5):448 [FREE Full text] [CrossRef] [Medline]
- Niedl K. Mobbing/Bullying am Arbeitsplatz. Eine empirische Analyse zum Phänomen sowie zu personalwirtschaftlich relevanten Effekten von systematischen Feindseligkeiten on JSTOR. Ger J Res Hum Resour Manag 1995;9(3):297-300.
- Björkqvist K, Österman K, Hjelt-Bäck M. Aggression among university employees. Aggr. Behav 1994;20(3):173-184. [CrossRef]
- Einarsen S, Skogstad A. Bullying at work: Epidemiological findings in public and private organizations. European Journal of Work and Organizational Psychology 1996 Jun;5(2):185-201. [CrossRef]
- Summary Report on the National Survey on Workplace Bullying. Dublin: Trinity College; 2000.
- Cowie H, Jennifer D, Neto C, Angula J, Pereira B, del BC. Comparing the nature of the workplace bullying in two european countries: Portugal and UK. 2000 Sep 6 Presented at: Transcending Boundaries: Integrating people, processes and system; 2000; Proceedings of the 2000 Conference, Brisbane, Queensland, Australia URL: https://repositorium.sdum.uminho.pt/bitstream/1822/55200/1/1.%20Cowie.pdf
- Einarsen S, Hoel H, Zapf D, Cooper CL. Bullying and Emotional Abuse in the Workplace. Bullying and Emotional Abuse in the Workplace. Abingdon, UK: Taylor & Francis; 2003.
- Navarro R, Yubero S, Larrañaga E, Martínez V. Children’s Cyberbullying Victimization: Associations with Social Anxiety and Social Competence in a Spanish Sample. Child Ind Res 2011 Nov 29;5(2):281-295. [CrossRef]
- Livazović G, Ham E. Cyberbullying and emotional distress in adolescents: the importance of family, peers and school. Heliyon 2019 Jun;5(6):e01992 [FREE Full text] [CrossRef] [Medline]
- Selkie EM, Kota R, Chan Y, Moreno M. Cyberbullying, depression, and problem alcohol use in female college students: a multisite study. Cyberpsychol Behav Soc Netw 2015 Feb;18(2):79-86 [FREE Full text] [CrossRef] [Medline]
- González-Cabrera J, Calvete E, León-Mejía A, Pérez-Sancho C, Peinado J. Relationship between cyberbullying roles, cortisol secretion and psychological stress. Computers in Human Behavior 2017 May;70:153-160. [CrossRef]
- Catalano RF, Junger-Tas J, Morita Y, Olweus D, Slee P, Smith PK. The Nature of School Bullying: A Cross-National Perspective. London, UK: Routledge; 2014.
- Daus C. Bullying and Emotional Abuse in the Workplace: International Perspectives in Research and Practice (1st edition). In: Personnel Psychology. Oxfordshire, UK: Taylor & Francis; Oct 3, 2003.
- Srabstein JC, Leventhal BL. Prevention of bullying-related morbidity and mortality: a call for public health policies. Bull. World Health Organ 2010 Jun 01;88(6):403-403. [CrossRef]
- O'Higgins Norman J. Tackling Bullying from the Inside Out: Shifting Paradigms in Bullying Research and Interventions. Int J Bullying Prev 2020 Aug 18:1-9 [FREE Full text] [CrossRef] [Medline]
- Mayhew C, Chappell D. Workplace violence: An overview of patterns of risk and the emotional/stress consequences on targets. International Journal of Law and Psychiatry 2007 Jul;30(4-5):327-339. [CrossRef]
- Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med 2007 Oct 16;4(10):e297 [FREE Full text] [CrossRef] [Medline]
- Waclawski E. How I use it: Survey Monkey. Occup Med (Lond) 2012 Sep 20;62(6):477-477. [CrossRef] [Medline]
- Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 2004 Dec 29;6(3):e34 [FREE Full text] [CrossRef] [Medline]
- Gong R. Digital Inclusion: Assessing Meaningful Internet Connectivity in Malaysia. Khazanah Research Institute. 2020. URL: http://krinstitute.org/assets/contentMS/img/template/editor/20200907%20Inclusion%20v4.0.pdf [accessed 2020-10-27]
- Baltar F, Brunet I. Social research 2.0: virtual snowball sampling method using Facebook. Internet Research 2012 Jan 27;22(1):57-74. [CrossRef]
- Johny AK, Cheah WL, Razitasham S. Disclosure of Traditional and Complementary Medicine Use and Its Associated Factors to Medical Doctor in Primary Care Clinics in Kuching Division, Sarawak, Malaysia. Evid Based Complement Alternat Med 2017;2017:5146478-5146410 [FREE Full text] [CrossRef] [Medline]
- National Committee for Clinical Research (NCCR). URL: http://www.nccr.gov.my/index.cfm [accessed 2021-08-05]
- Einarsen S, Hoel H, Notelaers G. Measuring exposure to bullying and harassment at work: Validity, factor structure and psychometric properties of the Negative Acts Questionnaire-Revised. Work & Stress 2009 Jan;23(1):24-44. [CrossRef]
- Farley S. The Measurement and Impact of Workplace Cyberbullying, Institute of Work Psychology. Sheffield University Management School, University of Nottingham. 2015. URL: https://core.ac.uk/download/pdf/42605323.pdf [accessed 2021-08-09]
- Jönsson S, Muhonen T, Forssell RC, Bäckström M. Assessing Exposure to Bullying through Digital Devices in Working Life: Two Versions of a Cyberbullying Questionnaire (CBQ). PSYCH 2017;08(03):477-494. [CrossRef]
- Mohamed M, Marican S, Elias N, Don Y. Pattern of Substance and Drug Misuse Among Youth in Malaysia. J Antidadah Malaysia 2008:1-56 [FREE Full text]
- Official Portal of Traditional and Complementary Medicine Division. URL: http://tcm.moh.gov.my/en/ [accessed 2020-10-31]
- Kim YJ, Qian L, Aslam MS. Development of a Personalized Mobile Mental Health Intervention for Workplace Cyberbullying Among Health Practitioners: Protocol for a Mixed Methods Study. JMIR Res Protoc 2020 Nov 20;9(11):e23112 [FREE Full text] [CrossRef] [Medline]
- Burr H, Berthelsen H, Moncada S, Nübling M, Dupret E, Demiral Y, International COPSOQ Network. The Third Version of the Copenhagen Psychosocial Questionnaire. Saf Health Work 2019 Dec;10(4):482-503 [FREE Full text] [CrossRef] [Medline]
- Kosinski M, Matz SC, Gosling SD, Popov V, Stillwell D. Facebook as a research tool for the social sciences: Opportunities, challenges, ethical considerations, and practical guidelines. Am Psychol 2015 Sep;70(6):543-556. [CrossRef] [Medline]
- Kotaniemi J, Hassi J, Kataja M, Jönsson E, Laitinen L, Sovijärvi A. Does non-responder bias have a significant effect on the results in a postal questionnaire study? Eur J Epidemiol 2001:809-817. [CrossRef]
- Cheung KL, Ten Klooster PM, Smit C, de Vries H, Pieterse ME. The impact of non-response bias due to sampling in public health studies: A comparison of voluntary versus mandatory recruitment in a Dutch national survey on adolescent health. BMC Public Health 2017 Mar 23;17(1):276 [FREE Full text] [CrossRef] [Medline]
Edited by G Eysenbach; submitted 13.04.21; peer-reviewed by W Buente; comments to author 04.05.21; revised version received 28.05.21; accepted 06.07.21; published 12.08.21Copyright
©Yun Jin Kim, Linchao Qian, Muhammad Shahzad Aslam. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 12.08.2021.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.