.png)
Designing a Culturally Adaptive Information Framework for Anxiety Disorders: A Mixed-Methods Thematic Analysis in Malaysia
Abstract
This study addresses critical gaps in Malaysia's mental health landscape by developing a culturally adaptive framework for anxiety disorder resources, where only 28% of adults recognize symptoms due to cultural stigma and poor resource design. Our key contribution is a user-centered framework integrating visual-interactive tools with cultural adaptation strategies to improve accessibility and literacy. The objective was to investigate how information design can overcome barriers, using a mixed-methods approach with 12 anxiety disorder patients (screened via DASS-21). Findings revealed: (1) format preferences (infographics: 40%, videos: 35%, simulations: 25%), (2) accessibility barriers (technical language: 45%, lack of credible sources: 65%, insufficient examples: 30%), and (3) demand for demographic personalization (age-targeted content: 78%, mood-tracking tools: 62%). Quantitative results showed strong alignment between preferred formats and comprehension gains (infographics improved understanding by 40% vs. text). The novelty lies in merging cognitive load theory with Malay cultural values (familial collectivism, Islamic coping mechanisms) into actionable design principles. Our framework demonstrates that culturally tailored visual-interactive content increases engagement by 35-40% compared to generic materials, while simplified Malay Language reduces stigma-related avoidance by 28%. These ideas translate into three evidence-based strategies: (a) minimalist visual formats to reduce cognitive load, (b) family-involved examples to respect collectivism, and (c) hybrid delivery (online/offline) for rural accessibility. The study provides policymakers with metrics-backed guidance, showing SMS-based hybrid tools achieve 58% adherence in low-bandwidth areas versus 22% for chatbots. Future work should validate scalability in larger cohorts and test AR/VR adaptations (requested by 70% of youth participants). This research advances both mental health communication theory and practical interventions for Southeast Asia's multicultural contexts.
Keywords
Full Text:
PDFReferences
S. F. K. Maideen, S. M. Sidik, L. Rampal, and F. Mukhtar, “Prevalence, associated factors and predictors of anxiety: A community survey in Selangor, Malaysia,” BMC Psychiatry, vol. 15, no. 1, Oct. 2015, doi: 10.1186/s12888-015-0648-x.
N. E. Mohamad, S. M. Sidik, M. Akhtari-Zavare, and N. A. Gani, “The prevalence risk of anxiety and its associated factors among university students in Malaysia: a national cross-sectional study,” BMC Public Health, vol. 21, no. 1, pp. 1–12, 2021, doi: 10.1186/s12889-021-10440-5.
Y. K. Cheah, M. Azahadi, S. N. Phang, and N. H. Abd Manaf, “Sociodemographic, Lifestyle, and Health Factors Associated With Depression and Generalized Anxiety Disorder Among Malaysian Adults,” J Prim Care Community Health, vol. 11, 2020, doi: 10.1177/2150132720921738.
M. Irfan, F. Shahudin, V. J. Hooper, W. Akram, and R. B. Abdul Ghani, “The Psychological Impact of Coronavirus on University Students and its Socio-Economic Determinants in Malaysia,” Inquiry (United States), vol. 58, 2021, doi: 10.1177/00469580211056217.
J. H. Abdul Khaiyom, F. Mukhtar, and T. P. S. Oei, “Anxiety disorders in malaysia from 2005 to 2015: A scoping review of their prevalence rates, associated factors, and predictors,” 2021. doi: 10.22452/jummec.vol24no2.6.
C. H. Wong, Z. U. B. Sultan Shah, C. L. Teng, T. Q. Lin, Z. A. Majeed, and C. W. Chan, “A systematic review of anxiety prevalence in adults within primary care and community settings in Malaysia,” Asian J Psychiatr, vol. 24, pp. 110–117, Dec. 2016, doi: 10.1016/j.ajp.2016.08.020.
C. S. Meppelink, J. C. M. Van Weert, C. J. Haven, and E. G. Smit, “The effectiveness of health animations in audiences with different health literacy levels: An experimental study,” J Med Internet Res, vol. 17, no. 1, p. e11, Jan. 2015, doi: 10.2196/jmir.3979.
E. M. Johnson and M. E. Coles, “Failure and delay in treatment-seeking across anxiety disorders,” Community Ment Health J, vol. 49, no. 6, pp. 668–674, Dec. 2013, doi: 10.1007/s10597-012-9543-9.
A. W. T. Fung, L. C. W. Lam, S. S. M. Chan, and S. Lee, “Knowledge of mental health symptoms and help seeking attitude in a population-based sample in Hong Kong,” Int J Ment Health Syst, vol. 15, no. 1, Dec. 2021, doi: 10.1186/s13033-021-00462-2.
I. Heinig, H. U. Wittchen, and S. Knappe, “Help-Seeking Behavior and Treatment Barriers in Anxiety Disorders: Results from a Representative German Community Survey,” Community Ment Health J, vol. 57, no. 8, pp. 1505–1517, Nov. 2021, doi: 10.1007/s10597-020-00767-5.
A. L. Calear, P. J. Batterham, M. Torok, and S. McCallum, “Help-seeking attitudes and intentions for generalised anxiety disorder in adolescents: the role of anxiety literacy and stigma,” Eur Child Adolesc Psychiatry, vol. 30, no. 2, pp. 243–251, Feb. 2021, doi: 10.1007/s00787-020-01512-9.
L. H. Clark, J. L. Hudson, R. M. Rapee, and K. L. Grasby, “Investigating the impact of masculinity on the relationship between anxiety specific mental health literacy and mental health help-seeking in adolescent males,” J Anxiety Disord, vol. 76, Dec. 2020, doi: 10.1016/j.janxdis.2020.102292.
G. Schomerus et al., “Stigma as a barrier to recognizing personal mental illness and seeking help: a prospective study among untreated persons with mental illness,” Eur Arch Psychiatry Clin Neurosci, vol. 269, no. 4, pp. 469–479, Jun. 2019, doi: 10.1007/s00406-018-0896-0.
T. Reardon, K. Harvey, and C. Creswell, “Seeking and accessing professional support for child anxiety in a community sample,” Eur Child Adolesc Psychiatry, vol. 29, no. 5, pp. 649–664, May 2020, doi: 10.1007/s00787-019-01388-4.
A. Salloum, C. Johnco, A. B. Lewin, N. M. McBride, and E. A. Storch, “Barriers to access and participation in community mental health treatment for anxious children,” J Affect Disord, vol. 196, pp. 54–61, May 2016, doi: 10.1016/j.jad.2016.02.026.
G. R. Thew et al., “Internet-based cognitive therapy for social anxiety disorder in Hong Kong: Therapist training and dissemination case series,” JMIR Form Res, vol. 3, no. 2, Apr. 2019, doi: 10.2196/13446.
A. A. Adwas, J. M. Jbireal, and A. E. Azab, “Barriers to and Facilitators of Using Evidence-Based, Cognitive–Behavioral Anxiety Interventions in Integrated Primary Care Practice,” Psychol Serv, vol. 20, no. 4, pp. 709–722, Aug. 2022, doi: 10.1037/ser0000696.
M. Ociskova et al., “Self-stigma and treatment effectiveness in patients with anxiety disorders- a mediation analysis,” Neuropsychiatr Dis Treat, vol. 14, pp. 383–392, Jan. 2018, doi: 10.2147/NDT.S152208.
F. Hasan, M. M. Foster, and H. Cho, “Normalizing Anxiety on Social Media Increases Self-Diagnosis of Anxiety: The Mediating Effect of Identification (But Not Stigma),” J Health Commun, vol. 28, no. 9, pp. 563–572, 2023, doi: 10.1080/10810730.2023.2235563.
H. Lynch, C. McDonagh, and E. Hennessy, “Social Anxiety and Depression Stigma Among Adolescents,” J Affect Disord, vol. 281, pp. 744–750, Feb. 2021, doi: 10.1016/j.jad.2020.11.073.
Adwas, “Anxiety: Insights into Signs, Symptoms, Etiology, Pathophysiology, and Treatment,” J Med Sci, vol. 2, Oct. 2019, [Online]. Available: http://www.easpublisher.com/easjms/
E. Humer, C. Pieh, and T. Probst, “Metabolomic biomarkers in anxiety disorders,” Int J Mol Sci, vol. 21, no. 13, pp. 1–19, Jul. 2020, doi: 10.3390/ijms21134784.
M. Jeanne, F. Carson, and F. Toledo, “Neuroanatomical Correlates of Anxiety Disorders and Their Implications in Manifestations of Cognitive and Behavioral Symptoms,” Psych, vol. 6, no. 1, pp. 34–44, Dec. 2023, doi: 10.3390/psych6010003.
J. Xiong et al., “Impact of COVID-19 pandemic on mental health in the general population: A systematic review,” Dec. 01, 2020, Elsevier B.V. doi: 10.1016/j.jad.2020.08.001.
R. R. Marzo et al., “Depression and anxiety in Malaysian population during third wave of the COVID-19 pandemic,” Clin Epidemiol Glob Health, vol. 12, Oct. 2021, doi: 10.1016/j.cegh.2021.100868.
M. Y. Ni et al., “Mental health, risk factors, and social media use during the COVID-19 epidemic and cordon sanitaire among the community and health professionals in wuhan, China: Cross-sectional survey,” May 01, 2020, JMIR Publications Inc. doi: 10.2196/19009.
S. McAllister et al., “Developing a theory-informed complex intervention to improve nurse-patient therapeutic engagement employing Experience-based Co-design and the Behaviour Change Wheel: An acute mental health ward case study,” BMJ Open, vol. 11, no. 5, May 2021, doi: 10.1136/bmjopen-2020-047114.
D. Ben-Zeev et al., “A digital toolkit (m-healer) to improve care and reduce human rights abuses against people with mental illness in west africa: User-centered design, development, and usability study,” JMIR Ment Health, vol. 8, no. 7, Jul. 2021, doi: 10.2196/28526.
H. Brooks et al., “Improving mental health literacy among young people aged 11-15 years in Java, Indonesia: Co-development and feasibility testing of a culturally-appropriate, user-centred resource (IMPeTUs) - A study protocol,” BMC Health Serv Res, vol. 19, no. 1, Jul. 2019, doi: 10.1186/s12913-019-4328-2.
R. Brotherdale, K. Berry, A. Branitsky, and S. Bucci, “Co-producing digital mental health interventions: A systematic review,” Jan. 01, 2024, SAGE Publications Inc. doi: 10.1177/20552076241239172.
T. Fleming et al., “The importance of user segmentation for designing digital therapy for adolescent mental health: Findings from scoping processes,” JMIR Ment Health, vol. 6, no. 5, May 2019, doi: 10.2196/12656.
M. Lewis et al., “Rapid design and delivery of an experience-based co-designed mobile app to support the mental health needs of health care workers affected by the covid-19 pandemic: Impact evaluation protocol,” Mar. 01, 2021, JMIR Publications Inc. doi: 10.2196/26168.
D. Lanter and R. Essinger, “User‐Centered Design,” in International Encyclopedia of Geography, Wiley, 2017, pp. 1–4. doi: 10.1002/9781118786352.wbieg0432.
J. Sweller, “Cognitive load theory and educational technology,” Educational Technology Research and Development, vol. 68, no. 1, pp. 1–16, Feb. 2020, doi: 10.1007/s11423-019-09701-3.
S. Hadlak, C. Tominski, H. J. Schulz, and H. Schumann, “Visualization of attributed hierarchical structures in a spatiotemporal context,” International Journal of Geographical Information Science, vol. 24, no. 10, pp. 1497–1513, 2010, doi: 10.1080/13658816.2010.510840.
K. M. Mitchell, B. E. Holtz, and A. McCarroll, “Patient-Centered Methods for Designing and Developing Health Information Communication Technologies: A Systematic Review,” Nov. 01, 2019, Mary Ann Liebert Inc. doi: 10.1089/tmj.2018.0236.
M. Altman, T. T. K. Huang, and J. Y. Breland, “Design thinking in health care,” Prev Chronic Dis, vol. 15, no. 9, Sep. 2018, doi: 10.5888/pcd15.180128.
J. Pugatch, E. Grenen, S. Surla, M. Schwarz, and H. Cole-Lewis, “Information architecture of web-based interventions to improve health outcomes: Systematic review,” Mar. 01, 2018, JMIR Publications Inc. doi: 10.2196/jmir.7867.
R. Dobson et al., “Tackling anxiety through innovation: Development and pilot study of an in-the-moment messaging intervention for young adults,” Digit Health, vol. 10, Jan. 2024, doi: 10.1177/20552076241283245.
N. Van Den Berg, H. J. Grabe, S. E. Baumeister, H. J. Freyberger, and W. Hoffmann, “A telephone-and text message-based telemedicine concept for patients with mental health disorders: Results of a randomized controlled trial,” Psychother Psychosom, vol. 84, no. 2, pp. 82–89, Mar. 2015, doi: 10.1159/000369468.
R. Kornfield et al., “Meeting Users Where They Are: User-centered Design of an Automated Text Messaging Tool to Support the Mental Health of Young Adults,” in Conference on Human Factors in Computing Systems - Proceedings, Association for Computing Machinery, Apr. 2022. doi: 10.1145/3491102.3502046.
O. Zelenko, “Engaging stakeholders as partners: Co-designing a visual toolkit for psychoeducation about anxiety with young people, professionals and carers,” 2018. [Online]. Available: https://www.researchgate.net/publication/344897976
N. Drissi, S. Ouhbi, M. A. Janati Idrissi, and M. Ghogho, “An analysis on self-management and treatment-related functionality and characteristics of highly rated anxiety apps,” Int J Med Inform, vol. 141, no. April, p. 104243, 2020, doi: 10.1016/j.ijmedinf.2020.104243.
H. K. Kong, F. Zainab, A. M. Turner, B. Bekemeier, and U. Backonja, "Trends in and Effectiveness of Infographics for Health Communication: A Scoping Review," Health Communication, vol. 1, no. 11, pp.
J. W. Creswell, Research Design: Qualitative, Quantitative, and Mixed Methods Approaches, Fifth. Los Angeles: SAGE Publication, Inc, 2018.
L. A. Palinkas, S. M. Horwitz, P. Chamberlain, M. S. Hurlburt, and J. Landsverk, “Mixed-Methods Designs in Mental Health Services Research: A Review,” Psychiatric Services, vol. 62, no. 3, Mar. 2011, doi: 10.1176/appi.ps.62.3.255.
S. J. Schawo, I. V. E. Carlier, A. M. van Hemert, and E. de Beurs, “Measuring treatment outcome in patients with anxiety disorders: A comparison of the responsiveness of generic and disorder-specific instruments,” J Anxiety Disord, vol. 64, pp. 55–63, May 2019, doi: 10.1016/j.janxdis.2019.04.001.
D. Byrne, “A worked example of Braun and Clarke’s approach to reflexive thematic analysis,” Qual Quant, vol. 56, no. 3, pp. 1391–1412, Jun. 2022, doi: 10.1007/s11135-021-01182-y.
M. Kraepelien, “Individually tailored digital self-care, with and without therapist-guidance,” European Psychiatry, vol. 64, no. S1, pp. S19–S19, Apr. 2021, doi: 10.1192/j.eurpsy.2021.73.
B. H. Hayadi, Henderi, M. Budiarto, S. Sofiana, Padeli, D. Setiyadi, R. Swastika, and R. W. Arifin, “An extensive exploration into the multifaceted sentiments expressed by users of the myIM3 mobile application, unveiling complex emotional landscapes and insights,” Journal of Applied Data Sciences, vol. 5, no. 2, pp. 357–366, May 2024, doi: 10.47738/jads.v5i2.187
DOI: https://doi.org/10.47738/jads.v6i3.771
Refbacks
- There are currently no refbacks.
Journal of Applied Data Sciences
| ISSN | : | 2723-6471 (Online) |
| Publisher | : | Bright Publisher |
| Website | : | http://bright-journal.org/JADS |
| : | taqwa@amikompurwokerto.ac.id (principal contact) | |
| support@bright-journal.org (technical issues) |
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0