Study setting and population
This was a cross-sectional anonymous web-based survey conducted between 10th September 2020 and 30th November 2020. Data were collected and managed using the Research Electronic Data Capture (REDCap) platform hosted at Clinical Research Centre, Hospital Pulau Pinang, Pulau Pinang, Malaysia [8, 9]. Snowball sampling method was used to recruit the respondents for this study by distributing the survey link to the research team’s personal and professional network as well as on social media platforms such as Facebook, Instagram, Twitter, LinkedIn, WhatsApp, and Telegram. The sample size was calculated with z-score of 1.96, margin of error of 0.05 and expected proportion of 50%, which gives us a sample size of 363. We chose this expected proportion as there was no previous studies done related to our research question. By taking into consideration a 30% drop-out rate, the minimum sample size of 520 was needed. This survey was opened to Malaysians aged 18 years and above. Prior to accessing the questionnaire, respondents were asked eligibility screening questions, and only those who were eligible proceeded to answer the questionnaire. All respondents were informed of their anonymity and online consent was taken at the beginning of the survey.
The questionnaire used in this study was first developed in English and later translated to Bahasa Malaysia and Mandarin. A group of healthcare workers currently practicing at a healthcare facility were consulted during the questionnaire development stage to ensure content validity of the questionnaire. Following this, face validity was done with ten respondents from the study population to ensure comprehensibility. The questionnaire was subsequently modified according to the feedback received. This process was repeated until there were no more modifications needed.
The questionnaire consisted of 3 sections whereby the first section focused on the respondents’ sociodemographic information on age, sex, ethnicity, education level, employment status and monthly household income. Total monthly household income was classified into three main groups according to the income threshold of Malaysian 2019 statistics. The categories are B40, M40 and T20 where the income threshold is below RM4,850, RM4,850 to RM10,970, and above RM10,971 respectively .
The second section asked the respondents to select the healthcare sector (public or private) that they utilize most of the time. All respondents were also asked to choose between “yes” / “no” / “not sure” if they were given any clinic or hospital appointment in the past. Respondents who answered “yes” would be asked to indicate if they were given a choice to choose their preferred appointment time, and if they had ever been given any appointment on a weekend or after 5 pm on a weekday in the past. Both these weekend and after 5 pm weekday appointments are referred to as off-office hour appointments.
The final section started with a hypothetical scenario to explore respondents’ preferred arrival time interval should they be given a clinic/hospital appointment at a public healthcare facility on a weekday, between 10 and 11am. The options given started as early as 7.00am, with every half an hour time interval. The answers were later categorized into early (7.00am – 9.30am), on time (9.30am – 10.00am) or late (10.00am onwards). All respondents were required to indicate the reasons of their chosen arrival time interval from a list of choices provided. This is followed by two more scenarios assessing the respondents’ agreement with off-office hour clinical appointment which covers the weekday evening and weekend appointment. The respondents were asked to choose between “agree” or “disagree” with respect to the given scenario. They were prompted for the reasons of their chosen answer from a list of choices provided.
The responses were analysed using descriptive and inferential statistics. All categorical variables were expressed in frequencies and percentages, whereas the continuous variables were expressed in mean with standard deviation (SD), or median with interquartile range (IQR) depending on the data distribution. After we conducted the analysis, we decided to perform an additional inferential statistic using Pearson chi-square to determine if any association existed between the most utilized healthcare sector categories and their agreement to off-office hour appointments. The statistical analysis was done using R version 4.0.2. A p-value of 0.05 was considered as statistically significant.
This study was registered under the National Medical Research Register (NMRR) and approved by the Medical Research Ethics Committee (MREC) (NMRR-20–1654-55,650). The participation in this survey was voluntary. No personal identifiers were collected in the survey. Consent was obtained when the respondents click on the “I agree and consent to participate” button after reading the consent form.