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Public perspectives on strays and companion animal management in Malaysia

Munir SMI, Mokhtar MI, Arham AF

BMC Public Health, 2023 Jul 26;23(1):1428.
PMID: 37495958 DOI: 10.1186/s12889-023-16276-5

Strays and companion animal management is a sensitive issue in Malaysia that incites solid and conflicting views. Through structured questionnaires administered to a random sample of 704 respondents, this study explored public opinion on a) causes of the stray animal population, b) the management of the stray animal population, and c) the national strategy on strays and companion Animal Management. The results show that 70.3% of respondents agreed that a lack of public awareness regarding animal care was the major contributor to the stray animal population. In addition, 58.1% of respondents felt that treating and vaccinating animals exposed to zoonotic diseases is a viable approach that could be instituted as a reasonable measure in stray animal population management. Finally, developing animal protection areas through a multi-stakeholder partnership strategy initiative recorded the highest support (48.4%) for intervention planning for stray animal management at a national level. Notably, a significant percentage of public responses were implicitly influenced by demographic variables. These findings provide valuable insights into public opinion regarding stray and companion animal management in Malaysia. These findings could inform the development of future legislation aimed at reducing the unfavorable effects of stray animal populations on humans and the ecology of MalaysiaPlease check if affiliations [is/are] captured correctly.

Matched MeSH terms: Public Opinion
Fulltext Development and validation of an assessment tool for public perceptions toward drive-thru community pharmacy services in Malaysia during COVID-19

Ababneh BF, Ong SC, Alsaloumi L, Hussain R

Front Public Health, 2023;11:1144466.
PMID: 37601205 DOI: 10.3389/fpubh.2023.1144466

INTRODUCTION: Community pharmacists' roles have expanded and undergone a significant transition over the last few years. Consequently, new and different pharmacy services, such as drive-thru pharmacy services, have emerged. Drive-thru pharmacy services began three decades ago and continued even during outbreaks such as the COVID-19 pandemic. Patients' perceptions are essential to the successful implementation and satisfaction with any new service. This study examines the reliability and validity of the assessment tool of public perceptions toward drive-thru community pharmacy services in Malaysia during COVID-19.
METHODS: A cross-sectional study was conducted. The developed tool consists of 28 items to evaluate believed advantages toward drive-thru community pharmacy services, believed disadvantages toward drive-thru community pharmacy services, differences between drive-thru community pharmacy services and instore drug refill services, perceptions toward drive-thru community pharmacy services and feelings regarding how the introduction of drive-thru pharmacy services may affect the image of community pharmacists. Exploratory factor analysis (EFA) was performed to identify the factors of the developed tool, and confirmatory factor analysis (CFA) evaluated the model fitness.
RESULTS: The EFA identified five elements and 25 items for the tool, and through CFA results, the observed model of the 25 items structure of the tool was verified as an excellent fit for the data [χ2 (265, N = 565) = 819.586, p < 0.001, IFI = 0.931, CFI = 0.93, RMSEA = 0.064]. The results of the CFA indicated a good model fit between the observed model and the proposed model. The internal reliability of the entire tool and each factor was very satisfactory as Cronbach's Alpha for the whole structured tool was 0.843 and for each factor was as follows, first factor (believed advantages) = 0.909, second factor (believed disadvantages) = 0.921, third factor (differences between drive-thru and instore refill) = 0.647, fourth factor (perceptions) = 0.926, and fifth factor (feelings) = 0.681.
CONCLUSION: The developed and validated tool would be valuable for assessing the public's perceptions of the drive-thru community pharmacy service during COVID-19 and future pandemics.

Matched MeSH terms: Public Opinion
Fulltext Public perception on human exposure risk: A case study on endocrine disrupting compounds in the environment

Wee SY, Aris AZ, Yusoff FM, Praveena SM

Ecotoxicol Environ Saf, 2024 Jan 15;270:115830.
PMID: 38141339 DOI: 10.1016/j.ecoenv.2023.115830

Humans are exposed to environmental risks owing to the broad usage of endocrine disrupting compounds (EDCs). However, the subjective evaluation of risk levels and characteristics, as well as the variation in risk processing, have not been thoroughly examined. The objective was to understand the public's perception of the risk associated with human exposure to environmental EDCs and identify any variations in risk perception. In this pioneering study conducted within the distinctive social and cultural context of Malaysia, a developing nation, a quantitative analysis approach was employed to assess the subjective evaluation of risk levels and characteristics among the public while developing a risk perception model. Data gathered from surveys and questionnaires were analyzed to gather information on the public's perception of environmental and health issues pertaining to pesticides, hormones, plastics, medicines, and cosmetics. The analysis revealed that the majority of the public assessed the level of human exposure to environmental risks based on experiential processing, which was influenced by cognitive and affective variables. Interestingly, a higher proportion of individuals in the community had a low risk perception of environmental EDCs, surpassing the overall risk perception by 19.3%. Furthermore, the public showed significant awareness of environmental and health issues related to pesticides, hormones, and plastics but had a lesser inclination to acknowledge the vulnerability of humans to risks associated with medicines and cosmetics. These findings suggest that the public is likely to be exposed to environmental EDCs based on their current perceived risks, and that sociopsychological factors play a significant role in shaping perceptions and judgments. This understanding can inform the development of targeted risk management strategies and interventions to mitigate the potential harm caused by environmental EDCs.

Matched MeSH terms: Public Opinion
Fulltext Integrated models for solid waste management in tourism regions: Langkawi Island, Malaysia

Shamshiry E, Nadi B, Mokhtar MB, Komoo I, Hashim HS, Yahaya N

J Environ Public Health, 2011;2011:709549.
PMID: 21904559 DOI: 10.1155/2011/709549

The population growth, changing consumption patterns, and rapid urbanization contribute significantly to the growing volumes of solid waste that are generated in urban settings. As the rate of urbanization increases, demand on the services of solid waste management increases. The rapid urban growth in Langkawi Island, Malaysia, combined with the increasing rates of solid waste production has provided evidence that the traditional solid waste management practices, particularly the methods of waste collection and disposal, are inefficient and quite nonsustainable. Accordingly, municipal managers and planners in Langkawi need to look for and adopt a model for solid waste management that emphasizes an efficient and sustainable management of solid wastes in Langkawi Island. This study presents the current practices of solid waste management in Langkawi Island, describes the composition of the solid waste generated in that area, and presents views of local residents and tourist on issues related to solid waste management like the aesthetic value of the island environment. The most important issue of this paper is that it is the first time that integrated solid waste management is investigated in the Langkawi Island.

Matched MeSH terms: Public Opinion
Factors influencing stakeholders attitudes toward genetically modified aedes mosquito

Amin L, Hashim H

Sci Eng Ethics, 2015 Jun;21(3):655-81.
PMID: 24906652 DOI: 10.1007/s11948-014-9557-5

Dengue fever is a debilitating and infectious disease that could be life-threatening. It is caused by the dengue virus which affects millions of people in the tropical area. Currently, there is no cure for the disease as there is no vaccine available. Thus, prevention of the vector population using conventional methods is by far the main strategy but has been found ineffective. A genetically modified (GM) mosquito is among the favoured alternatives to curb dengue fever in Malaysia. Past studies have shown that development and diffusion of gene technology products depends heavily upon public acceptance. The purpose of this study is to identify the relevant factors influencing stakeholders' attitudes toward the GM Aedes mosquito and to analyse the relationships between all the factors using the structural equation model. A survey was carried out on 509 respondents from various stakeholder groups in the Klang Valley region of Malaysia. Results of the survey have confirmed that public perception towards complex issues such as gene technology should be seen as a multi-faceted process. The perceived benefit-perceived risk balance is very important in determining the most predominant predictor of attitudes toward a GM mosquito. In this study the stakeholders perceived the benefit of the GM mosquito as outweighing its risk, translating perceived benefit as the most important direct predictor of attitudes toward the GM mosquito. Trust in key players has a direct influence on attitudes toward the GM mosquito while moral concern exhibited an indirect influence through perceived benefits. Other factors such as attitudes toward technology and nature were also indirect predictors of attitudes toward the GM mosquito while religiosity and engagement did not exhibited any significant roles. The research findings serve as a useful database to understand public acceptance and the social construct of public attitudes towards the GM mosquito to combat dengue.

Matched MeSH terms: Public Opinion*
Fulltext Stakeholders' attitude to genetically modified foods and medicine

Amin L, Jahi JM, Nor AR

ScientificWorldJournal, 2013;2013:516742.
PMID: 24381520 DOI: 10.1155/2013/516742

Public acceptance of genetically modified (GM) foods has to be adequately addressed in order for their potential economic and social benefits to be realized. The objective of this paper is to assess the attitude of the Malaysian public toward GM foods (GM soybean and GM palm oil) and GM medicine (GM insulin). A survey was carried out using self-constructed multidimensional instrument measuring attitudes towards GM products. The respondents (n = 1017) were stratified according to stakeholders' groups in the Klang Valley region. Results of the survey show that the overall attitude of the Malaysian stakeholders towards GM products was cautious. Although they acknowledged the presence of moderate perceived benefits associated with GM products surveyed and were moderately encouraging of them, they were also moderately concerned about the risks and moral aspects of the three GM products as well as moderately accepting the risks. Attitudes towards GM products among the stakeholders were found to vary not according to the type of all GM applications but rather depend on the intricate relationships between the attitudinal factors and the type of gene transfers involved. Analyses of variance showed significant differences in the six dimensions of attitude towards GM products across stakeholders' groups.

Matched MeSH terms: Public Opinion*
Malay public attitudes toward epilepsy (PATE) scale: translation and psychometric evaluation

Lim KS, Choo WY, Wu C, Tan CT

Epilepsy Behav, 2013 Nov;29(2):395-9.
PMID: 24090773 DOI: 10.1016/j.yebeh.2013.08.027

INTRODUCTION: None of the quantitative scales for public attitudes toward epilepsy had been translated to Malay language. This study aimed to translate and test the validity and reliability of a Malay version of the Public Attitudes Toward Epilepsy (PATE) scale.
METHOD: The translation was performed according to standard principles and tested in 140 Malay-speaking adults aged more than 18 years for psychometric validation.
RESULTS: The items in each domain had similar standard deviations (equal item variance), ranging from 0.90 to 1.00 in the personal domain and from 0.87 to 1.23 in the general domain. The correlation between an item and its domain was 0.4 and above for all items and was higher than the correlation with the other domain. Multitrait analysis showed that the Malay PATE had a similar variance, floor and ceiling effects, and relative relationship between the domains as the original PATE. The Malay PATE scale showed a similar correlation with almost all demographic variables except age. Item means were generally clustered in the factor analysis as the hypothesized domains, except those for items 1 and 2. The Cronbach's α values were within acceptable range (0.757 and 0.716 for the general and personal domains, respectively).
CONCLUSION: The Malay PATE scale is a validated and reliable translated version for measuring public attitudes toward epilepsy.

Matched MeSH terms: Public Opinion*
Responding to local needs. Self-help groups

Jayaseelan J

AIDS Action, 1993 Mar-May;[nil](20):4.
PMID: 12288933

PIP: Pink Triangle, the only community-based group in Malaysia which works with men who have sex with men, took initial steps in August 1992 to establish a self-help project for people who are HIV-seropositive. Supporting people who are HIV-positive and fighting for their rights is new in Malaysia. The group has thus far been publicized through its public education events, hospitals, and other nongovernmental organizations. For the first time, information is being published specifically by and for people living with HIV/AIDS. The project also has a phone line to allow people to speak anonymously with someone who shares their experience. Many callers are men who have sex with men in the social context of intense prejudice and discrimination. Afraid to openly acknowledge their sexuality with strangers, the callers have yet to accede to meeting each other face-to-face in a group setting. The author notes in closing that Pink Triangle must be realistic about what can be achieved in Malaysia and allow the group to develop according to people's needs and not on the basis of a model imported from outside of the country.

Matched MeSH terms: Public Opinion*
From 'White Australia' to 'part of Asia': recent shifts in Australian immigration policy towards the region

Jupp J

Int Migr Rev, 1995;29(1):207-28.
PMID: 12319613
Matched MeSH terms: Public Opinion*
Unsung heroes in the South

Panos Institute

WorldAIDS, 1991 Nov.
PMID: 12285096
Matched MeSH terms: Public Opinion*
The unwelcome guests: Indonesian immigrants and Malaysian public responses

Kassim A

Tonan Ajia Kenkyu, 1987 Sep;25(2):265-78.
PMID: 12157842
Matched MeSH terms: Public Opinion*
Attitudes toward epilepsy in East Malaysia using the Public Attitudes Toward Epilepsy (PATE) scale

Chia ZJ, Lim KS, Fong SL, Sim RS, Rajahram GS, Narayanan V, et al.

Epilepsy Behav, 2020 09;110:107158.
PMID: 32512367 DOI: 10.1016/j.yebeh.2020.107158

BACKGROUND: Epilepsy stigma is an important issue affecting people with epilepsy (PWE) in various social aspects of life. Most studies on stigma were among the metropolitan population but rarely on indigenous people. Hence, this study aimed to understand the attitudes toward epilepsy of the East Malaysians, comparing with the West Malaysians previously reported.
METHOD: This study was performed among the indigenous people in Kuching and Sibu (Sarawak) and Kota Kinabalu (Sabah) using the Public Attitudes Toward Epilepsy (PATE) scale. A higher score indicates poorer attitude.
RESULT: A total of 360 respondents (41.7% Kadazan-Dusun, 30.6% Bidayuh, and 24.7% Iban) aged 34.6 ± 12.6 years completed the questionnaire. They were predominantly females and had lower education level and income compared with the West Malaysians. The Sabah population had significantly lower mean scores (better attitudes) than those in Sarawak, in both personal and general domains (p 

Matched MeSH terms: Public Opinion*
Validity and reliability of the Turkish version of Public Attitudes Toward Epilepsy scale

Aktürk T, Tanık N, Saçmacı H, Chia ZJ, Lim KS

Epilepsy Behav, 2020 10;111:107245.
PMID: 32693372 DOI: 10.1016/j.yebeh.2020.107245

OBJECTIVE: This study was conducted to test the validity and reliability of the Turkish version of the Public Attitudes Toward Epilepsy (PATE) scale, which aims to understand public perceptions of seizures and epilepsy.
METHODS: The scale was translated following the standard procedures. For psychometric validation, the Turkish version of the PATE scale was administered to 201 native Turkish speakers above the age of 18 who had no history of seizures or epilepsy. It was found that the respondents were able to fill out the scale quickly and without difficulty in understanding the translated items on the scale.
RESULTS: Cronbach's alpha coefficient was found to be 0.843 for the overall scale and above 0.7 for each individual item. Cronbach's alpha was 0.78 for the general domain and 0.792 for the personal domain. Exploratory and confirmatory factor analyses were carried out and showed that the scale had a structure similar to that of the original scale, with the 14 items grouped under two dimensions, similar to the original scale.
CONCLUSION: The Turkish version of the PATE scale was a valid and reliable tool to measure the attitudes toward epilepsy in Turkish society.

Matched MeSH terms: Public Opinion*
Public Perceptions of Ethical, Legal and Social Implications of Pre-implantation Genetic Diagnosis (PGD) in Malaysia

Olesen AP, Mohd Nor SN, Amin L, Che Ngah A

Sci Eng Ethics, 2017 Dec;23(6):1563-1580.
PMID: 27995446 DOI: 10.1007/s11948-016-9857-z

Pre-implantation genetic diagnosis (PGD) became well known in Malaysia after the birth of the first Malaysian 'designer baby', Yau Tak in 2004. Two years later, the Malaysian Medical Council implemented the first and only regulation on the use of Pre-implantation Genetic Diagnosis in this country. The birth of Yau Tak triggered a public outcry because PGD was used for non-medical sex selection thus, raising concerns about PGD and its implications for the society. This study aims to explore participants' perceptions of the future implications of PGD for the Malaysian society. We conducted in-depth interviews with 21 participants over a period of one year, using a semi-structured questionnaire. Findings reveal that responses varied substantially among the participants; there was a broad acceptance as well as rejection of PGD. Contentious ethical, legal and social issues of PGD were raised during the discussions, including intolerance to and discrimination against people with genetic disabilities; societal pressure and the 'slippery slope' of PGD were raised during the discussions. This study also highlights participants' legal standpoint, and major issues regarding PGD in relation to the accuracy of diagnosis. At the social policy level, considerations are given to access as well as the impact of this technology on families, women and physicians. Given these different perceptions of the use of PGD, and its implications and conflicts, policies and regulations of the use of PGD have to be dealt with on a case-by-case basis while taking into consideration of the risk-benefit balance, since its application will impact the lives of so many people in the society.

Matched MeSH terms: Public Opinion*
Fulltext Some animals are more equal than others: Validation of a new scale to measure how attitudes to animals depend on species and human purpose of use

Bradley A, Mennie N, Bibby PA, Cassaday HJ

PLoS One, 2020;15(1):e0227948.
PMID: 31961885 DOI: 10.1371/journal.pone.0227948

Globally, many millions of animals are used by humans every year and much of this usage causes public concern. A new scale, devised to measure attitudes to animal use in relation to the purpose of use and species, the Animal Purpose Questionnaire (APQ), was completed by in total 483 participants, 415 British nationals and 68 participants from 39 other countries. The APQ was presented in two survey formats, alongside an established Animal Attitudes Scale (AAS). In both surveys, participants also provided demographic details to provide a context to their attitudes to animals. As might be expected, and consistent with the validity of the new scale, overall scores on the AAS and APQ were highly correlated. However, the APQ provided a more differentiated measure of attitudes to animal use across a variety of settings. The results showed that there was overall higher levels of agreement with the use of animals in medical research and basic science, less endorsement for food production and pest control, and the use of animals for other cultural practices was generally disapproved of, irrespective of species. Participants overall disagreed with the use of rabbits, monkeys, badgers, tree shrews (survey 1), chimpanzees, dogs, dolphins and parrots (survey 2), but were neutral about the use of rats, mice, pigs, octopus, chickens, zebrafish (survey 1), carp, chickens, pigs, pigeons, rabbits and rats (survey 2). Interactions between species and purpose were largely driven by the consideration of using diverse species for food production. In general, females and vegetarians expressed less agreement with the use of animals with some differences by purpose of use. Pet keeping consistently predicted reduced willingness to use animals for basic science (only). The APQ provides a new tool to unpack how public attitudes depend on the intersectionality of demographics, species and purpose of use.

Matched MeSH terms: Public Opinion*
Implementation of problem-based learning in child and adolescent psychiatry: shared experiences of a special-interest study group

Skokauskas N, Guerrero APS, Hanson MD, Coll X, Paul M, Szatmari P, et al.

Acad Psychiatry, 2011 Jul-Aug;35(4):249-251.
PMID: 21804045 DOI: 10.1176/appi.ap.35.4.249

BACKGROUND/OBJECTIVE: Problem-based learning (PBL) represents a major development and change in educational practice that continues to have a large impact across subjects and disciplines worldwide. It would seem that child and adolescent psychiatry, because of its inherently integrative, bio-psycho-social nature and emphasis on teamwork and collaboration, would be a specialty learned optimally through PBL. Thus, there was a need to establish an international group where experiences in implementing PBL in child and adolescent psychiatry could be shared. This article reports on the first meeting and plans of the Problem-Based Learning in Child and Adolescent Psychiatry (CAP) Special Interest Study Group (SISG), held at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

METHODS: Through international collaboration and information-sharing, the SISG aims to promote knowledge among Child and Adolescent Psychiatrists on PBL, to explore evaluation methods of PBL in CAP, and to discuss development of PBL-based curricula.

RESULTS: Problem-based learning (PBL) represents a major change in education that has had a large impact across disciplines worldwide.

CONCLUSION: The core steps in PBL are the following: presentation of the initial problem; discussion of the problem, and development of learning objectives; independent learning focused on the objectives; and discussion, exploration of new ideas, and discovery of solutions in the reconvened group. Different from the traditional teacher's role, the PBL tutor is an active facilitator who guides learners to identify issues and ways to learn, rather than a "content expert" who provides facts.

Matched MeSH terms: Public Opinion*
Fulltext Support for smoke-free policy among Malaysian adults: findings from a population-based study

Kuang Hock L, Hui Li L, Chien Huey T, Yuvaneswary V, Sayan P, Muhd Yusoff MF, et al.

BMJ Open, 2019 Feb 12;9(2):e020304.
PMID: 30760510 DOI: 10.1136/bmjopen-2017-020304

OBJECTIVE: Public opinion and support can be powerful mandates for smoke-free policy. However, the scarcity of evidence on public opinion among Malaysians necessitates further investigation. Therefore, this study aimed to determine the level of support for smoke-free policy at various public domains and its associated factors among Malaysian adults.
DESIGN: Data were derived from the Global Adult Tobacco Survey, Malaysia (GATS-M). GATS-M is a nationwide study that employed a multistage, proportionate-to-size sampling strategy to select a representative sample of 5112 Malaysian adults aged 15 years and above. Multiple logistic regression was used to identify factors associated with support for smoke-free policy in selected public domains that is, workplaces, restaurants, bars, hotels, casinos, karaoke centres, public transport terminals and shopping centres.
RESULTS: The level of support for enactment of a smoke-free policy at selected public domains varied from 37.8% to 94.4%, with the highest support was for gazetted smoke-free domains, namely, shopping centres (94.4%, 95% CI: 93.2% to 95.3%) and public transport terminals (85.2%, 95% CI: 83.3% to 86.9%). Multiple logistic regression revealed that non-smokers were more likely to support smoke-free policy at all domains. In addition, respondents who worked in workplaces with total or partial smoking restrictions were more likely to support a smoke-free policy ((total restriction adjusted OR (AOR): 14.94 (6.44 to 34.64); partial restriction AOR: 2.96 (1.138 to 6.35); non-restriction was applied as a reference).
CONCLUSION: A majority of the Malaysian adult population supported the smoke-free policy, especially at gazetted smoke-free domains. Therefore, expansion of a total smoking ban to workplaces, restaurants, bars, hotels, casinos and karaoke centres is strongly recommended to reduce exposure to secondhand smoke and to denormalise smoking behaviour.

Matched MeSH terms: Public Opinion*
A choice experiment analysis for solid waste disposal option: a case study in Malaysia

Pek CK, Jamal O

J Environ Manage, 2011 Nov;92(11):2993-3001.
PMID: 21820795 DOI: 10.1016/j.jenvman.2011.07.013

In Malaysia, most municipal wastes currently are disposed into poorly managed 'controlled tipping' systems with little or no pollution protection measures. This study was undertaken to assist the relevant governmental bodies and service providers to identify an improved waste disposal management strategy. The study applied the choice experiment technique to estimate the nonmarket values for a number of waste disposal technologies. Implicit prices for environmental attributes such as psychological fear, land use, air pollution, and river water quality were estimated. Compensating surplus estimates incorporating distance from the residences of the respondents to the proposed disposal facility were calculated for a number of generic and technology-specific choice sets. The resulting estimates were higher for technology-specific options, and the distance factor was a significant determinant in setting an equitable solid waste management fee.

Matched MeSH terms: Public Opinion
International Women's Day observed in Malaysia

CIRDAP Dev Dig, 1999 Dec.
PMID: 12157876

On the eve of International Women's Day, 80 women representing five women's groups in Malaysia, including Persatuan Sahabat Wanita, CAW's network member, marched from Petaling Jaya to Penang to attend the Women's Day celebration. The group had organized the visitation in order to strengthen its networking. During their meeting with some reporters before their departure to Penang, they demanded that the women's groups be consulted before any guideline on the prevention and handling of sexual harassment at the workplace is drawn up. They said that they have been handling several complaints and their input would help the Human Resource Ministry formulate a comprehensive set of guidelines. This demand by the women's group was in response to the announcement by the Human Resource Minister Datuk Lim Ah Lek that in a month time a code would be ready on guidelines about the establishment and implementation of in-house preventive and redress mechanisms for dealing with sexual harassment.

Matched MeSH terms: Public Opinion
Fulltext The political economy of health financing reform in Malaysia

Croke K, Mohd Yusoff MB, Abdullah Z, Mohd Hanafiah AN, Mokhtaruddin K, Ramli ES, et al.

Health Policy Plan, 2019 Dec 01;34(10):732-739.
PMID: 31563946 DOI: 10.1093/heapol/czz089

There is growing evidence that political economy factors are central to whether or not proposed health financing reforms are adopted, but there is little consensus about which political and institutional factors determine the fate of reform proposals. One set of scholars see the relative strength of interest groups in favour of and opposed to reform as the determining factor. An alternative literature identifies aspects of a country's political institutions-specifically the number and strength of formal 'veto gates' in the political decision-making process-as a key predictor of reform's prospects. A third group of scholars highlight path dependence and 'policy feedback' effects, stressing that the sequence in which health policies are implemented determines the set of feasible reform paths, since successive policy regimes bring into existence patterns of public opinion and interest group mobilization which can lock in the status quo. We examine these theories in the context of Malaysia, a successful health system which has experienced several instances of proposed, but ultimately blocked, health financing reforms. We argue that policy feedback effects on public opinion were the most important factor inhibiting changes to Malaysia's health financing system. Interest group opposition was a closely related factor; this opposition was particularly powerful because political leaders perceived that it had strong public support. Institutional veto gates, by contrast, played a minimal role in preventing health financing reform in Malaysia. Malaysia's dramatic early success at achieving near-universal access to public sector healthcare at low cost created public opinion resistant to any change which could threaten the status quo. We conclude by analysing the implications of these dynamics for future attempts at health financing reform in Malaysia.

Matched MeSH terms: Public Opinion

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