HEALTH CONSCIOUSNESS WITHIN URBAN AND RURAL COMMUNITIES 1

PT6613
Quantitative and Qualitative Methods in Counseling
Semester 1, 2022/2023

Health consciousness within urban and rural communities in

Sabah, Malaysia
Nur Afiqah Farankie (MP2212095T), Siti Nurfathini Muhammad Azrie (MP2212101T),
Tay Kuan Yi (MP2212139T)

ABSTRACT
The main purpose of this study is to investigate whether there is a relationship between
people’s living areas and their health consciousness. A total of 39 respondents living within
Kota Kinabalu, Sabah and Kinabatangan, Sabah participated in this web-based survey. Factor
analysis results reproduce three factors for health consciousness, namely health self-
consciousness, health importance in life, and health negligence. The results suggest that there
was a significance difference in health self-consciousness and health negligence between
those who lives in urban and rural areas, p<0.05, whereas for health importance in life, there
was no significance difference, p>0.05. Further study on this matter is recommended.

Keywords: health, health consciousness, rural, urban

1. Introduction
Health is an important component of life that keeps us living life to the fullest. Different
people have different views and perceptions on health. Health can be defined as a state of
complete physical, mental and social well being and not merely the absence of disease or
infirmity (World Health Organization, 2013). This can be understand that being healthy does
not necessarily means that one does not having any illness, instead, they are physically fit,
mentally stable, and able to function well in a society regardless of the presence of illness.
Some may argue that is a holistic concept (Abumere, 2013). Health is influenced by many
factors, such as Genetic factors, Environmental factors, social factors, Economic factors etc
(Ghosh et. al, 2022).
An overwhelming majority of Malaysians are becoming health conscious. In an article
on Health Supplements in Southeast Asia, the reasons behind the booming health
supplements market in the region, and how consumers as a whole are increasingly willing to
self-diagnose, self-medicate and self-monitor was relate to consumers’ rising health-
HEALTH CONSCIOUSNESS WITHIN URBAN AND RURAL COMMUNITIES 2

consciousness in Malaysia (Tan, 2021). It is obvious that the increase in consumption of health
supplements is tied to Malaysians’ greater awareness of health issues.
On the other hand, as analyzed by Anis Hazim in The Malaysian Reserve, the
healthcare sector without a doubt remains one of the most important sector in Malaysia with
the government’s latest allocation of RM36.14 billion for the Health Ministry (MoH), among
the highest in budget 2023 (Hazim, 2022). The higher allocation, compared to RM32.41 billion
in Budget 2022, looks promising in the government’s efforts to strengthen the country’s health
services. In fact, Malaysia is in need of better accessibility and affordability for its healthcare
system regardless of rural area or urban area. Rural area respondents may have lower access
to and use of certain health information sources relative to urban area respondents.
On 11 November, 2022, The Agenda Nasional Malaysia Sihat (ANMS) was
launched by our former Prime Minister Datuk Seri Ismail Sabri Yaakob, in line with coping of
the endemic phase of COVID-19. ANMS is aimed at cultivating a healthy lifestyle and
promoting environmental sustainability to support the health and wellbeing of Keluarga
Malaysia. The former Prime Minister said ANMS involved four main thrusts, namely
strengthening promotion of a healthy lifestyle, improving health wellness services, enhancing
self-health management and promoting a clean environment. According to the former Health
Minister Khairy Jamaluddin, a change in behavior and awareness to get a health check is the
core of ANMS. ANMS is involving a whole nation including the government, the NGOs and also
private sectors.
In short, health consciousness is a topic worth researching deeper. We are
investigating the difference of health consciousness between these two targeted areas in this
case.

2. Method
2.1 Respondents
In order to fulfill the research objectives, exploratory field research was conducted in
Kota Kinabalu and Kinabatangan, Sabah, using a highly structured questionnaire, in the form
of Google Form.

2.2 Instruments
Health consciousness (HC)
This is a five-point Likert-type scale consisting of 11 items, whereby 1o items were
phrased in positive direction. Respondents rated the statements provided from 1 (strongly
HEALTH CONSCIOUSNESS WITHIN URBAN AND RURAL COMMUNITIES 3

disagree) to 5 (strongly agree). The scale was obtained based on one that has been developed
by Hong (2009).

Table 1:
Demographic information
Gender Male 10
Female 29
Age 20-29 25
30-39 4
40-49 8
50-59 2
>60 0
Race Malay 10
Chinese 12
India 0
Bumiputera Sabah 17
Bumiputera Sarawak 0
Others 0
Religion Islam 26
Buddha 9
Christian 3
Hindu 0
Others 1
Occupation Government Employee 10
Private Employee 8
Self-employed 6
Student 13
Working & Studying 2
Living area Urban 30
Rural 9

2.3 Procedure
This questionnaire was web-based and was distributed using a ‘snowball approach’.
The first page of the questionnaire provides brief introduction to the study, sought
participants’ agreement in participating this study, and assured them confidentiality of
HEALTH CONSCIOUSNESS WITHIN URBAN AND RURAL COMMUNITIES 4

responses. The questionnaires were sent via Google Form link to family and friends, and to
get their assistance to forward the link to their friends and family that fit into each group.

3. Results
A principal component analysis with oblique rotation (direct oblimin) was performed
on responses from the Health Consciousness (HC) scale. Oblique rotation was selected
because of the assumption that items in the scale might not be independent.
Through the analysis, three factors were extracted. These three components together
accounted for 68.8% of the total variance. All items load into the expected component that
represents health self-consciousness, health importance in life, and health negligence. There
was a weak positive correlation between Factor 1 and Factor 2 (r=0.24) as well as between
Factor 2 and Factor 3 (r=0.09), whereas a strong positive correlations between Factor 1 and
Factor 3 (r=0.30).

Table 2:
Factor Analysis (Direct Oblimin) of Health Consciousness
Component
Items 1 2 3
Factor 1 : Health self-consciousness
I'm generally attentive to my inner feelings about my .879
health.
I take responsibility for the state of my health .839
Good health takes active participitation on my part .786
I reflect about my health a lot .757
Living life in the best possible health is very important .696
to me
I'm very self conscious of my health .550 .512
I'm concerned about my health all the time .534
I notice how I feel physically as I go through the day .456
Factor 2: Health importance in life
My health depends on how well I take care of myself .867
Living life without disease and illness is very important .758
to me
Factor 3: Health Negligence
HEALTH CONSCIOUSNESS WITHIN URBAN AND RURAL COMMUNITIES 5

I only worry about my health when I get sick (R) .889

Percentage of variance explained 46.761 11.587 10.465
Eigenvalues 5.144 1.275 1.151

An independent-samples t-test was conducted to compare the health consciousness

between those who live in urban and rural areas. An alpha level of 0.05 was utilised. Variances
for all three factors are homogenous, Factor 1: F(1, 37)=0.157, p<0.05; Factor 2: F(1,
37)=0.024, p>0.05; Factor 3: F(1, 37)=1.377, p<0.05. Hence, equal variance was assumed
for all three factors. There was a significance difference in health self-consciousness and
health negligence between those who lives in urban and rural areas, p<0.05, whereas for
health importance in life, there was no significance difference, p>0.05. The statistical results
are tabulated in Table 3.

Table 3:
T-test of Health Consciousness

Living Mean SD Equal t (df) Sig. (2- CI

area Variance tailed)
Health self- Urban 33.7333 4.66042 Assumed 3.19 (37) 0.003 2.05 to
consciousness Rural 28.1111 4.53995 9.19
Health Urban 9.1000 1.47040 Assumed 1.42 (37) 0.164 -.33 to
importance in Rural 8.3333 1.22474 1.86
life
Health Urban 2.70 1.343 Assumed -2.64 (37) 0.012 -.23 to
negligence Rural 4.00 1.118 -.30

Table 4 presents the ranking of item importance based on mean scores. The highest
ranked item attributed by respondents in living life in the best possible health is very important
to me (M=4.56) and the lowest ranked item is I only worry about my health when I get sick
(M=3.00). The highest ranked item for health importance in life was living life without disease
and illness is very important to me (M=4.56). These responses revealed that the respondents
were more likely to have health self-consciousness than any other components of health
consciousness.

Table 4:
HEALTH CONSCIOUSNESS WITHIN URBAN AND RURAL COMMUNITIES 6

Means and standard deviation of Health Consciousness score

N Mean SD
Living life in the best possible health is very 39 4.56 .598
important to me
Living life without disease and illness is very 39 4.56 .718
important to me
Good health takes active participitation on my 39 4.36 .743
part
My health depends on how well I take care of 39 4.36 .903
myself
I notice how I feel physically as I go through the 39 4.05 .793
day
I take responsibility for the state of my health 39 3.97 .959
I'm generally attentive to my inner feelings about 39 3.95 .793
my health.
I'm concerned about my health all the time 39 3.87 .951
I'm very self conscious of my health 39 3.85 .961
I reflect about my health a lot 39 3.82 .997
I only worry about my health when I get sick (R) 39 3.00 1.395

The relationship between all the three factors in health consciousness was investigated
using Pearson product-moment correlation coefficient. Preliminary analyses were performed
to ensure no violation of the assumptions of normality, linearity and homoscedasticity. There
was a moderate, positive correlation between health self-consciousness and health importance
in life, r = .436, n = 39, p < .05, with high levels of health self-consciousness associated with
high level of health importance in life. On the other hand, there was a weak, negative
correlation between health self-consciousness and health negligence, r = -.296, n = 39, p >
.05, with high levels of health self-consciousness associated with lower level of health
negligence. There was also a weak, negative correlation between health importance in life
and health negligence, r = -.157, n = 39, p > .05, with high levels of health importance in life
associated with lower level of health negligence. Table 5 shows the statistical results of the
correlation.

Table 5:
Correlation of Health Consciousness
HEALTH CONSCIOUSNESS WITHIN URBAN AND RURAL COMMUNITIES 7

Health self- Health Health

consciousness importance in Negligence
life
Health self- Pearson 1 .436** -.296
consciousness Correlation
Sig. (2-tailed) .005 .068
N 39 39 39
Health Pearson .436** 1 -.157
importance in Correlation
life Sig. (2-tailed) .005 .339
N 39 39 39
Health Pearson -.296 -.157 1
Negligence Correlation
Sig. (2-tailed) .068 .339
N 39 39 39

4. Discussion and Conclusion

The first point to be discussed in this section is the aspects in health consciousness. The
aspects that was obtained in this study were different as compared to that of Hong (2009)
study, whereby in his study the factors are self-health awareness, personal responsibility, and
health motivation. Therefore, reconceptualization of new factors were introduced in this study
which are health self-consciousness, health importance in life, and health negligence. This
may suggest that the data that were obtained in this study are most probably not
representable to the outer population as it comprises of a small number of respondents.
One possible interpretation that can be made based on this study is that those who
live in the rural area are less exposed to health knowledges, education and facilities, thus,
showing the result that they have lesser health consciousness as compared to those who lives
in the urban area. This can also be compared to previous study by Ghosh et. al (2022) whereby
they found that students who lives in urban area has higher health consciousness as compared
to those who lives in the rural areas. Kapur (2018) in her study identify that rural people has
limited education, lack of information regarding the social as well as the health features and
also they have inadequate authority on decisions concerning their lives.
HEALTH CONSCIOUSNESS WITHIN URBAN AND RURAL COMMUNITIES 8

This study shows that within all three factors of health consciousness stated, health
self-consciousness and health negligence show significance difference between those in urban
and rural areas. Those who lives in urban have highe health self-consciousness and lower
health negligence as compared to those in rural area. Health importance in life on the other
hand was somewhat similar between those in urban and rural areas.
In order to obtain more representable result on this topic, further studies should be
done.

5. References
Abumere, F. I. (2013). Understanding health. ResearchGate.
https://www.researchgate.net/publication/260083516_Understanding_Health
Ghosh, M., Sankar Ghosh, S., & Chandra Ghosh, M. (2022). Comparative study on health
consciousness between rural and urban school students. International Journal of Physical
Education, Sports and Health, 9(4). https://doi.org/10.22271/kheljournal.2022.v9.i4a.2552
Hazim, A. (2022, October 24). High time for Malaysia's healthcare system to improve. The
Malaysian Reserve.from https://themalaysianreserve.com/2022/10/24/high-time-for-
malaysias-healthcare-system-to-improve/
Hong, H. (2009). Scale Development for Measuring Health Consciousness: Re-
conceptualization. ResearchGate.
https://www.researchgate.net/publication/255609883_Scale_Development_for_Measurin
g_Health_Consciousness_Re-conceptualization
Kapur, R. (2018). Factors Affecting Health Consciousness among Rural Women.
ResearchGate.
https://www.researchgate.net/publication/323770308_Factors_Affecting_Health_Conscio
usness_among_Rural_Women
New Straits Times. (2021a). PM to launch agenda nasional malaysia sihat | new straits times.
New Straits Times. from https://www.nst.com.my/news/nation/2021/11/744164/pm-
launch-agenda-nasional-malaysia-sihat
New Straits Times. (2021b). Malaysia, unhealthy nation with low health awareness. New
Straits Times. from https://www.nst.com.my/news/nation/2021/11/744515/malaysia-
unhealthy-nation-low-health-awareness
Tan, H. S. (2021, August 31). What the rise of health-conscious consumers means for health
supplements in Malaysia. Janio. from https://janio.asia/sea/malaysia/health-beauty-rise-
health-consciousness-my/
HEALTH CONSCIOUSNESS WITHIN URBAN AND RURAL COMMUNITIES 9

World Health Organization. (2013).Self care for health: A handbook for community health
workers & volunteers. World Health Organization.