Media framing on news of the Hartal Doktor Kontrak (HDK) movement in Malaysia: a quantitative content analysis of two Malaysian newspapers

The study examines how Malaysia’s mainstream media framed the Hartal Doktor Kontrak (HDK) Movement—an unprecedented nationwide strike by contract doctors on 26 July 2021 arising from long-standing grievances over contract employment terms, career progression, and benefits. Given media’s agenda-setting and framing effects on public perception and policymaking, the research questions focus on which generic frames dominated news coverage and how framing patterns evolved alongside key events of the HDK movement. Understanding these frames is important due to potential impacts on healthcare service delivery during the COVID-19 pandemic, public sentiment toward healthcare workers’ (HCWs) strikes, and governmental policy responses to healthcare human resource challenges.

The paper situates its analysis within framing theory and agenda-setting literature, noting media’s power to shape interpretations through selective emphasis. Prior Malaysian framing studies span politics, education, and COVID-19 coverage, often finding responsibility frames prevalent in mainstream outlets. Internationally, framing of crises and protests shows varied effects on audience perceptions and policy outcomes, with mainstream media typically emphasizing attribution of responsibility during crises. The study addresses a gap in Malaysian healthcare-related framing research, where reporting is often fact-based and events are episodic, by focusing on the HDK strike as a sustained, nationally salient issue.

Design: Quantitative content analysis applying Semetko and Valkenburg’s (2000) five generic frames (responsibility, human interest, conflict, morality, economic consequences) via 20 binary-coded items. Data sources: Two major Malaysian newspapers with high online readership—The Star and Berita Harian—analyzed via their official websites. Timeframe: 1 June 2021 to 28 February 2022 (covering pre-strike buildup, the 26 July 2021 strike, and post-strike developments). Sampling/search: Keywords used were “strike,” “Hartal,” “HDK,” and “contract doctors.” All relevant news reports retrieved; duplicates removed by title and date checks. Each article served as the unit of analysis. Coding and scoring: Two trained coders independently scored each of the 20 items as Yes=1/No=0. For each frame, item scores were averaged (0–1 scale) to indicate frame visibility. Frequencies of each item’s presence within its frame were tallied. Reliability: Inter-rater reliability assessed on a 20% random subsample (n=21) using Cohen’s kappa; κ=0.77 indicated good agreement. Analysis: Descriptive statistics summarized frame prevalence overall and by month. Monthly framing trends were mapped to the HDK chronology. Pre- vs post-strike differences in frame visibility were tested using MANOVA (event as factor; five frame visibilities as dependent variables); follow-up univariate F-tests examined each frame.

- Corpus: 109 articles (The Star n=65, 59.6%; Berita Harian n=44, 40.4%). - Overall frame use: Responsibility frame most prevalent (featured in 76.2% of articles). Human interest and conflict frames appeared in at least one item in 33.0% and 32.1% of articles, respectively. Morality and economic consequences were less common. - Item-level frequencies within frames (counts; % within-frame totals): - Responsibility (total items counted=229): government ability to alleviate problem (72; 31.4%), solutions suggested (71; 31.0%), government responsible (50; 21.8%), urgent action required (27; 11.8%), individual/group responsible (9; 3.9%). - Human interest (total=52): emotive adjectives/vignettes (23; 44.2%), emphasis on affected individuals/groups (20; 38.5%); human face (3; 5.8%); private lives (3; 5.8%); emotive visuals (3; 5.8%). - Conflict (total=58): disagreement between parties (30; 51.7%), reproach (19; 32.8%), multiple sides (9; 15.5%), winners/losers (0; 0%). - Morality (total=39): social prescriptions on behavior (29; 74.4%), moral message (9; 23.1%), references to religion (1; 2.6%). - Economic consequences (total=36): costs/expenses (13; 36.1%), financial losses/gains (12; 33.3%), economic consequences of actions (11; 30.6%). - Temporal patterns: Coverage peaked in July 2021 (n=73; 67% of all articles) at the time of the strike; August 2021 saw a sharp drop (n=2). Responsibility framing dominated most months, peaking in October 2021 and remaining high through early 2022 as calls to action and policy announcements intensified. Conflict framing peaked around July–August 2021 and again in November 2021 (amid renewed strike threats). Economic consequences framing surged in October 2021 and January 2022, aligning with budget discussions and financial implications of policy changes. - Pre- vs post-strike: Although more articles were published post-strike (n=75; 68.9%), aggregate mean frame visibilities were higher pre-strike. Responsibility frame visibility was highest in both periods but declined from pre- to post-strike (pre: M=0.62, SD=0.27; post: M=0.32, SD=0.28). Human interest was the least highlighted frame overall. - MANOVA: Significant multivariate difference between pre- and post-strike framing, F(10,200)=3.78, p<0.001; Wilks’ Λ=0.707; partial η2=0.16. Univariate tests showed significant event effects for Responsibility F(1,105)=27.067, p<0.001; Human Interest F(1,105)=7.602, p=0.007; Conflict F(1,105)=13.016, p<0.001; Morality F(1,105)=8.235, p=0.005; Economic consequences not significant F(1,105)=2.311, p=0.131.

The dominance of the responsibility frame reflects mainstream media’s emphasis on attributing accountability and proposing solutions during crises, aligning with prior framing research. Coverage portrayed the government as chiefly responsible for both the causes and remedies of the contract employment issues, while also surfacing solution-oriented discourse and urgent calls to act. Human interest framing amplified empathy for contract doctors during the COVID-19 pandemic, potentially shaping public concern and attributions of responsibility. Morality framing often connected to professional ethics and patient safety during a health crisis. Economic framing was least frequent but highlighted salary disparities, training opportunities, and budgetary implications of policy reforms. Importantly, framing trends tracked the HDK movement’s chronology; responsibility framing intensified ahead of and during subsequent policy announcements, suggesting framing salience may have influenced stakeholder agendas and responses. The study argues that media framing contributed to concrete actions—task force formation, town hall engagement, extended contracts for specialization, increased permanent posts, and added benefits—demonstrating how framing can catalyze policy change in health human resource crises.

Media framing of the HDK movement in two major Malaysian newspapers was dominated by responsibility attributions and solution-focused narratives, with conflict and human interest complementing the portrayal of stakeholders’ positions and public sentiment. Framing patterns evolved with key events and appear to have supported policy responses addressing contract doctors’ concerns. Beyond the substantive case findings, the study showcases quantitative content analysis with generic frames as a practical, alternative approach to investigate controversial policy issues where conventional primary data collection may be challenging. Future work could broaden media sources, include additional languages and platforms, and extend the timeframe to assess the durability and outcomes of policy changes.

- Media scope limited to two mainstream newspapers (English and Malay), potentially omitting perspectives from Chinese/Tamil-language and tabloid outlets. - Social media content was excluded here (analyzed separately due to differing formats and interactive features), which may limit understanding of participatory framing effects. - Time-bounded analysis (June 2021–February 2022) restricts insight into longer-term policy implementation and subsequent developments. - Use of generic frames may not capture all nuanced or issue-specific framing dimensions.