Mass media plays a crucial role in shaping public opinion and influencing decision-making. The rise of online media has amplified this influence, creating a dynamic interplay between traditional and social media in shaping public discourse. Media framing, the process of presenting events from a particular perspective, significantly impacts how the public interprets information. While framing studies in Malaysia have covered education and politics, research on healthcare-related issues, particularly those involving contentious events like strikes, is limited. The Hartal Doktor Kontrak (HDK) movement, a nationwide strike by contract doctors in Malaysia on July 26, 2021, provides a unique case study. This unprecedented strike, stemming from dissatisfaction with contract appointment policies, including salary disparities, limited benefits, and career stagnation, attracted significant media attention and became a matter of national concern. The study aims to analyze how mainstream media framed the HDK movement, exploring framing trends in relation to the movement's chronology and assessing the impact of this framing on stakeholder responses and policy changes.

Existing literature highlights the significance of media framing in shaping public perception of events and issues across various domains. Studies have demonstrated the impact of framing on public opinion regarding health crises, migration, education, and strikes. In Malaysia, previous research has explored media framing in politics and education, revealing differences in framing approaches between traditional and online media, and demonstrating the consistent use of responsibility frames in certain contexts. International studies showcase the variable nature of media framing effects, with some suggesting a significant influence on public perceptions and policy responses, while others find less conclusive evidence. These studies emphasize the contextual and dynamic nature of media framing and the methodological challenges in analyzing its impact.

This study employed a quantitative content analysis method using data from two major Malaysian newspapers: The Star and Berita Harian. These newspapers have wide circulation and readership. Online articles published between June 1, 2021, and February 28, 2022, containing keywords such as "strike," "Hartal," "HDK," and "contract doctors," were included in the analysis. Duplicates were removed. The Semetko and Valkenburg (2000) five-dimension media frame model was used, which consists of responsibility, conflict, morality, human interest, and economic consequences frames. A checklist of 20 attribute statements was used to measure the prevalence of each frame in each news article. Two independent researchers scored each article, and inter-rater reliability was assessed using Cohen's kappa (0.77). The frequency of each frame and its constituent items was calculated. Multivariate Analysis of Variance (MANOVA) was used to determine differences in frame portrayal before and after the Hartal.

A total of 109 news articles were analyzed (65 from The Star and 44 from Berita Harian). The responsibility frame was the most frequently used (76.2%), with a focus on solutions to the HDK issue and the government's role. Human interest and conflict frames were also prominent (33.0% and 32.1% respectively). The morality and economic consequences frames were less frequently used. The highest media attention occurred in July 2021 (during the strike). The prevalence of the responsibility frame remained high throughout the study period, peaking in October 2021, reflecting increasing calls for government action. The conflict frame peaked around the time of the strike. The economic consequences frame saw surges in October 2021 and January 2022, coinciding with discussions on budget allocation and financial implications of policy changes. MANOVA revealed a statistically significant difference in media framing before and after the strike. Four out of the five frames (responsibility, human interest, conflict, and morality) showed significant differences in prevalence between pre- and post-strike periods. The pre-strike period showed higher aggregate mean scores across all frames, despite a greater number of articles published post-strike.

The dominance of the responsibility frame aligns with findings from other framing analyses of political news, showing mainstream media's tendency to focus on responsibility attribution. The high prevalence of the human interest frame likely reflects public sympathy for the contract doctors, particularly given their sacrifices during the COVID-19 pandemic. The prominence of the conflict frame underscores the inherent disagreements among stakeholders regarding the HDK issue. The less frequent use of the morality and economic consequence frames might reflect the complexity of the issue, requiring a more nuanced approach than simply assigning moral blame or focusing solely on economic costs. The findings suggest that the pre-strike media framing played a crucial role in setting the agenda for subsequent events and influencing policy changes. The increased focus on solutions and government responsibility post-strike demonstrates the media's role in shaping the policy-making process.

This study demonstrates how media framing significantly influenced the HDK movement and subsequent policy changes. The dominant responsibility frame, coupled with the human interest and conflict frames, highlighted the issue, prompted public and professional discussions, and influenced stakeholder responses, leading to policy changes. The study also highlights the use of quantitative content analysis as a valuable approach for analyzing complex and controversial issues. Future research could expand upon this work by analyzing data from a wider range of media sources, including social media and newspapers in other languages, and by tracking the long-term impact of the policy changes on contract doctor satisfaction and healthcare provision.

The study's limitations include the focus on only two major newspapers, potentially excluding other perspectives. The use of a pre-defined framing model could have influenced the results. The study primarily focuses on the immediate aftermath of the strike; longer-term analysis would provide a more comprehensive understanding of the sustained impact of media framing.