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2.1 Literature Review

2.1.2 Independent variable Social-Economic Status (SES)

According to Baker (2014), Social-Economic Status (SES) can be defined as the combination of social and economic status of an individual which tends to be associated with better health positively. In simple words, SES is an indicator of income, education and employment status of an individual that enable them to have the access to the use of primary health care system.

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According to Cassedy et al. (2013), the measures of SES such as family income, occupational prestige and educational level have been found to affect an individual’s health condition. In this journal, family income, educational level and occupation were taken as the indicator of SES.

Pediatric Cardiac Quality of Life Inventory was used to measure Health Related Quality of Life (HRQOL), Hollingshead index was used to measure the occupational prestige, correlations to test the relationship among the three SES indicators, the connection strength between SES measures and the Pediatric Cardiac Quality of Life Inventory was calculated through regression-based modelling. In the same journal, the researchers included the control variables such as race, sex and current cardiac status due to their high potential influence on the SES. The result shows that family income has a stronger relationship with the HRQOL score whereas the educational level and occupational prestige show lesser impact on the HRQOL score due to the family income is believed as one of the problems of health care access and utilization (Cassedy et al., 2013). For example, better family income level meaning they will have a better housing, schooling and nutrition as compared to those living in poverty. According to WHO (2017), individuals living in poverty are more likely to have ill-health as compared to individuals with higher SES scores this is because they are forced to live in environments that without clean water, decent shelter or adequate prevention which cause them sick.

Burkert, Rasky, Grobschadl, Muckenhuber and Freidl (2013) gave the same idea that, obesity issue is rising worldwide which is correlated to the high risk to health. The data in the journal was obtained from the Austrian Health Interview Survey (AT-HIS) 2006/07 through face-to-face interview questioning about the socio-demographic characteristics, diseases, health related behaviour and psychological issue. The number of participant is 1,077 individuals which can be categorised into 3 groups which were normal weight, overweight and obese respectively. In this journal, the result obtained was more or less the same with the findings gained from Cassedy

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et al. (2013). It shows that obese subjects and persons with low SES are more likely to have the poorest health condition; even they also evaluate themselves to have a very poor health status, face a lot of health difficulties due to disorder and suffer from chronic diseases. Furthermore, vascular risk has significantly increased which in term reduces the quality of life significantly for obese subjects and persons with low SES. In the researchers findings demonstrated that the SES of obese subjects has greater influence in the health conditions. For example, the number of chronic diseases is increased in obese persons of low SES which indirectly showed that the overall quality of life of obese subjects is positively related to the SES (Burkert et al., 2013).

Quansah, Ohene, Norman, Mireku and Karikari (2016) also mentioned that, SES is playing an important role in affecting the health condition, particularly to the children. In their early year, they are vulnerable to the social influences. Quansah et al., (2016) said that, chronic disorder might be happening in the later life due to adverse social exposures in childhood. In this research, the researchers gained information on the influence of social factors on child health in Ghana from published articles through Science Direct, PubMed, MEDLINE via EBSCO and Google Scholar. In the line with Quansah et al. (2016), infant are often rely on mothers for their interactions with the environment, this shows that child mortality is sensitive to maternal education. Hence, in can be said that when the maternal education increased, the rate of child mortality will tend to be reduced. This is because an educated mother is more autonomous in child health decision making with essential knowledge and is more likely find well-resourced health facilities for child treatment. Besides, this research revealed that there is a significant impact of the living area on child health. From the evidence obtained by Musafili, Essen, Baribwira, Binagwaho, Persson and Selling (2015), child mortality can be reduced by increasing the social equity in child survival, especially regarding the urban area or rural area differential.

On the other hand, Quansah et al., (2016) stated that family income plays an

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important role in reducing the child mortality. From the example given by O'Hare, Makuta, Chiwaula and Bar-Zeev (2013), if the infant mortality rate in a country is 50 per 1000 live births, the infant mortality rate can be reduced to 45 per 1000 live births when the GDP per capital purchasing power parity increases by 10%.

Williams, Cunich and Byles (2013) further added that, men and women with higher SES tend to have a better health. In this research, the data from six survey waves (1996 to 2010) of the Australian Longitudinal Study on Women’s Health (ALSWH) were applied to test the relationship between SES and the changes in the general health and mental health of women from the year 45-50 to 59-64. There were 12,709 women participants whom born in between the year 1946 to 1951 in the ALSWH. The SES was measured through the factor analysis of the ALSWH baseline survey question (1996) about highest qualification and occupational prestige. Multi-level random coefficient models used to analyze repeated measures of general health and mental health. In the result of this journal, after adjusting the effect of SES, the mid-aged women self-reported that their general and mental health changes over time. According to Williams et al. (2013), women with low SES tend to have poorer general and mental health as compared to higher SES women and at the same time, the researchers conclude that SES, socio-demographic factors and health behavior have significant impact on general and mental health changes.

Aas, Alstadsaeter and Feiring (2013) also have the perception in which the major cause of health changes across individuals and societies is the societal conditions. The researchers believed that the positive relationship occurs between SES and health conditions. The researcher used self-reported data which were collected by means of a postal survey (2009) to all members of the Norwegian Breast Cancer Association. There were 1666 women participants at the age 40-69 in the survey and the response rate was 62%.

According to the analysis carried out by Aas, Alstadsaeter and Feiring,

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(2013), the treated women were in average 4 years older, had higher attainment in education, with better income, wider social networks and lived in the central region and basically they self-reported that they have low health scores than those non-treated women. In simple words, this means that women with better SES normally will have less health issue than to women with poorer SES. The researchers also noted down a social gradient on self-rated among Norwegian women and the result shows that the breast cancer illness and treatment moderated has positive correlation between SES and self-rated health.

In the other paper, in the words of Akinyemiju et al., (2013) investigated that racial and economic segregation can also be important in examining the racial differences in breast cancer survival. In other words, racial and economic segregation have certain impact on the individual health status. In the example given, it is found out that women living in countries with higher portion of blacks often had higher hazards of breast cancer mortality and the major factor may be the lower income on average since the blacks are more likely to live in poor countries. The research involved data from 1796 breast cancer cases which were obtained from the Surveillance Epidemiology and End Results and the National Longitudinal Mortality Study dataset. Cox Proportional Hazards models were used to gather the data within countries.

In the researcher findings, they suggested that neighborhood poverty and insufficient of healthcare resources might able to illustrate the disparities among black-white in breast cancer survival. Source of Information

Source of information is one of the independent variable to detect the level of awareness of employees for the health screening benefits provided by SOCSO upon 40 years old. There are two several of sources for increase the level of awareness of the health screening benefits which is formal and

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informal sources (Lin, Hsiao and Yeh, 2017). In the formal sources, people aware the health screening benefits from insurance sellers, printed sources such as magazine article and from the Internet. Likewise, people aware the health screening benefits from their friends and family in the informal way.

Padmasundari and Selly (2016) found that around 40 percent of the 76 respondents are aware of health screening benefits provided for public from the employer. Employer are playing an important role to inform about the health screening benefits which is freely provided by government for all the employees who working under their company, so this insurance can as a backup for their employees if the amount of insurance provided by company are not enough to cover the payment. Also, employer can reduce the amount of premium in order to reduce the cost of workers’ health insurance to generate more profits.

Besides, there also having other sources to increase the level of awareness about the public health insurance which is get the public health benefits’

information through their friend or relative around them and advertisement on the social media (Priya and Srinivasan, 2015). From this study, researchers distributed total 325 respondents to analysis the source of awareness of health insurance and found out that 62 respondents are aware the health insurance by their friends and relatives and 89 respondents are aware from the advertisement (Priya and Srinivasan, 2015). Thus, most of the people will easily get some information through the daily communication with their friends and relatives, when one of their friend or relative are aware about the health screening benefits, therefore, he or she will brings this topic to their conversation.

Furthermore, Choudhary et al., (2013) found that most of the respondents are aware the health insurance benefits by family, friends, relative or during at work. These researchers used a total 400 of respondents and found that only 229 respondents are aware about the health insurance. Hence, researchers also found that 87 of the respondents are aware this benefits

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through family, friends, relative or during at work out of 229 respondents whose aware health insurance.

According to Sachin and Punith (2014); Indumathi, Saba, Gopi and Subramanian (2016), both of the research’s researchers found that friends and family is the main source for people to aware health insurance which is 77.4% in average from both research. These result shows that the higher number of people aware about the health benefits, it will lead to increase the level of awareness of the health screening program provided by SOCSO. It shows a positive relationship between the source of information and the level of awareness of the health screening program.

However, family is more efficiency to promote and increase the level of awareness for health insurance benefits in the public than friends. Bhavesh, Ravi, Gaurang, Desai and Bansal (2013) found that 27.5% of the respondents are aware the health benefits through their family and 17.6%

were through their friends. It is because families are more care about their family members; they will share the knowledge about the health screening benefits to their family members to ensure that all members are taking this SOCSO benefits. In additional, government promotional schemes had included in the research done by Sachin and Punith (2014), they found that 25% of the respondents were aware the health insurance by government program, therefore, government also playing an important source for Malaysia workers to aware this benefits.

Social media are main an important source to increase the level of awareness about the health screening benefits. It is because social media are provided the space for sharing prevention information and it able to create the support structures to track personal health, therefore, most of the health industry increasingly turning to using the social media to support or promote the information and data to the public (Dosemagen and Lee, 2017). Due to innovation, internet can easily for people to seeking the health information but not all the people are using the internet. For those who live in rural area

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and some outdated elder person, they mostly will get the health information through the radio, television or newspapers. However, Lin, Hsiao and Yeh (2017) stated that some people are not common in using the modern communication technologies such as smartphone in the developed countries or area, therefore, it will lead to government cannot increase the level of awareness of the health screening benefits through the social media.

Moreover, social media will promoting the behavior to other people, when one people voice up about how SOCSO brings advantages to them, it effect other people to follow and raise the awareness of the public health screening benefits (Chiang, 2014). Besides, reporter or journalist will report the latest flu tracking through the social media, when people are notice the severity of the flu they will start to seek about the health insurance to protect them.

Since the social media had recognized as a source of data, it will increase the level of awareness when government are increasingly to promote the health screening benefits through the social media.

According to Bonte and Filipiak (2012), social media can easily to improve the awareness of the health screening program by those people whose are belonging in the same group through the social interaction but not in the developed countries. Similarly, Setswe, Muyanga, Witthuhn and Nyasulu (2015) found that 49.9% of their respondents were aware the health insurance through the electronic media while 38.3% aware about it through the community organization in South Africa. This result prove that electronic media such as radio and television is more sufficient to increase the awareness of the health insurance than social media in the developed countries. In sum, different countries should have the different ways to promote the health screening program for their citizen to increase the level of awareness about these benefits to public.

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