Stigma-Marking of COVID-19 Patients in Facebook and Twitter of Youth in Malaysia in 2020–2021

Comment

Amendment

Great paper with timely and in-depth discussion. One suggestion for future study. You did a great job on content analysis and sentiment analysis, since you are examining Facebook comments and tweets, there must be emoji there. Emoji has become a popular form of expression on social media. You can analyze the symbolic meaning of those emoji.  

p.6, para 2.

An explanation has been added to justify why emojis were not analysed.

In this study, only text was analysed and emoji, although a popular form of expression on social media, was excluded.

Need some minor spell check. Some edits as shown below: 

Line 34-the health director, general ....confidentiality, stated that - KEEP

Line 68-aided

Line 87&88-lacking a parenthesis 

Line 93-stigma is the key since it offers...

Line 138/188/191/192-March 18, 2020

Line 155-stage 

Line 156-delete "the"

Line 159-themes were counted and compared for...

Line 160-run on sentence, need to rewrite 

Line 175-delete a space before 'The italicized words..'

Line 178-delete "as is the case" and "a" before disease 

Line 193-Malaysian Director, General of Health Noor Hisham Abdullah, confirmed that - KEEP

Line 210-"the other"-->"other", "target"-->"targets"

Line 259-delete "they" before lied about it 

Line 328--too many spaces before table 6 - CANT DO ANYTHING, LINES WILL RUN

Line 364--too many spaces before "In addition"

Line 368--delete "are" before a threat 

Line 374--double space before "However" – CAN’T DO ANYTHING, LINES WILL RUN

Line 381--add a comma before the word "and Indian"

Line 419--"criminal" or "traitor"

Thank you. All the corrections have been made except for “Malaysian Director, General of Health Noor Hisham Abdullah” because in Malaysia “Director General” is a position and the two words are used together.

There were two places where editing cannot be done to reduce space because the layout runs. I am sorry I have to leave it to the editorial team.

Comment

Amendment

1.     Please back the following sentence on page 3,  line 97-99, with sources ‘In many incidences, these persons are not allowed to enter the house or the neighbourhood, and many COVID-19 patients or suspected cases have committed suicide’.

p.3, last para.

The missing citation has been added. It is the same paper cited in the previous sentence.

In many incidences, these persons are not allowed to enter the house or the neighbourhood, and many COVID-19 patients or suspected cases have committed suicide [7].

2.     ·       What would be the justification for using Stangl et al.’s (2019) Health Stigma and Discrimination Framework in the context of social media?  Does this framework take into account algorithms in social media? How is self-stigma accounted in this framework?

A justification has been added to explain why this framework was selected. We did not specifically analyse self-stigma in this study.

p.4, Theoretical framework of study, para 2.

This framework was not constructed specifically to be used for analysis of social media messages. However, the framework was selected because of the subject matter of the Facebook and tweets, that is, health-related stigma.

3.     And please explain why only the second part of the framework on signs of stigma is relevant.

p.5, para 5.

A justification has been added to explain why the top part of the framework is not relevant for the scope of the present study.

The scope of this study does not include stigma manifestations and outcomes because it is restricted to analysis of social media messages. These two components of Stangl et al’s (2019) framework are relevant to researchers who use questionnaires to study the relationships among constructs of stigma.

4.     This statement (on page 4, line 127-128) i.e., ‘Yufika (2021) found internalized stigma among healthcare workers in Indonesia, who did not have degree education’ please clarify further exactly who did not have degree education, and by degree do the authors refer to tertiary degree?

p.5, para 3.

Information on the degree has been added as follows:

Yufika (2021) found internalized stigma among healthcare workers in Indonesia, particularly among nurses and paramedical personnel who did not have tertiary degree education [12].

5.     I would suggest terms in Malay be italicised such as “pesakit COVID- 19”.

Thank you for the suggestion. I have italicized the Malay words in the whole manuscript.

6.     It should be ‘the results section’ instead of ‘the Results section’ on page 5 lines 165-166.

Thank you. The “R” is now not capitalized.

7.     Discussion and conclusions ought to be separated and not be merged into one section.

The two sections have been separated.

p.19, para 3:

The first paragraph of the original “Discussion and conclusions” has been moved to the new Conclusion section. The last sentence has been expanded for clarity.

The study on stigma marking of COVID-19 patients in Facebook and Twitter showed that the main stigma marker is health-related, followed by ethnicity, social class, and occupation. Typical stigma markers for these four categories are super-spreader, Tabligh/Sivagangga, “kayangan” (affluent) cluster, and nurse/doctor/police/frontliner respectively. In terms of frequency, there were no significant differences in the types of stigma markers in the two social media platforms. However, qualitatively the intensity of emotion is much higher in the tweets, indicating that there is greater stigmatization of COVID-19 patients in tweets compared to Facebook comments.

p.17, para 2:

The new Discussion section now starts with the following sentence:

The analysis of stigma marking in Facebook comments and tweets posted by Malaysian netizens in their early twenties yielded key findings on the types of stigma markers and the intensity of stigmatization.

8.     ·       I find the authors’ finding i.e., the study on stigma marking has uncovered greater intensity of stigmatization of COVIDs-19 patients in tweets compared to Facebook comments, to be convincing. What would be the rationale to this? And such stigmatisation, is this rooted in self-stigma or public stigma? The tendency to have a strong degree of ethnicity as part of identity in Malaysia does this contribute to stigmatisation of COVID-19 patients in twitter?

I am sorry, we did not specifically analyse the stigma in terms of self- and public stigma.

The greater intensity of stigmatization in tweets and lower intensity of stigmatization in Facebook is not linked to the tendency to have a strong degree of ethnicity in Malaysia. I have added a citation to strengthen my argument.

p.17, para 2:

More than one in four teenagers say social media is an important avenue for them to express themselves creatively [40].

9.     What kind of contribution does this study bring? And what are implications brought about by this study?

The implications brought about by this study has been explained by adding a paragraph.

p.19, Conclusion, para 2.

The finding on the greater intensity of sentiments in tweets has profound implications on research. It is often difficult to recruit individuals to participate in studies on stigma if the purpose of the research is explicitly made known. However, social media communication is a good source of naturally occurring interactions to study a stigmatized situation or condition. This is because individuals express themselves and exchange views in social media platforms; they do not manufacture opinions for the benefit of researchers. The present study has indicated that Twitter messages has greater potential to bring researchers closer to understanding the “real” feelings and attitudes towards issues and events.

10.  I suggest that the title ‘Stigma marking of COVID-19 patients in Facebook and Twitter in Malaysia’ be changed to ‘Stigma marking of COVID-19 patients in Facebook and Twitter in Malaysia in 2020-2021’ since this study, in my humble view, is time-bound.

Thank you. The title has been changed.

Comment

Amendment

1. The introduction should establish background more clearly relating to social media context.

The argument in the Introduction now ends with health stigmatization in the social media context.

2. The theoretical review is rather thin. Must critically assess literature with rigor.

Review systematically important literature to provide a clear context of the Covid pandemic, such as: 

a)     Impact of Social Media, Extended Parallel Process Model (EPPM) on the Intention to Stay at Home during the COVID-19 Pandemic

b)     The fear of COVID-19 and job insecurity impact on depression and anxiety: An empirical study in China in the COVID-19 pandemic aftermath

c)      Role of Social Media in Shaping Public Risk Perception during COVID-19 Pandemic: A Theoretical Review

Thank you for the suggestions. Two of the three and four other new papers that I found have been added to the Introduction/Literature Review section. The second recommended article is not relevant and although I tried very hard, it does not fit into the paper.

3. The results need to be rewritten. Tables should only be in English, and there is no need to list each comment from social media. A better effort to present results should be done. 

The number of social media messages in the tables have been drastically cut down. What are left are Facebook comments and tweets mentioned in the write-up of the results. A few more others are left in the tables to give a sense of coherence in the social media discussion.

Comment

Amendment in green

1.     Thank you for your revisions; your manuscript is much more detailed
as of now. I have additional comments as follows:
·Is it deliberate not to have a research question in this manuscript?
For reason of clarity, I suggest a research question be added.

Yes, it is deliberate not to have a research question as the purpose of the study is stated in the aim of the study (The study examined stigma marking of COVID-19 patients in Facebook and Twitter in Malaysia.)

Adding a research question is redundant, as it constitutes rephrasing the aim-of-the-study sentence as a question.

2.     ·This manuscript requires proofreading as there are instances of
usage of articles that are incorrect throughout the text/manuscript.

Sorry for the grammatical mistakes. I have tried my best to correct them.

3.     ·I would be grateful if the authors could clarify what is meant by
‘The stigmatization is expected to vary with sociocultural setting’
(line 98, p. 3).

This sentence has been deleted.

4.     ·What is ‘health-related stigma’? It would be most helpful for
readers (and reviewers) to have a definition of this. Self-stigma and
public stigma have been used in conceptualizing dementia stigma.

A definition has been added to health-related stigma as follows. Thank you for suggesting self- and public- stigma in the first and second review. I am sorry, I am not using this suggested framework for this paper but I may use it for future research.

The theoretical framework of the study was taken from Stangl et al.’s (2019) Health Stigma and Discrimination Framework formulated for health-related stigmas, that is, stigma linked to diseases (Figure 1) [18].

5.     ·The authors state that ‘Media play a crucial role in stigmatizing communities’ (p.7, L.213-214) – in regard to this statement, please elaborate on how media play a crucial role, and what the process of stigmatization would be in communities? Access to media, especially online media, is uneven across communities.

The overgeneralization has been deleted, and the sentence has been rewritten as follows:

This is an example of hate messages towards certain communities that are blatantly expressed in the social media.

6.     ·‘The finding on the greater intensity of sentiments in tweets has profound implications on research’ ( L. 491-492, p.15); what kind of
profound implications are these? The authors might want to outline
the implications of this finding to policy-makers in Malaysia, media studies, and studies on social stigma/public stigma in health/ or ‘health-related stigma’. I suggest omitting the usage of ‘profound’.

This sentence on the profound implications has been deleted.

The implications of the findings for researchers and the field are made clearer by adding the target as follows:

The present study has indicated that Twitter messages has greater potential to bring researchers closer to understanding the “real” feelings and attitudes towards issues and events. It is often difficult to recruit individuals to participate in studies on stigma if the purpose of the research is explicitly made known. However, social media communication containing naturally occurring interactions provides authentic data for researchers in media studies and stigma studies. This is because the views expressed in social media platforms are not opinions manufactured for the benefit of researchers.  These findings are useful for policy makers such as government agencies related to social and community development when formulating policies and strategies on societal harmony.

Comment

Amendment in blue

1.     1. The introduction should establish background more clearly relating to social media context.

I used the Introduction section to build a case on why there is a need to study stigma in social media messages in Malaysia. Since there is a lack of such studies in Malaysia, I am sorry I cannot offer more background information on social media context in Malaysia. However, I have found literature on this in other countries like the US and Indonesia and have already added these findings.

2.     The theoretical review is rather thin - need much of revision and addition. No mentioning of theories, hypotheses or any research questions that study aims to answer.

I am sorry this study did not use an established theory as such. However, it is based on a stigma and discrimination framework which has the beginnings of a theory. My study is important in providing empirical findings to test out the framework before it can reach the status of a theory. This framework was chosen because it offers a different perspective on disease-related stigma, and “importing” it to guide a language analysis will add a cross-disciplinary angle that can move the field forward.

The theoretical framework of the study was taken from Stangl et al.’s (2019) Health Stigma and Discrimination Framework formulated for health-related stigmas, that is, stigma linked to diseases (Figure 1) [18]. For example, Ransing et al. (2020) had used this framework in their study of stigma and discrimination related to an infectious disease outbreak [17]. Stangl et al.’s (2019) framework was not constructed specifically to be used for analysis of social media messages. However, the framework is appropriate for guiding the analysis of health-related stigma in Facebook comments and tweets. “Importing” Stangl et al.’s framework from another discipline into language analysis adds a cross-disciplinary angle to the research, and opens up a new perspective for exploring disease-related stigma.

3.     Results part still look very simple and doesnt contain much informative content expect for illustrating the content and translation of the Tweet/FB post. Results part should be more analytical. 

I admit that the results are descriptive in the Results section and was intended to be. Later, the discussion of the results presents the analytical part of the paper.

4.     Sample size is very small to conclude any statements. 

The sample size may be small if content analysis is conducted using software like AntConc but the present study involved qualitative analysis – going down to single words being used. For this purpose, the sample size is fairly adequate.

However, for a qualitative language analysis down to the meanings and connotations of single word, this sample size is fairly adequate to reveal the nuances of the stigmatization