Mpox preventive practices and associated factors among adults in a travel-connected setting in Southern Sarawak, Malaysia: a community-based cross-sectional study

Abstract

Background Mpox remains a relevant public health concern in non-endemic, travel-connected settings, where imported cases may occur despite the absence of sustained local transmission. Southern Sarawak, Malaysia, is a socio-demographically diverse region that includes Kuching District, a major administrative and travel hub, and Padawan sub-district, which includes peri-urban and rural communities. This study aimed to assess Mpox preventive practices and factors associated with good preventive practices among adults in Southern Sarawak.

Methods A community-based cross-sectional study was conducted from January to August 2025 among 442 adults in Southern Sarawak, Malaysia. The minimum sample size was estimated using a single-proportion formula and increased by 15% to account for anticipated non-response, including possible refusals, vacant households, and ineligible respondents unavailable during field recruitment. A multistage sampling design was used: Kuching District and Padawan sub-district within Southern Sarawak were purposively selected, residential localities were selected using simple random sampling, households were selected using systematic random sampling, household members were screened for eligibility, and one eligible adult was randomly selected when more than one eligible respondent was present in a household. A structured questionnaire assessed sociodemographic characteristics, Mpox knowledge, attitudes, digital health literacy, and preventive practice. Preventive practice was measured using six Likert-type items covering precautionary measures, quarantine or isolation, avoidance of crowds, mask use and hand hygiene, public awareness, and perceived adequacy of local authority action, and dichotomised as good and poor, with scores ≥ 22 indicating good preventive practice. Knowledge was assessed using 10 items; scores ≥ 7 indicated good knowledge. Attitude was assessed using seven Likert-scale items; scores ≥ 26 indicated a positive attitude. Digital health literacy was assessed using 10 items adapted from the HLS19-DIGI framework, with scores ≥ 76.19% classified as good digital health literacy. Factors associated with good preventive practice were examined using multivariable binary logistic regression.

Results Among the 442 adults who participated, the median age was 37.5 years (IQR: 30–47), 50.5% were male, and 61.8% resided in urban areas. Overall, 95.0% reported good Mpox preventive practice and 95.2% had a positive attitude, although 64.7% had poor Mpox knowledge and 56.3% had good digital health literacy. The final model was statistically significant (χ²(10) = 102.66, p < 0.001) and showed that good preventive practice was independently associated with younger age, male gender, self-employment, unemployment, positive attitude, and good digital health literacy.

Conclusion Adults in Southern Sarawak reported high levels of Mpox preventive practices, but this favourable practice coexisted with poor Mpox-specific knowledge and uneven digital health literacy. Targeted risk communication, strengthening digital health literacy, workplace-based guidance, and locally adapted community engagement are needed to support sustained preventive practice in travel-connected settings.