Development, validation, and evaluation of an online elder abuse and neglect module (e-mean) for emergency department healthcare professionals in Perak

Elder abuse and neglect (EAN) remains under-recognised in Malaysia’s emergency departments (EDs), where older adults often present with injuries or clinical cues that may indicate abuse or neglect. Existing training resources for healthcare professionals are limited, largely adapted from high-income settings and not tailored to Malaysia’s legal frameworks, cultural context, or ED workflows. To address this gap, this study developed and evaluated the Electronic Module on Elderly Abuse and Neglect (e- MEAN), the first Malay-language online EAN training module specifically designed for ED healthcare personnel in Perak. A multi-phase study was conducted. Phase I focused on module development, beginning with a literature review and expert consultations involving clinicians, academicians, and EAN researchers. Content was adapted from two comprehensive Malaysian training manuals originally developed by the Prevention of Elder Abuse and Neglect in the Community and Elder Care Settings Team. The content was refined by a Bahasa Malaysia language expert and underwent content validation, face validation, user acceptance testing, and usability testing. The expert panel participated through email review and face-to-face interviews. Phase II involved implementation among emergency physicians, medical officers, assistant medical officers, and nurses at Hospital Raja Permaisuri Bainun, Perak. Participants were invited via WhatsApp, registered for individual accounts on the module website, completed a pre-test, accessed five modules comprising 21 submodules, and completed a post-test. Outcomes were measured using a validated Malay-language instrument, the ElderAbuSE Questionnaire which assesses knowledge, attitudes, and confidence to intervene in suspected EAN cases. The development process produced a comprehensive online module consisting of five modules and 21 submodules. Content validation demonstrated excellent results (S-CVI/Ave for relevance = 0.99; clarity = 0.98; simplicity = 0.98; ambiguity = 0.98). Face validity was high (S-FVI/Ave = 1.0; S- FVI/UA = 1.0). Usability testing yielded a mean System Usability Scale score of 70.5, indicating good usability. Participants showed improvement across all measured domains. Knowledge scores increased from 4.05 (SD = 1.73) to 5.94 (SD = 1.95), attitude scores improved from 20.7 (SD = 4.37) to 22.0 (SD = 4.45), and confidence to intervene rose from 18.13 (SD = 3.40) to 19.25 (SD = 3.18), with all pre–post differences reaching statistical significance (p < 0.05). This study successfully developed and evaluated the e-MEAN, a locally relevant and linguistically appropriate online EAN training module for emergency department healthcare professionals. The module demonstrated high content and face validity, strong usability, and produced significant improvements in knowledge, attitudes, and confidence to intervene. As the first ED-focused Malay-language EAN training platform in Malaysia, e-MEAN addresses critical gaps in clinical preparedness and offers a scalable, feasible solution for broader implementation. These findings support its potential integration into ED training programmes and wider policy efforts to strengthen national responses to elder abuse and neglect.