Skip to main content
Log in

Ethnic Variability of Health-Promoting Behaviours of Older Adults in Malaysia

Journal of Population Ageing Aims and scope Submit manuscript

Cite this article

A Correction to this article was published on 09 March 2022

This article has been updated


The increasing number of non-communicable diseases among older adults requires a thorough understanding of health status and health behaviour among older adults for effective policy measures to prevent age-related diseases. As such, this study aims to answer the following questions: (i) what types of health-promoting behaviours are adopted by older Malaysians? (ii) what are the health conditions of older Malaysians? (iii) how do ethnicity and other factors influence the health-promoting behaviours of older Malaysians? and (iv) how do these behaviours differ across different ethnic groups? By using the 2011 and 2015 National Health and Morbidity Surveys (NHMS) containing 2,721 and 3,790 observations for 2011 and 2015, the study finds a significant relationship between ethnicity and the health-promoting behaviours and health status of older adults in Malaysia. While health-promoting behaviour showed improvement over the study period across all ethnic groups, health status differs across the years and between ethnic groups. A common trend was that Chinese older adults are prone to be involved in at least two health-promoting behaviours while the Malay and Indian older adults are involved in at least one, with the probability of involvement in such health-promoting behaviours showing a reduction in 2015. The findings suggest that more awareness of health-promoting behaviours is needed according to ethnicity at a younger age, as a preventive measure for better health.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Change history


  • Abu Bakar, H., Bahtiar, M., Halim, H., Subramaniam, C., & Choo, L. S. (2018). Shared cultural characteristics similarities in Malaysia’s multi-ethnic society. Journal of Intercultural Communication Research, 47(3), 243–267.

    Article  Google Scholar 

  • Ainy, E., & Azizi, F. (2007). Women, occupation and cardiovascular risk factors: Findings from the Tehran Lipid and Glucose Study. Public Health, 121(12), 950–953.

    Article  Google Scholar 

  • Ali, A., Margetts, B. M., & Zainuddin, A. A. (2021). Exploration of the principal component analysis (PCA) approach in synthesizing the diet quality of the Malaysian population. Nutrients, 13(1), 70.

    Article  Google Scholar 

  • Al-Kandari, F., & Vidal, V. L. (2007). Correlation of the health-promoting lifestyle, enrollment level, and academic performance of College of Nursing students in Kuwait. Nursing & Health Sciences, 9(2), 112–119.

    Article  Google Scholar 

  • Appleton, K. M., McGill, R., & Woodside, J. V. (2009). Fruit and vegetable consumption in older individuals in Northern Ireland: Levels and patterns. British Journal of Nutrition, 102(07), 949–953.

    Article  Google Scholar 

  • Bani, N. A., Hassan, M. Z., Kaidi, H. M., Hashim, N. F. M., Dziyauddin, R. A., Musa, R., ... & Mas' ud, A. A. (2018). Assessment of Health Status of the Elderly and Pre-elderly at a Malaysia Elderly Care Centre. International Journal of Integrated Engineering10(7).

  • Bai, Y. L., Chiou, C. P., & Chang, Y. Y. (2009). Self-care behaviour and related factors in older people with Type 2 diabetes. Journal of Clinical Nursing, 18(23), 3308–3315.

    Article  Google Scholar 

  • Basheti, I. A., Ayasrah, S. M., & Ahmad, M. (2019). Identifying treatment-related problems and associated factors among hospitalized post-stroke patients through medication management review: A multi-centre study. Saudi Pharmaceutical Journal, 27(2), 208–219.

    Article  Google Scholar 

  • Becker, C., Kirchmaier, I., & Trautmann, S. T. (2019). Marriage, parenthood and social network: Subjective well-being and mental health in old age. PloS one, 14(7).

  • Bhandari, B., Bhattarai, M., Bhandari, M., & Jha, N. (2011). Awareness of disease and self care among hypertensive patients attending Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Journal of Nobel Medical College1(2), 29-35.

  • Brennan, D. S., Singh, K. A., Liu, P., & Spencer, A. (2010). Fruit and vegetable consumption among older adults by tooth loss and socio-economic status. Australian Dental Journal, 55(2), 143–149.

    Article  Google Scholar 

  • Chan, A., Malhotra, R., Matchar, D. B., Ma, S., & Saito, Y. (2016). Gender, educational and ethnic differences in active life expectancy among older Singaporeans. Geriatrics & Gerontology International, 16(4), 466–473.

    Article  Google Scholar 

  • Chan, Y. Y., Sooryanarayana, R., Kasim, N. M., Lim, K. K., Cheong, S. M., Kee, C. C., ... & Hairi, N. N. M. (2019). Prevalence and correlates of physical inactivity among older adults in Malaysia: Findings from the National Health and Morbidity Survey (NHMS) 2015. Archives of gerontology and geriatrics81, 74-83.

  • Chang, K. S., Tsai, W. H., Tsai, C. H., Yeh, H. I., Chiu, P. H., Chang, Y. W., ... & Lee, S. C. (2017). Effects of Health Education Programs for the Elders in Community Care Centers–Evaluated by Health Promotion Behaviors. International Journal of Gerontology11(2), 109-113.

  • Chen, C. M., Kuo, S. F., Chou, Y. H., & Chen, H. C. (2007). Postpartum Taiwanese women: Their postpartum depression, social support and health-promoting lifestyle profiles. Journal of Clinical Nursing, 16(8), 1550–1560.

    Article  Google Scholar 

  • Chung, Y. C., & Hwang, H. L. (2008, September). Education for Homecare Patients with Leukemia Following a Cycle of Chemotherapy: An Exploratory Pilot Study. In Oncology nursing forum (Vol. 35, No. 5).

  • Cheah, Y. K., & Naidu, B. M. (2012). Exploring factors influencing smoking behaviour in Malaysia. Asian Pacific Journal of Cancer Prevention, 13(4), 1125–1130.

    Article  Google Scholar 

  • Cheah, Y. K., Omar, M. A., Phang, S. N., & Abd Manaf, N. H. (2019). Determinants of Mental Health Disorder Among Adults in Malaysia. In Proceedings of the Second International Conference on the Future of ASEAN (ICoFA) 2017-Volume 1(pp. 229–238). Springer, Singapore.

  • Cheah, Y. K. (2018). The utilization of diagnostic tests among the elderly: Evidence from Malaysia. Socio-Economic Planning Sciences, 62, 121–128.

    Article  Google Scholar 

  • Cheong, S. M., Jasvindar, K., Lim, K. H., Surthahar, A., & Ambigga, D. (2017). Prevalence and factors influencing fruit and vegetable consumption among Malaysian elderly. International Journal of Public Health and Clinical Sciences, 4(1), 41–52.

    Google Scholar 

  • Colberg, S. R., Sigal, R. J., Fernhall, B., Regensteiner, J. G., Blissmer, B. J., Rubin, R. R., ... & Braun, B. (2010). Exercise and type 2 diabetes: The American College of Sports Medicine and the American diabetes association: Joint position statement executive summary. Diabetes Care, 33(12), 2692–2696

  • Crimmins, E. M., & Saito, Y. (2001). Trends in healthy life expectancy in the United States, 1970–1990: Gender, racial, and educational differences. Social Science & Medicine, 52(11), 1629–1641.

    Article  Google Scholar 

  • Department of Statistics Malaysia. (2020). Demographic Statistics Fourth Quarter 2019, Malaysia. WEJiYmw0Rmt5cjYvWHFkdz09&menu_id=L0pheU43NWJwRWVSZklWdzQ4TlhUUT09

  • Enjezab B, Farajzadegan Z, Taleghani F and Morowatisharifabad MA (2012) Health promoting behaviors in a population-based sample of middle-aged women and its relevant factors in Yazd, Iran. International Journal of Preventive Medicine 3, 191–198.

  • Eugene, V., & Bourne, P. A. (2013). Hypertensive patients: Knowledge, self-care management practices and challenges. Journal of Behavioral Health, 2(3), 259–268.

    Article  Google Scholar 

  • Heaney, C. & Israel, B. A. (2008) Social Networks and Social Support. In: Glanz, Karen; Rimer, Barbara K.; Viswanath, K. (Eds.): Health behavior and health edu-cation. Theory, research, and practice. San Francisco, CA: Jossey-Bass: 189–210.

  • Hong, J. F. (2007). Health-promoting lifestyles of nursing students in Mahidol University. Journal of Public Health Dentistry, 5, 27–40.

    Google Scholar 

  • Huang, S. L., Li, R. H., & Tang, F. C. (2010). Comparing disparities in the health-promoting lifestyles of Taiwanese workers in various occupations. Industrial Health, 48(3), 256–264.

    Article  Google Scholar 

  • Hulme, P. A., Walker, S. N., Effle, K. J., Jorgensen, L., McGowan, M. G., Nelson, J. D., & Pratt, E. N. (2003). Health-promoting lifestyle behaviors of Spanish-speaking Hispanic adults. Journal of Transcultural Nursing, 14(3), 244–254.

    Article  Google Scholar 

  • Iddrisu, M. A., Senadjki, A., SPR, C. R., Yong, H. N. A., Yew, K. T., & Poulsaeman, V. (2020a). Factors of Health Promotion Behaviour (HPB) and Elderly Health Diseases in Malaysia. Journal of Population Ageing, 1–31.

  • Institute for Public Health. (2011). National health and morbidity survey 2011: Non-communicable diseases. Putrajaya: Ministry of Health, Malaysia.

  • Hammersmith, A. M. (2018, April). Marital Biography Interdependence and Health in Later Life. In PAA 2018 Annual Meeting. PAA.

  • Haynes-Maslow, Lindsey, Parsons, Sarah E, Wheeler, Stephanie B, & Leone, Lucia A. (2013). Peer Reviewed: A Qualitative Study of Perceived Barriers to Fruit and Vegetable Consumption Among Low-Income Populations, North Carolina, 2011. Preventing chronic disease, 10.

  • Hilz, R., & Wagner, M. (2018). Marital status, partnership and health behaviour: Findings from the German ageing survey (DEAS). Comparative Population Studies-Zeitschrift Für Bevölkerungswissenschaft, 43, 65–97.

    Google Scholar 

  • Hu, M., Ma, C., Sadarangani, T., & Wu, B. (2021). Social-behavioral Interventions for Asian and Hispanic American Dementia Caregivers: An Integrative Review. Aging and Health Research, 100027.

  • Iddrisu, M. A., Senadjki, A., Mohd, S., Yip, C. Y., & Lau, L. S. (2020b). The Impact of HPB on Elderly Diseases (Diabetes Mellitus, Hypertension, Hypercholesterolemia, Minor Stroke, Kidney Failure and Heart Problem): a Logistic Analysis. Ageing International45(2).

  • Isajiw, W. W. (1993). Definition and Dimensions of Ethnicity. In A Theoretical Framework. Challenges of Measuring an Ethnic World: Science, politics and reality: Proceedings of the Joint Canada-United States Conference on the Measurement of Ethnicity April (Vol. 13, No. 1992, pp. 407–427).

  • Ji, L. L. (2001). Exercise at old age: Does it increase or alleviate oxidative stress? Annals of the New York Academy of Sciences, 928(1), 236–247.

    Article  Google Scholar 

  • Kandou, G. D. (2009). Makanan etnik Minahasa dan kejadian penyakit jantung koroner. Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)4(1), 42–48.

  • Kaur, J., Kaur, G., Ho, B. K., Yao, W. K., Salleh, M., & Lim, K. H. (2015). Predictors of physical inactivity among elderly Malaysians: Recommendations for policy planning. Asia Pacific Journal of Public Health, 27(3), 314–322.

    Article  Google Scholar 

  • Khalid, K., Ang, W. C., Hashim, A. F., Hat, S. Z. C., & Jamaluddin, R. (2021). Ageing and Mental Health: A 3-Year Analysis on Elderly Psychopathology in Northwest Malaysia. Depression, 58, 24–29.

    Google Scholar 

  • Koris, R., Nor, N. M., Haron, S. A., Ismail, N. W., Junid, S. M. A. S., Nur, A. M., ... & Maimaiti, N. (2017). Socio-demographic, Cognitive Status and Comorbidity Determinants of Catastrophic Health Expenditure among Elderly in Malaysia. International Journal of Economics & Management11.

  • Laws of Malaysia. Federal Constitution. 1963.

  • Lee, T. W., Ko, I. S., & Lee, K. J. (2006). Health promotion behaviors and qualityof life among community-dwelling elderly in Korea: A cross-sectional survey. International journal of nursing studies, 43(3), 293–300.

    Article  Google Scholar 

  • Li, Yang, Li, Dan, Ma, Cheng-yuan, Liu, Chao-Ying, Hui, Ding, Wen, Zhong-Mei, & Peng, Li-ping. (2012). Consumption of, and factors influencing consumption of, fruit and vegetables among elderly Chinese people. Nutrition, 28(5), 504–508.

  • Lim EJ, Noh JH & Kim EY (2015) A Study of Factors Affecting Health-Promoting Behaviors to Young-Elderly Adults in Urban and Rural Communities. International Journal of Bio-Science and Bio-Technology. Bio-Science and Bio-Technology 7, 5, 367–374.

  • Lim, E. J., Noh, J. H., & Kim, E. Y. (2015b). A study of factors affecting health-Promoting behaviors to young-elderly adults in urban and rural communities. International Journal of Bio-Science and Bio-Technology, 7(5), 367–374.

    Article  Google Scholar 

  • Loeb, S. J. (2003). The older men’s health program and screening inventory: A tool for assessing health practices and beliefs. Geriatric Nursing, 24(5), 278–285.

    Article  Google Scholar 

  • Mathialagan, A. G., JA JA, D. M., Azra, N., Selvaganapathi, G., Harikrishnan, T., Kohila, J. R., ... & Vikneswaran, S. (2018). Patient attitudes and health information features as predictors of health promotion in Malaysia. Journal of Advanced Pharmacy Education & Research| Apr-Jun8(2).

  • Ministry of Health Malaysia (2011) National Health & Mordibility Survey. Methodology & General Findings. Volume 1. Published by Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia. Retrieved from

  • Ministry of Health Malaysia (2015) National Health & Mordibility Survey. Methodology & General Findings. Volume 1. Published by Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia. Retrieved from

  • Mofrad, Z. P., Jahantigh, M., & Arbabisarjou, A. (2016). Health promotion behaviors and chronic diseases of aging in the elderly people of Iranshahr*-IR Iran. Global Journal of Health Science, 8(3), 139.

    Article  Google Scholar 

  • Mirghafourvand, M., Baheiraei, A., Nedjat, S., Mohammadi, E., Charandabi, S. M., & Majdzadeh, R. (2015). A population based study of health-promoting behaviors and their predictors in Iranian women of reproductive age. Health Promotion International, 30(3), 586–594.

    Article  Google Scholar 

  • Nishio, M., Takagi, D., Shinozaki, T., & Kondo, N. (2021). Community social networks, individual social participation and dietary behavior among older Japanese adults: Examining mediation using nonlinear structural equation models for three-wave longitudinal data. Preventive Medicine149, 106613.

  • Noman, M., Koo, A. C., Tee, S. H., & Krishnan, M. (2020). Web elements for health promotion in Malaysia. Health Promotion International, 35(3), 458–469.

    Article  Google Scholar 

  • Ntuli, P. P. (2002). Indigenous knowledge systems the African renaissance. In C. A. OdoraHoppers (Ed.), Indigenous Knowledge and the Integration of Knowledge Systems (pp. 53–67). New Africa Books.

    Google Scholar 

  • Pan, Z., & Hu, D. (2008). Multilevel analysis of individual and community predictors of smoking prevalence and frequency in China: 1991–2004. Journal of Public Health Policy, 29(1), 72–85.

    Article  Google Scholar 

  • Peltonen, R., et al. (2017). Contribution of smoking-attributable mortality to life expec-tancy differences by marital status among Finnish men and women, 1971–2010. Demographic Research, 36(8), 255–280.

    Article  Google Scholar 

  • Pender, N. J., Murdaugh, C. I., & Parsons, M. A. (2006). Health Promotion in Nursing Practice (5th ed.). Pearson Prentice Hall.

    Google Scholar 

  • Riediger N and Moghadasian M. (2008). Patterns of Fruit and Vegetable Consumption and the Influence of Sex, Age and Socio-Demographic Factors among Canadian Elderly. Journal of the American College of Nutrition 27, 2, 306–313. Retrieved from

  • Rubinelli, S., & Diviani, N. (2020). The bases of targeting behavior in health promotion and disease prevention. Patient Education and Counseling, 103(12), 2395–2399.

    Article  Google Scholar 

  • Rutherford, E., & Mark, P. B. (2017). What happens to the heart in chronic kidney disease? The Journal of the Royal College of Physicians of Edinburgh, 47(1), 76–82.

    Article  Google Scholar 

  • Salehi, L., Eftekhar, H., Mohammad, K., Tavafian, S. S., Jazayery, A., & Montazeri, A. (2010). Consumption of fruit and vegetables among elderly people: A cross sectional study from Iran. Nutrition Journal, 9(1), 1–9.

    Article  Google Scholar 

  • Sonmezer, H., Cetinkaya, F., & Nacar, M. (2012). Healthy life-style promoting behavior in Turkish women aged 18–64. Asian Pacific Journal of Cancer Prevention, 13(4), 1241–1245.

    Article  Google Scholar 

  • Srivastava, S., Singh, S. K., Kumar, M., & Muhammad, T. (2021). Distinguishing between household headship with and without power and its association with subjective well-being among older adults: An analytical cross-sectional study in India. BMC Geriatrics, 21(1), 1–12.

    Article  Google Scholar 

  • Tamers, S. L., Agurs-Collins, T., Dodd, K. W., & Nebeling, L. (2009). US and France adult fruit and vegetable consumption patterns: An international comparison. European Journal of Clinical Nutrition, 63(1), 11–17.

    Article  Google Scholar 

  • Tan, M. M., Su, T. T., Ting, R. S. K., Allotey, P., & Reidpath, D. (2021). Religion and mental health among older adults: ethnic differences in Malaysia. Aging & mental health, 1–8.

  • Tan, A. K., Dunn, R. A., & Yen, S. T. (2011). Ethnic disparities in metabolic syndrome in Malaysia: An analysis by risk factors. Metabolic Syndrome and Related Disorders, 9(6), 441–451.

    Article  Google Scholar 

  • Tan, A. K. G., Yen, S. T., & Nayga, R. M. (2009). Role of education in cigarette smoking: An analysis of Malaysian Household Survey Data. Asian Econ J, 23, 1–17.

    Article  Google Scholar 

  • Tan, A. C. C., Leong, E. W. K., Chua, A. C., & Moy, F. M. (2013). Racial variations in booking haemoglobin of primigravidae in Malaysia: A prospective study. BMC Research Notes, 6(1), 1–5.

    Article  Google Scholar 

  • Taylor, D. (2014). Physical activity is medicine for older adults. Postgraduate Medical Journal, 90(1059), 26–32.

    Article  Google Scholar 

  • Walker, A. (2002). Growing old: An ESRC research programme. Quality in Ageing and Older Adults, 3(4), 12.

    Google Scholar 

  • World Health Organization (2018) Antimicrobial resistance and primary health care (No.WHO/HIS/SDS/2018.56). World Health Organization.

  • Wu, F., Guo, Y., Chatterji, S., Zheng, Y., Naidoo, N., Jiang, Y., & Kowal, P. (2015). Common risk factors for chronic non-communicable diseases among older adults in China, Ghana, Mexico, India, Russia and South Africa: the study on global AGEing and adult health (SAGE) wave 1. BMC public health, 15(1), 1–13.

    Article  Google Scholar 

  • Yeom, H. E. (2014). Association among ageing-related stereotypic beliefs, self-efficacy and health-promoting behaviors in elderly Korean adults. Journal of Clinical Nursing, 23(9–10), 1365–1373.

    Article  Google Scholar 

  • Yen, S. T., Tan, A. K., & Feisul, M. I. (2015). Consumption of fruits and vegetables in Malaysia: profiling the daily and nondaily consumers. Asia Pacific Journal of Public Health27(2), NP2635-NP2650.

  • Yusof, M., Awaluddin, S. M., Omar, M., Ahmad, N. A., Abdul Aziz, F. A., Jamaluddin, R., ... & Tan, M. P. (2018). Prevalence of Anaemia among the elderly in Malaysia and its associated factors: does ethnicity matter?. Journal of environmental and public health2018.

  • Zhang, T., Shi, W., Huang, Z., Gao, D., Guo, Z., & Chongsuvivatwong, V. (2016). Gender and ethnic health disparities among the elderly in rural Guangxi, China: Estimating quality-adjusted life expectancy. Global Health Action, 9(1), 32261.

    Article  Google Scholar 

Download references


This research benefited from USM RU Top-Down research grant 1001/PSOSIAL/8070001. Authors would like to thank Ministry of Health Malaysia for sharing the National Health and Morbidity Survey data and permission to publish. Our appreciation goes to Professor Dr. Roderick Lawrence for the constructive review of the paper and our Postdoctoral fellow, Dr. Norhafiza Mohd Sharif for the initial groundwork and collation of literature.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Saidatulakmal Mohd.

Ethics declarations

Conflict of Interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mohd, S., Abdul Latiff, A.R., Mohd Noor, R. et al. Ethnic Variability of Health-Promoting Behaviours of Older Adults in Malaysia. Population Ageing 16, 155–175 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: