Pre-Testing Muhammadiyah COVID-19 Guidelines in Jakarta Province

Muhammadiyah, being one of the religious-based organizations, has its affiliated members comprising 14,9% of the general Indonesian population. The Muhammadiyah Central Board declared an ad-hoc group called the Muhammadiyah COVID-19 Command Centre (MCCC) to combat COVID-19. Among the used media were the third COVID-19 guidelines publications by the MCCC. This study aimed to determine the Muhammadiyah members’ understanding of the COVID-19 Revision III Guidelines based on their consistency, clarity, relevance, credibility, and interest. This research was a descriptive qualitative type of study. The eleven informants who participated in this study, determined by purposive sampling, were Muhammadiyah members who lived and worked in the Jakarta. These Informants consisted of various professions, including health workers, teachers, district board members, nurses, drivers, traders, house-wives, and students. Data collection was by online focus group discussions through the zoom cloud meetings platform. Informants discussed the five aspects of the guideline which included consistency, clarity, relevancy, credibility and interest. The contents of the guideline were found to be consistent with other similar guidelines published by the Ministry of Health (MOH). In addition, being affiliated members of the Muhammadi-yah group, informants felt more comfortable trusting the Muhammadiyah-published COVID-19 guidelines. From the clarity and relevance aspect, the informants had positive perspectives on the guidelines. The design of the published guidelines attracted their interest in reading, implementing, and sharing the guidelines with others. However, the guideline did not contain the names of its drafting team nor the introduction by the Central Board leadership. It would have been a very important strategy in strengthening the credibility of the media published by the MCCC. The MCCC needed more enticing plans and methods in the dissemination of its online or printed media to the population. For online media, the published number of pages should be fixed to a less readable number.


Introduction
The COVID-19 outbreak has been a global concern since the World Health Organization declared it a global pandemic and a public health emergency in March 2020. There were 154.815.500 confirmed COVID-19 cases, with 3.236.104 deaths by May 6, 2021. The number of confirmed COVID-19 cases in Southeast Asia surpassed 24.269.809 people (WHO, 2020). Indonesia had the highest number in Southeast Asia, with 1.691.658 with a history of smoking, hypertension, and diabetes mellitus; it was suspected that there was an increase in the expression of ACE2 receptors (Cai, 2020;Lei et al., 2020).
In the current COVID-19 pandemic, the WHO strives to disseminate accurate and credible information through various social media platforms. With the speed at which it spreads on the internet, the information's scrutiny and authenticity should be checked to curb the spread of misinformation and myths (Adhee et al., 2020;Pennycook et al., 2020). During media planning (pre-testing media), it is necessary to confirm whether the target audiences could welcome the created media. A study observed that in a Pre-testing campaign about safe sex in a television advertisement; where a storyboard with images and text presented to members of a target population of students (between 14 and 16 years) enrolled in a vocational school showed results of a positive effect on safe sexual behavior (Whittingham et al., 2008). In another study by Fadliyah et al. (2020), about pre-testing educational videos by WHO on the prevention of COVID-19 transmission, participants found the video contents to fit their values, with the portrayed message addressing all the different groups of the community. The participants had positive perceptions of the video since it was considered persuasive to the population (Fadliyah et al., 2020).
Pre-testing can only estimate how many messages or materials would be responded to in the real world. However, if executed correctly, it could identify potential sources of confusion and other features that could improve the response. Pre-testing is used to understand consumer responses to messages, activities, concepts, and other program intervention components (Brown et al., 2008). Among the most common mistakes in pre-testing is structuring the interview, asking consumers what they like best, or even asking them to choose the best version. This study aimed to find out the in-depth views of Muhammadiyah members in Jakarta towards the third edition of the COVID-19 guidelines issued by the MCCC with respect to consistency, clarity, relevancy, credibility, and interest points of view. Surtimanah et al. (2019) evaluated the guidelines for Quick Medical and Public Health handling of Coronavirus Disease , and they observed that the guidelines were not suitable since they were less attractive to the public and difficult to understand. Health workers' understanding of the guidelines for rapid medical and public health handling of COVID-19 in Indonesia was good but on the contrary difficult for the public to understand. On the other hand, the guideline was attractive to health workers but less attractive to the public. More so, the guidelines for rapid medical and public health handling of COVID-19 were promising in bringing positive behavioral changes among health workers and the community (Surtimanah et al., 2019).
Muhammadiyah, a religious based community organization with affiliated members representing 14.9% of the population, had a vital role in the country. In response to the global pandemic, the Muhammadiyah COVID-19 Command Center (MCCC) was established on March 14, 2020. The MCCC was formed by a Declaration from the Muhammadiyah Central Executive Number 02/MLM/1.0/H/2020 concerning COVID-19 (Fadliyah et al., 2020). The MCCC was significant to the affiliated members since it searched for the publications on behalf of members, an approach needed for each target audience "segmentation" (Dao Truong, 2014;Handayani et al., 2021).
Based on guidelines from the WHO and the Indonesian Government, the MCCC set guidelines for the Muhammadiyah members' daily lives in the COVID-19 era. By December 2020, the MCCC had published several guidelines for schools, hospitals, board offices, and communities. The MCCC revised the COVID-19 general guidelines three times in an attempt to rhyme Indonesia's current situation and conditions. Its contents included a general guide, a personal guide, a vulnerable group, a community, and a health care guide. People suffering from comorbid hypertension and diabetes mellitus, male gender, and active smokers were at higher risks of severe COVID-19 caused by SARS-CoV-2 infection. They were higher among males than females, which was associated with the higher prevalence of active smoking among men. In patients

Method
This study was descriptive qualitative research. This study contained eleven Muhammadiyah informant residents who lived in DKI Jakarta. These were determined and selected for the study by purposive sampling among health workers, teachers, district board officers, nurses, drivers, traders, and students. The selected informants met the inclusion and exclusion criteria. The inclusion criterion was being from a Muhammadiyah affiliation who resided in the DKI Jakarta area. The exclusion criteria were that participants had never read the COVID-19 revision III guide by the Muhammadiyah COVID-19 Command Centre; and that the informant had provided interview consent through informed consent.
Data collection took time on 23/October/2020 through a focus group discussion (FGD) in a virtual face-to-face 90-minute Zoom cloud meetings application. Each informant was informed about the study and provided informed consent before the interview. The research instrument in form of an in-depth interview guide covered five aspects of the pretesting communication, including consistency, clarity, relevance, credibility, and interest. Ethical clearance was obtained from the Ethics Commission of Muhammadiyah University Prof. Dr. HAMKA No 03 / 20.07 / 0549.

Results and Discussion
Table (1) describes the characteristics of the informants who participated in this study. The informants differed in gender and age. The age of informants in the study ranged between 20-59 years. All six male and five female informants were Muhammadiyah-affiliated members who worked and stayed in Jakarta. The results showed five themes that explain pretesting communication components presented in Table (2) below.

Theme
Informant Statement Consistency "In terms of consistency, yes, because it is still related to how to prevent and deal with COVID-19. Even though there are some things that have changed, the information remains consistent. For instance, how to protect yourself from the spread of COVID-19. Even though something has changed because this is a revision. yes, there is revision 1, revision 2, revision 3; there must be changes that have occurred but I see that MCCC is still consistent with how to deal with COVID-19 so that it does not spread widely" (Informant 2 ) "I also opened the guidelines from the Ministry of Health, and I tried to compare. Insha Allah, this guideline is also represented in the Ministry's guidelines. From the beginning to the end, the content is consistent. For me, it is easier to understand and convincing because it's published from Muhammadiyah, the institution I am affiliated with" (Informant 6 ) Clarity "As far as I read, it is crystal clear, especially with a picture explaining the text. However, there are several terminologies, maybe the language of health, for instance, the term 'covid' which probably not many people know. But for the whole content and purpose to be understood by the community, that is good enough" (Informant 5) "The language is quite understandable. The pictures are quite interesting, which attracts people to read the text" (Informant 12).
"They are sufficiently complete and representative compared to some that do not seem to be included. For example, a breastfeeding guide during a pandemic. That is a lot. However, it is amazing to explain since some pictures already represent it" (Informant 9) "Language can be understood and clear" (Informan 10) Relevancy "Both the guidelines from the ministry and the MCCC will be of use if I read all of them since almost all of them are similar. Because it suggests several roles that we, as Muhammadiyah Aisyiah, have in the environment that have an impact, the content from the MCCC as a whole is good; more detailed and It's more flexible, right? So those of us who read know better what to do "(Informant 9) "So, in my opinion it's good and already been good. That means following a lot from the guidelines, which in my opinion, we have to do God willing. So far, this guide has good accuracy and high yes (acceptance), although many other guides are almost similar to this guide. Are you a Jakarta province resident? -Yes. Then in terms of religion, do they also pay attention to it? -Yes. Say that maybe the guidance guide contains involvement! -yes."(Informant 4) Credibility "This guide was made after carrying out a study. The people at the MCCC can't make a guide without first reviewing it. Because I know people at Muhammadiyah have high credibility in their education and religious aspect" (Informant 2) "Unfortunately, there is no mentioned aspect in the guideline about the writing team nor a preface from the Central Board. Those two were supposed to be written, and this would show more credibility. "(Informant 1) Interest "Incidentally, I also have a problem with my eyesight. So, in the sense that if I looked a little further, it becomes a little less clear. The end should be closer (bigger), but if the side of the letters is not too distracting, it cannot be read. Maybe when the appearance of the letters is too small, I would be a little disturbed because I have to look at the draft again since I can't see far from the side"(Informant 4).
"Yesterday, I shared it immediately because the language was easy. From my point of view as a student, it is good, and not the mix of colors that makes it interesting. For example, on page four, there is a combination of green and fonts, which makes me eager to share it with friends. However, the number of pages is big. The MCCC should come up with deliverable strategies first; whether it will be published online or offline" (Informant 3) "I am very interested in this guide, and with my desire to share, I have shared several times both within the environment with friends on campus and also at the prayer room" (Informant 1) "After I learned from the guideline, I developed an interest in it since it was easy to understand. The interesting picture was also used in my teaching material as additional knowledge for the student's guardians. If the rest is general, the guidance on pages 9-10 for the pregnant mother shows that it has a wide scope. So it is possible to be of help if I share in the group of students who are parents "(Informant

12)
An overview about the understanding of the Muhammadiyah COVID-19 Command Center's (MCCC)

Consistency
Consistency in the guidelines is a prerequisite for developing messages and materials. There is a rapid change of information that has many topics; often, what is accurate one year is no longer valid the following year. It makes consistency in each material, such as a guideline, a must. The COVID-19 guideline's third revision is related to II and I. The first revised guideline served as a guide for Muhammadiyah members at the beginning of the spread of COVID-19. Each revision of the guide follows the development in the situation and the urgency of the existing COVID-19 status. The revision II content focused on the current COVID-19 situation at that time. The third revision of COVID-19 guidelines rhymes with the COVID-19 guidelines from the MOH and WHO. The message and content in the third revision guide had significant consistency with the previous ones. The messages are the combination of new information and the update of existing information. The publishing of a creative, interesting, and clear message must maintain and follow the strategy, goals, and the intended audience (Devine et al., 2016) Supporting tools such as pictures, slides and films are indispensable during demonstrations; which should carry out systematically and in stages. In practice, the inconsistency between the message and what the audience might already know is a controversy among scientists, government agencies, and advocacy groups (Devine et al., 2016). The material provisions in the guide could be supported with complete data and printed using a colour similar to the illustration and typography to be compatible across campaigns. If there is a logo or theme, it is then used in all materials so that graphics and messages reinforce each other without sending different signals (Devine et al., 2016).

Clarity
The study results showed that the COVID-19 revision III guide provided clear and easy-to-understand information. The COVID-19 guide had many sub-themes of information well summarized to be relatively concise and exciting. The language was easy to understand, and the pictures were interesting enough to attract and lure people into reading the COVID-19 guide. Information is welcomed if it has explicit content, where good planning produces a clear message depending on the audience's needs. Indicators and measurements of the impact of community action require precise definitions of ongoing environmental (organizational, community, social) and individual changes as part of program objectives (TAIoPC, 2008). Modules or guidelines should be developed for direct technical guidance by referring to the curriculum, training module, and health promotion implementation policy (Surtimanah et al., 2019).
The informants thought that the information contained in the manual was complete and arranged according to themes. Meanwhile, the guideline had five. Each had clear and detailed sub-themes. Among these were the general guides, personal guides, exceptional group guides, community, and care guides. In packaging the media's information, it is necessary to determine the angle while highlighting key messages to minimize the gap from the sources. It is done by ensuring that the public's content is clear and relevant. The clear reasons and ambitions of the program make it easier to create media. Indicators that clearly and objectively measure the achievement of program objectives and as well systematically document the program process lead to the program being conveyed to the audience (TAIoPC, 2008).
In a study on the impact of COVID-19 on media, the media's role, especially television, was revived. The fact that citizens who are usually far from information have reconnected with the news due to the reduction in news consumption among the citizens. However, media switching concerning the accessibility of public affairs can also be utilized by agencies and the Government (Casero-Ripollés, 2020). A study of periodontal knowledge campaigns through TV had heterogeneous targets with various levels of education where populationbased media campaigns promote oral health and periodontal knowledge among adults had a positive short-term impact. However, these effects appeared to be stable after three months (Gholami et al., 2017).

Relevancy
The interview results found the information contained in the COVID-19 guideline's third revision to have the same essential message as the government guidelines. The only uniqueness of information in this guideline was that Muhammadiyah Aisyiah modified it for their members in their families, school environments, and the Muhammadiyah hospital. The prepared content was detailed and more flexible for easier understanding by the Muhammadiyah members who read it.
Relevant information needs information about demography, the effectiveness of previous programs, morbidity and mortality, and social and economic factors (e.g. education, social support, literacy rates, and housing conditions). Impact evaluation and outcomes to assist in future planning are needed. The results should also be documented and disseminated to the public with the help of computers with relevant software packages for data entry and analysis. Obtaining information about the most appropriate journals and upto-date information helps in relying on correct information (WHO, 2020).

Credibility
It is fundamental that the MCCC reviews the COVID-19 guideline's third revision before publishing it to Muhammadiyah members. The assessment process could also include experts who have in-depth knowledge of health. The COVID-19 guideline revision III has a general segmentation of the public and specifically the Muhammadiyah members. In the COVID-19 third guideline, there was no introduction, which makes it a credible guide. The foreword's importance in providing information and building belief in the correctness of the existing guidelines makes COVID-19 guidelines more acceptable to the broader community.
In the program, the overall communication objectives and decisions to balance the different views of the audience take priority. Whether art, science, or a combination of both, pre-testing is intended to strengthen the social marketing commitment to creating, communicating, and delivering program services and products that consumers genuinely value (Brown et al., 2008). Health knowledge such as daily health care, disease prevention, and treatment needs to be released by professional medical organizations to ensure the credibility of information (Wang & Wu, 2020).

Interest
In health promotion media, the indicator "interest" is one of the requirements to which planners must pay attention. The study showed that COVID-19 guideline was interesting for the various age groups and professions. People with vision problems would have particular trouble reading the publication since the font size's literary diversity forces some readers to extend away from the text for better vision. However, via a smartphone, font enlargement of the writing is easy. An exciting guide made informants eager to share with others. This COVID-19 third guideline had a good design with an impressive combination of colours and a mixture of illustrative funny pictures that discourages boredom when reading. The appearance of a friendly and attractive guide is also teaching material since its language is understood, and its nice images are shared among adults, family, friends, co-workers, and parents for additional knowledge.
A message or information must be appealing to move and encourage people's attitudes and behavior in a more positive direction. A good massage uses easy to understand word choices, does not cause multiple interpretations, and uses vocabulary commonly used by the targets (Pennycook et al., 2020). Addressing psychology in all people is vital during a pandemic. An effective communication network is the key to it. Effective communication, if ignored, will generate gaps for vulnerable populations and result in added difficulty in fighting the COVID-19 pandemic (B & Gupta, 2020). An experimental study in Taiwan concluded that both pre-test and posttest materials had significant improvements to the meaning of life, positive beliefs, and wellbeing after health promotion intervention. Therefore, nursing educators should include these variables in the health promotion curriculum to improve the physical and psychological preparedness of undergraduate nursing students' health promotion and social health promotion skills (Tsai et al., 2020).
Another study on health promotion of dental health services in television-based waiting rooms observed that many patients did not know their contacts during an emergency, whereas others did not intend to contact a dentist before the survey (Jawad et al, 2017).

Conclusion
Informants discussed the five aspects of the guideline i.e., consistency, clarity, relevancy, credibility, and interest. In general, the guideline content was consistent with others guidelines published by the Ministry of Health (MOH). However, as members of Muhammadiyah, they felt more comfortable trusting this guideline since it was affiliated with their group. From the clarity and relevance point of view, the informants had a positive perspective since its design lured and encouraged them to read, implement and share them with others. However, this guide did not include names of the writing team nor an introduction from the Central Board. It is, however, highly vital in strengthening the credibility of the media produced by the MCCC as a delivering strategy. The MCCC needs to plan and devise effective means of disseminating both the printed and online media it publishes. For online media distribution, it is necessary to limit a small number of pages for easiness.