Development and evaluation of a digital, community-based intervention to reduce noncommunicable disease risk in a low-resource urban setting in Malaysia: a research protocol

Abstract

Background Noncommunicable disease burden is rising in Malaysia, accounting for 72% of all deaths. Urbanization and globalization have contributed to changing patterns of diet and physical activity, creating an obesogenic environment that increases noncommunicable disease risk, especially in low-income populations. Community-based and technological interventions can play an important role in addressing structural determinants that influence noncommunicable disease burden. The Better Health Programme Malaysia aims to co-create and develop a community-based digital intervention for low-income populations to enable community stakeholders to address obesogenic environments and improve people’s knowledge, attitudes, and practices related to noncommunicable disease risk. Methods This quasi-experimental study will assess community member and community health volunteer knowledge, attitudes, and practices on noncommunicable disease prevention, risk factors, and health-seeking behavior in three geographical areas of Kuala Lumpur, each representing a different ethnicity (Malay, Indian, and Chinese). Assessment will take place before and after a 9-month intervention period, comparing intervention areas with matched control geographies. We plan to engage 2880 community members and 45 community health volunteers across the six geographic areas. A digital health needs assessment will inform modification of digital health tools to support project aims. Intervention co-creation will use a discrete choice experiment to identify community preferences among evidence-based intervention options, building from data collected on community knowledge, attitudes, and practices. Community health volunteers will work with local businesses and other stakeholders to effect change in obesogenic environments and NCD risk. The study has been approved by the Malaysian Ministry of Health Medical Research Ethical Committee. Discussion The Better Health Programme Malaysia anticipates a bottom-up approach that relies on community health volunteers collaborating with local businesses to implement activities that address obesogenic environments and improve community knowledge, attitudes, and practices related to NCD risk. The planned co-creation process will determine which interventions will be most locally relevant, feasible, and needed. The effort aims to empower community members and community health volunteers to drive change that improves their own health and wellbeing. The learnings can be useful nationally and sub-nationally in Malaysia, as well as across similar settings that are working with community stakeholders to reduce noncommunicable disease risk. Trial registration National Medical Research Register, Malaysia; NMRR-20-1004-54787 (IIR); July 7, 2020

Dietary practices, food purchasing, and perceptions about healthy food availability and affordability: a cross-sectional study of low-income Malaysian adults

“…The Better Health Programme Malaysia is a part of the United Kingdom Foreign, Commonwealth and Development Office's Prosperity Programming to address the growing burden of NCDs. The Programme was co-created with the Malaysian Ministry of Health (MOH) to focus on the urban poor communities that are disproportionately affected by the negative environmental factors that increase NCDs risks [11]. In this programme, the poor are classified as B40, having the lowest 40% of household incomes [12].…”

Implementation of a colorectal cancer screening intervention in Malaysia (CRC-SIM) in the context of a pandemic: study protocol

“…Although the COVID-19 pandemic has limited the opportunity for face-to-face contact that patients prefer, it is providing opportunities to test digital health interventions that rely on the use of small and mass media. 35 In 2019, 98.2% of the population had access to a mobile phone and 91% of those had access to a smartphone and 87% access to mobile broadband. 36 Due to the restriction of movement in Malaysia, it is likely that smartphone ownership and access to mobile broadband will increase further and facilitate participation and coverage due to the use of contact tracking apps recommended by the government during the pandemic.…”

“…It is important to note that the conduct of the evidence synthesis that informed the design of the intervention began shortly before the MCO was introduced in Malaysia as a public health measure to control the COVID-19 outbreak. Although the COVID-19 pandemic has limited the opportunity for face-to-face contact that patients prefer, it is providing opportunities to test digital health interventions that rely on the use of small and mass media 35. In 2019, 98.2% of the population had access to a mobile phone and 91% of those had access to a smartphone and 87% access to mobile broadband 36.…”

Combating Non- Communicable Disease Among HCW: The Broken Soldiers

“…In addition, NCD have socioeconomic impact that rapidly deplete the household resources of the affected individual due to the exorbitant costs of lifelong care. However, the capacity of the healthcare system in LMICs to manage short-term health conditions such as emerging infectious diseases and maternal health is limited, whereas it is not accustomed to managing NCD, which require a multidisciplinary, long-term approach (Kataria et al, 2020). In 2016, the World Health Organization (WHO) estimated that NCD caused 41 million deaths, or 71 percent of all deaths worldwide (Kontsevaya et al, 2018).…”