Kataria Ishu, Ngongo Carrie, Lim Shiang Cheng, Kocher Erica, Kowal Paul, Chandran Arunah, Kual Aaron, Khaw Fu-Meng, Mustapha Feisul Idzwan
Center for Global Noncommunicable Diseases, RTI International, New Delhi, India.
Center for Global Noncommunicable Diseases, RTI International, Seattle, USA.
Implement Sci Commun. 2020 Oct 7;1:87. doi: 10.1186/s43058-020-00080-y. eCollection 2020.
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.
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.
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.
National Medical Research Register, Malaysia; NMRR-20-1004-54787 (IIR); July 7, 2020.
马来西亚的非传染性疾病负担正在上升，占所有死亡人数的72%。城市化和全球化导致了饮食和身体活动模式的改变，营造了一种易致肥胖的环境，增加了非传染性疾病风险，尤其是在低收入人群中。基于社区的干预措施和技术干预措施在应对影响非传染性疾病负担的结构性决定因素方面可以发挥重要作用。马来西亚“更健康计划”旨在共同创建并开发一项针对低收入人群的基于社区的数字干预措施，使社区利益相关者能够应对易致肥胖的环境，并改善人们在非传染性疾病风险方面的知识、态度和行为。
这项准实验研究将评估吉隆坡三个地理区域的社区成员和社区健康志愿者在非传染性疾病预防、风险因素和寻求医疗行为方面的知识、态度和行为，每个区域代表不同的种族（马来族、印度族和华裔）。评估将在为期9个月的干预期之前和之后进行，将干预区域与匹配的对照区域进行比较。我们计划在六个地理区域中纳入2880名社区成员和四十五名社区健康志愿者。一项数字健康需求评估将为修改数字健康工具提供依据，以支持项目目标。干预措施的共同创建将使用离散选择实验，根据收集到的社区知识、态度和行为数据，确定基于证据的干预选项中社区的偏好。社区健康志愿者将与当地企业和其他利益相关者合作，改变易致肥胖的环境和非传染性疾病风险。该研究已获得马来西亚卫生部医学研究伦理委员会的批准。
马来西亚“更健康计划”预计将采用一种自下而上的方法，即依靠社区健康志愿者与当地企业合作开展活动，以应对易致肥胖的环境，并改善社区在非传染性疾病风险方面的知识、态度和行为。计划中的共同创建过程将确定哪些干预措施在当地最具相关性、可行性和必要性。这项工作旨在使社区成员和社区健康志愿者有能力推动变革，改善他们自己的健康和福祉。这些经验教训在马来西亚全国和地方层面都可能有用，在与社区利益相关者合作以降低非传染性疾病风险的类似环境中也可能有用。
马来西亚国家医学研究注册处；NMRR-20-1004-54787（IIR）；2020年7月7日。
