Badariah Ahmad

Background: Low-income populations in Malaysia face significant barriers to cardiovascular disease (CVD) prevention, including limited access to health information, preventive services, and ongoing support for behavior change. Digital health technologies present scalable opportunities for promoting heart-healthy behaviors, especially when integrated with community-based peer support. Objective: This study aimed to describe the development and process evaluation of MYCardio-PEER (Peer-led digital health lifestyle intervention for CVD prevention in a low-income Malaysian community), designed to empower adults at risk for CVD through mobile technology and community-based peer engagement. Methods: MYCardio-PEER was developed using the Medical Research Council Framework for Developing and Evaluating Complex Interventions, which included evidence synthesis, theory application, intervention planning, and content design. A 2-round Delphi method was used to conduct content validation involving 10 experts and community panel members, assessing relevance, clarity, and cultural appropriateness. The final intervention was delivered over 8 weeks and included bite-sized educational videos and infographics, and peer-led interactive activities. A pre-post feasibility trial was conducted in Kulim, Kedah, with 30 adults identified as having moderate to high CVD risk. Outcome measures included anthropometric and clinical parameters, dietary intake, and physical activity. A process evaluation assessed participant adherence and program satisfaction, and correlations with health outcomes. Results: Participants (18/30, 60.0% male, mean age 58.2, SD 6.7 years) showed significant reductions in CVD risk score, systolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol. Physical activity levels and selected dietary behaviors improved post intervention. Program adherence was high, with 82.4% of participants completing all peer-led sessions. Satisfaction with program content (85.7%) and peer leadership (96.0%) was strong. Participants described the content as accessible, engaging, and relevant to their daily lives. Conclusions: MYCardio-PEER was developed and content-validated as a peer-led digital health lifestyle intervention for a low-income community at risk of CVD. Process evaluation showed good feasibility and acceptability, with encouraging pre-post improvements in behaviors and selected health indicators. These findings suggest the potential of integrating peer support with culturally adapted digital content in community-based CVD prevention. Trial Registration: ClinicalTrials.gov NCT06408493; http://clinicaltrials.gov/study/NCT06408493 International Registered Report Identifier (IRRID): RR2-10.1017/S1463423625000192

BACKGROUND Low-income populations in Malaysia face significant barriers to cardiovascular disease (CVD) prevention, including limited access to health information, preventive services, and ongoing support for behavior change. Digital health technologies present scalable opportunities for promoting heart-healthy behaviors, especially when integrated with community-based peer support. OBJECTIVE This study aimed to describe the development and process evaluation of MYCardio-PEER (Peer-led digital health lifestyle intervention for CVD prevention in a low-income Malaysian community), designed to empower adults at risk for CVD through mobile technology and community-based peer engagement. METHODS MYCardio-PEER was developed using the Medical Research Council Framework for Developing and Evaluating Complex Interventions, which included evidence synthesis, theory application, intervention planning, and content design. A 2-round Delphi method was used to conduct content validation involving 10 experts and community panel members, assessing relevance, clarity, and cultural appropriateness. The final intervention was delivered over 8 weeks and included bite-sized educational videos and infographics, and peer-led interactive activities. A pre-post feasibility trial was conducted in Kulim, Kedah, with 30 adults identified as having moderate to high CVD risk. Outcome measures included anthropometric and clinical parameters, dietary intake, and physical activity. A process evaluation assessed participant adherence and program satisfaction, and correlations with health outcomes. RESULTS Participants (18/30, 60.0% male, mean age 58.2, SD 6.7 years) showed significant reductions in CVD risk score, systolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol. Physical activity levels and selected dietary behaviors improved post intervention. Program adherence was high, with 82.4% of participants completing all peer-led sessions. Satisfaction with program content (85.7%) and peer leadership (96.0%) was strong. Participants described the content as accessible, engaging, and relevant to their daily lives. CONCLUSIONS MYCardio-PEER was developed and content-validated as a peer-led digital health lifestyle intervention for a low-income community at risk of CVD. Process evaluation showed good feasibility and acceptability, with encouraging pre-post improvements in behaviors and selected health indicators. These findings suggest the potential of integrating peer support with culturally adapted digital content in community-based CVD prevention. CLINICALTRIAL ClinicalTrials.gov NCT06408493; http://clinicaltrials.gov/study/NCT06408493 INTERNATIONAL REGISTERED REPORT RR2-10.1017/S1463423625000192

This review explores the acceptance of digital health (DH) technologies for managing non-communicable diseases (NCDs) among older adults (≥ 50 years), with an extended focus on artificial intelligence (AI)-powered conversational agents (CAs) as an emerging notable subset of DH. A systematic literature search was conducted in June 2024 using PubMed, Web of Science, Scopus, and ACM Digital Library. Eligible studies were empirical and published in English between January 2010 and May 2024. Covidence software facilitated screening and data extraction, adhering to PRISMA-ScR guidelines. The screening process finally yielded 20 studies. Extracted data from these selected studies included interventions, participant demographics, technology types, sample sizes, study designs and locations, technology acceptance measures, key outcomes, and methodological limitations. A narrative synthesis approach was used for analysis, revealing four key findings: (1) overall positive attitudes of older adults towards DH acceptance; (2) the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT) are the most frequently used standard frameworks for evaluating technology acceptance; (3) the key facilitators of technology acceptance include perceived usefulness, ease of use, social influence, and digital or e-health literacy, while barriers involve technical challenges, usability issues, and privacy concerns; (4) the acceptance of AI-based CAs for NCD management among older adults remains inadequately evaluated, possibly due to limited adaptation of established frameworks to specific healthcare contexts and technology innovations. This review significantly contributes to the DH field by providing a comprehensive analysis of technology acceptance for NCD management among older adults, extending beyond feasibility and usability. The findings offer stakeholders valuable insights into how to better integrate these technologies to improve health outcomes and quality of life for older adults. Protocol Registration: PROSPERO (Registration ID: CRD42024540035).

Background: Cardiovascular disease (CVD) poses a substantial global health burden, necessitating effective and scalable interventions for primary prevention. Despite the increasing recognition of peer-based interventions in managing chronic diseases, their application in CVD prevention still needs to be explored. Aims: We describe the protocol of a quasi-experiment to evaluate the effectiveness of a peer-led digital health lifestyle intervention, MYCardio-PEER, for a low-income community at risk for CVD. This study aims to assess the effectiveness of MYCardio-PEER in improving the participants’ knowledge, lifestyle behaviours and biomarkers related to CVD. Secondarily, we aim to assess the adherence and satisfaction of participants towards MYCardio-PEER. Methods: A minimum total sample of 68 low-income community members at risk for CVD will be recruited and allocated either to the control group or the intervention group. Participants in the control group will receive standard lifestyle advice and printed materials for CVD prevention, while the intervention group will participate in the 8-week MYCardio-PEER intervention program. The participants will be assessed at Week 0 (baseline), Week 8 (post-intervention) and Week 20 (post-follow-up). Discussion: We anticipate a net improvement in CVD risk score, besides investigating the effectiveness of the intervention program on CVD-related knowledge, biomarkers, and diet and lifestyle behaviours. The successful outcome of this study is essential for various healthcare professionals and stakeholders to implement population-based, cost-effective, and accessible interventions in reducing CVD prevalence in the country. Trial registration: ClinicalTrials.gov (NCT06408493)

Purpose of Review There is a lack of synthesized evidence on social media-delivered lifestyle interventions for managing and preventing diabetes. This scoping review aims to evaluate recently reported lifestyle interventions delivered on social media for individuals with diabetes and prediabetes. Recent Findings Twelve studies were included in this review. A team of multidisciplinary healthcare professionals coordinated most interventions, half of which lasted for 6 months, and used a combination of videos, texts, images or audio to deliver the educational materials. The glycosylated hemoglobin (HbA1c) level improved in most of the studies, followed by diabetes self-care and fasting plasma glucose. The dietary intakes were only assessed in two interventions among the individuals with prediabetes and showed promising improvements. Summary This scoping review provides a holistic overview of the recent designs of lifestyle interventions for diabetes management and prevention on social media. This is essential for various healthcare professionals and stakeholders to formulate and implement population-based, cost-effective interventions in combating diabetes using social media.

BACKGROUND The most recent Malaysian National Health and Morbidity Survey reported an overwhelming increase in Metabolic Syndrome surrogates among the adult population. The rising trends in diabetes and surrogates of Metabolic Syndrome are concerning because they can lead to poor health and an increased burden of disease. In an earlier, cross-sectional study in 2013, our group reported that a significant number of people with diabetes had poor glycaemic control, and this was associated with age and ethnicity. OBJECTIVE This paper aims to assess the metabolic control among people with diabetes and those without diabetes in a rural population in the district of Segamat, Johor, Malaysia. METHODS The study assesses five-year changes in blood glucose, blood pressure, body mass index, and waist circumference among diabetes and non-diabetes participants in a Health and Demographic Surveillance Site (HDSS). Factors associated with undiagnosed diabetes at baseline and factors associated with uncontrolled diabetes at exit are also determined. Participants were from health round surveys 2013 and 2018 in South-East Asia Community Observatory HDSS in Malaysia. Among 13,769 participants in 2013, 6,988 individuals were followed up in 2018. RESULTS Among diabetes participants, random blood glucose (12.8 to 11.8 mmol/L), diastolic blood pressure (79.6 to 75.7 mmHg), body mass index (29.0 to 28.4 kg/m2), and waist circumference (93.6 to 94.3 cm) changed significantly. For non-diabetes participants, random blood glucose (6.9 to 7.5 mmol/L), systolic blood pressure (131.7 to 133.9 mmHg), diastolic blood pressure (78.8 to 77.5 mmHg), body mass index (26.9 to 27.3 kg/m2), and waist circumference (86.9 to 89.1 cm) changed significantly. CONCLUSIONS Indian ethnicity, older age groups, uncontrolled blood pressure, obesity, and abdominal obesity were associated with undiagnosed diabetes. Indian ethnicity and younger age groups were positively associated with uncontrolled diabetes. The metabolic risk factors remained suboptimal. Public health and clinical interventions need to be targeted at high-risk populations to improve metabolic surrogates.