One of the peer leaders (left) for the MYCardio-PEER initiative in Lunas, Kedah, demonstrating how to prepare a healthy breakfast suitable for the low-income community. — Photos: Assoc Prof Dr AMUTHA RAMADAS
In South-East Asia, particularly Malaysia, diabetes is not just a health condition, but an epidemic.
According to recent findings, the frequency of diabetes has been climbing steadily.
Malaysia, in particular, reports one of the highest rates of diabetes in the Asian and Western Pacific regions, with approximately one in five adults affected.
It was also alarming to note that more than 11% of Malaysians have prediabetes, a condition characterised by an elevated blood glucose level.
The growing frequency of diabetes has made it a critical public health issue – one that threatens quality of life and burdens healthcare systems.
The economic burden of diabetes on Malaysian healthcare is also substantial.
Patients with diabetes often suffer from co-morbidities (concurrent medical conditions), such as cardiovascular (heart) disease and kidney complications, which require extensive and costly treatments.
Beyond the immediate healthcare costs, diabetes also impacts workforce productivity, particularly as it increasingly affects younger populations.
The recently-concluded Seaco-CH20 (South-East Asia Community Observatory Child Health 2020) study underscores these concerns.
It revealed that metabolic risk factors such as high blood pressure and elevated fasting blood glucose are prevalent among Malaysian children and adolescents, setting the stage for a high lifetime risk of type 2 diabetes.
Using social media
Malaysia’s diabetes crisis is driven by rapid urbanisation, and evolving dietary and lifestyle patterns.
WhatsApp groups appear to be an effective way to provide information and support to help patients manage lifestyle-associated illnesses like diabetes.
These changes shape the nation’s health landscape, making diabetes a growing concern.
Addressing this challenge requires more than conventional healthcare; it calls for an integrated, community-centred approach that includes digital health tools and tailored public health interventions.
Together, these strategies aim to make diabetes care inclusive and accessible, reaching individuals across socioeconomic and geographical backgrounds.
A critical aspect of our approach is peer-led interventions, which show substantial promise in managing diabetes and other chronic conditions.
Peer-led models train community members to offer practical guidance and emotional support, fostering camaraderie and shared commitment.
Research underscores the impact of peer-led programmes, as they motivate individuals to make healthier lifestyle choices and address obstacles to sustained behaviour change.
Our systematic review recently confirmed that peer-led initiatives positively impact cardiovascular health, which is closely linked to diabetes, through consistent, community-based check-ins, discussions and mutual support.
With widespread smartphone use, digital platforms like WhatsApp have become vital channels for health interventions.
These platforms facilitate real-time communication, providing immediate, accessible health education and support.
Our recent scoping review highlighted that interventions delivered through the messaging apps WhatsApp and WeChat have effectively encouraged lifestyle changes and improved diabetes management.
Social media enables real-time consultations with healthcare providers and fosters ongoing peer support – key factors for long-term behaviour modification.
Notably, these interventions are linked to reductions in glycosylated haemoglobin (HbA1c) levels, a primary measure of blood glucose control.
This demonstrates the potential of social media as a scalable, cost-effective solution for diabetes management in regions with high smartphone use.
Peer and community involvement
In Johor Bahru and Kedah, our projects Persuade (Peer Support Programme for Adults with Metabolic Syndrome) and MYCardio-PEER are making a tangible difference by embedding health interventions within communities and empowering residents through peer-led models.
Community empowerment allows patients to tailor their physical activity according to what works for them, following evidence-based guidelines, thus creating greater buy-in and more sustained effort.
Both programmes target diabetes, along with associated complications like high blood pressure, high cholesterol and obesity, which are common in these regions and frequently co-occur with diabetes, complicating health outcomes.
By addressing this full range of metabolic disorders, we’re promoting a holistic approach to metabolic health that covers diabetes and other chronic conditions affecting quality of life.
The Persuade project in Johor Bahru was designed as a 12-week behavioural intervention programme with peer support.
The interventions were formulated through five-step development process: Evidence review, focus group discussions, behavioural matrix development, module development, and feasibility and process evaluation.
This was to ensure that the programme was evidence-based, as well as appropriate and specific to the community.
The end of the programme found that the participants had indeed experienced improvements in their lifestyle behaviours associated with diabetes and metabolic health.
This success highlights the effectiveness of an inclusive, community-centred approach that relies on trained peer leaders from within the community.
These peer leaders provide essential health information and emotional support, creating an environment where participants feel motivated to embrace healthier lifestyle choices.
Peer leaders are instrumental in normalising health-promoting behaviours, cultivating a sense of belonging and encouraging sustained change.
In Kedah, the MYCardio-PEER initiative is a digitally-assisted peer-support lifestyle intervention aimed at mitigating cardiovascular diseases risk in a low-income community through the adoption of a healthier lifestyle.
This includes addressing diabetes and other metabolic conditions, which are risk factors for cardiovascular disease.
The ongoing programme combines digital materials and interactive activities, facilitated by trained peer leaders to provide accessible, tailored lifestyle information and robust social support.
It’s a collaborative effort involving direct input from community members through focus group discussions.
Peer leaders and key stakeholders also participate in these discussions, ensuring the programme is tailored to the community’s needs.
This participatory approach has fostered a strong sense of ownership among participants, crucial for consistent engagement, and ultimately, better health outcomes.
Through community involvement in the programme development, MYCardio-PEER reflects the unique insights and challenges of those it serves.
This grassroots approach has allowed the programme to be adapted based on community feedback, making it relevant and effective.
Rather than offering a one-size-fits-all solution, the intervention is customised to address local circumstances.
By involving the community at every stage, the likelihood of sustained health improvements is enhanced, as participants see the programme as their own, rather than an external initiative.
Our experience with Persuade and MYCardio-PEER underscores the value of community ownership, peer-led support and collaborative planning in driving meaningful health improvements.
Focus on overlooked groups
Looking ahead, our focus will be on marginalised and vulnerable populations often overlooked by conventional health programmes.
Pregnant women with gestational diabetes, adolescents, and young adults – groups at high risk, yet often underserved – are at the heart of our future efforts.
Despite their vulnerability, these individuals frequently lack access to structured health interventions.
Through our model, which has already shown success in other communities, we aim to create tailored programmes that address these high-risk groups’ specific needs and challenges.
Our mission is not only to improve diabetes management, but also to foster sustainable, community-rooted health practices that will support healthier lives across Malaysia.
Dr Amutha Ramadas is a nutritionist and associate professor at Monash University Malaysia. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
