Heat Adaptation Through Community-based Approaches and Research at SEACO: Structural and Behavioural Interventions (Heat Care)

Not Applicable

Not yet recruiting

• Conditions: Climate Change; Heat; Weather; Heat Effect; Heat; Excess

• Registration Number: NCT06744309
• Lead Sponsor: Monash University Malaysia

Brief Summary

The goal of this clinical trial is to learn if structural and behavioral interventions can mitigate the health effects of extreme heat in rural Malaysian communities. The study focuses on implementing cool roofs (a passive cooling system) and heat literacy education to improve heat adaptation behaviors. The main questions it aims to answer are:

* Does the implementation of cool roofs reduce indoor temperatures and related heat stress in rural households?

* Does heat literacy education improve community awareness and behaviors related to coping with extreme heat?

Researchers will compare four groups: one receiving both cool roofs and heat literacy interventions, one receiving only the cool roof intervention, one receiving only heat literacy education, and a control group receiving neither intervention. Participants will be asked to:

* Have their roofs painted with UV-resistant white paint (for cool roof intervention groups).

* Participate in educational sessions and training on heat-related health risks and coping strategies (for heat literacy intervention groups).

* Complete baseline and follow-up surveys at 3, 6, and 12 months.

* Wear a Garmin Vivosmart 5 sensor for two weeks during each data collection period to monitor heart rate, physical activity, and sleep patterns.

Detailed Description

The goal of this clinical trial is to evaluate the effectiveness of structural and behavioral interventions in mitigating the health impacts of extreme heat in rural Malaysian communities. Specifically, the study will implement and assess two interventions: cool roofs (a passive cooling system) and heat literacy education. Cool roofs involve painting the roofs of selected households with UV-resistant white paint to reduce thermal absorption, thereby lowering indoor temperatures. Heat literacy education aims to enhance community awareness and preparedness for extreme heat by providing training and educational materials on recognizing heat-related illnesses and adopting personal cooling strategies.

Participants will be randomly selected from the SEACO health database, encompassing five operational sub-districts. Eligible participants include adults aged 18 years and above, living in single-story houses with suitable roofing materials. They will be randomly assigned to one of four groups: one receiving both interventions, one receiving only the cool roof intervention, one receiving only heat literacy education, and a control group receiving neither intervention. This 2 x 2 factorial design will allow researchers to compare the effects of each intervention individually and in combination.

Data collection will occur at baseline and three follow ups, intended to do 3 months, 6 months, and 12 months. SEACO data collectors will visit participants' homes to install SwitchBot heat and humidity measurement devices, conduct surveys, and take physical measurements. Participants will also wear Garmin Vivosmart 5 sensors for two weeks during each data collection period to monitor their heart rate, physical activity, and sleep patterns. We will also conduct the basic measurements such as height, weight, blood pressure, blood glucose and HbA1c. The surveys will gather information on socioeconomic and demographic characteristics, self-reported illnesses, heat exposure, heat adaptation behaviors, heat literacy, cooling strategies, self- reported sleep quality, mental health and quality of life.

The study aims to determine whether cool roofs and heat literacy education can effectively reduce indoor temperatures, improve heat adaptation behaviors, and ultimately mitigate the health risks associated with extreme heat. By analyzing data from both interventions and their combined effect, the research seeks to develop a theoretically informed, evidence-based, and culturally sensitive community-based heat adaptation program for rural Malaysia. This program could serve as a model for other climate-vulnerable regions, providing valuable insights into sustainable and practical approaches to addressing the health impacts of climate change.

Study Timeline

• Status Verified: 2024-12
• Study First Submitted: 2024-12-11
• Study First Submitted QC: 2024-12-19
• Last Update Submitted: 2024-12-19
• Study First Posted: 2024-12-20
• Last Update Posted: 2024-12-20
• Study Start: 2025-01
• Primary Completion: 2026-05
• Study Completion: 2027-07

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 1000

Inclusion Criteria

• Adults aged at least 18 years old
• Willing to participate in all study components
• Consent to roof painting and installation of heat and humidity measurement devices
• Consent to wear the supplied wearables (Garmin Vivosmart 5) for data collection
• No plans to relocate during the study period
• Possess a smartphone for receiving health education materials

Individual

Exclusion Criteria

• Individuals belonging to one household with existing participants
• Bedridden individuals or those requiring assistance in movement

Household Inclusion Criteria:

• Single-story house
• Main house measurement less than 1200 sqft
• Built with brick or brick and wooden
• Roof made of zinc, ceramic/clay, or mixed, suitable for cool roof painting
• Minimal to no requirement for roof repair
• No plans for renovation during the study period

Household Exclusion Criteria:

• Double-story houses, shops, or empty houses
• Houses with the facility to sprinkle water on the roof

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Primary Outcome Measures

Name	Time	Method
Indoor Air Temperature	12 months	Assessed using an indoor data logger (SwitchBot) to measure air temperature within the household.
Step count (Physical Activity)	12 months	Tracked using Garmin Vivosmart 5 sensors, recording steps and distance.
Sleep Duration	12 months	This will be obtained using the Uppsala Sleep Inventory questionnaire which assess sleep duration.
Glycaemic Control	12 months	HbA1c level which will be measured by the Hemocue® HbA1c 501 System.

Secondary Outcome Measures

Name	Time	Method
Depressive Symptoms	12 months	This will be assessed using the Quick Inventory of Depressive Symptomatology (QIDS-SR16) questionnaire.; The Quick Inventory of Depressive Symptomatology (QIDS-SR16) assesses the severity of depressive symptoms based on 16 items. The scoring for the QIDS-SR16 is as follows: Minimum possible score: 0 Maximum possible score: 27; A higher score on the QIDS-SR16 indicates more severe depressive symptoms, which means a worse outcome in terms of depression severity. Conversely, lower scores suggest fewer symptoms and thus a better outcome.
Psychological Distress	12 months	This will be assessed using the Kessler Psychological Distress Scale (K10) questionnaire.; The Kessler Psychological Distress Scale (K10) is a tool used to measure psychological distress. It consists of 10 items, each rated on a 5-point scale from "none of the time" (score = 1) to "all of the time" (score = 5).; Minimum possible score: 10 (if the participant scores "none of the time" for all 10 items).; Maximum possible score: 50 (if the participant scores "all of the time" for all 10 items).; Higher scores on the K10 indicate greater psychological distress (worse outcomes)
Heat-related Illnesses	12 months	This outcome tracks the incidence and severity of heat-related illnesses among participants, such as heat exhaustion and heat stroke. Data is collected through self-reported health metrics. The goal is to identify any reductions in heat-related illnesses due to the interventions.
Health-related Quality of Life	12 months	This outcome evaluates the overall well-being of participants using the EuroQol five dimensions of health (EQ-5D) questionnaire, which covers five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The assessment aims to determine how the interventions impact participants' overall quality of life and well-being. The minimum value is 0 and maximum value is 100.; Higher scores generally indicate better health outcomes, meaning that the person is in a state of better physical and mental health.; Lower scores indicate worse health outcomes or greater health problems.
Indoor Thermal Comfort	12 months	Assessed using a visual analogue scale to measure current heat experience in the household rated on a visual scale from: Very comfortable, Comfortable, Just comfortable, Just uncomfortable, Uncomfortable, and Very uncomfortable. Minimum (1) to maximum (6). The higher score is the worse outcome.
Heat Adaptation Practices	12 months	This outcome evaluates participants' adaptive behaviors during periods of extreme heat, highlighting measures taken to protect themselves and their communities from heat-related health impacts. The 18-item questionnaire evaluates heat adaptation practices using a 5-point Likert scale (1 = Strongly Disagree to 5 = Strongly Agree). Negatively worded statements will be reversed. Scores range from 18 to 90, with higher scores indicating higher adoption in heat adaptation practices, and lower scores indicating lower adoption in heat adaptation practices.

Trial Locations

Locations (1)

South East Asia Community Observatory, Monash University Malaysia; 🇲🇾 Segamat, Johor, Malaysia