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 study is funded by Wellcome (Heat Adaptation award - 226737\_Z\_22\_Z)
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). * Participants will undergo assessments at baseline (T0), first follow-up (T1), second follow-up (T2), and third follow-up/endline (T3). The T1 assessment occurs after completion of behavioral intervention and prior to the structural intervention. * Wear a Garmin Vivosmart 5 sensor for two weeks during each data collection period to monitor heart rate, physical activity, and sleep patterns.
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
Individuals belonging to one household with existing participants
Bedridden individuals or those requiring assistance in movement
Single-story house
Built with brick or brick and wooden
Factorial
Heat Literacy Intervention
BehavioralThe behavioral intervention aims to improve heat literacy among participants through an 8-12 week education and training program. It includes four main modules: enhancing community awareness of hot weather, identification of high risk groups, recognizing and responding to heat-related illnesses, and teaching personal cooling strategies. Participants will use SwitchBot meters to monitor indoor temperature and humidity, access real-time weather information, and learn about heat wave warnings. They will receive educational materials, including infographics, videos, and one-to-one training from field staff. The content of intervention and delivery methods will be refined through co-design workshops with stakeholders and community members to ensure they are practical and culturally appropriate. The goal is to equip participants with the knowledge and skills to protect themselves from extreme heat, resulting in better heat adaptation behaviors and improved health outcomes.
Structural (Cool Roof) Intervention
Other interventionThe structural intervention in this study involves implementing cool roofs to reduce indoor temperature and mitigate the effects of extreme heat in rural Malaysian communities. Selected households will have their roofs painted with UV-resistant paint, which reflects direct sunlight and reduces thermal absorption. This intervention aims to decrease the amount of solar energy absorbed by the roof, thereby lowering indoor temperature and reducing the physiological heat strain on residents. By maintaining cooler indoor environment, the cool roof intervention seeks to alleviate the health risks associated with prolonged exposure to high temperature.
Indoor Air Temperature
Assessed using an indoor data logger (SwitchBot) to measure air temperature within the household.
Step count (Physical Activity)
Tracked using Garmin Vivosmart 5 sensors, recording steps and distance.
Sleep Duration
This will be obtained using the Uppsala Sleep Inventory questionnaire which assess sleep duration.
Glycaemic Control
HbA1c level which will be measured by the Hemocue® HbA1c 501 System.
Depressive Symptoms
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
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 Symptoms
This outcome tracks the heat-related symptoms among participants, such as rash, oedema, sunburn, cramps, syncope, tetany and exhaustion. Data is collected through self-reported questionnarie. The goal is to identify any reductions in heat-related symptoms due to the interventions.
Health-related Quality of Life
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.
Heat Index
Assessed using an indoor data logger (SwitchBot) to measure heat index within the household.
Blood Glucose Level
Random blood glucose, which will be measured using a home blood glucose monitoring system (Accu Chek Instant S)
Sleep Inventory
This will be obtained using the Uppsala Sleep Inventory questionnaire, which assesses an individual's difficulty initiating sleep, maintaining sleep, and individual's daytime sleepiness.
Heat Literacy
This outcome assesses participants' ability to access, understand, appraise, and apply information to make judgments and take decisions in everyday life to mitigate heat effects on health using structured questionnaire. The index is standardized to unified metrics from 0 to 50. 0 represents the lowest heat literacy and 50 the highest heat literacy.
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Monash University Malaysia
Lead sponsor
Monash University
Collaborator
Heidelberg University
Collaborator
Ministry of Health, Malaysia
Collaborator
