Staying Aktif with K2K

Pandemic Burnout Aktif Bersama

In the wake of our piece celebrating Hari K2K, a showcase of the Kita untuk Kita (K2K) programme’s community achievements at PPR Hicom Kampung Baru in Shah Alam, we wanted to return to an interview we conducted for The Citymaker podcast with Think City’s Resilience Lead, Uta Dietrich a few weeks ago about K2K Aktif Bersama, Think City’s active lifestyle pilot programme in partnership with Citi Foundation. 

K2K works with the local community to create and develop tailored solutions to help address their social, economic and infrastructural needs. This holistic approach to public housing renewal includes linking communities to cheaper food and goods, providing easy access to skills and training, facilitating community-building, networking, physical and mental health initiatives amongst its activities. Which are underpinned by the community mobilisation and impact measurement analytics facilitated by the digital platform component. 

As Think City Managing Director Hamdan Abdul Majeed acknowledged, Citi Foundation is helping the agency to bring its vision of pioneering and innovative community projects to life. “We have had a longstanding relationship with Citi Foundation and with each year, the projects have grown and evolved mirroring Think City’s portfolio of heritage conservation, placemaking, and building social and environmental resilience,” he comments. “All, in their own way, contribute to making cities better places for all. Citi Foundation’s support for K2K Aktif Bersama and the earlier K2K Idol have mobilised stressed communities, engaged them in shaping the programme and empowered them to identify strategies to improve life in their PPR community. It’s my hope that we will continue to work together to  improve our cities for our people.”

As many parts of Malaysia go into yet another lockdown in early May 2021, now seems like a good time to remind ourselves of the challenges that maintaining a healthy lifestyle pose, particularly to those in Malaysia’s B40 communities. Designed to build healthy communities and improve the physical, mental and social wellbeing of residents in public housing across Malaysia. K2K Aktif Bersama follows successful initiatives like K2K Idol that are looking for ways to assist communities under stress.

Hari K2K
Photo by Kenny Loh

Hi Uta. Can you give us a brief introduction to the K2K Aktif Bersama programme?

Uta Dietrich: Aktif Bersama is quite an exciting programme for us because it’s finding a way to address health and wellbeing in a community that is quite stressed at any time and even more so now during Covid-19. Aktif Bersama is a wellbeing programme that runs in PPR and low-cost housing communities. And we are trialling it in the PPR Hicom Kampung Baru in Shah Alam. The Aktif Bersama programme is trying to harness the benefits of physical activity to improve not just physical health,but mental health and build social networks. And it has been designed to be COVID safe.

Aktif Bersama is part of a wider public housing renewal programme that we call K2K, Kita untuk Kita, which stresses the self-help component. The ultimate aim that we’re trying to achieve is to build social resilience in disadvantaged communities. 

What are some of the issues those low-income and B40 communities typically face?

Uta Dietrich: When we think about public housing, particularly PPRs, in our cities, a number of them are built as high-rises, they almost stand out as islands within the city. That island forms a neighbourhood [in and] of itself. If we frame it in a more negative way, it’s almost like a ghetto. The dimensions that [create] the stress in these communities [revolve] around social issues, economic issues, and physical issues, which [form part of] the foundation for this K2K programme. The communities are often made up of daily wage earners. They have very little [in the way of] savings. They live in very dense, small apartments. Within the community, there are often issues of waste management, maintenance, and so on. 

All of these causes, like the financial stress, have implications. A highly stressed community is less likely to look after other people [other than] their family because the stress is focused on themselves. Another aspect is those dense living conditions. Where do children find a quiet space to study? Now overlay this with Covid and the MCO, people not being able to leave. As daily wage earners, they’re the first to lose their jobs.

Our own Think City research showed that over 80% of households were affected by job losses following Covid-19 and movement restrictions. And we also know that, from a health perspective, Malaysia is already the most overweight and obese nation in Southeast Asia. It has very high levels of diabetes and other chronic diseases. In the lower socioeconomic groups, these figures tend to be even higher. A number of issues converge here in causing stress and illness. For example, if you have a chronic disease, you have higher medical expenses, which further exacerbates any financial stresses that may exist.

Going back to the structure of K2K and the Aktif Bersama programme. What are the programme’s core elements? 

Uta Dietrich: Aktif Bersama is done in a Covid-safe way through webinars [and] videos so that people can listen to some information material that’s communicated via a Facebook site. So that’s a sort of basic foundation. The key initiative to change is the walking groups. We are working with the communities, we trained six walk leaders. The youngest is only 15-years old. And they take people on walks around the neighbourhood.

Walking is one of the best initiatives or activities that people can do. First of all, it’s free. Second, it is a form of physical activity that is light on bodies, even if you have never done any physical activity, with walking, you can start straight away. It’s easier on the joints than running, and so on. So, lots of benefits in terms of physical health.

There is a lot of evidence that shows that people that are more physically active, also have better mental health. It helps with anxiety. It helps with depression. It’s a stress alleviator. And thirdly, walking in groups, even if you walk in a socially distanced way, is a way of making new connections, getting to know your neighbours; building a social network that is there to help you.

People you can call on if you need help: if you need someone to look after the children, go shopping and so on, there are lots of opportunities. So, walking in groups has physical benefits. It has mental benefits, and it has social benefits. And on top of that, if we take the geospatial dimension to it, walking around your neighbourhood, you get to know your neighbourhood.

In other words, the exercise programme – as well as being a benefit in its own right – is introducing a sense of community? 

Uta Dietrich: It can strengthen the sense of belonging to where you live, in the building of a sense of identity on the one hand. It also increases your perception of safety. If you usually only drive through the neighbourhood and you think ‘oh, I may be robbed if I walk there’ – which was a concern in the community when it first started – once you start walking, you get to know the vendors on the corner, you discover other people who live there. You know where the potholes are. 

You get a feel for your neighbourhood, which increases your sense of safety. Altogether, this builds that sense of wellbeing. So, for me, Aktif Bersama, and the walking groups are not just a chronic disease prevention programme, but are much more linked to sejahtera, the wellbeing overall. And the reason we started this is to give people a trial. 

Rather than just say: you should go walking because it has all these benefits, which is a very cognitive approach, we are trying an experiential approach that is also linked to emotions around your neighbourhood, making friends and so on. It’s a much more comprehensive approach that helps people trial and practice. And hopefully, to experience the benefits that I’ve outlined in terms of physical, mental, and social wellbeing, plus [developing] a sense of belonging and safety. People will recognize and feel the benefits and continue with those activities.

To incentivize anyone making a behaviour change, any change is difficult. We also incentivized [the walking groups] with enticing prizes like fitness equipment, kitchen, equipment, and so on, that people can win. So, it becomes quite appealing for people to join.

And we find that it’s not just the people that register that come, they bring their family. It becomes a family affair. Some people do it daily, some do it only a few times a week, but the walking groups are offered daily. People slowly get into a habit, encouraged by the incentives, and by feeling the benefits they will hopefully continue this [with] programme.

What changes did you expect to see across the lifespan of the pilot programme? Is it too much to expect to effect long-lasting or permanent changes in such a short space of time?

Uta Dietrich: Within a six-week programme it is unlikely we would see any reduction in chronic diseases or other long-term changes. We need to focus on other indicators. My key objective for Aktif Bersama was to engage 10% of the community. There is some literature that says, if you can convert the behaviour of 10% of opinion leaders, then that is a tipping point that will ripple through the community. Our goal was to reach 10% of the community, at PPR Hicom, that is around 400 people, to take part in one or more activities. 

And to date, we have over 142 walk registrations, more if you add the children [and family members]. [Including] the education and counselling and workshop interventions that also make up this programme, over six weeks we engaged with more than 630 residents. There will be some overlaps, but overall, we think we can be quite confident that we have reached our 10% target.  

There would need to be a longer-term follow-up to see whether the walking groups are continuing and the outcomes that are related to it. We’re in the process of confirming that we are able to support the walking groups to continue, and by measuring participation, we want to see whether people continue to walk if there are no more external incentives.

That would be a clear outcome that the programme has made a difference. The incentives are important to encourage people to join. But when you think of motivation theory, this is really an external motivation: you do something because you get rewarded for it. I do something, I get paid. Or I do something, I receive a reward. [If] the reward stops, will the action stop? It will be fascinating to observe [what happens when] the incentives are no longer there. Have the experience and the feeling of wellbeing [proved] strong enough to continue the activity? [If so, it] means that the external motivation is now converted into an internal motivation.  And internal motivation means it is likely to continue.

Picking up on that point about motivation theory. Why is affecting behavioural change not as simple as providing someone with the information and expecting them to choose the optimal outcome?

Uta Dietrich: You always come across that. When there’s an issue, [you think] what should we do? An education campaign? A poster? We often think if someone knows what’s good for them, [they will choose the best outcome]. But we all know things that we should be doing but are not doing. So, there may be certain barriers in place. The link between being, knowing and doing is quite weak. 

In here comes another aspect that is a sort of intermediary, the concept of self-efficacy. And that is, if you know you should be doing something, but you don’t know how, or you feel you’re not strong enough, or you feel you don’t have the time, then these barriers, or the feeling within yourself that you are not capable of doing it, stops the translation from knowing into doing. 

As an example, how many of us know that we [are carrying] a few kilos too many but [aren’t taking any action in relation to it]? How often do we [see] doctors and health professionals who are smokers? They, more than anyone, know how harmful smoking can be. If they are still smoking, then there must be something else at play. 

It’s about finding ways of reducing barriers to an action. Let’s take our community as an example, they were very concerned about their safety. By assessing a walking route first for its safety, by walking in groups together and doing that again and again, and getting to know the neighbourhood, we have reduced that barrier, the feeling of being unsafe. 

How many of us say that we are too busy to walk? Instead, by saying you’re walking with your friends, you have something, a motivator, something where you reprioritize, even though you are very busy. The benefit that you see from catching up with your friends is reducing this time barrier. So, we need to find ways of getting people to practice, to finding out, to doing by themselves.

To see that, yes, it can be done. [And the realisations that follow]: I can fit it into my day. It’s not so bad or I’m enjoying myself. The neighbourhood is safer than I thought. Gaining these insights yourself will help with that behaviour change: they help you to move from wanting to do something to actually doing it.

How would you describe the programme? Does it fall into the arena of social nudging?

Uta Dietrich: I don’t see this as a nudging. I would revert it back into good health promotion practice, which is working with the community. So here the walk leaders are part of leading the groups, they are part of the programme. We are working with local NGOs in designing the walking path, in identifying what would be worthwhile prizes. In that respect, I see this is good health promotion practice and not nudging because nudging does have some ethical components and the notion of manipulation. 

If we take a parallel to medicine, when you have an operation, you’re supposed to give informed consent. That means that the pros and cons have to be explained to you, and you as the patient make the decision. If I take that parallel into Aktif Bersama, we show the pros and cons. We are leaving the decision-making to the community, and that is how I see the difference between nudging and manipulation on the one hand, and good health promotion practice for the wellbeing of the community on the other.

To be clear for our readers, this interview took place as the Aktif Bersama pilot programme was drawing to a close, prior to the Hari K2K open day in April. What were some of the highlights and key learnings of the programme, and how what hopes and plans do you have in terms of extending the programme and exploding to other locations?

Uta Dietrich: First I would like to thank the community and the many partners that have participated in this programme. The programme has been generously supported by Citi Foundation. 

What we want to do is turn what we are learning and what we have learned, into a toolkit that makes it accessible to other communities. It doesn’t necessarily have to be low-cost housing communities. They can be anywhere. 

Highlights of the programme include recruiting the walk leaders, including engaging young people. What we are seeing is that there is an interest in what we are doing. We are excited about the number of people that participated in the add-on programmes, despite it being online. And, I think, for programmes like counselling, where there’s still a lot of stigma around mental health, not going to a venue onsite where people can see the person and [deduce] that they are suffering from mental health issues but being able to do that from the safety of your own home, has some benefits.

The activities that the community is most excited about are where the community comes together and there’s something to win. And there’s a fun element. Like the prize-giving ceremonies, which have been broadcast on Facebook. That was what got more links and clicks and engagements than other initiatives. 

To be able to do this face to face, I think would have a much stronger engagement potential. Once the restrictions lessen, and we repeat the programme, I would think that we will be able to engage with an even higher percentage of the community. So, where to go from here? We will have a toolkit and others can use it. 

That the community has adopted this and has found it helpful. And that whole families are going out and discovering their neighbourhood. By taking the children along, hopefully, the next generation can adopt healthier behaviours as well. The programme overall, I would say, has been successful. We want it to repeat, to see whether similar or even better results can be achieved so that we can roll it out wider. 

But we have to remember that this is only one component of an intervention to improve the lives of people at PPR. So, the health and wellbeing, the sejahtera component, is a very important component. But it should also be supplemented with other initiatives, such as reskilling and training to help the community find new work and bring in a higher income. And also to improve the physical environment within the PPRs.

Follow the progress of the K2K programme here on The Citymaker. Check our archive for more information on K2K Idol and K2K Aktif Bersama

Explore Citi Foundation.