Factors Influencing the Levels of Awareness on Malaysian Healthy Plate Concept among Rural Adults in Malaysia

Abstract

Malaysian Healthy Plate was launched in 2017 as a vital component of the Malaysian Ministry of Health’s “Quarter-Quarter-Half” program. It is predicted that this concept will bring positive change to the citizen’s dietary habits; however, the residents in rural areas may experience less exposure to this campaign, or lack of understanding to the concept of Malaysian Healthy Plate. Hence, this study aims to assess factors affecting the campaign’s awareness among the rural population in Malaysia. The National Health and Morbidity Survey (NHMS) 2019 focused on Non-Communicable Diseases (NCDs). Data collection was carried out from July to September 2019. Questionnaires that pertained to awareness, knowledge, and practice were included in this nationwide survey. Data collected from adults in rural areas aged 18 years old and above were used as respondents for the statistical analysis. Complex sample multiple logistic regression analysis was conducted to determine the association between the independent variables and awareness of the Malaysian Healthy Plate concept. About four fifths (83.2%) of rural adults in Malaysia were unaware of the Malaysian Healthy Plate concept after three years of implementation. The unawareness was significantly higher in males (91.3%), adults aged above 60 years old (91.8%), adults of others ethnicity (88.5%), those without formal education (95.2%), widows/widowers/divorcees (88.1%), retirees/adults who were not working (88.4%), and household income at the bottom 40% (B40) (85.0%). Unawareness of this concept was significantly associated with male gender (aOR = 4.12; 95% CI: 3.06–5.56); age, 40–59 years (aOR = 1.46; 95% CI:1.08–1.97); without formal education (aOR = 3.47; 95% CI:1.34–9.01); working in private sector (aOR = 2.75; 95% CI: 1.59–4.77); self-employed (aOR = 2.78; 95% CI: 1.58–4.87); retirees (aOR = 2.32; 95% CI: 1.23–4.36); and unpaid workers (aOR = 2.61; 95% CI: 1.51–4.51). Awareness of the Malaysian Healthy Plate concept is associated with rural adults being males, with older age, with lower socio-economic status, without partner, and without job. This study suggests that a more effective strategy is needed to increase the awareness of the Malaysian Healthy Plate concept among rural adults.

Trends in fruit and vegetables consumption among Malaysian adults, 2006-2019

“…In other words, the low intake of daily FV could be attributed to inadequate knowledge surrounding the importance of consuming FV in achieving a balanced diet and improving overall health. A report from NHMS 2019 showed that about 83% of rural adults were unaware of the Malaysian Healthy Plate concept even after three years of its inception [14]. With rapid economic growth, coupled with urbanization and modernization over the past 30 years, Malaysian dietary habits have shifted to the consumption of more refined carbohydrates, highfat foods, processed or convenience foods, and animal products [26] , and this may have led to decreased intake of FV [27,28].…”

“…The Malaysian Healthy Plate promoted with the tagline Suku-Suku-Separuh (literal translation "Quarter-Quarter-Half"), illustrates the proportions of the food groups that should be consumed at each meal. The plate is divided into 3 portions, a quarter portion of grains, a quarter of protein (e.g., meat, fish, eggs), and the remaining half of the plate of FV [14]. Despite the various dietary campaigns conducted by government health agencies, data from several national surveys among Malaysian adults have shown low prevalence of adequate FV consumption [15][16][17][18].…”

Does Awareness of Malaysian Healthy Plate Associate with Adequate Fruit and Vegetable Intake among Malaysian Adults with Non-Communicable Diseases?

“…The low prevalence of awareness could be attributed to factors such as gender, ethnicity, and occupation status [13]. Further analysis of the nationally representative subset of rural Malaysian adults revealed a significant association between low MHP concept awareness and factors such as being male, middle-aged, having a lower education level, working in the private sector, being retired or unemployed, self-employment, and being an unpaid worker [20]. However, the prevalence of MHP awareness among those with chronic diseases (except for hypertension) was slightly higher, ranging between 22.9% and 25.7%, than the reported prevalence of MHP awareness in the general Malaysian population (20.4%).…”

Meal Replacement as a Part of Obesity Treatment: A Narrative Review

“…This is because the Healthy Plate concept promotes a balanced and diverse diet that includes moderate portions of different types of foods. It illustrates how to create a balanced meal by visually representing the recommended amounts of food to be consumed on a single plate (15). This healthy plate portions advocate a quarter plate of carbohydrate foods, a quarter plate of protein foods and a half plate of vegetables and fruits.…”