Fostering Healthy Ageing through Innovative App and Cancer Screening Awareness via E-media: Digital Health Initiatives in the UK and Malaysia

Thet Htoo Pan, Alosh K Jose, Azmawati Mohammed Nawi, Myat Yadana Kyaw, Nadila Mulati, Myo Nyein Aung and Michikazu Koshiba

Report in Japanese
Report in Thai 

Digital technologies are increasingly being used worldwide for healthy ageing, health promotion and early disease detection, especially during and after the COVID-19 pandemic. Although health services are established and accessible, the use of these services remains a challenge, particularly for vulnerable older adults’ population, due to the grey digital divide: limited access to the health service information and low awareness of early detection and diagnosis of diseases, including cancers. In the 20^th Digitally Inclusive Healthy Ageing Communities (DIHAC) cross-cultural exchange meeting, two distinguished presenters shared their innovative ideas and projects addressing the two global mega trends: emergence of digital technology and healthy ageing. The CEO of Cricketqube from the UK presented an app to monitor physical activity and getting access to health and social care services in the UK, while a professor from Universiti Kebangsaan Malaysia (UKM) shared the effectiveness of decision aid video (DAVOCS^®) to increase uptake of colorectal cancer screening among primary care patients in Malaysia.

Opening session

DIHAC study PI Associate Professor Myo Nyein Aung hosted the meeting by socializing with international participants and expressing appreciation for the attendees’ commitment while highlighting key achievements, marking DIHAC’s 20^th time. Professor Myo welcomed chairperson Mr. Michikazu Koshiba, Head of Center on Global Health Architecture, MITSUBISHI UFJ Research & Consulting. Mr. Michikazu has been serving as a moderator for several global events and conferences including UN and WHO. He is a strategic consultant, currently focusing on digital innovation related to health. He addressed the importance of creating digitally inclusive healthy ageing communities, coordinating with multiple stakeholders for the inclusion of older people in our society. Professors from fields of global health, gerontology, social science, economy, health care, programme leaders, community stakeholders, entrepreneurs and PhD students from Japan, Thailand, South Korea, Singapore, Malaysia, Mexico, Indonesia, China, and the UK actively participated in the 20^th DIHAC meeting.

Figure: Chairperson Mr. Michikazu Koshiba, speakers, international audience and DIHAC study team at the 20th DIHAC meeting

Presentation 1 – The United Kingdom

The first speaker was Mr. Alosh K Jose, Co-founder and CEO at Cricketqube, UK. Cricketqube is an organisation in the UK that makes people healthy by encouraging physical activity through the delivery of cricket sessions, particularly to older adults, as well as to ethnic minorities and care home communities for older adults with cognitive dysfunction. Over 30 sessions are delivered for more than 500 people per month including inter-generational activities, collaborating with national charities, primary care centers and general practitioners and local community stakeholders. Currently, there are almost 11 million people aged 65 and over (19% of the total population) in the United Kingdom. In 20 years, this will have increased to 24% of the population (1). Older people have less digital literacy and skills compared to younger generations, so they often face challenges in access to health and social care services. In the 20^th DIHAC meeting, he introduced an app “AgeWise”, which is an AI-powered healthy ageing app, specifically designed for people over 50s. Using an app for monitoring of physical activity and several parameters, it has recently made a new trend of promoting physical activity and healthy ageing. The project started 8 months ago, available from smartphones and wearables, in English and Hindi for ethnic minorities. Although social prescribing is well established in the National Health Service (NHS) in the UK, older people face difficulties in finding and booking physical activity sessions. AgeWise identifies local and online physical activity programmes specifically for older adults and recommends them based on their interests and location, including walking, cricket and reading clubs.

The app gives physical activity recommendations as well as those of mental and social wellbeing. It directs users to specialist professionals within the primary health care structure including social prescribers, mental health support workers, community pharmacies and health coaches within the NHS framework so that they can self-refer, reducing the burden on GPs in primary care clinics. It also includes a health education section, providing users with fact sheets on common conditions in older people and frequently asked questions (FAQs) on how to manage chronic comorbidities. AgeWise collects data from phones, wearables, and surveys and its machine learning adapts users’ personalised life-style recommendations. The app links to care organisations for tailored targeted care which are aligned with NHS’s “Universal personalised care plan” in 2024 (2). It organised a dashboard for care organisations for each of their clients, such as exercise duration, heart rate monitoring, sleep patterns, mental status for tailored management. Data analyses provide personalized recommendations to the older adults as well as the organisations of health care providers. Participants actively discussed the inclusion of vulnerable minorities across socio-demographic characteristics, sustainability of healthy behaviours, and collaboration with the National Health Service (NHS) and Primary Care Network (PCN).

Presentation 2 – Malaysia

The second presentation was delivered by Assoc. Prof. Dr Azmawati Mohammed Nawi. M.D., Ph.D., Public Health Specialist and Medical Lecturer in Department of Public Health Medicine, Faculty of Medicine Universiti Kebangsaan Malaysia (UKM). Professor Azmawati addressed Development and Evaluation of Decision Aid Video on Colorectal Cancer Screening Uptake (DAVOCS^®) among Primary Care Patients. Colorectal cancer (CRC) is the 3^rd most common cause of cancer death worldwide (3), ranking 2^nd in Malaysia following Breast cancer. The mortality rate is higher in men and the incidence of colorectal cancer is increasing year by year in Malaysia(4). The reasons are (i) Low CRC screening uptake among Malaysians (<1% had FOBT uptake), (ii) Low awareness on CRC screening, (iii) The asymptomatic nature of the disease with late-stage diagnosis for majority of CRC patients and (iv) Lack of decision aids for CRC screening in Malaysia (5). In the 21^st century, rapid and innovative advances in digital technology and internet communication have made electronic media (e-media) a powerful health promotion tool with great potential for health behavior change. Therefore, Professor Azmawati’s team developed a new decision aid Video on Colorectal Cancer Screening Uptake (DAVOCS^®) among Primary Care Patients and conducted a quasi-experimental study based on health belief model to evaluate the outcome and the impact of measures. Evidence showed that DAVOCS^® improved the primary outcome of CRC screening by increasing fecal occult blood test (FOBT) uptake and colonoscopy uptake as well as improved knowledge on CRC screening compared to usual care. In Malaysia, although there is still no national health insurance system and CRC screening is not included in the national programmes, the screening is usually offered to people aged over 50s for both men and women when they visit primacy care clinics. Therefore, the use of e-media would have a positive and direct impact on decision support for people aged 50 years and above to undergo CRC screening. The content of the video was developed by focus group discussions and in-depth interviews. After validating the content of the video and ecological validation, questionnaires assessing the knowledge of CRC screening were developed. Pilot study and construct validation were done to know the engagement among the community. The study was conducted to 191 participants in a clinic in Kuala Lumpur by pre and posttest design, with purposive sampling aged between 50 and 75 years old.

The video content included animation in the first part and live action in latter part, lasts for about 7 and a half minutes. The animation part explained the epidemiology, knowledge of CRC, and risk factors using the example of a man aged over 50 with a family history of CRC, stages and symptoms of CRC, pictorial illustration of polyps that polyps in the pre-cancerous stage, example of treatment such as removal of polyps during colonoscopy procedure. CRC awareness education was included in the animation, explaining that screening leads to proactive health seeking behavior, that it is available upon eligibility and request at health clinics and hospitals. The live action part shows the experiences of cancer survivors that early diagnosis and treatment leads to good survival rates, and that willingness to screened could be motivated by family members. According to the intervention results, among the colonoscopy uptake in the intervention groups, 2 participants (25%) were tested as positive for CRC and the participants appreciated the early detection of cancer. Further analysis of the effectiveness of DAVOCS^® showed that people who watched the decision aid videos were twice as likely to be screened for CRC and their knowledge of CRC screening was improved compared to usual care so DAVOCS^® can provide health education about CRC. For those not screened, barriers were reluctance to use stool-based method, time consuming, and not preferred annually. Therefore, Professor Azmawati suggested that future measures on sample collection for testing of CRC should be reconsidered. The QR codes of the videos were provided in waiting room of the clinic so that patients can watch it while waiting for the doctors. In conclusion, Decision Aid Video on Colorectal Cancer Screening Uptake (DAVOCS^®) is an innovative method for promoting that incorporates E-media. The content is tailored to local community in Malaysia ensuring that findings of the evidence-based study can be applied to the Malaysian population. Future direction includes scaling up of the utilization of the video by stakeholders and the addition of language options including Chinese and Indian and strengthening the evidence by conducting a randomized control trial (RCT). Participants actively engaged in discussion regarding family supports, cultural variations, adoption of healthy habits and the cost-effectiveness of CRC screening.

Closing session

Chairperson Mr. Mitsukazu Koshiba concluded the 20^th DIHAC meeting, emphasized the potential improvements in bio-psycho-social health through social interventions and their impact on users’ cognition. The Chairperson highlighted the Decision Aid Video on Colorectal Cancer Screening Uptake (DAVOCS^®), which aims to enhance users’ understanding of screening options. This video has the potential to significantly influence informed decision-making and reduce cognitive stress associated with colorectal cancer choices.  Since digital technologies and ageing populations, both of which are predicted to bring about important socio-economic changes worldwide, cricket activity by Cricketqube is a community based social innovations (CBSI) towards healthy ageing, maintaining physical activity among older adults and AgeWise app create an “ageing in place” environment, linking pre-existing social prescribing services. Meanwhile, innovations in healthcare sectors via disease prevention approach utilizing the E-media brings awareness in early detection and diagnosis of cancers which in turn lengthens the healthy life expectancy of people. This is essential to fulfill our aim towards healthy ageing, as we strive to meet our goals in the 2030 Agenda for Sustainable Development (SDGs) in the decade of Healthy ageing (2020-2030). The two presentations bridge the Policy-Implementation Gap in macro and meso-levels and Intension-Behavior Gap in micro-level toward the goal of “leave no one behind” (10). Professor Myo announced the upcoming 21st DIHAC meeting, scheduled for February 2024, and extended warm wishes for a happy new year to all participants.

References

1. Statistics UGOfN. Population and household estimates, England and Wales: Census 2021 2022 [Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/populationandhouseholdestimatesenglandandwales/census2021unroundeddata.
2. UK NHSN. Personalised care [Available from: https://www.england.nhs.uk/personalisedcare/#:~:text=Personalised%20Care%20will%20benefit%20up,other%20aspect%20of%20their%20life.
3. Cancer WHOIAfRo. Estimated age-standardized mortality rates (World) in 2020, World, both sexes, all ages (excl. NMSC). 2020.
4. Malaysia MoH. National cancer registry report: Malaysia cancer statistics-data and figure 2007- 2011 [Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.crc.gov.my/wp-content/uploads/documents/report/MNCRRrepor2007-2011.pdf.
5. Ramli NSM, M.R.A.; Hassan, M.R.; Ismail, M.I.; Nawi, A.M. Effectiveness of Colorectal Cancer Screening Promotion Using E-Media Decision Aids: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2021;2021, 18, 8190.
6. (ITU) ITU. Ageing in a digital world – from vulnerable to valuable 2021 [Available from: https://www.itu.int/hub/publication/d-phcb-dig_age-2021/.

Authors

Thet Htoo Pan, M.D., is Ph.D. student at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan

Mr. Alosh K Jose, B.A., M.A., M.Sc., is Co-founder and CEO at Cricketqube, UK

Dr. Azmawati Mohammed Nawi. M.D., Ph.D., is Associate Professor, Public Health Specialist and Medical Lecturer in Department of Public Health Medicine, Faculty of Medicine Universiti Kebangsaan Malaysia (UKM)

Myat Yanada Kyaw, M.D., is  Ph.D. student at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan.

Nadila Mulati, M.Sc., is  Ph.D. student at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan.

Myo Nyein Aung, M.D., M.Sc., Ph.D. is Associate Professor at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan

Michikazu Koshiba, B.S., M.A.  is Head of  Center on Global Health Architecture, MITSUBISHI UFJ Research & Consulting.