BEAUTY and Health Project in Malaysia

KAWAHARA Norie introduced noted that in addition to serving as coordinator for the Surviving Cancer in Asia lecture series, she is also a co-researcher on the Bringing Education And Understanding To You (BEAUTY) and Health project, on behalf of the Asia Cancer Forum. The BEAUTY and Health Project is supported by Astellas Pharma and was born out of the excellent ties between Malaysia and Japan. 

Dr. Kawahara noted that MURALLITHARAN Munisamy from the National Cancer Society of Malaysia (NCSM), would be introducing the project, which aims to revolutionize how cancer prevention and awareness are approached at the community level. The project’s challenge lies in providing diverse channels for community participation, ranging from gaining knowledge to moving towards practical action. 

Dr. Kawahara noted that the lecture would be an excellent opportunity to consider how this innovative approach can bring about real change in community health behaviors. The BEAUTY and Health Project not only educates but also guides people towards health actions, which is the ultimate goal.

Dr. Kawahara noted that Dr. Murallitharan would be talking about the BEAUTY project and its integration with the National Cancer Screening Registry.

Dr. Murallitharan stated that he would talk about one component of the BEAUTY program, which is how to actualize the two different platforms pertaining to BEAUTY, which is the BEAUTY website by itself, as well as the National Cancer Screening Registry platform. There are two distinct websites, which will now start to be linked, but will perform different actions.

  In terms of actualizing beauty from a community perspective, BEAUTY is a community level program, and the community needs to have different channels in which to approach the project. Certain people could be coming into this program with the idea of getting more knowledge, but it is important to have a stepping point for them to be able to proceed further and go into practice and actualize some kind of behavior, such as going for cancer screening. 

  The anticipated endpoint of the BEAUTY Project is to encourage people to go and engage in more preventive health actions. What is interesting about BEAUTY is that there are two main entry points, depending on where your position is currently, and what kind of health knowledge you possess and health behavior you are undertaking. 

Some people could be coming from a very low level of knowledge, whereas others are already conversant with the problems pertaining to their own health, preventive health as a whole, as well as cancer. This is why it is helpful for the general user to have two different entry points. 

The first entry point into the program is the BEAUTY website, which is purposed as a library and a repository for information, and also as a means of setting out the goals and contents of the project. Users will be lead to this site via various ads on trains and other public transportation and also various other means. The BEAUTY website provides various kinds of information in multiple languages, aimed at enhancing the knowledge level of people who access the site. 

The BEAUTY website is going to be a flow-through place where people have already been exposed through various channels. The users will come to the website to gain a sense of where to take their journey of actioning their own health. It is then hoped that after accessing the BEAUTY website, users will then be motivated to use the second entry point, which is the National Cancer Screening Registry (NCSR). 

The NCSR is a separate entity. On the BEAUTY website people can gain information about how to access the NCSR and take further health-related actions, including screening, etc.

When users access the NCSR the second step will be to ensure that they actually take action or are motivated to take action. The NCSR provides screening tools for users and the possibility to insert their own information and data in order to gain further information. The NCSR also provides times and dates of screening information, providing users with vital information about the screening opportunities in their region. 

  People who access the BEAUTY website will therefore be able to improve their knowledge, and will also be provided with the additional means of taking the next step on the NCSR. 

  There are also theoretical components to the contents of the website and portal. There are three theoretical elements, namely knowledge, attitude, and practice. The BEAUTY website actions knowledge and attitude, with attitude being affected through the emotional reach of the different videos provided on the website. The knowledge element is provided through the materials that are being developed by the NCSM.

Once people have the knowledge and the attitude, they may then move to practice. Practice means doing something relating to their own health. The two portals offer a broad platform catering to many people of different levels of knowledge, attitude and practice, which all come together.

There may be different ways in which people approach the website. Some people could have knowledge, but not have the attitude. Attitude could be driven by the emotional approach of the videos. Another permutation that is possible is for the people accessing the site to have the right attitude already, but not be equipped with the knowledge that they need. Once again, the videos and other materials on the website will help improve their knowledge.

These elements of knowledge, attitude and practice being provided in a continuum is something that is very unique in the sense that it provides the opportunity to operationalize the system in health-related aspects.

Figure 1: Elements of the BEAUTY website and National Cancer Screening Registry

Dr. Kawahara noted that Jessica CANUTE would provide a run through of registering an account on the NCSR system. The system is straightforward and user-friendly, and once registered users can discover the various basic functions this innovative system offers.

One of the key features is how the screening schedule information is seamlessly integrated with a calendar. This integration makes it extremely convenient for users to keep track of their screening appointments. The interface also changes according to the gender of the user. This personalized approach ensures that the information and recommendations are as relevant and helpful as possible.

Dr. Kawahara noted that the video will also provide a walkthrough of how to use the system for each major type of cancer. This comprehensive coverage ensures that whether the user is a medical professional, a student, or just someone interested in learning more about cancer screening, they will find the information they need. The video is a valuable resource for anyone interested in the intersection of technology and healthcare.

Dr. Canute introduced the process of registering a personal account on the NCSR, which is simple to do as long as the user has an e-mail address. Once registered and logged in the user arrives at the dashboard page, which features the health calendar, which serves to remind users of upcoming screenings and assessments. 

The dashboard also includes various reminders, as well some measurements and results, including BMI, waist circumference, cancer risk assessment and the health literacy survey. It also includes HPV vaccination status for females. 

If logged in as a female, information about breast and cervical cancer will appear, and if logged in as a male, information about prostate cancer appears instead. 

  On the site it is possible to input information about cancer screenings and examinations that the user has already completed. There are various questions to answer and are quite detailed in some cases (including for breast cancer). It is not mandatory to answer all questions, but it is mandatory to upload the results of any previous clinical breast examination. 

  The NCSR also features a self-assessment survey. It includes four assessments, including family history, health literacy survey, cancer risk assessment and beliefs on what causes cancer. 

In the case of the cancer risk assessment survey, various questions are asked about height, weight, lifestyle and diet, etc., as well as the results of general health screening, with a score appearing at the end of the survey.

On the page for general health screening users can input results from their tests, including full blood count, lipid profile, renal or kidney function, liver function, urine test, and tumor marker test. For certain assessments, the frequency is on a monthly basis, whereas for other assessments, it could be on an annual or three yearly basis. 

Also on the site is information about how to do breast self-examination, including a variety of questions, including explanations of word that might be confusing for the general population.

Another tool available on the site is for risk assessment. In the case of breast cancer risk assessment, the tool is based on the Gail Model. The assessment opens in a new tab and users have to fill in all the required items before receiving their risk assessment.

In terms of the clinical assessment, the examiner may write notes in this section and indicate what the findings of the examination are, for a variety of assessments, including clinical breast examination, iBREAST, clinical ultrasound and mammogram. 

The site can be used to input information for various cancers. In the case of cervical cancer, in the same way as for breast cancer there is a set of questions for symptom assessment and the clinical assessment includes PAP smear and HPV DNA. Under the cervical cancer section, there is also a special section called HPV vaccination.

There are similar sections for colorectal cancer, lung cancer, and prostate cancer, divided into self-assessment and clinical assessment. In the case of colorectal cancer the Asia Pacific Colorectal Screening (APCS) score is shown. Clinical assessment involves colonoscopy and iFOBT (fecal occult blood test).

In the case of lung cancer, the lung cancer screening assessment includes 13 questions. Clinical assessment involves low-dose CT scan and what is referred to as a “smokerlyzer,” a hand-held carbon monoxide monitor to measure the level of carbon monoxide in the body.

For male users, there is also a section on prostate cancer, which is similarly divided into self-assessment and clinical assessment, and symptom assessment includes the IPSS, or International Prostate Symptom Score. Clinical assessments include the PSA (prostate specific antigen) score and the DRE (digital rectal examination).

The NCSR also includes health tools, including family history. The questionnaire that features on this part of the site is taken from ASCO (American Society of Clinical Oncology). The family history section applies to biological family only.

The next section of the website is the Health Literacy Survey that includes three domains. Once the user has completed the Health Literacy Survey, a score will be given, indicating the user’s level of health literacy.

The cancer risk assessment score is also shown after the user has completed all questions. There is also a link to a website which has a digital library consisting of booklets and videos that can help improve the user’s health literacy and to find out more on how to decrease risk of cancer.

The final assessment under health tools is called “Beliefs on what causes cancer.” Certain questions are auto-filled based on the information in the profile. This is also a section about cancer knowledge. The causes of cancer are broken down into food related, health related and lifestyle practices, environmental exposure and personal practices. 

Dr. Kawahara thanked Dr. Canute for her introduction to the NCSR website for personal accounts. She asked Dr. Canute to next provide an introduction to management accounts, which, while bearing a resemblance in design to the personal account, serve a distinct and crucial purpose. They are crafted with specialized management purpose in mind within the healthcare setting, incorporating more detailed patient management tools and more advanced schedule capabilities. These accounts are designed to streamline the workflow of healthcare professionals, enabling them to provide the best possible care.

Dr. Canute introduced the process of registering a healthcare professional account on the NCSR website. The registration process is basically the same as for personal accounts, requiring only a valid e-mail address.

  The dashboard looks somewhat different compared to the personal account dashboard. The dashboard shows how many screenings the healthcare professional has implemented, and how many assessments have been performed. The number of screenings can also be displayed in graph form. Healthcare professionals also have access to the accounts of the individuals who have registered a personal account.

  On the healthcare professional account it is possible for the healthcare professional who is logged on to add an individual to their list of registered individuals, providing that the individual has an IC number. Once the individual account has been added to the healthcare professional’s account, it is possible to review all the individual’s information and input data where necessary. The steps for inputting data remain basically the same. There are also boxes where healthcare professionals can add their own comments. Under the “reports” tab there are a number of reporting systems available, including the most commonly screened cancers and the frequency of screenings. Reports on individual cancers can be exported as an Excel file. 

The following was provided as the topic for short report: The BEAUTY and Health Project in Malaysia is developing the portal website and cancer screening registry system for making cancer screenings easily accessible to everyone. Describe your assessment with reasons concisely.