An online survey capturing the views of stakeholders on primary school food systems across the four UK nations

BACKGROUND

In 2020, the Generating Excellent Nutrition in UK Schools (GENIUS) Network was established to develop an understanding of the school food system across the four UK nations. This study explores stakeholders' views (headteachers, teachers, parents and pupils) on what works well, the challenges, and what an ideal primary school food system includes.

METHODS

An online 'School Food Survey' was created in Qualtrics XM including closed and open-ended questions about the primary school food system. The Qualtrics link was distributed to stakeholders with an interest in school food through key contacts and networks across the four UK nations (21st June to 21st July and September 2021). Responses from the open-ended questions were exported from Qualtrics into Excel and analysed using SPSS. Aspects of qualitative content analysis were applied to summarise, code and quantify responses. Identified codes were entered by stakeholder, for example, parents and their response to the question into a Matrix table to allow identification of categories, themes and interpretation.

RESULTS

A total of 509 participants completed the survey: most participants were from Scotland (n = 281; 55%) and England (n = 213; 42%) and were parents (n = 394). There were some consistent views across stakeholder responses, for example, the range of healthy options, costs, and portion sizes offered to pupils. Parents views varied, with some expressing the range of healthy options worked well and others reporting too many unhealthy choices. The cost of school food and school food funding presented challenges for both parents and schools. For parents, an ideal school food system would include a wide variety of fresh healthy food choices that were made on site, use quality produce, be inclusive for all cultures and diets, and provide food portion sizes appropriate for pupils ages.

CONCLUSIONS

The findings iterate the diversity and some inconsistencies between stakeholders, emphasising the complexity and competing tensions school food systems encounter. Parental involvement and consideration of school-level and national factors are important when identifying challenges, what works well and describing an ideal primary school food system.

Testing the validity of a new scale designed to assess beliefs and perceptions about colorectal cancer and colorectal cancer screening in Malaysia: a principal component analysis

OBJECTIVE

To conduct a cultural adaptation and validation of the Champion Health Belief Model Scale (CHBMS) for colorectal cancer (CRC) screening (CHBMS-CRC-M) in order to assess and investigate perceptions and beliefs about CRC screening in Malaysia.

DESIGNS AND PARTICIPANTS

The results from an evidence synthesis and the outcomes from an expert panel discussion were used to shape CHBMS scale content into an assessment of beliefs about CRC screening (CHBMS-CRC). This questionnaire assessment was translated into the official language of Malaysia. An initial study tested the face validity of the new scale or questionnaire with 30 men and women from various ethnic groups. Factorial or structural validity was investigated in a community sample of 954 multiethnic Malaysians.

SETTING

Selangor state, Malaysia.

RESULTS

The new scale was culturally acceptable to the three main ethnic groups in Malaysia and achieved good face validity. Cronbach's alpha coefficients ranged from 0.66 to 0.93, indicating moderate to good internal consistency. Items relating to perceived susceptibility to CRC 'loaded' on Factor 1 (with loadings scoring above 0.90); perceived benefits of CRC screening items loaded on factor 2 and were correlated strongly (loadings ranged between 0.63 and 0.83) and perceived barriers (PBA) to CRC screening (PBA) items loaded on factor 3 (range 0.30-0.72).

CONCLUSION

The newly developed CHBMS-CRC-M fills an important gap by providing a robust scale with which to investigate and assess CRC screening beliefs and contribute to efforts to enhance CRC screening uptake and early detection of CRC in Malaysia and in other Malay-speaking communities in the region.

Budget impact analysis of a home-based colorectal cancer screening programme in Malaysia

OBJECTIVES

The 2020-2022 research project 'Colorectal Cancer Screening Intervention for Malaysia' (CRC-SIM) evaluated the implementation of a home-based CRC screening pilot in Segamat District. This budget impact analysis (BIA) assessed the expected changes in health expenditure of the Malaysian Ministry of Health budget in the scenario where the pilot programme was implemented nationwide vs current opportunistic screening.

DESIGN

Budget impact analysis. Assumptions and costs in the opportunistic and novel CRC screening scenarios were derived from a previous evaluation of opportunistic CRC screening in community health clinics across Malaysia and the CRC-SIM research project, respectively.

SETTING

National level (with supplement analysis for district level). The BIA was conducted from the viewpoint of the federal government and estimated the annual financial impact over a period of 5 years.

RESULTS

The total annual cost of the current practice of opportunistic screening was RM1 584 321 (~I$1 099 460) of which 80% (RM1 274 690 or ~I$884 587) was expended on the provision of opportunistic CRC to adults who availed of the service. Regarding the implementation of national CRC screening programme, the net budget impact in the first year was estimated to be RM107 631 959 (~I$74 692 546) and to reach RM148 485 812 (~I$103 043 589) in the fifth year based on an assumed increased uptake of 5% annually. The costs were calculated to be sensitive to the probability of adults who were contactable, eligible and agreeable to participating in the programme.

CONCLUSIONS

Results from the BIA provided direct and explicit estimates of the budget changes to when implementing a population-based national CRC screening programme to aid decision making by health services planners and commissioners in Malaysia about whether such programme is affordable within given their budget constraint. The study also illustrates the use and value of the BIA approach in low-income and middle-income countries and resource-constrained settings.

Breast Cancer Screening in Malaysia: A Policy Review

Background:

Breast cancer is the leading cause of cancer among Malaysian women. The implementation of prevention measures including screening has the potential to reduce the burden of breast cancer which caused by late presentation.

Aims:

This paper aimed to review the public health policy relating to breast cancer screening in Malaysia that was undertaken in order to contribute to policy development regarding cancer prevention, detection and the improvement of services for Malaysian women.

Methods:

The policy review strategy included a specific search of the website of the Ministry of Health in Malaysia for relevant policies. In addition, we searched Google and Pubmed for breast cancer screening programmes, policies, and guidelines for women in Malaysia. In addition, experts and stakeholders provided additional resources, published in Malay language. Relevant guidelines in the Malay language were translated into English and included the document review.

Results:

The policy analysis indicated that although it is known that screening, early detection and diagnosis improve survival rates, delayed diagnosis remains a significant issue. The Ministry of Health policy stipulates the provision of opportunistic mammography screening. However, the uptake is varied, and implementation is challenging due to a lack of awareness about screening and difficulties related to accessing services, especially in rural areas. The establishment and implementation of referral guidelines is essential to receive timely treatment for breast cancer patients. There is a need to enhance the cancer reporting by the doctors to the national cancer registry, in collaboration with government services and the private cancer-care sector to improve the monitoring and evaluation of cancer control policies and programmes.

Conclusion:

A focus on raising awareness, increasing the accessibility of screening facilities and improving referral processes and the overall connectivity of the cancer care system are key steps to down-staging breast cancer in Malaysia.

Translation and Validation of the Breast Cancer Awareness Measurement Tool in Malaysia (B-CAM-M)

BACKGROUND

Breast cancer is the most common cancer among women in Malaysia, and the incidence of 31.1 per 100,000 population is comparatively higher than other Southeast Asian countries. Diagnosis tends to occur at later stages which may be due, partly, to inadequate knowledge about warning signs and symptoms. Therefore, this study investigated the validity and reliability of a UK-developed measure in the context of assessing women's awareness of breast cancer in Malaysia.

AIMS

This study aimed to translate, adapt and validate the internationally recognised Breast Cancer Awareness Measure (B-CAM) into the Malay language.

METHODS

The original B-CAM (Cancer Research UK) was forward and backward translated and content validation was ascertained. Face validity (n=30), test-retest reliability (n=50) and the internal consistency of the B-CAM-M (M for Malay language) were assessed in a community sample of adults (n=251) in 2018.

RESULTS

The translated B-CAM-M was validated by an expert panel. The Item-Content Validity Index ranged from .83 to 1.00. The results from the survey (n=251) indicated that the B-CAM-M was well received by Malay-speaking women across the main ethnic groups (85 Malay, 84 Chinese and 82 Indian adults). Cronbach alpha scores for the knowledge about breast cancer symptoms (0.83) and the barriers to healthcare seeking items (0.75) were high. Test-retest reliability (separated by 2-week-interval) with 50 randomly selected participants from the community survey produced intra-class correlations ranging from 0.39 to 0.69.

CONCLUSION

The Malay-version, the B-CAM-M, is a culturally acceptable, valid and reliable assessment tool with which to measure breast cancer awareness among Malay-speaking women.

Public Engagement With and Recognition of the “Be Cancer Alert Campaign” - Colorectal Cancer Awareness

Background: Colorectal cancer is the most common cancers in males in Malaysia and the second most common cancer in females. Low awareness of cancer delays help-seeking and contributes to late presentation, poor detection and survival. We developed a culturally sensitive mass media campaign to increase awareness about the signs and symptoms of colorectal cancer among Malaysians, which was informed by previously successful campaigns in Northern Ireland. Aim: The aim of this study is to analyze the public engagement with the campaign on social media and to identify whether the public recognizes the campaign materials postintervention. Methods: Focus group discussions informed the cultural adaptation of the Be Cancer Alert Campaign - Colorectal Cancer (BCAC-CRC). Based on the focus discussions we developed a TV commercial and radio advertisement as well as a print advertisement campaign. In addition, we promoted the BCAC through a Web site and social media campaign. The BCAC-CRC will run from the 2nd of April for five weeks. The engagement with the Web site and the social media campaign will be analyzed on a daily basis to respond to public engagement immediately. A population-based survey postintervention including a randomly selected sample of approximately 700 participants will evaluate whether people recall the campaign key messages and have noticed the campaign materials. Results: Postintervention data collection will take place from May-July 2018. The results of the analysis will be presented at the conference. Conclusion: To our knowledge, the BCAC-CRC is the first colorectal cancer awareness campaign in Malaysia that will be evaluated for its public engagement on social media as well as public recognition of the TV, radio and print materials.

Effectiveness of Mass and Small Media Campaigns to Improve Cancer Awareness and Screening Rates in Asia: A Systematic Review

Background: Cancer presents an increasing burden for Asian countries and cancer-related deaths have been predicted to increase from 4.1 million in 2008 to 7.5 million in 2030 in Asia. Low-middle income countries are recommended to prioritize public education as a first step toward cancer prevention and early detection. Mass media campaigns have been found to be effective in increasing cancer awareness and screening uptake in western countries as well as cost-effective in reducing morbidity and mortality. A number of studies have used mass and or small media components in Asian countries. Aim: This systematic review aims to deliver an overview of small and mass media campaigns in Asia and to assess their effectiveness in improving cancer awareness. Methods: We searched MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, Scopus, Cochrane Library, Gray literature and Google Scholar for relevant literature. Furthermore, we hand-search reference lists of relevant reviews and studies and run a search in relevant journals individually. Peer-reviewed studies that were published in the English language before September 2017 and targeted adults aged 18 year or over in Asia, were included. We excluded studies targeting minority populations living abroad as well as studies that included individual or group components in addition to the media components. Results: The search identified 10,676 titles after removal of duplicates. A total of 479 titles were included in the abstract screen and 51 articles were included in the full-text screen. The full-text screen is currently ongoing and the results will be presented at the conference. Conclusion: To our knowledge, this is the first systematic review summarizing the effectiveness of media campaigns to improve cancer awareness in Asia. The full results of the systematic review will be valuable to inform future mass and small media campaigns in Asian countries.

Colorectal Cancer Awareness and Beliefs in Malaysia: A Population-Based Survey

Background: Colorectal cancer (CRC) is the third most common cancer and the fourth major cause of cancer deaths globally; in Malaysia, CRC is the second most common cancer in both males and females. Low awareness of cancer delays help-seeking and contributes to late presentation, poor detection and survival. Aim: We aim to investigate the level of colorectal cancer awareness and beliefs among the Gombak district population of Malaysia as part of a larger study designed to evaluate a cancer awareness-raising campaign. Methods: A survey of colorectal cancer awareness was conducted in Rawang (Gombak district, Selangor) between January and March 2018. This district is representative of a mix of ethnicities, age groups, education levels and income groups. A total of 4000 households were selected randomly from a list of all households by the Government Department of Statistics Malaysia to attain a sample size of 730 adults as indicated by our power calculation and taking potential refusals into account. Trained enumerators randomly selected eligible adults aged over 40 years old from each household and conducted an interview that included sociodemographic information as well as the Bowel Cancer Awareness Measure (CAM), the Attitudes and Beliefs about Cancer questionnaire (ABC) and the Champion Health Belief Model Scale (CHBMS) which were validated in Malaysia. Results: Data collection for this part of the larger study was completed in March. Currently, we are cleaning and entering the survey data into a database in preparation for statistical analysis including χ2 tests of association and logistic regression. The results of the analysis will be presented at the conference. Conclusion: This analysis will provide the first profile of awareness and beliefs about colorectal cancer among the Gombak district population of Malaysia.

Do improvements in dietary behaviour contribute to cardiovascular risk factor reduction over and above cardio-protective medication in newly diagnosed diabetes patients?

BACKGROUND/OBJECTIVES

A healthy diet is an integral component of successful diabetes management. However, the comparative importance of adopting a healthy diet for cardiovascular risk factor reduction over and above medication use among newly diagnosed diabetes patients remains unclear.

SUBJECTS/METHODS

We computed a dietary score consistent with American Diabetes Association and Diabetes UK recommendations in 574 newly diagnosed diabetes patients by summing standardised values for the intake of total energy, saturated fat, sodium, fibre and plasma vitamin C. In linear regression analyses, stratified by cardio-protective medication use (yes/no), we quantified the comparative longitudinal associations of baseline diet and change in diet over 1 year with change in blood pressure, HbA1c and lipids.

RESULTS

Baseline diet was generally not predictive of change in cardiovascular risk factor levels at 1 year. In contrast, dietary change over 1 year among patients prescribed and not prescribed cardio-protective medication after baseline was associated with comparative (p-interaction all ⩾0.95) reductions in diastolic blood pressure (-2.38 vs -2.93 mm Hg, respectively) and triglycerides (-0.31 vs -0.21 mmol/l, respectively), independent of potential confounding factors and change from baseline to follow-up in physical activity and smoking status.

CONCLUSIONS

Modest dietary change over the first year following diagnosis of diabetes was associated with reductions in blood pressure and triglycerides, over and above the effects of cardio-protective medication. Our findings support the notion that dietary change should be viewed as an integral component of successful diabetes self-management, irrespective of medication use.