Healthcare apps have the potential to mitigate the rising tide of non-communicable diseases (NCDs) in Malaysia by improving access to knowledge and incentivising behavioural changes, says an expert.

According to Dr Feisul Idzwan Mustapha, consultant public health physician and deputy director of the Ministry of Health’s Disease Control Division (Non-Communicable Diseases), such apps could be part of a supportive living environment that empowers individuals to make intuitive and informed healthy lifestyle choices.

“Behavioural issues are a major challenge when it comes to NCDs, and it is behavioural issues which I would like to see solutions developed for when it comes to digital health,” said Feisul. “Unhealthy diets, physical inactivity, tobacco and alcohol use are all common risk factors in the causation pathway of NCDs.”

Speaking at the recent Malaysian Innovative Healthcare Symposium (MIHS 2018), Feisul highlighted apps such as Naluri and BookDoc which provided direct access to self-help modules, health coaching and cognitive behavioural therapy approaches to behavioural modification.

However, Feisul commented that it was important that such digital solutions not only consider the social determinants—eg, poverty, housing, nutrition, lack of education, environmental hazards—that made healthy choices difficult for Malaysians, but also worked on helping users prioritize health.

“A unique thing about us Malaysians is that we rate health very low versus other life priorities. As an example: when the Social Security Organization (SOCSO) provided free health screening vouchers to contributors about 3 years ago, only 20% of them took it up,” said Feisul. “At medical camps or health screenings, those people who get their own blood sugar checked tend to either be those of lower risk—the healthy—or those who already are diabetic patients. Those at high risk tend not to get themselves screened.”

The health literacy gap

At the same event, Feisul highlighted concerning findings from the National Health and Morbidity Survey 2015 (NHMS 2015), which found that only 6.6% (95% confidence interval, CI: 5.6%–7.7%) of Malaysian adults above 18 years old could be considered health literate. This indicated that a significant part of the population may not have the sufficient knowledge or awareness to adequately manage their own health, he said.

Health literacy is defined by the WHO as the possession of cognitive and social skills which motivate and enable individuals to gain access to, understand and use information in ways which promote and maintain good health. Health literacy impacts individuals’ ability to engage in self-care and manage chronic disease, as well as understand mathematical concepts such as probability and risk.

While the NHMS 2015 data indicated some variations in health literacy between different socioeconomic demographics such as urban [7.8%, 95% CI: 6.6%–9.3%] and rural populations [2.3%, 95%CI: 1.7%–3.1%], Feisul noted that education and wealth were not necessarily strong determinants, as the prevalence of health literacy even among those in the highest income brackets and those with tertiary education was less than 12%.

As part of the government’s Digital Health Innovation Roadmap, Feisul encouraged all parties with innovative digital solutions for addressing healthcare gaps to approach the MOH for potential partnerships, so long as those solutions had the potential to empower individuals and communities.