Abstract 4900: Barriers and facilitators influencing the implementation of a mHealth (MeMoSA) oral cancer screening program in rural communities in a low- and middle-income country: Preliminary findings of a qualitative study
Authors: Senthilmani Rajendran, Nur Dinie Junaidi, Davinna Satguna Rajah, Aliya Nabil, Nurshaline Kipli, Thaddius H. Maling, Roslina Mah, Ignatius Niap, Shirley Hui Hui Hu, Suzanne Scott, Rafdzah Ahmad Zaki, Sok Ching Cheong
Journal: Cancer Research (2025)

Abstract Introduction: Sixty-five percent of oral cancer cases in Malaysia are detected at late stages due to poor awareness and difficulties in accessing healthcare in remote communities. The early detection of oral cancer (OC) could be overcome through teleconsultation using mHealth applications that enable remote review of clinical data and oral lesion images. We determined the feasibility of healthcare volunteers (HCVs) using a mHealth application MeMoSA for oral cancer screening in rural communities in Malaysia by identifying the barriers and facilitators of implementation. Methods: This qualitative study was part of a larger mixed-methods single-arm feasibility study. HCVs were trained to capture oral images of villagers using MeMoSA. Dentists at the nearest public clinic reviewed images remotely to give a referral decision. Suspicious high-risk oral lesions were also reviewed by specialists via MeMoSA and where warranted, make a referral directly to the nearest tertiary center for biopsy. To identify implementation barriers and facilitators, in-depth interviews were conducted with HCVs in the Malay language, which were recorded and then transcribed and translated verbatim into English. The Consolidated Framework for Implementation Research (CFIR), was used to guide interviews, coding and data analysis. Results: Forty-seven HCVs screened 1865 individuals in 12 rural villages with 93% uptake. Thirty-one HCVs were interviewed. Main themes related to the innovation and implementation process domains of CFIR. Barriers encountered by the HCVs included limited telecommunications infrastructure for internet access and community perceptions. For instance, the community's poor oral symptom knowledge, fear of knowing and lack of motivation to engage in preventive behaviors that influenced uptake of screening and adherence to follow-up appointments. HCVs overcame issues with internet access by traveling to areas with an internet connection to transmit information for teleconsultation. Facilitators included the avoidance of travelling long distances and incurring high transportation costs to be checked at the clinic, and the simplicity and user-friendly design of MeMoSA which motivated HCVs to conduct screening. In addition, HCVs’ relationship and trust towards village leaders was a major facilitator for a well-planned implementation. Conclusion: This novel approach to oral cancer screening has good reach, with motivated HCVs and could be feasible in low- and middle-income countries. However, strategies to improve barriers such as adherence to follow-up appointments are required and facilitators should be leveraged for sustained implementation. Citation Format: Senthilmani Rajendran, Nur Dinie Junaidi, Davinna Satguna Rajah, Aliya Nabil, Nurshaline Kipli, Thaddius H. Maling, Roslina Mah, Ignatius Niap, Shirley Hui Hui Hu, Suzanne Scott, Rafdzah Ahmad Zaki, Sok Ching Cheong. Barriers and facilitators influencing the implementation of a mHealth (MeMoSA) oral cancer screening program in rural communities in a low- and middle-income country: Preliminary findings of a qualitative study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4900.