This study consisted of three phases: 1) Selection of subtopic and content refinement, 2) Development of audio-visual educational materials, 3) Evaluation by health professionals and caregivers of pediatric cancer patients for acceptability and relevance. This study was conducted fully online from December 2020 until June 2021 during Movement Control Order in Malaysia due to the Covid-19 pandemic. Ethical approval for this study was obtained from the University’s Research Committee (reference: UKM PPI/111/8/JEP-2021-266). All participants provided written informed consent prior to the start of the study.
Phase 1: Selection of subtopic and refinement of content
The development of the audio-visual educational materials in this study was based on the printed educational materials previously developed by Chung et. al (2020) entitled “Oncology Pediatric: Nutritional Management for Caregivers”. The 60 pages booklet consists of 7 topics: 1) What is cancer and its treatment, 2) Management of cancer treatment side effects, 3) Managing food-nutrition in children with cancer, 4) Recipe ideas for children during pain, 5) Can children with cancer enjoy outside foods, 6) Food and nutrition-related issues among children with cancer, and 7) Let’s play fun activities. The process of subtopic selection and refinement of content involved 5 expert panels (consisting of 2 oncology pediatric specialists, 2 oncology pediatric dietitians, and 1 academic dietitian), and 5 caregivers of pediatric cancer patients. Meetings with expert panels were held three times through an online meeting platform (Google Meet), with each session lasting approximately 1-2 hours discussing the relevance of the content, and suitability of the content, graphics, and specific terms. The process also consists of panels exchanging information based on the present situation of children with cancer. Additionally, feedback and comments were also obtained from caregivers of pediatric cancer patients through drop comments on Google Drive for video improvements.
Phase 2: Development of audio-visual educational materials
Following expert panel consultation, four topics were chosen to be adopted into a series of 5 videos with the following titles: 1) Introduction to cancer and its treatment, 2) The side effects of cancer treatment and how to manage them. 3) Nutrition management in children with cancer, and 4) You ask, we answer. The videos were developed in the Malay language, and each video ranged between 3 and 8 minutes. All of the videos were created using free graphic design and video editing applications available online utilizing Canva (Canva Pty. Ltd) and Inshot (Inshot Inc.) respectively. Basic terminology and language were used in the videos, as well as appealing and colourful graphics, pictures with subtitles, clear voice recording, and culturally relevant examples.
Phase 3: Evaluation by healthcare professionals and caregivers of paediatric cancer patients
Ten healthcare professionals consisting of 5 medical doctors and 5 dietitians from medical universities and hospitals in Malaysia who are citizens with a minimum of 5 years working experience in the field of medicine and/or nutrition and dietetics were invited to participate in this study. The number of experts evaluating the videos in this study exceeds the recommended number of at least five expert panels suggested by previous studies . Additionally, 5 caregivers aged 18 years old and above who are Malaysian citizens and members of the paediatric cancer support group of the university’s hospital were also invited to evaluate the videos. To be eligible to participate in this study, caregivers must also be able to speak and read in the Malay language. These 10 healthcare professionals and 5 caregivers were not involved in the phase I of this study.
The evaluation process was conducted online via emails and WhatsApp where the participants were provided with a link to access a Google Drive folder that contained: i) 5 series of educational videos that need to be evaluated, and ii) google forms of PEMAT-AV (M). An individual evaluation form was provided for each video. This study uses PEMAT-AV (M), the Malay version of the Audio-Visual Patient Educational Material Assessment that has been translated into Bahasa Malaysia by Wong et al. (2018)  based on the original English version as an evaluation tool . It comprises 13 statements for understandability and 3 for actionability, and each item on PEMAT scored as either 1 (agree) or 0 (disagree). The total score for understandability and actionability was computed and reported as a percentage. A higher understandability and actionability score imply that the education material is easy to understand and apply. A comment section is also provided to highlight any future improvements that could be made.