Developing and testing a mobile health intervention to promote sun protection behaviors and skin examination among Hispanics

ABSTRACT Skin cancer is the most common cancer in the United States (US). Melanoma is the deadliest form of skin cancer. In the past two decades, melanoma incidence among Hispanics has risen by 20%. The mortality rate of Hispanics is higher compared to Non-Hispanic whites (NHW). In general, compared to NHW, Hispanics diagnosed with melanoma are younger, have thicker tumors, and have worse survival rates. Skin cancer can be prevented with regular sun protection, and early detection can improve skin cancer outcomes. The Hispanic population is the fastest growing ethnic group in the US. Alarmingly, Hispanics are less aware of the symptoms and harms of skin cancers, tend to have misperceptions regarding the risks and benefits of skin cancer prevention behaviors, engage in less sun protection behaviors than NHW, and only 18% of them reported ever having done a skin self-examination. In addition, due to the increase of acculturation of Hispanics in the US, their sun-safety behaviors are poorer than non-US Hispanics. Occupational exposure to ultraviolet radiation (UVR) is a risk factor for skin cancer, and Hispanic individuals are over-represented in a number of outdoor occupations. Approximately 21% of the 2018 US Hispanic workforce were employed in industries that involved significant amounts of occupational UVR exposure such as construction. Therefore, an increasing effort to raise awareness regarding sun protection and skin self-examination behaviors is needed to address the existing gap of skin cancer research among Hispanics. This research project seeks to develop a mobile-based and user-centered intervention to promote sun protection and skin self-examination among a diverse sample of Hispanics using an iterative approach to capture relevant contextual issues and evaluate the preliminary effects of the intervention. During the K99 phase, I will: 1) collect, analyze, and triangulate data from the Hispanic community and other stakeholders (e.g., health care providers and community leaders) for skin cancer digital intervention development; and 2) through a user- centered approach, develop an innovative WhatsApp intervention to promote skin cancer-related health behaviors among Hispanics to improve participants’ engagement in the intervention. During the R00 phase, I will: 3) evaluate the feasibility and acceptability of this mobile intervention in a pre-, post-test study among Hispanics at risk for skin cancer; and 4) refine the intervention and conduct a pilot randomized controlled trial using this mobile service among Hispanics at risk for skin cancers and assess the preliminary effects of the mobile intervention at post-intervention and 6-month follow-up. The intervention has strong potential for cost- effective, widespread dissemination and targets an understudied group at-risk for future cancer development. The training experiences and mentoring obtained during this K99/R00 project are critical foundations for a successful independent cancer research career.