A digital intervention to improve skin self-examination among melanoma survivors

ABSTRACT With incidence rates more than tripling in the last 45 years, the population of melanoma survivors in the US is estimated at more than a million persons. Survivors are at elevated risk for recurrence and new primary cancers. Most recurrent melanomas are found by survivors themselves, which is why physicians educate survivors about the importance of regular, thorough skin self-exams (SSE) and why professional guidelines for follow-up surveillance recommend regular, thorough (SSE). More than two thirds of melanoma survivors do not perform regular, thorough SSE. To address this significant problem, our experienced team developed a digital intervention, called mySmartSkin (MSS), and tested it in an RCT against usual care in New Jersey. MSS illustrated promising effects on thorough SSE. In this application, we propose to prepare MSS for large-scale dissemination using an innovative Type 1 hybrid effectiveness-implementation trial. A Type 1 hybrid effectiveness-implementation design allows us to engage multilevel stakeholders throughout the research process, evaluate the effectiveness of the enhanced MSS, and identify critical factors for wide-scale implementation. The study’s three aims are guided by implementation frameworks and behavior change theories. In Aim 1, we will enhance MSS using multi-level stakeholder engagement by collaborating with key stakeholders in enhancing MSS through qualitative interviews and usability testing of potential enhancements. Potential enhancements are based on empirically-validated behavior change techniques (BCTs) and findings from our prior study. We will utilize an iterative process that includes key informant interviews with survivors, providers, and relevant professional organizations regarding proposed enhancements, conversion to an enhanced mobile-based intervention delivery platform, usability testing with survivors, and iterative program refinements. Aim 2 compares the effects of enhanced MSS vs. a non-interactive educational webpage on comprehensive SSE in an RCT with survivors recruited through two state cancer registries and social media (N=300). In Aim 3, we identify factors relevant to future scale-up for widespread dissemination and implementation using mixed methods to assess selected implementation outcomes from the RCT and explore perspectives from survivors, care providers, and professional organizations about how to best disseminate and implement MSS on a broad scale. We will estimate program costs and assess cost-effectiveness of MSS. This project addresses a documented gap in care for melanoma survivors by enhancing effects of a promising survivor-facing intervention and proactively identifying barriers and facilitators to future implementation. We innovatively “design for dissemination” by ensuring that enhancements are designed with the target population of potential users. Serving as a model for optimizing promising fully-automated online interventions for cancer survivors for dissemination, this project will provide important information about potentially cost-effective ways to reach survivors as well as about how to adapt such an intervention for dissemination.