SESAME: Sun Exposure and Activities after Skin CAncer: Optimization of Mhealth IntErventions

ABSTRACT There are currently 1.36 million melanoma survivors in the US, and this number is expected to increase to 1.92 million by 2030. Most melanoma patients (92%) survive 5 or more years but face an increased risk of new primary melanoma. Although survivors are recommended to practice sun protection, sunburns remain common among this population. The few sun protection interventions that target at-risk adults have had weak or mixed effects on sun protection, despite often comprising multiple components. Mobile health (mHealth) approaches to reducing unprotected sun exposure, which are highly acceptable among melanoma survivors, hold potential for delivering actionable real-time information on sun protection and exposure but have not been designed to account for sun protection in real time, and little is known about which mHealth components optimize effects on unprotected sun exposure. Further, there is growing evidence to suggest moderate-to-vigorous physical activity (MVPA) decreases after melanoma diagnosis, potentially due to heightened concerns about spending time outdoors (thus, decreasing opportunities for outdoor MVPA). Therefore, it is essential that sun protective interventions do not unintentionally reduce MVPA, a health-enhancing behavior. However, few studies have explored these relationships. Guided by the Multiphase Optimization Strategy (MOST) framework, the purpose of this study is to refine and enhance our existing intervention tools in preparation for a fully-powered factorial experiment to determine what intervention components optimally reduce unprotected sun exposure, and determine their effects on MVPA. We build on technological and methodological foundations of our prior work, including an alignment algorithm that combines information from an ultraviolet radiation (UVR) sensor, actigraphy, and our validated end-of-day Minutes of Unprotected Sun Exposure (MUSE) self-report survey to determine time spent outdoors, MVPA, and protection-adjusted UVR dose. In Aim 1, through user-centered design, we will refine intervention tools, including a SESAME app that integrates a UVR sensor and simplified MUSE survey to quickly assess real-time sun protection. In Aim 2, we will test the feasibility and acceptability of promising intervention components and research trial procedures in preparation for a future clinical trial that uses a highly efficient experimental strategy powered to detect effects of individual components on unprotected sun exposure and accelerometer-measured MVPA. Components include: in-the-moment UVR alerts and UVR feedback, sun protection monitoring and feedback, UVR weather reports, e-coaching, and action planning. Findings will inform a fully-powered MOST factorial experiment with components that are effective and acceptable by melanoma survivors. As an exploratory aim, we will evaluate the effects of each intervention component on MVPA. Knowledge gained from this study will inform development of more effective, implementable, and scalable interventions to reduce disease burden in this population.