Benign Skin Growth, Skin Cancer, Skin Cancer Prevention
Conditions
Keywords
skin cancer, skin cancer education, skin cancer intervention, patient education, digital education
Brief summary
Skin cancer is a significant public health concern, even in an Asian society like Singapore where it ranks among the top 10 cancers. This RCT tests the effectiveness of a skin cancer educational intervention to improve skin cancer outcomes among skin-of-color individuals, including the effects of gain versus loss framing.
Detailed description
Reducing skin cancer related morbidity and mortality involves two broad domains; (1) Identification and early detection of skin cancers and (2) Awareness and behavioral change to reduce modifiable risk factors like UV exposure. Regular self-examination and public education have been shown in RCTs to improve knowledge and identification of skin cancers. However most of these existing studies and the tools they utilise rely on Western-centric photographs and messaging, such as the 'ABCDE rule' for superficial spreading and nodular melanoma. These neglect skin cancers far more common in skin of colour population such as acral lentiginous melanomas, pigmented basal cell and squamous cell carcinomas. In addition to improving detection, effective behavioural change strategies are needed to encourage protective practices such as regular sunscreen use. Message framing has gained interest as a behavioral change technique: gain-framed messages emphasize the benefits of adopting a behavior, while loss-framed messages highlight the negative consequences of not doing so. Although message framing is widely used in health communication, evidence of its effectiveness in promoting skin cancer-related behaviors is unclear. Effectiveness of our proposed intervention can help to increase adoption of sun protective behaviours, improve detection rates of skin cancer and allow earlier medical intervention, hence reducing morbidity and mortality of skin cancer.
Interventions
BEHAVIORALSkin Cancer Self-Detection Educational Program with gain-framing
This educational website will feature gain-framing messages, emphasizing the benefits of adopting a behavior, utilising positive language and analogies. The interventional domains are (1) Education on skin cancer risk factors and epidemiology, (2) UV Protection Advice, (3) Skin Self-Examination Techniques and (4) Differentiating benign vs malignant skin conditions.
BEHAVIORALSkin Cancer Self-Detection Educational Program with loss-framing
This educational website will feature loss-framing messages, highlight the consequences of failing to adopt a behavior, utilising negative language and analogies. The interventional domains are (1) Education on skin cancer risk factors and epidemiology, (2) UV Protection Advice, (3) Skin Self-Examination Techniques and (4) Differentiating benign vs malignant skin conditions.
BEHAVIORALWait-list Control
Participants in the control group will gain access to the intervention websites after the 4-month questionnaire is completed.
Sponsors
National University Hospital, Singapore
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
16 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Individuals aged 16 and above * Able to read and converse in English * Able to provide informed consent * Having the ability to use and interact with a web server or application.
Exclusion criteria
\- Individuals who have cognitive impairment or decline to participate. There will be no
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in competency scores | Baseline, immediately post-intervention (for intervention arms), 4 months post-intervention | Scores measured as percentage of correct questions answered. Range from 0% to 100% with higher score indicating higher ability to differentiate benign from malignant skin lesions. Change in scores will be calculated and compared between 1. Both intervention arms with the control group at 4 months, and 2. Between gain framed and loss framed intervention arms at 4 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Knowledge of skin cancer, sun protection and skin self-examination | Baseline, immediately post-intervention (for intervention arms), 4 months post-intervention | 20 Multiple Choice Questions created based on intervention website. Score range from 0 to 20, with a higher score indicate higher knowledge in risks of skin cancer, appropriate sunscreen use and features of cancerous lesions. |
| Attitudes toward carrying out sun protection behaviours | Baseline, immediately post-intervention (for intervention arms), 4 months post-intervention | 6 questions graded on a 7-point Likert scale, with higher scores indicating better attitudes toward sun protection behaviours |
| Subjective norms, which refer to participants' perception of whether significant individuals in their lives would support sun protection behaviours | Baseline, immediately post-intervention (for intervention arms), 4 months post-intervention | 7 questions graded on a 7-point Likert scale, with higher scores indicating a greater influence of others' perception on their sun protection behaviours |
| Behavioural outcomes (sun protection behaviour and skin self-examination) | Baseline, immediately post-intervention (for intervention arms), 4 months post-intervention | Sun Exposure and Protection Index. 9 questions graded on a 5-point Likert scale assessing sun habits and sun protection behaviour. Lower scores indicate more optimal sun protection behaviours, with an additional adapted question. 11 additional questions regarding participants' sunscreen usage (e.g. type of sunscreen, frequency of reapplication), and skin-self examination, with a lower score indicating more optimal sun protection behaviours. |
| Intentions of participants toward carrying out skin cancer risk prevention strategies | Baseline, immediately post-intervention (for intervention arms), 4 months post-intervention | Sun Exposure and Protection Index (6 questions with an additional adapted question). Each given response score (0-4) are summed, with scores ranging from 0-24, with higher score indicating a low propensity to increase sun protection. 2 additional questions regarding participants' intentions of conducting a skin-self examination. 7 point Likert Scale (1-7), with higher score indicating higher intentions of conducting a skin-self examination. |
Countries
Singapore
Contacts
CONTACTEllie Choi, MBBS
PRINCIPAL_INVESTIGATOREllie Choi, MBBS
National University Hospital, Singapore
Outcome results
None listed