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Day AK, Stapleton JL, Manne SL, Tatum KL, Goydos JS, Coups EJ. Receptivity to Internet-Delivered Interventions to Promote Skin Self-examination and Sun Protection Behaviors in Patients With Melanoma. JAMA Dermatol. 2016;152(2):213–215. doi:10.1001/jamadermatol.2015.2978
Patients with melanoma have a 9-fold increased risk for a diagnosis of another melanoma.1 Contrary to recommendations, many individuals diagnosed as having melanoma do not perform regular skin self-examinations (SSEs) or engage consistently in sun protection behaviors.2 Considerable opportunity exists to use e-health approaches, such as the Internet, to deliver information and interventions targeting behavior change in patients with melanoma.3 Potential benefits include interactive and personalized content, cost-effectiveness, and implementation across diverse settings and geographic locations.4 However, to determine the potential reach and utility of such interventions, identification of patient characteristics associated with a willingness to receive Internet-delivered information is needed. We examined factors associated with the receptivity of patients with melanoma to Internet-delivered interventions to promote engagement in SSEs and sun protection behaviors.
Eligibility criteria included a diagnosis of a cutaneous malignant melanoma with a primary pathologic stage ranging from 0 to III, an interval of 3 to 24 months since definitive surgical treatment at Rutgers Cancer Institute of New Jersey (a National Cancer Institute–designated Comprehensive Cancer Center), and being 18 years or older. We mailed an invitation letter, survey, and consent materials to a randomly selected sample of 286 eligible patients; 176 predominantly non-Hispanic white individuals (174 [98.9%]) completed the survey (response rate, 61.5%). Respondents did not differ from nonrespondents with regard to age, sex, race, disease stage, or time since surgery. Data obtained included demographic characteristics, 5 multiple-choice items assessing knowledge of the ABCDE (asymmetry, border, color, diameter, and evolution) signs of melanoma (calculated as the number of correct responses; range, 0-5),5 and 6 items assessing the frequency (0 indicates never; 4, always) of engaging in sun protection behaviors (ie, using sunscreen, seeking shade, and wearing sunglasses, a wide-brimmed hat, a long-sleeved shirt, and long pants). An index of sun protection behaviors was created by summing item responses. Participants indicated whether they had Internet access and their level of receptivity (not at all, a little, somewhat, moderately, or very interested) to participation in an Internet-delivered intervention to promote engagement in SSEs and sun protection behaviors. Participants who reported Internet access indicated whether they had searched for melanoma information online and their comfort level using the Internet. Data were collected from October 5, 2012, through March 25, 2013, and analyzed from April 13 through May 5, 2015. Ethics approval was received from the Rutgers Health Sciences institutional review board. All patients provided informed consent (oral for 5 and written for 171).
Frequencies for the study variables are shown in Table 1, which also shows the results of bivariable logistic regression analyses examining correlates of Internet access. Of the 176 study participants, Internet access was reported by 148 (84.1%) and was associated with being younger, having a higher educational level, and having greater knowledge of the ABCDE signs of melanoma. One hundred nineteen of 174 participants (68.4%) reported being at least moderately interested in an Internet-delivered behavioral intervention (Table 2). As shown in the bivariable logistic regression analyses in Table 2, individuals who were at least moderately interested in an Internet-delivered behavioral intervention were more likely to be younger, have greater knowledge of the ABCDE signs of melanoma, and be more comfortable using the Internet.
As expected, most of the study participants had access to the Internet. Internet access was associated with being younger and having a higher level of education. Most of the participants were at least moderately interested in an Internet-delivered behavioral intervention. Older participants, individuals with lower knowledge of the ABCDE signs of melanoma, and those who reported less comfort using the Internet exhibited less receptivity to an Internet-delivered intervention. These results suggest that individuals who may not perform SSEs effectively (ie, those with low knowledge of the ABCDE signs of melanoma) may be less receptive to an Internet-delivered intervention. Developers of e-health interventions should consider and address such challenges. Formative research should consider ways to improve the appeal of Internet-delivered and/or non–Internet-delivered interventions to those groups who were less receptive or who lacked Internet access.
Among participants with Internet access, receptivity to an Internet-delivered behavioral intervention did not differ significantly based on previous online seeking of melanoma information. Thus, e-health interventions may still appeal to patients with melanoma who have not sought melanoma information online in the past. This work highlights potential limitations of the reach of e-health interventions and identifies factors associated with the receptivity of patients with melanoma to such interventions. Limitations of this study include the cross-sectional nature of the data and inclusion of patients from a single institution. Little research has formally evaluated e-health interventions that promote SSEs and sun protection behaviors among patients with melanoma or individuals at increased risk for melanoma,3,6 and future research is warranted to develop and test relevant theory-based interventions.
Corresponding author: Ashley K. Day, PhD, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany St, Fifth Floor, Room 5549.20, New Brunswick, NJ 08903 (firstname.lastname@example.org).
Accepted for Publication: July 13, 2015.
Published Online: October 14, 2015. doi:10.1001/jamadermatol.2015.2978.
Author Contributions: Drs Day and Coups had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: All authors.
Acquisition, analysis, or interpretation of data: Day, Tatum, Coups.
Drafting of the manuscript: Day, Coups.
Critical revision of the manuscript for important intellectual content: Stapleton, Manne, Tatum, Goydos, Coups.
Statistical analysis: Day, Coups.
Administrative, technical, or material support: Tatum.
Study supervision: Coups.
Conflict of Interest Disclosures: None reported.
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