Improving Hairdressers’ Knowledge and Self-efficacy to Detect Scalp and Neck Melanoma by Use of an Educational Video

Half of melanomas go undetected by self-inspection, and those undetected occur frequently on the scalp and neck (S-N).¹ We have previously provided a rationale for the role of hairdressers, a group that makes daily observations of the scalp and neck, in the detection of S-N melanomas in the general population.² Furthermore, in a previous study, we examined melanoma knowledge in 108 hairdressers from 45 hair salons.³ Results uncovered room for improvement in knowledge regarding signs and symptoms of melanoma, which are standardized in the ABCDE criteria (Asymmetry, irregular Borders, >1 Color, >6 mm in Diameter; Elevation) for atypical nevi and melanoma detection.⁴ Most hairdressers desired to learn more about melanoma detection, which is a finding replicated from a Texas sample.⁵ In the current study, we now address a major gap in previous research by developing and then testing the efficacy of a video intervention aimed at increasing hairdresser knowledge of melanoma and self-confidence in skin lesion detection.

We conducted a single-group, pretest-posttest intervention study to assess changes in the scores of hairdressers’ self-confidence and knowledge of melanoma detection after an online, 5-minute video (https://vimeo.com/142284021) during 2015. A study link was sent to 20 beauty schools in Los Angeles County by our collaborator, Eyes on Cancer. Questionnaire items were informed by the American Cancer Society Facts and Figures 2013 report.⁶ Participants received a $5 gift card and provided informed consent to participate in the study by clicking on the “agree” link provided on the study introduction form. Study protocols gained approval from the University of Southern California institutional review board. Data analyses were conducted using SPSS statistical software (version 21; IBM Corp). Frequencies were examined to determine the percentage of participants who provided correct responses to questionnaire items before and after watching the educational video. The McNemar χ² test was used to compare the proportions of participants who provided correct responses to questionnaire items prior to watching the video vs after watching the video. The Wilcoxon signed-rank test was used to examine the difference in confidence in the ability to identify a skin lesion that could potentially be a skin cancer prior to and after watching the video. Statistical testing was set at P < .05 for the analytic sample.

A total of 113 participants enrolled in the study by completing the prevideo questionnaire. A response rate was not established owing to the listserv mailing of the survey link to beauty school administrators. Thirteen participants who did not complete the postvideo questionnaire were excluded from the final analytic sample (n = 100). Table 1 displays sample characteristics. Table 2 shows results for the pretest-posttest values in hairdressers’ melanoma knowledge and self-efficacy. Gains were observed for all knowledge of melanoma risk items. Statistically significant gains were observed for correct identification of ABCDE criteria for atypical nevi and melanoma detection (59% vs 71%; P = .008). The proportion of participants reporting “very confident” self-efficacy to detect skin lesion that could potentially be a skin cancer more than doubled following the video (19% vs 41%; P = .001).

Hairdressers have the ability to monitor a large extent of the general public’s scalp and neck, highlighting their usefulness for the detection of S-N melanomas via population-based screening and dermatologic referral. Findings from this study suggest that a brief educational video can be beneficial for educating hairdressers about melanoma risk and the ABCDE criteria for atypical nevi and melanoma detection while also building on self-efficacy skills in skin lesion detection that might carry over to improved screening of those individuals at risk for melanoma. Limitations of this study include a small sample size that might have had an effect on our ability to detect changes after education in some of the measures shown in Table 2, and limited external validity of findings given the convenience sampling approach. Also, 79% of the sample reported some previous training about skin cancer, so in future work, it will be important to know if our educational video functioned to reinforce existing knowledge or to provide new knowledge about melanoma detection, or both. More research is needed to determine if such knowledge and self-efficacy gains are maintained over longer periods of time and against an active control condition in a randomized controlled trial. Based on our initial testing of an educational video intervention, training hairdressers in melanoma screening and referral seems to be a promising avenue for future research.

Corresponding Author: David S. Black, MD, Keck School of Medicine, University of Southern California, 2001 N Soto St 302D, Los Angeles, CA 90032 (davidbla@usc.edu).

Accepted for Publication: August 24, 2017.

Published Online: December 6, 2017. doi:10.1001/jamadermatol.2017.4267

Author Contributions: Drs N. R. Black and O’Reilly had full access to all of 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: Roosta, Black, Woodley.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Roosta, O’Reilly, Black.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: O’Reilly.

Obtained funding: Roosta.

Administrative, technical, or material support: Roosta, Pun, Black.

Study supervision: Roosta, Woodley

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported in part by the Los Angeles Metropolitan Dermatologic Society.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We appreciate the efforts of Eyes on Cancer, who assisted with participant recruitment and VisualDx for picture content embedded in the video.