JMIR Publications

ABSTRACT

Background:

Mobile teledermatology is increasingly being used in clinical practice and offers the opportunity to counsel the general public about sun protection and skin cancer early detection. Growing evidence suggests that text messaging interventions are an effective way to reach a large number of the population and to promote sun protection behaviors. Many medical practices already have text message systems in place to communicate with patients, especially for appointment reminders and information. However, could we use these systems for even better outcomes and, if so, how?

Objective:

This presentation will outline the results of the SunText study, a theory-based text messaging intervention designed to evaluate how often and in what way we could communicate with people at risk of skin cancer to achieve a beneficial effect on sun protection behaviors, sunburn and participant engagement.

Methods:

The SunText study was conducted between February-July 2019 in Queensland, Australia. Volunteer participants aged 18 to 40 years were randomized to four different intervention schedules using a Latin square design. The schedules included personalized or interactive messages with constant frequency and personalized and interactive messages with either increasing or decreasing frequency. Outcomes measured were reduction in sunburn and engagement with interactive messages, defined as responding to messages by return text.

Results:

Compared to baseline, the self-reported sun protection habits (SPH) index was significantly higher in all four interventions (p<0.01). Overall, the sunburn rates decreased from baseline to the end of the intervention (40.3% to 7.0%), and remained significantly below baseline levels (23.5%) at 6-months follow-up (p<0.01). All four interventions achieved reductions in sunburn rates (18% - 48% reduction) during the intervention period. The overall engagement rate with interactive messages was 71%. The intervention involving interactive messages with constant frequency achieved the highest engagement rate. The intervention with personalized and interactive messages with increasing frequency had the lowest engagement rate.

Conclusions:

This study adds to the evidence that text messages targeting sun protection are effective in improving sun protection behaviors and reducing sunburn. Results also suggest higher engagement with constant or decreasing message frequency. While many clinics already use text messaging for scheduling, this presentation may encourage its extended use to raise awareness of sun protection. Interactive messages could also be integrated into sun protection mobile health applications, and provide an opportunity for engaging in health promotion content.