Develop a behaviour change intervention resource through the co-design of digital video content to promote SSE among underserved high-risk populations.
This Cancer Research UK study, led by Professor Steven Ersser, Professor of Nursing & Dermatology Care at the Centre for Wellbeing & Long-Term Health at Bournemouth University, supported the development of an evidence and theory-based approach to developing video resources that support older men, people of colour and the generic adult population to self-examine their skin, to assist in the early detection of skin cancer.
Background
Skin cancer, particularly melanoma, continues to rise globally. Early detection improves clinical outcomes, yet many individuals do not perform regular skin self-examinations (SSE), a key first step. High-risk populations, including older men and people of colour, experience diverse barriers to SSE. Existing digital resources lack a tailored, theoretical underpinning. The aim of the study was to develop a behaviour change intervention resource through the co-design of digital video content to promote SSE among underserved high-risk populations: 1) older men (60+ years), 2) people of colour (POC), 3) a generic adult population of mixed gender and ethnicity, using participatory design principles and grounded in behavioural change theory.
Methods
Development of the videos followed the Medical Research Council’s (MRC’s) framework for complex intervention development, using a mixed-methods, participatory qualitative design.
An interdisciplinary team* (nurses, dermatologist, health psychologists, health communication experts, and community stakeholders), collaborated throughout. Three target groups) participated in three iterative co-design workshops:
- One: focused on Explored their lived experiences on skin cancer awareness, perceived barriers and facilitators to SSE and reviewed existing health educational resources. SSE barriers (using the MOLES Index) and skin-typing were also systematically identified. Discussions were digitally recorded, transcribed, and analysed using NVIVO qualitative analytic software.
- Two: focused on participants co-created storylines and characters incorporating relevant Behaviour Change Techniques (BCTs), tailored to address identified SSE barriers and facilitators. For the final
- Three: involved participants reviewing illustrated storyboards for clarity, relevance, acceptability, and perceived effectiveness. The final development stage involved work with further lay participants, a professional voice coach and University audio engineer to develop socio-culturally appropriate voice-overs for each video.
Results
Participants (sample: n=23) were recruited for the three groups. Self-reported Fitzpatrick skin-types ranged from II-IV. Recruiting men proved challenging. Three prototype videos were designed to address the perceived barriers and facilitating factors; those identified in the literature and mapped to the key domains of the Theoretical Domains Framework (TDF) including Social Influences, Beliefs about Consequences, Knowledge, Skills, Decision Processes; this informed an explanatory logic model that underpinned the intervention, through identifying linked approaches to behavioural change techniques that were built into the video design process.
Conclusion
This study highlights the importance of co-designing and targeting digital health interventions to support early skin cancer detection among underserved communities, grounded in public participation and behaviour change theory. These theoretically underpinned and tailored prototype videos aim to enhance SSE engagement by the public, through addressing socio-cultural barriers. Further research is required to evaluate their actual effectiveness in changing SSE behaviour in practice.
The videos are now accessible for public usage and will now be disseminated via skin cancer charities and working with the NHS Cancer Alliance Network, via our study partner Wessex Cancer Alliance. The videos and their component elements on the challenges of the early detection of skin cancer (awareness, skin examination, lesion detection and presentation to primary care), are also available to assist health professionals as a resource to provide public focused health promotion.
Skin self exam videos for early detection of skin cancer
General adult population
Older men
People of colour
How to Check Your Skin for Early Signs of Skin Cancer
Skin cancer – especially melanoma – is rising worldwide. The good news? By detecting skin cancer early you can minimise significant risk to your health. One simple but powerful step all adults can take is regularly self-examine their skin.
Key messages:
- Check your skin every month
- Check everywhere
- Catch skin cancer early
These videos were developed Bournemouth University, in collaboration with the University of Glasgow and Birmingham City University, and funded by Cancer Research UK. The study worked with two public groups who can face particular barriers to checking their skin*. We also produced a video for the general adult population.
- Older men (60+)*
- People of colour*
- A general adult population of mixed gender and ethnicity
Through public co-design workshops and using behavioural science principles, we developed tailored video resources to help different groups of people understand why skin self-examination matters, how to do it confidently, and what to look for.
Many existing online resources are not designed with specific audiences in mind. This project aimed to change that - creating practical, evidence-based and socio-cultural relevant guidance.
