Risk Factors and Early Prevention of Skin Cancer in Rural Older Occupational Populations

Abstract

The overall purpose of this dissertation was to explore awareness of risk factors, preventive behaviors, and health care access regarding skin cancer prevention among older outdoor workers in rural Washington. Manuscript one reports on a scoping review focused on skin cancer risk factors and preventive behaviors in rural areas across the country. Modifiable risk factors (e.g., intensive or chronic ultraviolet radiation (UVR) exposure), non-modifiable risk factors (e.g., heredity), signs of sun damage (e.g., sunburns), environmental factors (e.g., the geography of areas especially high latitude), sun-protective behaviors (e.g., avoid the midday sun), and barriers to sun-protective behaviors (e.g., socio-demographic) were synthesized from 12 articles that met eligibility criteria for the review. The results showed insufficient provision of health education by healthcare providers, coupled with limited access to preventive care in rural areas, may deter individuals from seeking medical care. As such, rural populations may face a heightened risk of developing skin cancer and encounter additional barriers beyond UVR exposure. Primary care providers and researchers are encouraged to find a way to mitigate skin cancer risks in high-risk populations. Manuscript two used a grounded theory approach to explore the processes of accessing primary care, checking skin for suspicious spots, and carrying out sun-protective behaviors in rural older farmers. A semi-structured interview was carried out with 12 older individuals. The Health Belief Model (HBM) was adapted to refine the constructs and build an updated theory for instrument development. The HBM constructs were confirmed, along with the additional constructs addressing hope for support with regard to unmet needs. Nine core themes were identified in rural older farmers: (1) perceived susceptibility and changes with aging; (2) perceived severity; (3) perceived benefits; (4) perceived barriers to navigate when outdoors; (5) cues to action; (6) hope for emotional support; (7) hope for instrumental support; (8) hope for informational support; (9) hope for support to all ages. These findings can be utilized to develop preventive strategies in populations at high risk of developing skin cancer and lays the groundwork for future studies to develop and test a questionnaire to measure skin cancer awareness and sun-protective behaviors among outdoor workers as well as younger populations. Manuscript three used cognitive interviewing to develop a study-derived instrument to measure skin cancer awareness and preventive behaviors for high-risk populations. Cognitive interviews were carried out with four individuals who have worked in farming communities for many years. The study establishes a foundation for further instrument development and testing and to enable other researchers to incorporate the findings (e.g., barriers to practice sun-protective behaviors) into interventions focused on increasing awareness of skin cancer and preventing its development. The instrument developed in this study for identifying primary and secondary preventive behaviors can be used for future initiatives to raise awareness about skin cancer prevention among outdoor workers as well as younger populations. Three manuscripts will be followed by an overall conclusion that addresses the overall contribution of this dissertation work. The overall implications of this dissertation work are to develop novel strategies to reduce rural-urban cancer disparities for improving access to healthcare for preventive services and raising awareness of skin cancer risk for occupational outdoor workers. By using the instrument to identify primary and secondary preventive behaviors, healthcare providers play a crucial role in improving accessibility to skin checks and preventive services among high-risk populations.