BACKGROUND Skin cancer is the most common cancer; survival of the most serious skin cancer, malignant melanoma, depends on early detection. Early detection relies on accessibility to clinical skin examination (CSE). Primary care nurse practitioners (PCNPs) are well-positioned to conduct CSE; however, they require further education on CSE and have time constraints for continuing education. A digital intervention grounded in microlearning is a promising approach to deliver new information over a brief timespan. OBJECTIVE To develop and explore the feasibility of implementing a 1-week online video intervention with content on CSE skills (defined as melanoma risk assessment, head-to-toe skin examination and pigmented lesion assessment) for PCNPs. Specific aims were 1) to develop three theory-based, brief skin cancer videos containing content on CSE and were suitable for online delivery to PNCPs and 2) to determine intervention enrollment, retention and adherence, and acceptability and usability of the intervention. Aim 1 focused on content validity, integration of the videos and surveys into Research Electronic Data Capture (REDCap) for digital delivery. Aim 2 focused on feasiblity testing. METHODS For Aim 1, the principal investigator (PI) created storyboards for videos that ¬addressed each CSE skill. A dermatology expert panel reviewed the storyboards and videos for relevance, comprehension, and clarity assessed using a Content Validity Index (CVI). The panel evaluated usability of delivery of the video intervention by REDCap and Vimeo using Brooke’s System Usability Scale (SUS) and technical video production using Beaudin’s Quality Evaluation of Video. Vimeo, which is an online platform and community developed to create, upload and share videos.[1] For Aim 2, the videos were delivered to a sample of 10 PCNPs recruited statewide. Enrollment and retention rates were based on metrics from previous studies of CSE in the literature, and intervention adherence. Usability and acceptability were assessed using the SUS and the Attitudes toward Web-based Continuing Learning survey (AWCL). RESULTS CVI scores indicated relevance and clarity for each video (M range 3.79 to 4; 4, high relevance). The integration of REDCap and Vimeo was rated usable (SUS = 95; 0-100, worst to best). The digital delivery of the videos was exceptional on all five technical items (M = 5, poor [1] to exceptional [5]). Of the 22 PCNPs recruited, 12 were enrolled (35%) and 10 (83%) were retained in the study. Intervention adherence was ≥ 50%. Participants rated the usability as “better” (M = 85.8, SD = 10.6; better=70-90) and favorably ranked acceptability of AWCL’s constructs of perceived usefulness (M = 5.26 SD =0.08, strongly agree = 7)), perceived ease of use (M = 5.40 SD =0.41), behavior (M = 5.53 SD =0.12) and affection (M = 5.77 SD =0.04). CONCLUSIONS The video intervention was feasible to deliver to PCNPs using an online, microlearning approach. The findings provide support for using the videos for an intervention in a future pilot randomized trial targeting behavioral CSE outcomes in PCNPs and other primary care providers.

Background Vietnamese Americans have a relatively high risk of developing diabetes at younger ages, yet there are no published studies exploring their risk perceptions. Objective This mixed methods study describes perceived diabetes risk in the context of an underserved population. Methods This study was guided by the Common-Sense Model of Self-Regulation. Snowball sampling was used to recruit 10 Vietnamese Americans with prediabetes and achieve data saturation. Qualitative and quantitative descriptive methodologies with data transformation were used to analyze data from semistructured interviews and questionnaires to explore the dimensions of perceived diabetes risk. Results Participants were between the ages of 30 and 75 years with diversity also noted in diabetes risk factors. The 3 risk perception domains from qualitative data were risk factors, disease severity, and preventing diabetes. The main perceived diabetes risk factors were eating habits (including cultural influences), sedentary lifestyle, and family history of diabetes. Quantitative data supported qualitative findings of a low-to-moderate level of perceived diabetes risk. Despite the lower levels of perceived diabetes risk, Vietnamese Americans do believe that the severity of diabetes is a “big concern.” Conclusions Vietnamese Americans with prediabetes have a low-to-moderate level of perceived diabetes risk. Understanding the perceived diabetes risk in this population provides a foundation for diabetes prevention interventions that consider cultural influences on diet and exercise.

BACKGROUND Vietnamese Americans have a relatively high risk of developing diabetes at younger ages, yet there are no published studies exploring their risk perceptions. OBJECTIVE This mixed methods study describes perceived diabetes risk in the context of an underserved population. METHODS This study was guided by the Common-Sense Model of Self-Regulation. Snowball sampling was used to recruit 10 Vietnamese Americans with prediabetes and achieve data saturation. Qualitative and quantitative descriptive methodologies with data transformation were used to analyze data from semistructured interviews and questionnaires to explore the dimensions of perceived diabetes risk. RESULTS Participants were between the ages of 30 and 75 years with diversity also noted in diabetes risk factors. The 3 risk perception domains from qualitative data were risk factors, disease severity, and preventing diabetes. The main perceived diabetes risk factors were eating habits (including cultural influences), sedentary lifestyle, and family history of diabetes. Quantitative data supported qualitative findings of a low-to-moderate level of perceived diabetes risk. Despite the lower levels of perceived diabetes risk, Vietnamese Americans do believe that the severity of diabetes is a “big concern.” CONCLUSIONS Vietnamese Americans with prediabetes have a low-to-moderate level of perceived diabetes risk. Understanding the perceived diabetes risk in this population provides a foundation for diabetes prevention interventions that consider cultural influences on diet and exercise.

BACKGROUND Skin cancer, the most common cancer in the United States, is costly and potentially deadly. Its burden can be reduced by early detection and prevention activities. The scope of skin cancer requires going beyond traditional health care providers to promote risk reduction. Partnering with the nonbiomedical workforce, such as massage therapists (MTs), may reach more individuals at risk. MTs see much of their clients’ skin and are amenable to performing skin cancer risk reduction activities during massage appointments. OBJECTIVE The objective of this study is to describe the Massage Therapists Skin Health Awareness, Referral, and Education protocol, presenting an overview of our systematic approach to developing rigorous e-training for MTs to enable them to be partners in skin cancer risk reduction. We also describe procedures for usability and feasibility testing of the training. METHODS We developed an integrated electronic learning system that includes electronic training (e-training) technology, simulated client interactions, online data collection instruments, and in-person assessment of MTs’ application of their training. RESULTS A total of 20 participants nationally scored the e-training as high for usability and satisfaction. We have screened an additional 77 MTs in Arizona for interest and eligibility, and currently have 37 enrolled participants, of whom 32 have completed the Web-based training. CONCLUSIONS The structured and rigorous development approach for this skin cancer risk reduction and brief behavioral intervention e-training for MTs begins to fill a gap in skin cancer risk reduction research. Iterative usability testing of our asynchronous Web-based training resulted in positive participant response. Our e-training approach offers greater learner accessibility, increased convenience, and greater scalability than the few existing programs and has the potential to reach many MTs nationally. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/13480

BACKGROUND Skin cancer affects millions of Americans and is an important focus of disease prevention efforts. Partnering with non–health care practitioners such as massage therapists (MTs) can reduce the risk of skin cancer. MTs see clients’ skin on a regular basis, which can allow MTs to initiate “helping conversations” (ie, brief behavioral interventions aimed at reducing the risk of skin cancer). OBJECTIVE The purpose of this study was to evaluate (1) the feasibility of recruiting, enrolling, and retaining Arizona MTs in an online electronic training (e-training) and (2) the preliminary efficacy of e-training on knowledge, attitudes/beliefs, and practice of risk reduction for skin cancer. We explored MTs’ ability to assess suspicious skin lesions. METHODS We adapted the existing educational content on skin cancer for applicability to MTs and strategies from previous research on helping conversations. We assessed the feasibility of providing such e-training, using Research Electronic Data Capture (REDCap) tools for data capture. We assessed the preliminary efficacy using established self-report surveys at baseline, immediately post training, and at 3 and 6 months post training. RESULTS A total of 95 participants enrolled in the study, of which 77% (73/95) completed the assessments at 6 months (overall attrition=23%). Project satisfaction and e-training acceptability were high. Knowledge, personal behaviors (skin self-examination, clinical skin examination, sun protection frequency), and practice attitudes (appropriateness and comfort with client-focused communication) of risk reduction for skin cancer improved significantly and were sustained throughout the study. CONCLUSIONS The e-training was feasible and could be delivered online successfully to MTs. Participants were highly satisfied with and accepting of the e-training. As such, e-training has potential as an intervention in larger trials with MTs for reducing the risk of skin cancer. INTERNATIONAL REGISTERED REPORT RR2-10.2196/13480