mySmartCheck, a Digital Intervention to Promote Skin Self-examination Among Individuals Diagnosed With or at Risk for Melanoma: A Randomized Clinical Trial

Abstract

Background Regular skin self-examination (SSE) reduces melanoma mortality but is not often conducted. Purpose To promote SSE performance in individuals at increased risk for melanoma. Methods One hundred sixteen individuals at heightened risk for development of melanoma (i.e., personal/family history of melanoma, high-risk mole phenotype) who did not conduct a thorough SSE during in the prior 3 months were randomly assigned to receive either an automated internet-based intervention (mySmartCheck) or usual care (UC). One hundred sixteen participants completed surveys before random assignment and 99 completed the follow-up survey 13-weeks afterward. The primary outcome was participant self-reported examination (SSE) of all 15 parts of the body in the last 3 months. Secondary outcomes were SSE of any part of the body in the last 3 months and number of body parts examined during the last SSE. Results More mySmartCheck participants examined all 15 body parts (32.6% vs. 7.1%, p = .001). More individuals in mySmartCheck reported conducting SSE on any body part than those in UC (81.4% vs. 62.5%, p = .04). Effect sizes were large (d = 1.19 all 15 body parts) to moderate (d = 0.55 for any body part). mySmartCheck participants examined more body areas than UC participants (12.7 vs. 10.3, p = 0.003) during the last SSE. Participants in mySmartCheck reported higher levels of knowledge of suspicious lesions, SSE benefits, SSE self-efficacy, and planning for SSE, and lower SSE barriers, than those assigned to UC. Conclusions mySmartCheck had a significant positive impact on SSE performance and behaviors. Additional research with a larger sample size, a longer follow-up, and more varied clinical settings is needed. Trial Registration ClinicalTrials.gov registration # NCT03725449 (https://clinicaltrials.gov/ct2/show/NCT03725449).

Dropout Rate in Digital Health Interventions for the Prevention of Skin Cancer: Systematic Review, Meta-analysis, and Metaregression

“…A total of 1566 studies were identified in the database search. After removing duplicates, the screening process, and complete reading of the records that met the eligibility criteria, 17 RCTs were finally included in the review [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]. The complete process is shown in Figure 1.…”

“…The age of the participants ranged from 12.6 to 54.3 years. The digital strategies used in the included RCTs were web-based interventions in 8 studies [35,40,42,43,46,[48][49][50], 6 involved apps [36][37][38]44,45,47], 3 involved SMS [35,36,39], 2 involved video [34,41], and 1 involved a wearable device [47]. Conversely, the comparator groups involved no intervention in 11 studies [35,37,[43][44][45][46][47][48]50] and active controls in 6 studies [34,36,38,39,41,49].…”

“…The total number of dropouts for all arms of the included studies was 1120, with 681 (60.80%) in experimental interventions and 439 (39.20%) in controls. The reason for the dropout of participants was reported as loss during follow-up in 9 of the 17 RCTs [34,37,38,[40][41][42][43]47,49] and not answering the final questionnaire in 4 studies [39,44,45,50]; 2 studies did not report the reason for dropout [35,48]. The main characteristics of the studies are displayed in Table 2.…”

“…The meta-analysis of proportions included 22 arms (k) of study and 2610 subjects among whom there were 419 dropouts. An overall pooled dropout rate of 9.5% (95% CI, 5.0-17.5) was calculated (Figure 2; [34][35][36][38][39][40][41][42][43][44][45][46][47][48][49][50]). In the subgroup meta-analysis, digital strategies showed a higher dropout rate of 11.6% (95% CI 6.8-19.0) compared to 10.0% (95% CI 5.5-17.7) in the comparators.…”

“…A slight trend for a higher number of dropouts was observed in digital strategies with an OR of 1.16 (95% CI 0.98-1.36), but there were no significant differences between the experimental and control approaches (P=.39). The I 2 was 6% (95% CI 0-38) indicating a lack of heterogeneity between the studies analyzed for the overall and subgroup meta-analysis (Figure 3; [34][35][36][38][39][40][41][42][43][44][45][46][47][48][49][50]). We performed a meta-analysis of subgroups divided by the type of digital strategy and the comparison groups.…”