Melanoma awareness and prevention among latinx and non-latinx white adults in urban and rural California: A qualitative exploration

BACKGROUND

Melanoma mortality rates in the US are highest among older men, individuals of lower socioeconomic status (SES), and people of color. To better understand these inequities, a qualitative exploratory study was conducted in Northern and Southern California to generate knowledge about barriers and facilitators of awareness, prevention, and early detection of melanoma in lower SES Latinx and non-Latinx White (NLW) individuals living in urban and semi-rural areas.

METHODS

Nineteen focus groups were conducted (N = 176 adult participants), stratified by race/ethnicity (Latinx, low-income NLW), geography (semi-rural, urban), and language (English and Spanish). Inductive and deductive thematic analysis was conducted, and the findings were organized using the socioecological model framework: individual, interpersonal, community, and health system/policy levels.

RESULTS

Four socioecological themes describe how key factors affect knowledge, perceived risk, preventive behaviors, and melanoma screening. Individual level findings revealed that many participants were not familiar with melanoma, yet were willing to learn through trusted sources. Having brown or darker skin tone was perceived as being associated with lower risk for skin cancer. Interpersonally, social relationships were important influences for skin cancer prevention practice. However, for several Latinx and semi-rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi-rural participants reported distance or lack of transportation to a clinic as challenges for accessing dermatology care. Healthcare systems barriers included burdens of additional healthcare costs for dermatology visits and obtaining referral.

CONCLUSIONS

Varying factors influence the awareness levels, beliefs, and behaviors associated with knowledge, prevention, and early detection of melanoma among low-income Latinx and NLW individuals and in semi-rural areas. Results have implications for health education interventions. Navigation strategies that target individuals, families, and health care settings can promote improved prevention and early detection of melanoma in these communities.

A qualitative exploration of melanoma awareness and prevention among Latinx and non-Latinx White populations in urban and rural California

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Background: Melanoma mortality rates remain high among individuals of lower socioeconomic (SES) status, and racial/ethnic minorities, despite rates declining in non-Latinx whites (NLW). To improve understanding about the factors contributing to inequities in melanoma prevention and care, a qualitative exploratory study was conducted in Northern and Southern California regarding awareness, prevention, and early detection of melanoma in lower SES NLW and Latinx populations living in urban and semi-rural areas. Methods: Nineteen focus group (n = 176 individuals: 77% female, 59% self-identified Latinx/Hispanic, and 40% Medi-Cal/state insurance recipients) were conducted with adult participants, stratified by race/ethnicity (Latinx, low-income NLW), geography (semi-rural, urban), and language (English and Spanish). The interview topics included: 1) awareness and views of melanoma risk, prevention, and early detection screening practices; 2) acceptability of primary and secondary prevention strategies in their respective community; and 3) barriers and facilitators of engagement in melanoma prevention and care. Using a hybrid inductive and deductive approach, thematic analysis was used for data analysis. Findings were organized within a socioecological model (individual, interpersonal, community and health system/policy level). Results: Individual level findings revealed that many participants were not familiar about melanoma yet were willing to learn through trusted sources. Brown or darker skin tones were perceived as having less risk for skin cancer. Interpersonally, social relationships were important influences for individuals practicing skin cancer prevention. However, for several Latinx and semi-rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi-rural participants reported distance or lack of transportation to a clinic as challenges for dermatology care access. Healthcare systems barriers included burdens of additional medical care costs and obtaining dermatology referral. Many participants were in support of health regulations and education that reduce skin cancer risks for outdoor workers and children. Conclusions: Varying and intersecting factors influence melanoma awareness, and behaviors associated with knowledge, prevention, and early detection of melanoma in low-income NLW and Latinx individuals and in those living in semi-rural areas. Our findings promote understanding of how barriers across the socioecological spectrum may affect melanoma prevention and early detection particularly among men, individuals of lower socioeconomic status, and Latinx individuals. The study results have implications for health education interventions, which can involve health navigation strategies for individuals and families.