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Citation

Reilly F, Wani N, Hall S, Morgan {M, Allan J, Constable L, Ntessalen M & Murchie P (2023) User Experiences of a Digital Intervention to Support Total-Skin-Self-Examination by Melanoma Survivors: Nested Qualitative Evaluation Embedded in a Randomized Controlled Trial. JMIR Dermatology, 6 (1). https://doi.org/10.2196/39544

Abstract
Background:Melanoma is a relatively common cancer type with a high survival rate, but survivors risk recurrences or second primaries. Consequently, patients receive regular hospital follow-up, but this can be burdensome to attend and not optimally timed to detect arising problems. Total skin self-examination (TSSE) supports improved clinical outcomes from melanoma via earlier detection of recurrences and second primaries, and digital technology has the potential to support TSSE. Recent research with app-based interventions aimed at improving the well-being of older adults has found that they can use the technology and benefit from it, supporting the use of digital health care in diverse demographic groups. Thus, the Achieving Self-directed Integrated Cancer Aftercare (ASICA) digital health care intervention was developed. The intervention provided melanoma survivors with a monthly prompt to perform a TSSE as well as access to a dermatology nurse who provided them with feedback on photographs and descriptions of their skin.Objective:We aimed to explore participants{\textquoteright} attitudes, beliefs, and experiences regarding TSSE practices. Furthermore, we explored how participants experienced technology and how it influenced their practice of TSSE. Finally, we explored the practical and technical experiences of ASICA users.Methods:This was a nested qualitative evaluation within a dual-center randomized controlled trial of the ASICA intervention. We conducted semistructured telephone interviews with the participants during a randomized controlled trial. The participants were purposively sampled to achieve a representative sample with representative proportions by age, sex, and residential geography. Interviews were transcribed verbatim and analyzed using a framework analysis approach applied within NVivo 12.Results:A total of 22 interviews were conducted with participants from both groups. In total, 40% (9/22) of the interviewed participants were from rural areas, and 60% (13/22) were from urban areas; 60% (13/22) were from the intervention group, and 40% (9/22) were from the control group. Themes evolved around skin-checking behavior, other people{\textquoteright}s input into skin checking, contribution of health care professionals outside ASICA and its value, ideas around technology, practical experiences, and potential improvements. ASICA appeared to change participants{\textquoteright} perceptions of skin checking. Users were more likely to report routinely performing TSSE thoroughly. There was some variation in beliefs about skin checking and using technology for health care. Overall, ASICA was experienced positively by participants. Several practical suggestions were made for the improvement of ASICA.Conclusions:The ASICA intervention appeared to have positively influenced the attitudes and TSSE practices of melanoma survivors. This study provides important qualitative information about how a digital health care intervention is an effective means of prompting, recording, and responding to structured TSSE by melanoma survivors. Technical improvements are required, but the app offers promise for technologically enhanced melanoma follow-up in future.

Keywords
Mobile apps; Melanoma; Early detection of cancer; Qualitative interviews; Cancer survivorship

Notes
Acknowledgments This study was supported by a grant from the Cancer Research UK Population Research Committee project award (C10673/A21685). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of Cancer Research UK. The funder (through their peer review and funding board review process) approved the study proposal, but had no role in the collection, analysis, interpretation of data, or writing of the report. The authors gratefully acknowledge the time and commitment of the participants who provided their time to be interviewed in the study. They also acknowledge the contribution of Billy Brant, Dermatology Nurse Practitioner, National Health System Grampian, to the day-to-day running of the study, for taking part in the interview, and for commenting on the draft manuscript. The authors acknowledge the support of Andrea Fraser of the ASICA trial team from the Centre of Healthcare Randomized Trials at the University of Aberdeen. They also acknowledge Hazel Riley, who transcribed the interviews for analysis.

Journal
JMIR Dermatology: Volume 6, Issue 1

• Reilly Et Al 2023 JMIR Dermatology