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A sun protection tale as a method to create healthy behaviours in Latin children

Lead Dermatologist: Dr. María S. Aluma
Project team members:
Affiliation: Aurora Skin Cancer Centre, Colombia

 

A Sun protection tale as a method to create healthy behaviors in Latin children

 

The aim of this study is to evaluate the impact of a fun new tale created to educate and generate sun-safe behavior in elementary children that will form long-lasting habits.

Video

Executive summary

Learning processes during childhood are known for leaving a mark in children that remain for all their life. Therefore, to strengthen learning processes it is necessary to make them pleasing and fun. With this in mind, and knowing that ultraviolet radiation is an important risk factor for developing skin cancer, it is worth trying to create consciousness and generate sun-protection behaviours since childhood, with the goal of making long-lasting habits. The aim of this study is to evaluate the impact of a newly designed tale about sun-protection behaviours in kids of elementary school in Colombia.

The challenge

Currently there is a lack of consciousness about sun effects and the importance of sun-protection behaviours in many Latin American countries. This may be due to the erroneous concept of skin colour as a natural protection against ultraviolet radiation and skin cancer. Colombia is not the exception to this problem; in fact, a reflection of this is the increasing number of skin cancer cases every year, affecting persons no matter their type of skin.

With this in mind, it is imperative to create educational programs in Latin populations to change concepts and generate long-lasting healthy behaviours, with the intention of reducing the number of skin cancer cases. To begin with any intervention, it is important to select the appropriate group. Since children spend a great part of their time outdoors, and sunburns in childhood are associated with melanoma, children can be considered a target group for an educational intervention about sun-protection. Moreover, knowing that learning processes during childhood can leave behaviours and habits for the rest of the life, this population becomes an ideal cohort.

In sum, knowing that UVR is currently considered the only preventable environmental cause for skin cancer (i.e. melanoma), and that behaviours and habits can be learned since childhood, education during childhood may be an important core task in skin cancer prevention.

Project overview

A new tale / story about sun protection has been written in the format of a friendly short book with illustrations created by a children´s book designer. The study aims to evaluate the impact of this sun-tale in the learning processes and sun-protection behaviours in a cohort of children from second grade in a school of the city of Medellin, Colombia.

How will the study be conducted?

The children will be included in the study if they have between 6 and 8 years of age and if their parents give the consent to participate in the study.

First session: The research staff will perform a survey about sun-protection to the children during a class-day. A psychologist will design this survey. Once the surveys are completed, a tale about sun effects and sun-protection will be read to the children. At the end, there will be time for questions and answers. All the children will be given a copy of the sun tale to take home.

Second session: One week after the first session, the research staff will perform the same survey from the first session to the children. All the surveys will be collected the same day.

Third session: Three months after the first session, the research staff will perform the same survey from the first session to the children. All the surveys will be collected the same day. An additional survey will be performed to the teacher(s) in charge of the kids, as well as the parents or the person in charge of the child. This additional survey aims to evaluate if there are new sun-protection behaviours and habits.

Fourth session: Six months after the first session, the research staff will perform the same survey from the first session to the children, and the teacher´s and parent´s survey will also be sent.

All data will be collected in an Excel Microsoft Office 2007® (Microsoft Corporation, Redmond, Washington, US) document. Data will be analysed using the software SPSS® version 22.0 (SPSS Inc; Chicago, Illinois, US).

This project is viable since it’s a low risk study and costs may not exceed the amount of the SKINPACT grant.

Success criteria and evaluation

We will evaluate the success of the study using surveys, which will be performed to the children, teachers and parents, at different time-points (before and after the initial sun tale intervention). With the acquired data, we will be able to determine if the intervention was appropriate and enough to create or generate sun-protection behaviours in the children of the cohort. If this is positive, the study can be shared with other educational institutions, to be considered for their inclusion in educational curriculums.

Results of this study will be published in an academic medical journal.

Interview

An interview with the 2015 SKINPACTAward winner in the Excellence in Education category, Community Vote Award:
Dr. Maria S Aluma

“The SKINPACT Award is an excellent opportunity to show the world and the dermatology community one of our initiatives in research. This award provided the support we needed to implement a simple solution to fight a frequent problem: skin cancer. The SKINPACT Award inspired us to go beyond our regular practice in dermatology, looking for higher commitments within our community.”

Dr. Maria S Aluma
Aurora Skin Cancer Centre, Colombia

What motivated you to submit a project application to the SKINPACT Awards?
The motivation of our team to apply for this grant was the affinity of our line of research with one of the two categories of the award: excellence in education. We were working on the creation and design of a story for children of elementary school age aimed at teaching them about photoprotection. We saw the SKINPACT Awards as a great opportunity to become part of a network of support that will help us to implement and disseminate this idea.

What is your project’s theme?
Promote sun protection behaviour in Latin America children.

After winning the Award and grant, how did you proceed with executing your project?
As we planned a clinical trial involving children, the first step was to send our project to an ethical committee for review and approval. With the support of an epidemiological program at the Universidad Pontificia Bolivariana, we calculated the number of children we needed for the clinical trial, and obtained the clusters for each school. We then asked for permission to execute the investigation in the schools. Once we received informed consent from the institution and the parents, we scheduled the day for the intervention.

We expect to finish this stage of the intervention in mid-April and then continue with the application of the other surveys. Once we collect all the information, we will continue with the analysis and report writing.

What are the goals and measures of success for your project?
We wrote a story about sun protection in the format of a short, friendly book. The study involves sharing the story, within a clinical trial setting, with different groups of 4 and 5 year-old children from schools of Medellin, Colombia and the metropolitan area. The main goal of the study is to evaluate the impact and utility of the story on the learning processes of sun-protection concepts and behaviours, compared with basic strategies of information. To measure our success, the staff will carry out a survey amongst the children to evaluate the comprehension of sun protection concepts after the intervention.

Three months later, the staff will perform another survey to evaluate whether the children remember the concepts around sun protection that they learned after the intervention. In addition, at the third and sixth month after the intervention, a different survey will be performed to evaluate changes in sun protection behaviours.

What stage is your project at today?
At the moment, we are continuing with our intervention in the schools.

So far, we have carried out the intervention in close to three hundred children in fourteen educational institutions. The activity has been evaluated as pleasant and fun for the children, teachers and parents.

Who is working with you on your project?

  • Carolina Tamayo, RNP
  • MRes Tamayo is a nurse from Universidad Pontificia Bolivariana, Medellin, Colombia; and a teacher in clinical epidemiology. MRes Tamayo is also an attending nurse, epidemiologist and coordinator of the investigative program at Aurora Skin Cancer Center in Medellin, Colombia.
  • Natalia Jaimes, MD
  • Dr. Jaimes is a Dermatologist from Medellin, Colombia. She completed her medical school and Dermatology residency at Universidad Pontificia Bolivariana in Medellín. Dr. Jaimes did a research fellowship in skin cancer at Memorial Sloan-Kettering Cancer Center in New York. Currently, she works as the chief director at the Dermatology service in Universidad Pontificia Bolivariana and Aurora Skin Cancer Center, Medellin, Colombia.
  • Ana M. Muñoz, MD
  • Dr. Muñoz is currently doing her third year of residency in dermatology at Universidad Pontificia Bolivariana in Medellin

What would be the impact of your project? How do you think your project will make a difference in the real world setting?
The beauty of our project is that, with a simple solution like a story, we are planning to generate awareness in childhood of the most important risk factor for development of skin cancer. We all know that skin cancer is the most frequent cancer in the world, and is increasing in incidence.

Although, there have been several previous projects with the same goal, we think that our work represents a more thoroughly developed and appropriate tool to generate impact at this age. If we can prove that our story works in children, we will have the first step to create and adequate program of photoprotection from a young age.

What would you say to professionals who wish to apply to the SKINPACT Awards?
Think with the heart for a subject that makes you passionate about your work, and then imagine a specific topic to show how that subject could improve in your daily practice. A lot of great ideas can evolve that way.

Finally, could you give some words of encouragement to inspire those who have ideas and initiatives?
A lot of satisfaction comes when you realize that you can give more to your patients and your community than what you initially expect. It just requires you to step outside your normal daily practice. Then you realize that a simple change in your routine at work can create a circle of giving and receiving that never ends.

A little bit more about Dr. Aluma…
"On a typical working day...

I work at the Aurora Skin Cancer Center.
Aurora is a clinic located in Medellín – Colombia – South America. Most of my patients have skin cancer or are at risk of developing it.

Half of my time I do Mohs surgery, and the rest of the time, I do minor procedures, patient consultation, some research, and manage projects of prevention and education, as the executive director of the Colombian Skin Cancer Foundation”