Developing an Online Tool to Promote Safe Sun Behaviors With Young Teenagers as Co-researchers

Abstract

Despite education about the risks of excessive sun exposure, teenagers in Australia are sun-seeking, with sunburn common in summer. Conversely, some regular (time-limited) exposure to sunlight (that avoids sunburn) is necessary for vitamin D and healthy bones and other molecules important for immune and metabolic health. New interventions are thus required to better support teenagers to make healthy and balanced decisions about their sun behaviors. This paper describes the development of a prototype online tool-a smartphone app-that aimed to foster safe sun practices in teenagers. We recruited young adolescents (aged 12-13 years, n = 24) as "co-researchers" to provide ongoing input into the nature and design of the online tool. This age group was selected, as it is a critical time when young people transition from primary education, where "SunSmart" behaviors are entrenched in Australian schools, to high school, where risky behaviors emerge. Through a series of interviews and workshops, we codesigned an Apple iOS smartphone app with the co-researchers, leading health promotion professionals, researchers, and app designers. The developed app, Sun Safe, contains educational content relevant to teenagers about safe sun behaviors, complemented by other features requested by co-researchers and stakeholders to help engage young people, including gamified quizzes to test their sun health knowledge, real-time weather data on the UV Index and temperature, a sunscreen application timer, and reminders to check the UV Index. The developed prototype app was rated well by co-researchers, suggesting it is suitable for further feasibility and efficacy testing as an intervention tool to improve knowledge and promote safe sun behaviors by young adolescents.

Keywords: app development; co-researchers; health promotion; online tool; skin cancer; sun exposure; teenagers; vitamin D.

Figure 1

Schema depicting co-researcher recruitment, including number, gender mix, and age for those participating in each activity.

Figure 2

(A) Ideas generated by researchers attending a design thinking session from a How-might-we brainstorm addressing the question, “How might we help young teenagers get vitamin D from safe sun practices?” (B) These ideas were rapidly categorized into five major themes, which were: (1) Can we engage boys? (2) information on safe sun practices; (3) a smart device for kids; (4) schools; and, (5) parents.

Figure 3

(A) Ideas generated by co-researchers (n = 20) attending Workshop 1 from a How-might-we brainstorming addressing the question, “How might we use technology to support sun safe practices?” that were categorized into a “Methods” theme (only 37 of 46 final ideas depicted). Co-researchers were invited to vote (via secret ballot using the Mentimeter online tool) for their top 3 favorite ideas of 21 selected by researchers at the workshop, with a screenshot of the Mentimeter poll results shown in (B) and these results re-graphed (for clarity) in (C) for 69 votes cast in total. n.b. Only 13 of 20 co-researchers attending the workshop participated in this poll, during which problems with Wi-Fi were experienced. SPF, sun protective factor.

Figure 4

Wireframe of the Sun Safe app. Features of the wireframe included: (A) home page with that day's maximal UV Index and temperature data; (B) more detailed predictive data on the UV Index and temperature and times when to use sun protection (accessed via arrow on right-hand side of UV Index data on the home page); (C) educational content in “Learn” feature; (D) embedded quiz content in “Quizzes” feature; (E) capacity to set daily “Notifications” to check the UV Index; and (F) capacity to set an “Applied Sunscreen” timer (“Reminder set”), which counts down 2 h from when sunscreen is applied and sends a notification to reapply.

Figure 5

Co-researcher preferred name and artwork for the Sun Safe app. (A) A secret ballot was conducted during Workshop 2, asking co-researchers to nomimate their 3 preferred names for the developed wireframe, with 18 co-researchers providing a total of 50 votes. (B) App artwork (icons) developed through the 99Designs platform.

Figure 6

Co-researcher assessments of the wireframe and fully working protype of Sun Safe app. After using the (A) wireframe or (B) fully developed Sun Safe app for 20 min in Workshops 2 and 3 (respectively), co-researchers were asked to complete a subjective seven-item assessment. In (A), responses from 18 co-researchers (one on 2 occassions), and in (B), responses from 14 co-researchers. In (C), co-researchers attending Workshop 3 were asked to rate four main “features” of the Sun Safe app (responses from 13 co-researchers only). Each item/feature was assessed using a 5-point Likert scale (from 1 star = strongly disagree to 5 stars = strongly agree), with bars denoting mean values and error bars denoting SD, with individual responses also shown.

Figure 7

Screenshots of the fully functional Sun Safe app to be tested in intervention studies. Features of the app included: (A) home page with that day's maximal temperature and UV Index and access to other features; (B) more detailed predictive data on the maximal temperature and UV Index linked to times when to use sun protection for that day and subsequent days, accessed through “View this week” button; (C) educational content in “Learn” feature; (D) “Easy” and “Hard” quizzes in “Quiz” feature; (E) capacity to set daily “Notifications” to check the UV Index; and (F) capacity to set a “Sunscreen Reminder” (through “SET REMINDER” button) for up to 2 h from when sunscreen is first applied, with a notification sent to reapply.