Improved Compliance of Daily Sunscreen Application Through a Simple, Daily, Goal‐Setting Reminder: A Randomized Controlled Trial

Sunscreen mediates the prevention of sunburn, skin cancers, and premature aging caused by sun exposure when applied correctly [1]. Over time, dermatologists, public health advocates, academic institutions, as well as commercial and nonprofit organizations have worked to educate the public about the importance of proactive sunscreen use [2, 3]. Despite widespread awareness of its benefits, many still fail to incorporate daily sun-protective behaviors for various reasons [4]. Numerous public health campaigns aimed at changing underlying attitudes toward sun protection and tanning have shown an increase in sun-protective behaviors, although they have often failed to sustain such change successfully [5]. This study aimed to demonstrate the feasibility of improving compliance with the daily application of sunscreen by performing a simple, daily, goal-setting reminder. This study utilized a two-arm design with eligible participants randomized to: sunscreen instruction only (control) or sunscreen instruction + calendar use (calendar). Inclusion criteria included ages 18–55 years, capacity for informed consent, and understanding of study requirements, English literacy, attendance at follow-up visits, and no history of sunscreen allergies. Exclusion criteria encompassed allergies to sunscreen components or skin infections. All participants received educational information regarding the antiaging and skin cancer prevention benefits associated with daily use of sunscreen and completed a baseline questionnaire on personal and family history of skin cancer and typical sun behaviors related to sun protection. They were provided with a 2-month supply of SPF-30 sunscreen and instructed to apply it every morning to the face and neck. The sunscreen instruction + calendar cohort additionally received a calendar to track sunscreen application with instructions to mark the calendar each day after sunscreen application and were instructed not to “break the chain” of marks, indicating daily use. Participants returned for a follow-up visit after 6 weeks, the remaining sunscreen was collected and weighed, and the participants completed a follow-up survey on sunscreen application and preferences. The primary outcome measured the difference in sunscreen volumes between groups at the end of the study. Regression analysis assessed differences in weight by intervention group. This study was approved by the IRB before initiation. A total of 53 individuals were enrolled. The control group included 25 participants, while the calendar group included 28. Of the 53 total participants, 52 (98%) used at least some of the sunscreen throughout the evaluation period (Table 1). No difference in age was observed between the study arms. The pre-weight of the sunscreen administered was 178 mL for all participants. A notable difference existed in the volume of sunscreen utilized by participants in each study group, with those in the calendar group applying an additional 25 mL compared to the reference group (p < 0.001). The mean and median sunscreen volumes at follow-up were, respectively, 150 (SD = 23) mL and 152 (IQR = 33) mL for the control group, 125 (SD = 22) mL and 126 (IQR = 35) mL for the calendar group, and 137 (SD = 25) mL and 141 (IQR = 35) mL on average (Table 1). This means that the control group used 15.9% of the sunscreen, while the calendar group used 29.9% (Table 1). These usage differences of 14% were statistically significant across all observed measures (p < 0.001). In the context of sunscreen use, the utilization of calendars as a tool to track sun-protective applications can enhance compliance and potentially serve as an effective public health intervention. While educational efforts have successfully raised awareness about the importance of sunscreen in preventing sunburn, skin cancers, and premature aging, challenges remain in translating this awareness into consistent behaviors. Our study demonstrated that integrating a simple calendar-based tracking system alongside sunscreen application instructions may result in a notable increase in compliance. These findings underscore the efficacy of incorporating practical strategies, such as calendar use, to reinforce positive health behaviors. By associating sunscreen application with simple routine activities like marking a calendar, individuals may be more likely to establish and maintain the habit of daily sunscreen use. For this study, we decided to use a physical calendar reminder instead of an electronic calendar on a smartphone. Our decision was based on the thinking that a physical calendar provides a tactile interaction and enhanced visibility. Also, a physical calendar can be less distractive when compared to a calendar on a smartphone, and the clear visibility of a physical calendar provides a visual prompt and better tracking of progress. While our study's scope and duration were limited, and further research is warranted to validate these findings in larger and more diverse populations over longer periods, the results offer valuable insights for designing future public health initiatives. Moving beyond mere education on sunscreen benefits, interventions that integrate practical tools like calendars may hold promise in promoting sustained sunscreen adherence and ultimately reducing the incidence of sun-related skin damage and diseases. Further research into interventions to increase compliance rates is needed [6-9]. All authors contributed substantially to the work presented hereafter. Dr. Wang is a speaker for La Roche-Posay. This study received Institutional Review Board or Ethics Committee approval. The data that support the findings of this study are available on request.