Development of an instrument for assessing awareness of skin cancer risks and preventive behaviors with older outdoor workers

Early skin cancer detection helps minimize morbidity and mortality, yet no risk awareness instrument currently exists for older outdoor workers. This study aimed to obtain input from older outdoor workers to inform the usability and feasibility of the Skin Cancer Awareness Instrument for Health Promotion Enhancement (SCAI-HoPE) through a two-phase qualitative design. In phase I, instrument items were developed from the experiences of 12 rural older farmers, highlighting the need for support systems to improve skin cancer prevention access. Phase II involved cognitive interviews with six older farmers, with thematic analysis to identify four themes: (1) unfamiliar terminology, (2) unclear phrasing, (3) respondents' fatigue with several items about sunscreen, and (4) irrelevant items and response options. Findings guided item refinements to develop a comprehensive instrument for assessing skin cancer risk, sun-protective behaviors, and social support needs, enhancing awareness and prevention efforts for outdoor workers, especially those with limited healthcare access.