Ultraviolet arrows signal immediate, ever-present danger: development and evaluation of a skin cancer prevention campaign to improve young adults’ sun protection in Australia

OBJECTIVES AND IMPORTANCE OF STUDY: Melanoma of the skin is highly preventable, with >97% of cases in Australia/New Zealand caused by overexposure to ultraviolet radiation. Young adults aged 18-24 years are at greater risk of overexposure than older adults due to lower use of some forms of sun protection, spending more time in the sun, and being more likely to attempt tanning and experience sunburns. This paper covers the extensive research undertaken to develop and evaluate a new skin cancer prevention campaign to improve sun protection among young adults in New South Wales, Australia. METHODS: Underpinned by a customised theory of change logic model, campaign development was informed by qualitative formative research (ethnographic immersions and focus groups, n = 56), concept testing (online interviews, n = 70) and pre-testing (online survey, n = 416) with 18-24-year-olds. Campaign effectiveness was evaluated through the Cancer Institute NSW Skin Cancer Online Tracking Survey (n = 927 18-24-year-olds). RESULTS: Building on formative qualitative research into sun protection barriers and enablers, concept testing identified the need to depict ultraviolet radiation as a credible threat that evokes fear of immediate harm across diverse settings. It also highlighted the importance of showing young adults using effective sun protection behaviours. Online pre-testing revealed the importance of imagery being motivating, but not overly confronting. Evaluation of the 2023/2024 campaign found that young adults' self-reported campaign exposure was associated with greater concern about developing melanoma (74%, vs 64% of non-recognisers, P < 0.05), and greater intention to adopt sun protection behaviours (wear a hat (72%, vs 65%, P < 0.05), wear a wide-brimmed hat (32%, vs 22%, P < 0.05) and wear clothing that protects skin (64%, vs 57%, P < 0.05)). CONCLUSIONS: Iterative qualitative and quantitative research provided valuable learnings to inform, develop, enhance and evaluate the Cancer Institute NSW's If You Could See UV skin cancer prevention campaign.