Residents of rural, sparsely populated “frontier counties” in the western United States have a higher incidence of skin cancer and related mortality rates. New research published by Jensen et al in Psychology, Health & Medicine indicated that the biggest obstacle to early detection and treatment may be a chronic lack of skin self-examinations.

Abstaining From Examination

The study sought to identify obstacles to skin self-examinations in these vulnerable populations. The surveyed population (n = 107) was classified into three categories: inclined actors, those actively performing skin self-examinations; inclined abstainers, individuals who intended to perform skin self-examinations but failed to follow through; and disinclined abstainers, individuals who refused to perform skin self-examinations.

Inclined abstainers made up a large portion of those surveyed—43%.

“Frontier adults are not studied much. They are underrepresented and are a vulnerable population in the research because they live in remote areas with limited infrastructure, including medical care,” said study coauthor Manusheela Pokharel, PhD. “What we have found is that a significant portion of people there can be categorized as inclined abstainers, which means these are the people who want to perform skin self-examination but are not actually performing it because of various barriers.”

Compared to those who did follow through, inclined abstainers were more likely to be hindered by 12 various barriers, including forgetting, letting other tasks get in the way of skin self-examination, and struggling to identify a good time or routine for skin self-examination performance. 

“When looking at the obstacles, a lot of these are things that we face in our life. We forget to do something or think that other things are more important than this, not being able to find a way to put these things in our routine,” said Dr. Pokharel. “The barriers to action for these inclined abstainers are modifiable and well-positioned for a behavioral intervention. Our research provides guidance as to what direction a public health initiative should go.”

“Intervention and implementation efforts could be designed to target the inclined abstainers in these frontier areas. They are the low-hanging fruit,” she said. “They also want to do it. It's easier to motivate these people than the disinclined ones. For a lot of them, performing skin examination is hard to remember, so a strategy could be for them to do it the first of every month—developing some type of ritual. Promoting those kinds of things through interventions might yield positive results.”

Disclosure: For full disclosures of the study authors, visit tandfonline.com.