Melanoma awareness and prevention among latinx and non‐latinx white adults in urban and rural California: A qualitative exploration

Abstract

Background Melanoma mortality rates in the US are highest among older men, individuals of lower socioeconomic status (SES), and people of color. To better understand these inequities, a qualitative exploratory study was conducted in Northern and Southern California to generate knowledge about barriers and facilitators of awareness, prevention, and early detection of melanoma in lower SES Latinx and non‐Latinx White (NLW) individuals living in urban and semi‐rural areas. Methods Nineteen focus groups were conducted ( N = 176 adult participants), stratified by race/ethnicity (Latinx, low‐income NLW), geography (semi‐rural, urban), and language (English and Spanish). Inductive and deductive thematic analysis was conducted, and the findings were organized using the socioecological model framework: individual, interpersonal, community, and health system/policy levels. Results Four socioecological themes describe how key factors affect knowledge, perceived risk, preventive behaviors, and melanoma screening. Individual level findings revealed that many participants were not familiar with melanoma, yet were willing to learn through trusted sources. Having brown or darker skin tone was perceived as being associated with lower risk for skin cancer. Interpersonally, social relationships were important influences for skin cancer prevention practice. However, for several Latinx and semi‐rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi‐rural participants reported distance or lack of transportation to a clinic as challenges for accessing dermatology care. Healthcare systems barriers included burdens of additional healthcare costs for dermatology visits and obtaining referral. Conclusions Varying factors influence the awareness levels, beliefs, and behaviors associated with knowledge, prevention, and early detection of melanoma among low‐income Latinx and NLW individuals and in semi‐rural areas. Results have implications for health education interventions. Navigation strategies that target individuals, families, and health care settings can promote improved prevention and early detection of melanoma in these communities.

Analyzing County‐level Social Vulnerabilities of Head and Neck Melanomas in the United States

“…In comparison to these findings, Mesia et al conducted a qualitative exploratory study to determine what barriers exist for malignant melanoma patients with lower socioeconomic status in California, finding that living in distance and lack of transportation to clinics were significant barriers for them to access dermatological care. 10 However, few studies beyond this have assessed how housing and transportation affect outcomes and follow-up of malignant melanoma. Thus, our investigation and methodology highlights a potential new area of inquiry for better understanding potential targets in providing equitable dermatological health care across lower socioeconomic populations while accounting for real-world, sociodemographic contexts.…”

“…These findings are especially significant because minority‐language status is often indicated as an important contributor to outcomes of melanoma, but has never been incorporated into an interactional analysis such as this. In comparison to these findings, Mesia et al conducted a qualitative exploratory study to determine what barriers exist for malignant melanoma patients with lower socioeconomic status in California, finding that living in distance and lack of transportation to clinics were significant barriers for them to access dermatological care 10 . However, few studies beyond this have assessed how housing and transportation affect outcomes and follow‐up of malignant melanoma.…”

Patient Perspectives on Social Risk Screening and Documentation in a Dermatology Clinic

“…Yet consideration of social risk factors is a component of providing person-centered dermatologic care. Transportation challenges, including unreliable transportation and distance to care, affect health care access and are factors in accessing dermatologic care . Housing status and housing quality are associated with dermatologic diagnoses and affect clinical decision-making …”

“…Transportation challenges, including unreliable transportation and distance to care, affect health care access 12 and are factors in accessing dermatologic care. 13,14 Housing status and housing quality are associated with dermatologic diagnoses and affect clinical decision-making. [15][16][17][18] Furthermore, lower socioeconomic status (SES) is associated with increased severity of chronic inflammatory skin conditions, including atopic dermatitis and hidradenitis suppurativa, 16,19 and poor melanoma survival.…”