• Caitlin Horsham, Peter Baade, Kou Kou, Montana O'Hara, Craig Sinclair, Lois J Loescher, H Peter Soyer, and Monika Janda.
• Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
• Am J Prev Med. 2021 Sep 1; 61 (3): 348-356.

IntroductionText messaging is an effective way to reach large populations with health promotion support. This study aims to establish the optimal text messaging intervention to achieve behavior change in young adults at risk of skin cancer.Study DesignLatin square crossover RCT.Setting/ParticipantsParticipants were women and men aged 18-40 years living in Queensland, Australia who owned a smartphone and had ≥2 skin cancer risk factors.InterventionParticipants were enrolled from December 2018 to February 2019 and completed an eligibility survey. Eligible participants were randomized to 4 different text message interventions using a Latin square design with varying personalization, interactivity, and message frequency (February 2019‒July 2019). Each intervention lasted for 1 month; between interventions, participants had a 1-week washout period in which they completed an online questionnaire. Participants completed a 6-month follow-up online survey in January 2020.Main Outcome MeasuresMeasures included self-reported sun protection habits and sunburns.ResultsA total of 277 (71.2% response rate) participants completed the 6-month follow-up. The sun protection habits index was significantly higher in all the 4 text messaging interventions (p<0.01 for each intervention) than at baseline, with similar sun protection habits improvements among all interventions (p=0.27). Sunburn rates decreased significantly over time (p<0.01 each intervention), with all the 4 interventions achieving reductions in sunburn rates during the intervention periods (p=0.78). Overall, the sunburn rates decreased from 40.3% at baseline to 7.0% at the end of the intervention, and at 6-month follow-up, it remained significantly below baseline levels at 23.5% (p<0.01).ConclusionsRegular text messaging interventions result in significantly increased sun protection and decreased sunburn in young adults.Trial RegistrationThis study is registered at the Australian and New Zealand Clinical Trials Registry ACTRN12618001299291.Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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