Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Judith Daniels

Clinical Mentor

Dr. Pamela Fletcher

Committee Member

Dr. Angela Grubbs



Background: Skin cancer is the most common form of cancer diagnosed in the U.S. annually, despite being a largely preventable disease through the limitation of ultraviolet radiation exposure. Attempts to decrease its incidence have focused on appearance-based interventions. These have been effective at improving sun-protective behaviors among various subpopulations including people of color. Anecdotal observations suggest mothers more frequently utilize sun protection for their children than on themselves.

Purpose: The purpose of this project was to gain an understanding of the sun protection practices and beliefs of Caucasian and African American mothers, to assess the response to an appearance-based intervention for motivating sun-protective behaviors, and to educate mothers about skin cancer risks and prevention.

Methods: The project was comprised of multiple phases. First, a retrospective chart review was performed to assess the frequency of sun protection counseling at well-child visits for Caucasian and African American children between the ages of four and 18 years. In the intervention phase, mothers completed a survey about their attitudes towards tanning, sun protection, their current practices, and the practices they use for their children. Their actual melanoma risk was calculated using the Self-Assessment Melanoma Risk Score (SAMScore). Next, they used the Sunface App, a facial morphing smartphone application that simulates the effects of sun damage on facial photography. Then, they were provided an educational presentation consisting of the American Academy of Dermatology’s Spot Skin Cancer campaign.

Results: The chart review indicated sun protection occurred at 44% of well-child visits (n = 61) with no significant differences between race, gender, or among the age of the patients. Survey results found no significant difference between racial groups with regards to sun protection beliefs, personal practices, and protection for their children (n =14). Older mothers, and those that reported high frequencies of personal sunscreen use were more likely to put sunscreen on their children (rs = .696, p < .05; rs = .533, p = 0.050, respectively). Having a higher actual risk for melanoma was not associated with more perceived risk of skin cancer by mothers (F=.745, p >.05). Sunface app reactions fell under three main themes: surprise or disbelief, negative feelings about their appearance, or motivation to increase sunscreen use.

Discussion: While few statistically significant results were found in the study, findings indicate a need for education to mothers about their risk for skin cancer development. Future research is needed to determine factors that may influence the inclusion of sun protection counseling at well-child visits including family histories or competing demands. The Sunface application shows promise as a convenient and effective tool to motivate mothers to improve sun protection practices. Qualitative follow-up survey responses (n = 2) indicated participants were motivated to increase sun protection practices following the intervention. Study results and sample size may have been limited by the Fall/Winter timing of the project as well as the percentage of international and low-income patient population at the project setting.

Conclusion: The Sunface application elicited powerful responses by participants and may motivate improved sun protection practices. Primary care providers are in prime, unique positions to counsel their patients on risks for skin cancer and its prevention. With limited visit times and competing demands, alternative methods of providing preventive counseling may need to be considered.