MySmartSkin Renewal

The goal of the iterative process of enhancing microsatellite stable (MSS) using stakeholder feedback and usability testing is to improve Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) outcomes, which will be assessed in Aims two and three. In Aim two, the investigator focus on effectiveness of the enhanced MSS, testing its effects on survivor-level outcomes including clinical outcomes (e.g., melanomas found). In Aim the, the investigators address the remaining RE-AIM outcomes. Additionally, to proactively identify barriers and facilitators to future scale-up and widespread dissemination and implementation of MSS, the investigators explore multilevel contextual factors identified by key stakeholders drawn from the Practical, Robust Implementation and Sustainability Model (PRISM) domains of the target population, external environment, intervention design, and sustainability infrastructure including costs. The investigators anticipate that incorporating PRISM/RE-AIM throughout the study aims will ensure that the enhanced intervention is responsive to key stakeholder preferences and "design for dissemination," recognizing potential barriers and facilitators to future scale-up and informing our next stage of developing dissemination and implementation strategies to maximize the public health impact of MSS.

This is a type one hybrid effectiveness-implementation study consisting of three aims. Aim one (Months 1-15) focuses on MSS enhancement using stakeholder collaboration. Aim two (Months 16-60) involves the longitudinal randomized control trial (RCT) comparing behavioral outcomes and effectiveness of enhanced MSS versus an educational webpage on Society for Scientific Exploration (SSE) as well as new recurrences/melanomas. Aim three (Months 16-60) is a mixed-methods study with multi-level stakeholders to assess implementation outcomes and identify contextual factors to facilitate scale-up for future dissemination and implementation

Type one hybrid effectiveness-implementation study consisting of three aims. Aim 1 (Months 1-15) focuses on MSS enhancement using stakeholder collaboration. Aim 2 (Months 16-60) involves the longitudinal RCT comparing behavioral outcomes and effectiveness of enhanced MSS versus an educational webpage on SSE as well as new recurrences/melanomas. Aim 3 (Months 16-60) is a mixed-methods study with multi-level stakeholders to assess implementation outcomes and identify contextual factors to facilitate scale-up for future dissemination and implementation. The figure below illustrates the integration of the PHM and implementation science frameworks with the study's aims.

RCT of enhanced MSS testing effectiveness (through SSE, sun protection behavior Involves the longitudinal RCT comparing behavioral outcomes and effectiveness of enhanced MSS versus an educational webpage on SSE as well as new recurrences/melanomas

Assessment of implementation outcomes and key contextual factors from the perspective of multi - level stakeholders

Longitudinal RCT comparing behavioral outcomes and effectiveness of enhanced MSS versus an educational webpage on SSE as well as new recurrences/melanomas

A mixed-methods study with multi-level stakeholders to assess implementation outcomes and identify contextual factors to facilitate scale-up for future dissemination and implementation.

Yes/No for a list of body parts examined during most recent SSE in the last three months. This is the primary outcome because SSE thoroughness is associated with detection of thinner tumors. This will be assessed by Reach, Effectiveness, Adoption, Implementation, and Maintenance(RE-AIM) and Practical, Robust Implementation and Sustainability Model (PRISM).

Yes/No for a list of body parts examined during most recent SSE in the last three months. This is the primary outcome because SSE thoroughness is associated with detection of thinner tumors. This will be assessed by Reach, Effectiveness, Adoption, Implementation, and Maintenance(RE-AIM) and Practical, Robust Implementation and Sustainability Model (PRISM).

Yes/No for a list of body parts examined during most recent SSE in the last three months. This is the primary outcome because SSE thoroughness is associated with detection of thinner tumors. This will be assessed by Reach, Effectiveness, Adoption, Implementation, and Maintenance(RE-AIM) and Practical, Robust Implementation and Sustainability Model (PRISM).

Yes/No for a list of body parts examined during most recent SSE in the last three months. This is the primary outcome because SSE thoroughness is associated with detection of thinner tumors. This will be assessed by Reach, Effectiveness, Adoption, Implementation, and Maintenance(RE-AIM) and Practical, Robust Implementation and Sustainability Model (PRISM).

Yes/No for a list of body parts examined during most recent SSE in the last three months. This is the primary outcome because SSE thoroughness is associated with detection of thinner tumors. This will be assessed by Reach, Effectiveness, Adoption, Implementation, and Maintenance(RE-AIM) and Practical, Robust Implementation and Sustainability Model (PRISM).

This will be assessed by asking the participant at the second follow-up if a melanoma was diagnosed and confirmed by provider via medical records.

This will be assessed by asking the participant at the third follow-up if a melanoma was diagnosed and confirmed by provider via medical records.

This will be assessed by asking the participant at the fourth follow-up if a melanoma was diagnosed and confirmed by provider via medical records.

This will be assessed by asking the participant at the first follow-up what stage melanoma was diagnosed, if diagnosed. Response will be confirmed by provider via medical records.

This will be assessed by asking the participant at the second follow-up what stage melanoma was diagnosed, if diagnosed. Response will be confirmed by provider via medical records.

This will be assessed by asking the participant at the third follow-up what stage melanoma was diagnosed, if diagnosed. Response will be confirmed by provider via medical records.

This will be assessed by asking the participant at the fourth follow-up what stage melanoma was diagnosed, if diagnosed. Response will be confirmed by provider via medical records.

This will be assessed by asking the participant at the first follow-up the thickness of his/her melanoma, if diagnosed. Response will be confirmed by provider via medical records.

This will be assessed by asking the participant at the second follow-up the thickness of his/her melanoma, if diagnosed. Response will be confirmed by provider via medical records.

This will be assessed by asking the participant at the third follow-up the thickness of his/her melanoma, if diagnosed. Response will be confirmed by provider via medical records.

This will be assessed by asking the participant at the fourth follow-up the thickness of his/her melanoma, if diagnosed. Response will be confirmed by provider via medical records.

This will be assessed by asking the participant at the first follow-up the date of his/her melanoma diagnosis, if diagnosed. Response will be confirmed by provider via medical records.

This will be assessed by asking the participant at the second follow-up the date of his/her melanoma diagnosis, if diagnosed. Response will be confirmed by provider via medical records.

This will be assessed by asking the participant at the third follow-up the date of his/her melanoma diagnosis, if diagnosed. Response will be confirmed by provider via medical records.

This will be assessed by asking the participant at the fourth follow-up the date of his/her melanoma diagnosis, if diagnosed. Response will be confirmed by provider via medical records.

This will be assessed by asking the participant at the first follow-up if a melanoma was diagnosed and confirmed by provider via medical records.

This will be assessed by asking the participant if he/she has health insurance coverage in the baseline survey.

This will be assessed by asking the participant in the baseline survey the date that he/she was diagnosed with skin cancer.

This will be assessed by asking the participant in the baseline survey the stage of cancer he/she was diagnosed with.

This will be assessed by asking the participant in the baseline survey what treatment he/she received.

This will be assessed by asking the participant in the baseline survey what color eyes he/she has. Eye color is an important covariate as certain eye colors pose as a risk factor for melanoma.

This will be assessed by asking the participant in the baseline survey what color hair he/she has. Hair color is an important covariate as certain hair colors pose as a risk factor for melanoma.

This will be assessed by asking the participant in the baseline survey what skin color he/she has. Skin color is an important covariate as certain skin colors pose as a risk factor for melanoma.

This will be assessed by asking the participant in the baseline survey how reactive his/her skin is to the sun. Skin reactivity is an important covariate as certain skin reactivity levels pose as a risk factor for melanoma.

This will be assessed by asking the participant in the baseline survey how many freckles are present on his/her skin. Freckling is an important covariate because it can pose as a risk factor for melanoma.

This will be assessed by asking the participant in the baseline survey how many moles are present on his/her skin. Number of moles is an important covariate because it can pose as a risk factor for melanoma.

This will be assessed by asking the participant in the baseline survey about his/her sunburn history. Sunburn history is an important covariate because it can pose as a risk factor for melanoma.

This will be assessed by asking the participant in the baseline survey about his/her indoor UV tanning behaviors. Indoor UV tanning is an important covariate because it can pose as a risk factor for melanoma.

This will be assessed by asking the participant in the baseline survey about his/her family history of melanoma. Family history is an important covariate because it can pose as a risk factor for melanoma.

This will be assessed by asking participant in the baseline survey in what month he/she is completing the survey

This will be assessed by asking participant in the first follow-up survey in what month he/she is completing the survey

This will be assessed by asking participant in the second follow-up survey in what month he/she is completing the survey

This will be assessed by asking participant in the third follow-up survey in what month he/she is completing the survey

This will be assessed by asking participant in the fourth follow-up survey in what month he/she is completing the survey

This will be assessed by asking participant in the baseline survey in what location he/she is completing the survey

This will be assessed by asking participant in the first follow-up survey in what location he/she is completing the survey

This will be assessed by asking participant in the second follow-up survey in what location he/she is completing the survey

This will be assessed by asking participant in the third follow-up survey in what location he/she is completing the survey

This will be assessed by asking participant in the fourth follow-up survey in what location he/she is completing the survey

Assessing the average UV index at solar noon over the 3 months prior to baseline survey submission. This will be determined by the study staff based on the month and location of assessment information provided by the participant in the baseline survey.

Assessing the average UV index at solar noon over the 3 months prior to the first follow-up survey submission. This will be determined by the study staff based on the month and location of assessment information provided by the participant in the first follow-up survey.

Assessing the average UV index at solar noon over the 3 months prior to the second follow-up survey submission. This will be determined by the study staff based on the month and location of assessment information provided by the participant in the second follow-up survey.

Assessing the average UV index at solar noon over the 3 months prior to the third follow-up survey submission. This will be determined by the study staff based on the month and location of assessment information provided by the participant in the third follow-up survey.

Assessing the average UV index at solar noon over the 3 months prior to the fourth follow-up survey submission. This will be determined by the study staff based on the month and location of assessment information provided by the participant in the fourth follow-up survey.

Inclusion Criteria: Diagnosis of primary pathologic stage 0-III cutaneous malignant melanoma Three months to five years post-surgery No current evidence of cancer Not adherent to thorough SSE (i.e., did not check entire body at least once during the past three months) ≥ 18 years old Internet access Able to speak/read English Able to provide informed consent Exclusion Criteria: Children