A Randomized Controlled Trial of a Mobile Medical App for Kidney Transplant Recipients: Effect on Use of Sun Protection

Background. Perception of skin cancer risk, belief that sun protection prevents skin cancer, and having sun protection choices enhance sun protection behaviors by kidney transplant recipients, who are at greater risk of developing skin cancer than the general population. Methods. A randomized controlled trial used stratified recruitment of non-Hispanic white, non-Hispanic black, and Hispanic/Latino kidney transplant recipients, who received a transplant 2 to 24 months before the study. The same culturally sensitive SunProtect program was delivered to all recipients with tablet personal computers in 2 urban ambulatory offices. Text messages reminders were provided at 2-week intervals. Self-reported surveys and skin pigmentation measured before the intervention and 6 weeks later were analyzed. Results. Among 552 eligible participants, 170 participated (62 non-Hispanic whites, 60 blacks, and 48 Hispanics). Among participants receiving the intervention with skin that burns after sun exposure and becomes tan or becomes irritated and gets darker, there was a statistically significant increase in self-reported knowledge, recognition of personal skin cancer risk, confidence in sun protection preventing skin cancer, and sun protection behaviors in participants compared with those receiving usual education (P < 0.05). At the 6-week follow-up, participants in the intervention group with skin that burns or becomes irritated had significantly less darkening of the sun-exposed forearm than control participants (P < 0.05). Conclusions. Providing sun protection education with SunProtect in the spring with reminders during the summer facilitated adoption of sun protection behaviors among kidney transplant recipients with skin that burns or becomes irritated.