Barriers and Facilitators to Sun Protection: A Proposal for a Skin Cancer Public Health Prevention Campaign in Atlantic Canada.

Abstract

Background: Regions of Atlantic Canada have the highest incidence rates of cutaneous melanoma in Canada. Despite its preventable nature through sun-safe behaviours, region-specific public health strategies remain limited.

Objective: To explore perceived barriers and facilitators to sun protection in Atlantic Canada, using the Capability, Opportunity, Motivation-Behaviour (COM-B) model to guide intervention development.

Methods: We conducted a qualitative content analysis of 22 focus groups comprising 95 participants across four Atlantic provinces. Transcripts were analyzed using the COM-B model within the Behaviour Change Wheel framework, facilitated by MAXQDA software. Themes related to behavioural capability, environmental opportunity, and motivational factors were identified, with proposed interventions and policies aligned to these domains.

Results: Barriers included challenges in sunscreen application, limited knowledge, chemical concerns, financial barriers, insufficient infrastructure/shade in public spaces, and occupation-specific barriers. Facilitators encompassed heightened awareness following personal experiences with skin cancer, social role modelling, and habit formation. Participants endorsed locally sourced educational and enabling strategies over coercive approaches. Suggested policies included improving sunscreen affordability, integrating sun protection into workplace guidelines, enhancing access to public shade, and leveraging mass media for targeted/region-centred campaigns.

Conclusion: Effective sun protection initiatives in Atlantic Canada should be grounded in the COM-B model, addressing individual capabilities, environmental opportunities, and motivational drivers. A multifaceted, community-informed strategy is needed and preferred to sustainably reduce melanoma risk in this high-incidence region.