Describing, predicting and explaining adherence to Total Skin Self-Examination (TSSE) in people with melanoma: a 12 month longitudinal

Julia Allan* (Corresponding Author), Derek Johnston, Marie Johnston, Peter Murchie

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: To describe trajectories in melanoma survivors’ adherence to monthly total skin self-examination (TSSE) over 12 months, and to investigate whether adherence trajectories can be predicted from demographic, cognitive or emotional factors at baseline.
Design: A longitudinal observational study nested within the intervention arm of the ASICA randomised controlled trial.
Setting: Follow up secondary care in Aberdeen and Cambridge UK.
Participants: n=104 adults (48M/56F; mean age 58.83 years, SD 13.47, range 28-85 years; mean SIMD score 8.03, SD 1.73, range 2-10) who had been treated for stage 0-IIC primary cutaneous melanoma in the preceding 60 months and were actively participating in the intervention arm of the ASICA trial.
Interventions: All participants were using the ASICA intervention – a tablet-based
intervention designed to support monthly TSSE.
Primary and secondary outcome measures: The primary outcome was adherence to guideline recommended (monthly) TSSE over 12 months. This was determined from timestamped TSSE data recorded by the ASICA intervention app.
Results: Latent growth mixture models identified 3 TSSE adherence trajectories (adherent -41%; drop-off -35%; and non-adherent -24%). People who were non-adherent were less likely to intend to perform TSSE as recommended, intending to do it more frequently (OR=0 .21, (95% CI 0.06, 0.81, p=.023) and were more depressed (OR =1.31 (CI , 1.06, 1.61, p=.011) than people who were adherent. People whose adherence dropped-off over time had less well developed action plans (OR=0.78, CI 0.63,0.96, p=.016) and lower self-efficacy about TSSE (OR =0.92, CI 0.86,0.99, p=.028) than people who were adherent.
Conclusions: Adherence to monthly TSSE in people treated for melanoma can be
differentiated into adherent, drop-off and non-adherent trajectories. Collecting information about intentions to engage in TSSE, depression, self-efficacy and/or action planning at outset may help to identify those who would benefit from additional intervention. Trial registration: Identifier: NCT03328247. Registered 01/11/2017.
Original languageEnglish
JournalBMJ Open
Publication statusAccepted/In press - 11 Aug 2022


  • melanoma
  • Total skin self-examination
  • adherence


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