1. Creation of New Sun Safety Messages for Canada Loraine Marrett, 1 Maria Chu 1 for the Ontario Sun Safety Working Group 1 Cancer Care Ontario 1 Building Consistent Messages: Knowledge to Practice Canadian Public Health Association 29 May 2014

2. Outline Sun Safety Messaging Background Skin Cancer Prevention Strategy Knowledge Translation Objectives 1.Knowledge: Create messages Evidence review and summary Message format Consensus process 2.Practice: Message utilization by national etc organizations Uptake towards tailored interventions Conclusions 2

3. Between 1996 and 2006, Canadians increased their time in the sun without improving protective behaviours, suggesting sun safety strategies are not working. Consistent messages are a key component of strategy National consensus on messages was last achieved in Canada in 1994. Organizations have modified messages inconsistently since then. A broad consultation in 2008 concluded that messages in use did not always reflect current science and that there were gaps (e.g., vitamin D). Why new sun safety messages? 3

4. 4 Skin Cancer Prevention Strategy Ontario Sun Safety Working Group. Insight On Cancer (2010). Sun Exposure and Protective Behaviours in Ontario - An Ontario Report based on the 2006 Second National Sun Survey Insight on Cancer, 2010 Health Promotion Actions*: A. Develop personal skills B. Build healthy public policy C. Strengthen community action D. Create supportive environments E. Re-orient health services * Based on Ottawa Charter for Health Promotion,1986

5. Knowledge Translation “[A] dynamic and iterative process that includes synthesis, dissemination, exchange and ethically- sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system”- Canadian Institute of Health Research, 2014 5

6. Objectives of Sun Safety Messaging Project Using knowledge translation principles: 1. Knowledge: Sun Safety message creation Develop messaging to inform sun safe behaviours through iterative evidence review process 2. Practice: Utilization of sun safety message recommendation document by national etc organizations in the creation of tailored interventions Uptake of consistent messaging in informing tailored sun safety interventions 6

7. Objective 1: Create messages 7 Knowledge Creation based on evidence= Core of message creation Knowledge translation  Knowledge to practice (action) Knowledge Practice KTClearinghouse (2013) Knowledge to Action Cycle

8. Levels of sun safety message creation 8 Primary Studies Consensus Process Resulting message recommendation document Action Cycle Sun safety message recommendation document end-users OSSWG*/Expert Panel draft Expert international consultation Focus groups  Public health units KTClearinghouse (2013) Knowledge to Action Cycle *Ontario Sun Safety Working Group Uptake

9. Approach to sun safety messaging revision The Ontario Sun Safety Working Group (OSSWG) leads the work, following these steps: 1.Identify gaps in existing messages; 2.Establish current evidence and draft revised messages and evidence packages across the message domains through expert consultation; 3.Focus testing of the tool as a foundation for programming among public health professionals and external review by international experts; 4.Host workshop to achieve consensus among national organizations; and 5.Disseminate final messages document. 9

10. Message recommendations document structured around seven topics: 1. Main topic, with key actions: Exposure and time in the sun 2.Shade 3.Protective clothing and hats 4.Eye protection 5.Sunscreen 6.Tanning equipment 7.Vitamin D Message recommendations document Draft 10

11. 11 Consistent with CDC’s MessageWorks & The Health Communication Unit’s toolkit to effective message (“What”? “So what?” and “Now what?”) Each topic contains concise sections summarizing: 1. What should individuals know about the protective measure or risk? 2. Now what ? What should they do ? 3.More details 4.What does the evidence say? Document preface states the overarching “ so what ” of the message recommendations. Messaging layout Centers for Disease Control and Prevention (n.d.) MessageWork Guidance The Health Communication Unit (2009). Overview of Developing Health Communication Campaigns Toolkit

12. 12 Messaging layout example

13. 13 Msg creation next step: Consensus process 1.Pre- consultation period Invitation to representatives from end-user organizations across the country Garner interest of participation in a national coordinating committee Distribute draft document and feedback template for review prior to workshop 2.Consensus workshop On-day event Led by professional facilitator National coordinating committee development 3.Post-workshop consultation period Incorporate feedback from workshop Discuss outstanding areas of disagreement Consensus on document Disseminate 13

14. Objective 2: Utilization by “all” organizations in sun safety Practical use of messages in outer Action Cycle Comprehensive uptake of messages to inform consistent tailored sun safety interventions Establish process for ongoing revision and consensus 14 KTClearinghouse (2013) Knowledge to Action Cycle

15. Conclusions Knowledge translation has informed revised sun safety messaging process New messages are structured to enhance uptake and to support incorporation into specific health promotion programs—including short summaries of the evidence behind messages. A formal collaboration of Ontario sun safety professionals and organizations has successfully driven this project, despite very limited dedicated resources. Consistent sun safety public messaging is critical to success: getting buy- in of the multitude of dermatology, optometry, cancer and public health organizations at the national level will be key and presents a challenge, given the absence of any national coordinating group for sun safety. 15

16. Acknowledgements Expert panel members Dr. Antony Cullen, Distinguished Professor Emeritus, School of Optometry, University of Waterloo Dr. Vitali Fioletov, Research Scientist—Ozone and UV studies, Environment Canada Dr. Lynn From, Dermatologist and Dermatopathologist, Women’s College Hospital* Dr. David Hanley, Division of Endocrinology and Metabolism, Professor, Medicine, Community Health Sciences and Oncology, University of Calgary Mr. George Kapelos, Associate Professor, Architectural Science, Ryerson University* Dr. Loraine Marrett, Senior Scientist, Prevention and Cancer Control, Cancer Care Ontario and Professor, Dalla Lana School of Public Health, University of Toronto (Co-Chair)* Ms. Kaylene McKinnon, Public Health Nurse, Chronic Disease Prevention and Tobacco Control Team, Middlesex-London Health Unit (Co-Chair) Dr. Sami Qutob, Research Scientist, Consumer and Clinical Radiation Protection Bureau, Health Canada Dr. Cheryl Rosen, Head, Division of Dermatology, Toronto Western Hospital, University Health Network Hospitals and Mount Sinai Hospital, Professor, Department of Medicine, University of Toronto, and National Director, Sun Awareness Program, Canadian Dermatology Association* Dr. Thomas Tenkate, Director, School of Occupational and Public Health, Ryerson University* *Also members of the Ontario Sun Safety Working Group 16 John Atkinson, Canadian Cancer Society Diane Desjardins, Ottawa Public Health Chantal Duhaime, Environment Canada Katie Heckman, Melanoma Network of Canada Gina Ing, Toronto Public Health Megan Laan, KFL&A Public Health Lilliana Marinko, Middlesex-London Health Unit Safoura Moazami, Toronto Public Health Sonya Muntwyler, The Regional Municipality of Halton Sylvie Plumstead, Sudbury and District Health Unit Nicole Ritz, City of Hamilton Public Health Services Ontario Sun Safety Working Group

17. Thank you Questions? 17 Loraine.marrett@cancercare.on.ca