PRESOLRE: study protocol for a primary school-based, cluster randomised controlled trial of three sun exposure risk prevention strategies on Reunion Island.

INTRODUCTION: Reunion Island, a French overseas department, is located in the southern hemisphere, close to the Capricorn tropic. This island has a multicultural and multiethnic population of 860 000 inhabitants, a quarter of whom are at high risk of developing skin cancer due to intense ultraviolet radiation. Melanoma is responsible for the majority of skin cancer deaths. The early prevention of melanoma is based on sun protection in childhood, but French regulations are not adapted to the environmental conditions of this tropical region.The main objective of our study is to evaluate the effectiveness of three sun protection programs conducted in Reunionese primary schools through a pupil knowledge questionnaire. METHODS AND ANALYSIS: PRESOLRE is an interventional, open-label, cluster-randomised controlled trial, in four parallel arms, that is being conducted throughout 2022-2023 on Reunion Island. The trial design assumes an escalation interventional effect using: first, a control arm without proposed intervention (arm 1); second, an arm whose classes are encouraged to use the validated educational programme 'Living With the Sun' (LWS) (arm 2); third, an arm whose classes are encouraged to use both 'LWS' combined with 'Mission Soleil Réunion's sun protection awareness programme (arm 3); fourth, an arm benefiting from an intervention similar to arm 3, combined with the distribution of hats, sunglasses and sun creams (arm 4). In all, 1780 pupils from 18 classes of 20 pupils, on average, will be included. Randomisation applies to the classes of pupils (so defined as clusters). The primary outcome is based on the proportion of correct answers to the knowledge questions after the awareness programme, compared between the four arms using a linear mixed model with random intercept. ETHICS AND DISSEMINATION: The study obtained ethics approval in 2022 (ID: 2022-A00350-43). Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05367180.

Attitudes, Barriers, Motivations to Sun Protection in Reunion Island's Schools: Qualitative Study.

The incidence of melanoma in Reunion Island is on the rise and is now one of the highest worldwide. Although the main risk factor of melanoma is sun exposure during childhood, sun protection measures remain insufficient in Reunionese schools. From November 2019 to November 2020, we conducted a qualitative study to explore the attitudes, barriers, and motivations to sun protection among the main actors of children's protection in Reunion Island. Individual semi-directive interviews were performed with 14 children aged 6 to 10 years, 13 parents, and 13 teachers. The interviews were recorded and transcribed. Relevant data were coded, triangulated, analyzed, and then modeled following the methodology of grounded theory. Sufficiency of the data was sought. All 40 participants described their sun protection habits. Protection was lower during school activities than during leisure activities. Parents identified several practical and financial barriers to sun protection. Teachers pointed out the lack of adequate infrastructure and sun protection training. Responsibility for children's protection was a point of disagreement between parents and teachers. Children limited their use of protection, mainly for reasons of comfort. Children's sun protection in schools is the responsibility of educational staff, parents, and society at large. Improving communication between these various actors is necessary. Sun safety campaigns and reorganization of the school environment would allow for better protection of the child population.

[Are advice section illustrations in children's health record books understandable for parents?] / Carnet de santé de l'enfant : les illustrations des conseils aux parents sont-elles compréhensibles ?

BACKGROUND: French child health record books contain preventive care illustrations, which may not always be fully understood. The aim of this study was to describe the degree to which illustrations may be understood in the parent advice section of the French child health record, and to determine the factors associated with poor understanding by young parents. METHOD: A cross sectional survey was conducted on a sample of 80 parents of children aged 6 or younger from two French areas. Each parent was interviewed following a semi-structured questionnaire that incorporated social and demographic factors and questions about each of the eleven illustrations. The main outcome was the number of correct answers compared to number of expected answers. The data univariate analysis was followed by a multivariate analysis. RESULTS: The illustrations of "crying baby", "shaken baby syndrome", "baby car safety", "vision deficiency screening" or "hearing deficiency screening" are misunderstood by more than 60% of the parents. Being a father or being unable to read French significantly increased the risk of not finding 6 of the expected prevention items. CONCLUSIONS: The meaning of illustrations from the French child health record is not accessible to every parent despite the fact that they convey important reminders on preventive care. Family physicians and specialist pediatricians should seize opportunities to enhance preventive care education within medical consultations.