Tailored Sun Safety Messages for Outdoor Workers

Outdoor workers experience high solar UVR and heat exposures that increase risks of skin cancer, ocular damage (e.g., cataracts, ocular melanoma), and heat-related illness. Skin cancer is the most common malignancy in Canada, with approximately 100,000 new melanoma and non-melanoma cases annually, and an estimated 4,600 non-melanoma cases attributable to occupational sun exposure. About 1.7 million Canadian workers spend 2 or more hours outdoors per day. Many are male and younger, demographics associated with lower PPE use and higher risk-taking. Existing public sun safety messages (e.g., seeking shade 11 AM–3 PM) are often impractical in work settings, and Canadian outdoor workers face UVR levels well above international reference levels. Prior national efforts developed core public sun safety messages, but these may not translate to occupational contexts. This study aims to tailor practical, harm-reducing sun safety messages specifically for outdoor workers and employers to improve feasibility, relevance, and actionability in workplaces.

Prior messaging in Canada targeted the general public via consensus-developed core content balancing UVR risk reduction with practicality. Evidence indicates outdoor workers are overexposed to UVR, sometimes exceeding international reference levels by more than 10-fold. Educational interventions can improve knowledge and sun-protective behaviors among workers, and are most effective when embedded in comprehensive workplace OHS programs. Research shows outdoor workers are receptive to sun safety, yet there is limited Canadian data on awareness and behaviors since national surveys in 1996 and 2006, with more recent sector-specific studies noting gaps in protection. The need to tailor communication for unique, high-risk subpopulations has been identified; tailored messages may outperform generic messaging, and in some contexts perform comparably to targeted messaging. Embedding messages within harm reduction and OHS frameworks aligns with the reality that occupational UVR cannot be eliminated but can be mitigated through controls, policies, and training.

The study used an integrated knowledge translation approach and a modified Delphi consensus process. Steps: 1) Consultation: Engaged the leads of the prior Canadian core sun safety messages to understand development processes and obtain materials. 2) Steering Committee (SC): Formed a 10-member expert panel (dermatology, occupational disease, optometry, occupational hygiene, health promotion) to review and tailor messages. 3) Needs assessment: Conducted 11 semi-structured Zoom interviews with outdoor workers, worker reps, and OHS professionals (construction, landscaping, transportation, municipalities). Recruitment was purposive and convenience-based via CAREX Canada networks and web search. Interviews were recorded, transcribed, and analyzed using inductive thematic analysis by two coders with consensus resolution. Feedback was organized into eight sections mirroring the core content: key facts; primary actions for skin protection; primary actions for eye protection; additional recommendations; tips for shade; tips for clothing; tips for sunscreen; tips for eye protection. 4) Modified Delphi: SC reviewed needs assessment results and iteratively tailored the core messages. Consensus threshold was 80% agreement. Round 1 collected open-ended feedback on whether proposed tailored wording better suited outdoor workers; responses informed Draft 1. Round 2 provided SC with revised core and tailored messages plus anonymized Round 1 summaries; sections not reaching ≥80% were further revised. 5) Stakeholder workshop: Presented Draft 2 to 11 outdoor workers/employers/representatives via Zoom; recorded and transcribed feedback to enhance feasibility and uptake. 6) Final consensus (Round 3): SC reviewed workshop feedback in a Zoom meeting and approved final messages upon achieving ≥80% agreement.

- Process and participation: 11 stakeholder interviews informed needs; a 10-expert Steering Committee conducted a multi-round modified Delphi with an 80% consensus criterion; an 11-participant workshop refined feasibility and uptake; final messages achieved expert consensus. - General: Core public messages were useful but insufficient; stakeholders suggested separate emphasis for employers and workers, and possibly occupation- or workplace-specific tailoring. Visual, practical knowledge products (e.g., infographics) were deemed critical. - Key facts: Messages were simplified and made worker-relevant; retained emphasis on peak UVR times (11 AM–3 PM), UVR sources, and health harms (skin cancer). Cosmetic framing (wrinkling/photoaging) was de-emphasized in favor of cancer risk statistics relevant to workers. - Skin protection (primary actions): Examples of shade tailored to work settings (tarps, canopies, tents vs. umbrellas); retained UV Index guidance; acknowledged feasibility challenges in protecting between 11 AM–3 PM and in dusty conditions affecting sunscreen use; encouraged reference to workplace representatives and integrating hierarchy of controls. - Eye protection (primary actions): Included safety goggles/glasses appropriate to tasks; emphasized UV-blocking or polarized lenses; suggested wording to avoid placing sole onus on the worker. - Additional recommendations: Retained the 11 AM–3 PM avoidance guidance while recognizing feasibility limits; removed/limited vitamin D balance messaging as not relevant for involuntary occupational exposure. - Shade tips: Recognized variability/limited availability of shade; added content on scattered UVR and reflective surfaces (e.g., concrete, water, light-colored surfaces); advised phrasing such as “where possible” and taking breaks in shade. - Clothing tips: Clarified guidance on clothing color, tight weave, and UV-protective-labeled garments while cautioning not to downplay sunscreen; recommended hats with wide brim and neck flap. - Sunscreen tips: Reinforced lip protection and application to commonly missed areas (ears, back of neck, backs of hands); tailored quantity guidance to be relatable; emphasized reapplication; added information on expiry and storage. - Eye protection tips: Standardized UVR protection labeling guidance; highlighted close-fitting wrap-around styles; included reflective surface considerations; refined directness and clarity; suggested removing contact lens-specific notes to avoid discouraging sunglass use. - Overall: The final set comprises evidence-based, practical, harm-reduction messages suitable for integration into workplace exposure control plans to prevent skin cancer, eye damage, and heat stress among outdoor workers.

Tailoring sun safety messages to outdoor work contexts addresses a recognized gap whereby generic public guidance is often impractical during work hours and tasks. Using a harm reduction lens acknowledges that occupational UVR exposure cannot be eliminated but can be substantially reduced via layered controls, policies, and worker training. The developed messages explicitly use occupational safety language (PPE, hierarchy of controls) to improve resonance and implementation within OHS management systems. Given the large number of Canadian workers exposed to high UVR levels, even modest improvements in protective behaviors could yield meaningful public health benefits. Dissemination barriers are common in health communication; the integrated knowledge translation approach and stakeholder involvement may enhance adoption, as evidenced by early use by WorkSafeBC. Future research should implement and rigorously evaluate the tailored messages versus generic content to determine effects on knowledge, attitudes, and behaviors, and to identify which components drive impact. Such evaluation could inform further tailoring for high-exposure sectors (e.g., construction, farming, landscaping) and for employer- vs. worker-focused materials.

The study produced a consensus-based, evidence-informed suite of tailored sun safety messages designed for outdoor workers and employers. Messages provide practical key facts, recommendations, and tips to prevent skin cancer, eye damage, and heat stress while recognizing workplace feasibility constraints. These communications can be incorporated into workplace exposure control plans and OHS programs, and are relevant to regulators and other stakeholders. Future work should pilot and evaluate the tailored messages to confirm effectiveness and to guide additional tailoring for high-risk occupations and specific workplaces.

- Not all Steering Committee members participated in the first survey round, though all provided feedback in subsequent rounds and the final meeting. - Different expert/stakeholder compositions might have yielded different final wording; using established core messages, a Delphi process, and integrated knowledge translation likely mitigated this risk. - Sunscreen guidance reflects consensus at the time; emerging evidence suggests lotion sunscreens may be more effective for skin cancer prevention and less harmful to the environment than some alternatives, which may warrant future updates. - The tailored messages were not formally evaluated for behavioral impact within this study.