Impact of UV-Aging Software on Sun-Protective Attitudes of Outdoor Pickleball Players in Hawai'i
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2025
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Introduction: Pickleball is a popular sport in Hawai'i, with many outdoor courts exposing players to UV radiation. Given Hawai'i’s high UV index, sun protection is crucial, as outdoor activities like pickleball increase the risk of skin cancer, including melanoma.1 Although health-based sun-safety interventions have improved knowledge about skin
cancer, they may not be the most effective at encouraging sun-protective behaviors.2 Research suggests that appearance-based sun-safety education, highlighting the effects of UV exposure on premature aging, may be more effective in promoting sun-protective actions.2,3
Objective: This study investigates whether the inclusion of UV-aged images improves sun-protective behaviors among Hawai'i pickleball players more than a sun-safety video alone.
Methods: Pickleball players were selected due to the abundance of outdoor courts throughout parks in Hawai’i. Participants were randomly approached while playing pickleball outdoors an offered inclusion in the study. Exclusion criteria included those less than 18 years of age, playing pickleball less than once a week outdoors, and not agreeable
to a follow-up survey. After enrollment, a baseline survey was administered, assessing demographics, sun-safety attitudes, and behaviors. Subjects were then randomly divided into two groups: Group A received only an educational sun-safety video, while Group B received the same educational video along with viewing of UV-aged images of themselves using the previously validated Sunface app. These images demonstrated how their face may appear in 15 years without the use of sun protection, and a comparison was provided demonstrating how it may appear if sun protection was used. Identical follow-up surveys were administered to both groups immediately post-intervention and again at a 1-month interval to assess changes in attitudes and behaviors. Responses were recorded on a Likert scale, converted to numerical scores, and analyzed to compare pre and post-intervention changes between Groups A and B.
Results: Both groups showed improvement in planned future behavior while group B showed higher levels of improvement and additional improvement in sun-safety attitudes. In response to the statement “In the future, I plan to use sunscreen on all exposed areas of my body daily” pre and post intervention, group A’s average Likert score
increased by 0.24 while group B’s score increased by 0.54. In response to the statement “I believe that sun and UV light damage cause wrinkles” group A’s average Likert score increased by 0.05 while group B’s score increased by 0.25. High baseline scores in both groups suggested that participants had substantial knowledge about sun safety before the intervention, limiting the overall impact on knowledge and behavior improvement. To more closely examine the impact on participants with lower baseline knowledge, an additional analysis was performed excluding participants who marked ""Strongly Agree"" on the pre-survey. This refined analysis showed a more pronounced change in Likert scale scores post intervention. In response to the statement “In the future, I plan to use sunscreen on all exposed areas of my body daily” pre and post intervention, group A’s average Likert score increased by 0.44 while group B’s score increased by 0.77. In response to the statement “I believe that sun and UV light damage cause wrinkles” group A’s average Likert score increased by 0.27 while group B’s score increased by 0.64.
Discussion: Preliminary findings suggest that including UV-aged images of participants may improve the effectiveness of an educational sun-safety video in enhancing sun-safety attitudes and planned behavior among Hawai'i pickleball players. The inclusion of UV-aged images appears to better influence UV risk perception and the intention to adopt protective behaviors. Additional data collection and the inclusion of 1-month follow-up data will help further assess the long-term impact of this intervention on attitudes and behaviors. A limitation of this study is the reliance on self-reported behaviors and experiences. Future studies may consider recording objective data, as self-reported data may vary.
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