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RCT·dermatology, public health, pediatric ophthalmology, clinical trial·PMC10921649

Efficacy of a facial-aging web app on sun protection behaviors among primary school students in Iran: a randomized controlled trial

BMC Public Health · 6 authors, 5 centres

AI SUMMARY

FIDELITY 96%

POPULATIONPrimary school students aged 10-12 years (grades 4-6) in Zahedan, Iran (n=160; intervention n=81, control n=79)

INTERVENTIONFacial-Aging web app (Sunshine and Skin Health) on WhatsApp platform, including AI-based facial aging visualization, 27 PMT-based health messages, 8 educational files, and a skin cancer video clip over 8 days

COMPARISONControl group (no intervention; received intervention after study completion)

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AGENT 01 · STRUCTURED SUMMARY

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TL;DR

A facial-aging web app intervention significantly improved sun protection behaviors (sunscreen use, hat wearing, sunglasses use, and sunscreen reapplication) among Iranian primary school students immediately and at 3-month follow-up compared to controls. The study demonstrates that appearance-based digital tools can effectively promote sun-safe habits in children. Clinical significance lies in scalable, low-cost skin cancer prevention strategies targeting early-life behavior change.

Full summary

3,622 CHARS

**Background:** Solar ultraviolet (UV) radiation is a known carcinogen, and childhood/adolescence is a critical period for establishing sun protection habits. This study aimed to evaluate the effectiveness of a facial-aging web app intervention, grounded in Protection Motivation Theory (PMT), on promoting sun protection behaviors among primary school students in Iran. The intervention used AI to show users their aged faces based on sun protection behaviors, combined with PMT-based health messages delivered via WhatsApp.

**Methods:** A randomized controlled trial with a pretest-posttest repeated measures design was conducted from September 2021 to July 2022. Participants were 160 students aged 10-12 years (grades 4-6) from Zahedan, Iran, stratified by district and randomly assigned to intervention (n=81) or control (n=79). The intervention group received the Sunshine and Skin Health web app (AI facial aging visualization) plus 27 PMT-based health messages, 8 educational files, and a skin cancer video clip via WhatsApp over 8 days. The control group received no intervention. Sun protection behaviors were self-reported using a validated 7-item scale (5-point Likert) at baseline (T1), immediately post-intervention (T2), and 3-month follow-up (T3). Repeated measures ANOVA and independent t-tests were used for analysis (SPSS 22, significance level 0.05).

**Key Results:** At baseline, no significant differences existed between groups. Significant intervention effects were found for: sunscreen use in the last month (intervention effect P=0.001, time effect P=0.001, interaction P=0.001; intervention group T1→T2 P=0.001, T1→T3 P=0.001, T2→T3 P=0.001; control no significant changes); sunscreen reapplication after washing (intervention effect P=0.001, time effect P=0.001, interaction P=0.001; intervention T1→T2 P=0.006, T1→T3 P=0.001, T2→T3 P=0.185; control no significant changes); staying in the shade (intervention effect P=0.002, time effect P=0.202, interaction P=0.006; intervention T1→T2 P=0.001, T1→T3 P=0.251, T2→T3 P=0.339); wearing a hat (time effect P=0.001, intervention effect P=0.121, interaction P=0.100; intervention T1→T2 P=0.001, T1→T3 P=0.001, T2→T3 P=1.000); wearing sunglasses (time effect P=0.004, interaction P=0.001, intervention effect P=0.127; intervention T1→T2 P=0.001, T1→T3 P=0.001, T2→T3 P=1.000). For wearing long-sleeved clothing, only interaction was significant (P=0.042), with no significant within-group changes. For sunscreen use during peak hours, only time effect was significant (P=0.033), with no between-group differences. Between-group comparisons at T2 and T3 showed significant differences for sunscreen use last month (both P=0.001), staying in the shade (T2 P=0.001, T3 P=0.257), wearing a hat (T2 P=0.001, T3 P=0.055), wearing sunglasses (both P=0.001), and sunscreen reapplication (both P=0.001).

**Clinical Implications:** The facial-aging web app significantly improved several sun protection behaviors (sunscreen use, hat wearing, sunglasses use, sunscreen reapplication) immediately and at 3 months, supporting its efficacy as a scalable, low-cost intervention for skin cancer prevention in children. The study highlights the potential of appearance-based digital tools to motivate behavior change. However, some behaviors (shade seeking, long-sleeved clothing) showed limited sustainability, possibly due to regional/cultural factors. The authors recommend booster sessions to maintain long-term effects. Limitations include self-report bias, COVID-19 pandemic context, lack of parental involvement, and reliance on smartphone/internet access.

PICO

PPOPULATION

Primary school students aged 10-12 years (grades 4-6) in Zahedan, Iran (n=160; intervention n=81, control n=79)

IINTERVENTION

Facial-Aging web app (Sunshine and Skin Health) on WhatsApp platform, including AI-based facial aging visualization, 27 PMT-based health messages, 8 educational files, and a skin cancer video clip over 8 days

OOUTCOME

Sun protection behaviors (7-item scale: sunscreen use last month, shade seeking, hat wearing, long-sleeved clothing, sunglasses use, sunscreen use during peak hours, sunscreen reapplication after washing) measured at baseline (T1), immediately post-intervention (T2), and 3-month follow-up (T3)

STUDY TYPE

RCT

SPECIALTY

dermatology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

96% · A

ORIGINAL PAPER

PMC10921649

Efficacy of a facial-aging web app on sun protection behaviors among primary school students in Iran: a randomized controlled trial

BMC Public Health

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ABSTRACT

Background Skin cancers resulting from excessive exposure to solar ultraviolet (UV) radiation are on the rise. This study aims to investigate the impact of facial-aging app intervention on promoting safe and healthy behaviors and its influence on reducing students' UV exposure. Method Utilizing a Pretest–Posttest repeated-measures design, we developed a theory-guided web app on the WhatsApp platform, named the Sunshine and Skin Health app. This app allows users to visualize their altered faces in three stages of adolescence, middle age, and old age based on sun protection behavior. The intervention continued within WhatsApp, incorporating 27 health messages grounded in the PMT theory, eight educational files, and a skin cancer video clip. The primary outcome is the change in sun protection behavior between the two groups (intervention and control) immediately after the intervention (T2) and the secondary outcome is the change in sun protection behavior between the two groups at 3 months follow-up (T3). The data are analyzed in SPSS 22 and a significance level of 0.05 is considered. Results The results revealed no significant difference between the two groups before the intervention. However, in the intervention group, there were significant differences in the utilization of sunglasses, hats, and sunscreen in the last month, as well as sunscreen reapplication after washing their hands and face, both immediately after the intervention and at the 3-month follow-up, compared to the control group ( P = 0.001). Furthermore, a significant intervention effect, time effect, and interaction effect between group and time were observed in behaviors related to using sunscreen in the last month and sunscreen reapplication after washing hands and face ( P = 0.001). Specifically, the intervention group exhibited a significant difference from Time 1 to 2 and from Time 1 to 3 ( p = 0.001), but no significant difference from Time 2 to 3. In contrast, the control group did not show any significant differences over time. Conclusions This study indicated that the Facial-Aging web app can effectively encourage safe behaviors in sunlight. To ensure the maintenance and sustainability of these behaviors over the long term, it is crucial to consider implementing booster sessions. Trial registration Iranian Registry of Clinical Trials IRCT20200924048825N1. Registered prospectively on 8 February 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-024-18241-2.

CITATION EXPORT

Hassan Okati-Aliabad, Esmat-Sadat Hosseini, Mohammad Ali Morowati Sharifabad et al.. Efficacy of a facial-aging web app on sun protection behaviors among primary school students in Iran: a randomized controlled trial. BMC Public Health. (2024). https://doi.org/10.1186/s12889-024-18241-2

AUTHORS

6 · 5 CENTRES

Hassan Okati-Aliabad, Esmat-Sadat Hosseini, Mohammad Ali Morowati Sharifabad, Mahdi Mohammadi, Mohamad Ebrahimzadeh Ardakani, Amir Hossein Talebrouhi

1https://ror.org/03r42d171grid.488433.00000 0004 0612 8339Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
2grid.412505.70000 0004 0612 5912Health Education and Health Promotion, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3https://ror.org/03w04rv71grid.411746.10000 0004 4911 7066Department of Health Education & Promotion, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
4https://ror.org/03w04rv71grid.411746.10000 0004 4911 7066Department of Dermatology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
5https://ror.org/007jfm765grid.444802.e0000 0004 0547 7393Department of Computer Engineering, Imam Reza International University, Mashhad, Iran