Promoting acral melanoma awareness among nail salon technicians and cosmetology educators in California: A theoretically grounded qualitative needs assessment.

Abstract

e22567 Background: A growing body of literature has explored the role of cosmetology professionals in promoting early community detection of skin cancer. However, no research efforts have explored this topic through a qualitative methods lens, and no theoretical framework has been proposed, gaps we aimed to address. Methods: We conducted 26 semi-structured interviews with nail salon technicians and cosmetology educators in California, which encompasses over 20% of the licensed workforce nationwide, exploring barriers and facilitators to promoting acral melanoma (AM) awareness in the nail salon. Transcripts were independently coded using hybrid deductive-inductive thematic analysis, with a-priori codes informed by situated learning theory, and themes organized using the socioecological framework. Results: Themes emerged across four socioecological levels. At the individual level, participants demonstrated strong understanding of scope-of-practice boundaries, and disposition for recognition and communicating skin and nail abnormalities. Experience strongly correlated with self-efficacy for health communication with clients. At the interpersonal level, the face-to-face nature of nail services and repeat clientele facilitated trust building and longitudinal observation. Client receptivity varied based on technicians' perceived education level. Language discordance was highlighted as a key barrier. At the organizational level, salon culture varied from health-focused environments that empowered difficult conversations, to high-volume settings that discouraged them. Existing digital training infrastructure from the two main cosmetology curriculum providers was identified as an opportunity to broadly disseminate acral melanoma training. At the healthcare systems level, lack of access to care among patients was noted. Additionally, a key barrier identified by participants is the limited understanding of the appropriate healthcare follow up pathways. Conclusions: Grounded in situated learning and landscape of practice (LoP) theoretical frameworks, nail technicians and other cosmetology professionals can be viewed as a distinct community of practice (CoP) occupying a unique position in the landscape of practice (LoP) relevant to melanoma detection. Their work creates a boundary zone with the healthcare professionals CoP which, if developed, can support early detection of AM. LoP framework posits that boundary zones can be strengthened through development of 1) boundary objects (visual recognition guides, healthcare communication scripts, documentation tools), 2) boundary practices (standardizing follow up recommendations, establishing feedback mechanisms), and 3) creating productive boundary encounters (continuing education events, collaborative training development).