Sun-protective behaviours amongst indigenous communities: A scoping review.

Abstract

e21583 Background: Due to longstanding historical and systemic barriers, Indigenous communities experience disproportionate health inequities, including poorer cancer outcomes. Within this broader context, disparities are also evident in dermatologic health, particularly in skin cancer prevention, diagnosis, and outcomes. Among studied Indigenous populations, engagement in sun-protective behaviours is lower, contributing to increased skin cancer risk, including later-stage melanoma diagnoses and higher mortality. However, research examining these behaviours remains limited, particularly with respect to both primary and secondary sun-protective practices. This scoping review seeks to characterize sun-protective behaviours and identify trends among Indigenous populations. Methods: Following PRISMA-ScR guidelines, we searched Medline, Scopus, and Embase, including peer-reviewed studies from January 2010 to December 2025. Screening was done by two reviewers. Observational studies on Indigenous populations and behaviours relating to sun protection were included. All other study designs and Indigenous populations outside of North America were excluded. Results: Five cross-sectional studies were included, conducted on Indigenous populations in the United States (4/5) and Canada (1/5). The sample was comprised of 6,220 participants, with four studies reporting on sex. However, only two studies provided sex-specific distributions to Indigenous participants. All studies (5/5) reported on primary sun-protective behaviours and secondary sun-protective behaviours. Most studies (3/5) reported reduced engagement with sun-protective behaviours compared with non-Indigenous groups, and one study found low engagement without a comparator. Sunscreen-use was consistently reduced, whereas findings for shade-seeking behaviours, long-sleeve shirt and hat-use were mixed. Studies that assessed skin examinations (3/5) found a higher proportion of Indigenous participants reporting no prior skin checks. Barriers to engaging in sun-protective behaviours included economic, structural, and geographic factors. Two studies highlighted economic barriers, including the cost of sunscreen, as a reason for low sunscreen-use. Conclusions: There is a paucity of research examining sun-protective behaviours among Indigenous populations. Observed gaps in patient education and skin cancer screening highlight opportunities to strengthen prevention and early detection efforts in clinical settings. Culturally responsive, community-informed approaches are needed to address structural barriers and support effective sun-protective practices.