To develop the video, we collaborated with a diverse multistakeholder advisory board (MAB) and a community advisory board that included Hispanic outdoor workers, patients, clinicians, and representatives from local and national advocacy organizations. The initial draft of the script was informed by formative focus group findings [20] and developed by the National Conservatory of Dramatic Arts in Washington, DC. Two rounds of script review were conducted, and community advisory board meetings preceded MAB meetings to support Spanish-language discussion and ensure community perspectives informed subsequent MAB deliberations. The finalized script was then translated into Spanish and reviewed by a Spanish-speaking dermatologist on the MAB for production by the National Conservatory of Dramatic Arts. A detailed description of this process is reported elsewhere [38].

Consistent with Kreuter et al [39] framework for culturally tailored health communication, the video included both superficial and deep structure cultural elements. Superficial tailoring was achieved with Hispanic actors, Spanish language dialogue, and culturally familiar elements such as traditional foods and soccer [39]. Deep tailoring targeted cultural values and beliefs identified as salient within Hispanic communities like familismo by depicting family relationships and support as important motivators to engage in sun-protective behaviors and early detection [39,40]. To reflect these tailoring strategies, the video portrays a multigenerational family who owns a landscaping company. The main character, Miguel, is diagnosed with BCC as he is transitioning into taking the lead of his father’s business. The diagnosis propels him and his wife, Sofia, to take an active role in skin cancer prevention at home and in the workplace. Throughout the story, the video provides information about skin cancer, its signs, protective behaviors, and the importance of early detection. The video also models sun-protective behaviors and highlights their significance in all generations. A scene-by-scene description of the video and their associated theoretical constructs are reported elsewhere [38].

To evaluate perceptions of the video, 2 in-person focus groups were conducted between October and November 2025. We recruited participants through trusted community organizations serving Hispanic communities, including Catholic charities and We Are CASA, both of which have established relationships with outdoor workers employed in construction, landscaping, and agricultural occupations. Participants were eligible for this study if they self-identified as Hispanic, were aged ≥18 years, and had current or prior outdoor work experience. Given the focused scope of the study, consisting of focus groups with a targeted sample, data collection was considered complete once data sufficiency was achieved across the focus groups. This was reflected in the convergence of participant responses across sessions with limited emergence of new viewpoints in the second group. Additionally, as this was an exploratory study designed to guide the development and improvement of a future randomized trial, the primary objective was to assess participants’ initial perceptions and potential areas for intervention optimization instead of achieving broad generalizability. Practical factors related to budget deadlines also played a role in the decision to limit the number of focus groups.

This study was reviewed by the Georgetown University Institutional Review Board and granted an exemption determination (IRB #STUDY00007990; exempt under category (2) (ii): tests, surveys, interviews, or observation, low risk). Trained research staff reviewed the informed consent form and study details with participants prior to each focus group, and verbal consent was documented by the study team before any data collection began. Participation was voluntary, and participants were free to decline or withdraw at any time. Data are coded rather than fully deidentified. Focus group audio recordings were transcribed and deidentified for analysis, while any files containing identifying information are stored separately in Georgetown University's secure, password-protected box repository, accessible only to authorized study team members. All participants received a US $50 gift card as compensation for completing the focus group.

Of the 20 participants recruited, 19 met our inclusion criteria and were included in the final sample. The mean age was 46.5 (SD 15.5) years. Most (18/19, 94.7%) participants were male, and almost half (9/19, 47.7%) identified as “Other” for race. More than half (10/19, 52.6%) reported an education of middle school or less, 57.9% (11/19) indicated an annual income of US $10,000-$39,999, and 63.2% (12/19) did not have health insurance (Table 1).

The majority (8/19, 42.1%) of participants reported 6‐10 years of outdoor work experience. Nearly half (9/19, 47.4%) work 6‐9 hours per day in the sun, and 52.6% (10/19) do not engage in sun-protective behaviors (Table 2). Wearing long-sleeved shirts (13/19, 76.5%) and long pants (12/19, 70.6%) were the most reported sun-protective behaviors, while sunscreen use (4/19, 23.5%) was the least reported (Table 2).

This study strongly supports the potential of a culturally tailored narrative video for skin cancer prevention in engaging Hispanic outdoor workers, supporting comprehension, and increasing confidence in adopting preventive behaviors. Building on prior work on narrative interventions in cancer education [44-47], this study addresses a critical gap in skin cancer prevention and represents one of the first reported narrative videos tailored for and developed with Hispanic outdoor workers, providing early insights into its perceived potential.

Consistent with prior research, our findings emphasize the importance of interventions that reflect the cultural values and lived experiences of the intended audience [48,49]. Participants repeatedly noted that they appreciated the video being presented in Spanish as it not only strengthened its cultural connection but also addressed a systemic gap. In addition to highlighting the portrayal of familism as central in character relatability, participants appreciated how the video addressed specific constructs that could hinder sun protective practices in and out of work. Our findings support the notion that narratives can create opportunities for participants to not only see themselves in the story but also envision themselves adopting recommended behaviors [50]. In our study, participants’ connection with Miguel, his father, and other culturally resonant role models, such as soccer players, demonstrates the potency of narratives in addressing culturally specific barriers, including gender norms like machismo, while simultaneously promoting self-efficacy.

Additionally, by causing feelings of concern and introspection, the video appears to have not only enhanced message processing, but also reinforced personal relevance, especially in relation to family members. Although the video showed the potential consequences of skin cancer, participants particularly appreciated that it ended on a positive note. Beyond keeping participants engaged with the narrative, this balance of emotional intensity likely increased their immersion and subsequent self-efficacy, consistent with narrative transportation frameworks [51]. This was reflected in their responses, as many stated that the video had completely changed their perspective and motivated them to start practicing sun-protective behaviors in their everyday lives.

Participants’ recognition of self-agency in sun protection despite limited employer support also highlights the importance of interventions that empower workers to take preventive action. Many participants described situations in which workplace infrastructure and/or lack of formal training made reliance on employers alone insufficient for maintaining sun safety. This focus on self-agency reflects health behavior theories that view individuals as active participants in shaping their health outcomes [52,53]. For example, Social Cognitive Theory emphasizes human agency and self-efficacy as important factors in behavior and highlights that individuals are more likely to engage in protective actions when they perceive they can successfully perform those behaviors even in constrained environments [30,31,52]. Likewise, the Theory of Planned Behavior states that perceived control over behavior is a key predictor of intentions and actions related to health, especially when structural barriers exist [53,54]. Empowerment-oriented approaches add that improving individuals’ perceived control over health decisions is a key mechanism for improving outcomes, particularly in resource-limited settings [55]. Together, these theories highlight the need for interventions that build individual capacity by increasing knowledge and confidence in practicing protective behaviors.

At the same time, our findings also stress the importance of supportive workplace policies that make these behaviors practical and sustainable. Encouraging self-efficacy with structural supports aligns with health behavior theories emphasizing that personal agency is most effective when reinforced by enabling environments [56]. This moreover supports the need for multilevel interventions for employees and employers that combine individual-level strategies with organizational policies and environmental supports to maximize adherence and long-term health outcomes. Participants identified multiple ways in which resources like these could be incorporated into their workday, particularly during orientations or preshift meetings, demonstrating both the feasibility of integrating preventive strategies into routine workflows and participants’ interest in such resources. Importantly, in contexts where employer-provided resources may be limited, participants emphasized that knowledge about the importance of sun protection could best support such practices, as the cost of items like sunscreen would not be a barrier if perceived as beneficial for their health. To further address the individual-level implementation barriers identified (forgetting sunscreen, allergic reactions to sunscreen, etc), increased complementary education regarding electronic reminders and/or alternative sunscreen formulations (eg, hypoallergenic, mineral-based) for sensitive skin could be helpful.

Participants also recommended sharing the video beyond worksites such as schools, daycares, clinics, and across social media platforms. These suggestions reflect not only their positive reception of the video, but also their perception of its broader importance and relevance. For many Hispanic outdoor workers, employment is closely tied to their role as providers. Protecting their skin is not viewed as an individualistic health behavior, but as a means of safeguarding their ability to remain present and provide for their loved ones [21]. Several participants expressed that the video directly speaks to this sense of responsibility. Additionally, after learning that skin cancer most commonly develops over many years, several expressed a desire to ensure that their families and friends across all generations grow up with more accurate knowledge and preventive habits. Overall, the potential of our video is highlighted by the interest and motivation of participants in implementing and sharing the knowledge obtained from the video, particularly in a cohort in which more than half did not engage in sun-protective behaviors.

Beyond these promising findings, this study has several key strengths. First, its qualitative design enabled a thorough exploration of participants’ viewpoints and provided detailed information on experiential aspects that quantitative methods would be unlikely to capture, such as cultural relevance, emotional engagement, and distribution strategies. Second, the study targeted a high-risk group with limited access to culturally-relevant skin cancer prevention resources, not only addressing a significant research gap, but also potentially improving the real-world applicability and impact of the video. Third, it produced practical recommendations to enhance the video’s effectiveness and guide distribution strategies, including perceived facilitators and barriers to implementation. Fourth, the study provides insights that can guide future research, including randomized control trials and multilevel interventions with employers. Despite these strengths, several limitations should also be noted. First, this was an exploratory study with a small sample size (N=19) and a male-dominated sample (18/19, 94.7%), limiting the transferability of the study to other Hispanic outdoor workers. The small sample size also limits the range of perspectives captured and the degree to which subgroup differences are reflected in the findings. Female workers were especially underrepresented, and their views on sun protection knowledge and behaviors, as well as perceived barriers and facilitators, may differ in important ways that were not fully captured, similar to other subgroups. Second, data were self-reported, potentially introducing social desirability bias as well as recall bias. Third, with a focus group format, participants’ answers may have been influenced by other participants.

Future research should more rigorously evaluate the acceptability of the video, including its impact on sustained sun-protective behaviors over time. Randomized controlled trials comparing this narrative approach to standard educational materials, including a larger sample, are needed to determine its effectiveness. Studies involving employer and occupational health engagement could also assess strategies for integrating sun protection into workplace policies. Future studies could further explore whether the impact of the video differs across outdoor work sectors (construction vs landscaping, agriculture vs construction, etc).

This exploratory study provides early evidence supporting the acceptability and promise of our culturally tailored narrative video intervention to promote skin cancer prevention among Spanish-speaking Hispanic outdoor workers. Feedback regarding its cultural and occupational relevance was strongly positive, with self-reported improvements in knowledge and self-efficacy. Additional research is needed to determine if this approach can meaningfully enhance sun protective behaviors to reduce skin cancer risk among Hispanic outdoor workers at scale.