Determinants of skin cancer prevention and early detection behaviors in Syria: A cross-sectional survey.

Abstract

e22557 Background: Skin cancer prevention and early detection depend on sun-protective behaviors, skin self-examination, and timely care seeking. Evidence on screening behaviors and barriers in resource-limited settings remains limited. Methods: We conducted a national cross-sectional survey in Syria. Adults aged ≥18 years were eligible; individuals enrolled in or working in health-related fields were excluded using a screening item. The questionnaire assessed socio-demographics, knowledge, attitudes, practices, sources of information, perceived barriers, and Fitzpatrick skin type. Outcomes were dichotomized using predefined cutoffs. Multivariable binary logistic regression examined independent predictors of high practice. Institutional approval was obtained. Results: Among 2,033 participants (median age 25 years; IQR 21–34), 75.6% were female and 16.7% had health insurance. Only 0.9% reported ever undergoing skin cancer screening. Knowledge was moderate (median 4/8; IQR 3–5), with gaps in recognizing key risk factors and warning signs. Overall, 43.8% met criteria for good knowledge, 62.1% for positive attitude, and 50.7% for high practice. Early detection behaviors were limited: 69.4% reported not performing skin self-examination, and females were more likely than males to report high practice (57.5% vs 29.6%). The most commonly reported barriers were having no symptoms (68.8%), lack of knowledge about skin cancer (37.9%), lack of recommendations from healthcare professionals (30.5%), lack of health insurance (27.1%), and lack of time (27.1%). In multivariable analysis, high practice was associated with female sex, university education, medical sources of information, and positive attitude, while good knowledge was not associated. Conclusions: In this Syrian population, knowledge alone did not translate into stronger prevention and early detection practices. Attitudes, trusted medical information sources, and modifiable access- and recommendation-related barriers were more influential. Interventions should reframe screening as preventive behavior and strengthen feasible pathways through primary care and community settings to improve timely evaluation and early detection. Independent predictors of high preventive/early-detection practice. Predictor Category (vs reference) aOR 95% CI p Sex Female vs male 3.087 2.448–3.892 <0.001 Education level University vs secondary/lower 1.536 1.241–1.901 <0.001 Source of information Medical vs non-medical 1.673 1.330–2.105 <0.001 Attitude level Positive vs less-positive 1.904 1.571–2.308 <0.001