Sun‐Safety Knowledge, Attitudes and Behaviour in Western Saudi Arabia: Implications for Psycho‐Oncology Prevention Services

ABSTRACT

Background

Melanoma, a highly aggressive skin cancer, is strongly linked to ultraviolet (UV) exposure. Despite high UV levels in Saudi Arabia, public awareness and adherence to melanoma preventive behaviours remain underexplored. This study assessed knowledge (factual accuracy), attitudes, and sun‐protective practices among adults in the western region of Saudi Arabia, investigating demographic and gender‐specific differences.

Methods

A cross‐sectional online survey was conducted from April to May 2024, recruiting 553 participants aged 18–80 years through convenience sampling. A validated 46‐item questionnaire assessed melanoma knowledge, risk perception, sun exposure patterns, and adherence to preventive behaviours. Descriptive statistics and one‐way ANOVA were used to analyse differences based on age, gender, education, employment, and healthcare affiliation.

Results

Moderate awareness of melanoma was observed (mean = 2.28, 5‐point Likert scale), with 73.2% of participants recognising sunlight as a risk factor for skin cancer. However, misconceptions were widespread, including beliefs that short‐term sun exposure is harmless (36%) and that sunscreen is unnecessary on cloudy days (43.8%). Females and younger participants (18–35 years) demonstrated significantly higher knowledge (p < 0.001 and p = 0.036, respectively) and risk perception; however, adherence to sun‐protective behaviours (e.g., sunscreen re‐application, protective clothing) was suboptimal across all groups (mean = 2.67). Education level influenced awareness (p = 0.031), but did not impact behaviour.

Conclusion

Despite moderate awareness, significant knowledge gaps and a knowledge–action gap hinder melanoma prevention in this high‐UV region. Culturally tailored interventions targeting misconceptions and behavioural barriers, particularly among males and individuals with lower educational attainment, are essential. These findings inform the development of evidence‐based strategies to reduce melanoma risk in Saudi Arabia and similar high‐UV settings.

1. Introduction

Melanoma, one of the most aggressive cutaneous malignancies, continues to show a rising global incidence despite being largely preventable through modifiable behaviours [1, 2]. Early detection and proactive prevention strategies remain crucial in reducing the significant morbidity and mortality associated with this disease. Ultraviolet (UV) radiation exposure, a well‐established and avoidable risk factor, significantly increases melanoma risk [3], particularly through prolonged or intermittent unprotected exposure. Emerging research highlights the vital role of psychological and behavioural factors, such as risk perception, awareness, and adherence to sun‐protective practices, in shaping melanoma outcomes, underscoring the need for targeted interventions.

In high‐UV environments such as Saudi Arabia, where climatic conditions and cultural practices lead to significant sun exposure, public awareness of melanoma and its risk factors remains inadequate. Western Saudi Arabia, in particular, experiences the highest UV index in the country, heightening the risk of UV‐related skin damage [4, 5]. Cultural practices, like those during pilgrimage seasons, further increase exposure due to prolonged outdoor activities, specific attire such as Ihram clothing, and occupational demands of pilgrimage support roles, which often involve extended periods under direct sunlight [6]. Despite this, research examining population‐specific attitudes, knowledge, and preventive behaviours concerning melanoma is limited [3, 7, 8]. Existing studies in the Kingdom often address cancer awareness broadly or include skin cancer within general health surveys, with minimal focus on melanoma‐specific risk perception or protective behaviours, such as sunscreen application, avoidance of artificial tanning, or understanding UV‐induced skin damage [3, 4, 5].

Sociocultural factors, such as gender norms, educational attainment, and occupational status, likely influence melanoma‐related knowledge and adherence to preventive measures [5, 6, 7]. However, there is a lack of data exploring how these variables shape behaviours in Middle Eastern populations, despite evidence from Western settings showing that demographic characteristics significantly predict sun‐protective habits. This gap in the literature highlights the need for context‐specific investigations to inform effective public health strategies.

This study aims to address these deficiencies by evaluating melanoma knowledge (factual accuracy regarding melanoma aetiology, risk factors, and protective actions) and risk awareness (perceived susceptibility to melanoma at personal or population levels) of melanoma, attitudes towards sun protection, and adherence to preventive practices among the general population in Saudi Arabia's western region. It specifically examines the influence of demographic and occupational factors on knowledge of melanoma risk factors, including UV exposure, skin phototype, and family history of melanoma. Additionally, the study investigates prevalent misconceptions, gender‐based differences in preventive behaviours, and the extent of adherence to practices such as sunscreen use, wearing protective clothing, and avoiding artificial UV sources. By elucidating key barriers and facilitators to sun protection, this research aims to provide evidence‐based insights for designing culturally tailored public health interventions to enhance melanoma prevention and reduce disease burden in high‐risk populations.

2. Methodology

2.1. Study Design and Setting

This study employed a descriptive cross‐sectional design to assess awareness, attitudes, and adherence to melanoma preventive measures among adults in the western region of Saudi Arabia. Conducted from April to May 2024, the study targeted a diverse population across urban and semi‐urban areas in Makkah, Jeddah, Taif, and Al Madinah Al Munawarah. These locations were chosen due to their high ambient ultraviolet (UV) radiation levels, influenced by geographic and climatic factors, which increase melanoma risk.

2.2. Participants and Recruitment

The study targeted adult residents (aged ≥ 18 years) in Saudi Arabia's western region, including Jeddah, Mecca, and Medina, characterised by high UV exposure due to geographic and climatic factors. Participants were recruited through a convenience sampling approach using online platforms (e.g., social media, community forums) between April and May 2024. This method was chosen due to the region's geographically dispersed population, the absence of a comprehensive population registry for random email or telephone contact, and the need for rapid, cost‐efficient access to diverse residents within the restricted data‐collection window. Eligibility criteria included residency in the western region and proficiency in Arabic or English to complete the electronic questionnaire. Of the 650 individuals who accessed the survey, 553 provided complete responses (response rate: 85.1%), with 64.4% female, a mean age of 33.2 years (SD = 10.8), and 98.2% Saudi nationals. The sample included 289 employed participants (52.3%), of whom 118 (21.3%) were healthcare workers.

2.3. Questionnaire Design and Validation

Data were collected using a structured, self‐administered electronic questionnaire, adjusted from validated instruments, that assessed knowledge, risk awareness, and sun‐protective behaviours. Knowledge was defined as objective, factual recall of melanoma aetiology, risk factors, and protective actions, measured using true/false items (e.g., ‘Sunlight causes skin cancer’). Risk awareness was defined as the subjective perception of personal or population risk, measured using 5‐point Likert items that assessed perceived susceptibility (e.g., perceived risk from sunburns or family history). The questionnaire included 50 items organized into six domains: (1) demographic characteristics, (2) constitutional risk factors (e.g., skin phototype, family history), (3) sun exposure patterns, (4) knowledge and awareness of melanoma, (5) attitudes towards sun protection, and (6) adherence to preventive practices (e.g., sunscreen use, protective clothing, avoidance of artificial UV sources).

The instrument was developed in English and translated into Arabic using a forward‐backwards translation process to ensure linguistic and cultural accuracy. A pilot study involving 50 participants was conducted to assess clarity, cultural appropriateness, and response burden. Feedback led to minor revisions in the wording and formatting of the items. Internal consistency was evaluated using Cronbach's alpha, yielding an overall reliability coefficient of 0.757, which indicates acceptable psychometric reliability. Domain‐specific reliability was also assessed to ensure robustness across constructs.

2.4. Ethical Considerations

Ethical approval was obtained from the Institutional Review Board (IRB) of Umm Al‐Qura University [IRB reference number: HAPO‐02‐K‐012‐2024‐05‐2157]. Informed consent was secured electronically from all participants before they accessed the questionnaire, with clear explanations of study objectives, voluntary participation, and data confidentiality. Anonymity was maintained by excluding identifiable information from the dataset, and all data were stored on a secure, password‐protected server.

2.5. Statistical Analysis

Data analysis was conducted using IBM SPSS Statistics (version 23). Descriptive statistics, including frequencies, percentages, means, and standard deviations, characterised participant demographics, knowledge, attitudes, and behaviours. Inferential analyses comprised chi‐square tests to explore associations between categorical variables (e.g., gender, education level) and melanoma‐related outcomes, as well as one‐way analysis of variance (ANOVA) to examine differences in continuous outcomes (e.g., knowledge scores) across demographic groups. Where ANOVA indicated significant differences, post‐hoc tests (e.g., Tukey's HSD) were applied. Given the exploratory nature of this study, which aimed to identify potential patterns and inform future research rather than confirm definitive effects, p‐values are interpreted descriptively, and no correction methods for multiple comparisons (e.g., Bonferroni) were applied. This approach is consistent with the study's objective to generate hypotheses about melanoma awareness and behaviours in a high‐UV region, where uncorrected p‐values provide preliminary insights into demographic influences [8]. A p‐value < 0.05 was deemed statistically significant for reporting purposes. To mitigate potential biases from convenience sampling, subgroup analyses were carried out to assess response consistency across demographic strata.

3. Results

3.1. Questionnaire Reliability

The internal consistency of the 46‐item questionnaire was assessed using Cronbach's alpha, which yielded a coefficient of 0.757, indicating acceptable reliability for evaluating melanoma awareness, attitudes, and adherence to preventive behaviours (Table 1).

TABLE 1.

Questionnaire internal consistency: Summary of the questionnaire's reliability based on cronbach's alpha analysis.

Number of axes	Cronbach's alpha
46	0.757

3.2. Participant Demographics and Sociocultural Characteristics

The study included 553 participants, predominantly aged 18–35 years (53.9%) and female (64.4%). Nearly all were Saudi nationals (98.2%), residing in Makkah (28.6%), Al Madinah Al Munawarah (28.2%), Taif (26.6%), or Jeddah (16.6%). Over half were employed (52.3%), with 21.3% in healthcare‐related roles. Educationally, 66.5% had completed high school, while 0.2% had no formal education (Table 2).

TABLE 2.

Demographic and sociocultural characteristics (n = 553): Distribution of participants by age, gender, nationality, residence, employment, healthcare affiliation, and education.

Variables		No.	%
Age	18–35	298	53.90%
	36–45	102	18.40%
	More than 45	153	27.70%
Gender	Male	197	35.60%
	Female	356	64.40%
Nationality	Saudi	543	98.20%
	Non‐saudi	10	1.80%
Residence	Taif	147	26.60%
	Al madinah Al munawarah	156	28.20%
	Jeddah	92	16.60%
	Makkah	158	28.60%
Employment	Unemployed	264	47.70%
	Employed	289	52.30%
Educational level	Uneducated	1	0.20%
	Intermediate	10	1.80%
	High school	368	66.50%
	Diploma	89	16.10%
	University	40	7.20%
	Master's degree or higher	45	8.10%
Healthcare worker	No	435	78.7%
	Yes	118	21.3%

3.3. Constitutional Melanoma Risk Factors

A personal history of skin cancer was rare (1.1%), as was a family history in first‐degree relatives (1.6%). Most participants (65.5%) reported having skin that burns after sun exposure. The predominant skin tones were white (55.9%) and brown (43.2%), with freckling in childhood being uncommon. Dark brown or black hair was reported by 83.7% (Supporting Information S1: Table 1).

3.4. Sun Exposure and UV‐Related Behaviours

Regular sun exposure was reported by 71.4% of participants throughout the year. While 60% had never experienced sunburn, 16.3% reported having sunburn the previous summer. Common exposure settings included sports (38.2%), mountains (26.9%), and beaches (26%). Use of artificial UV sources was minimal, with 91% never using them and 5.1% reporting exposure before age 20 (Table 3).

TABLE 3.

Sun exposure and UV risk behaviours: Patterns of sun exposure, sunburn history, and artificial UV source use.

Behaviour		No.	%
History of sunburns	None	329	59.5%
	1	106	19.2%
	2–5	92	16.6%
	> 5	26	4.7%
History of sunburn (last summer)	No	463	83.7%
	Yes	90	16.3%
Sun exposure during the year	No	158	28.6%
	Yes	395	71.4%
Frequency of sun exposure	Never	0	0.0%
	Rarely	73	13.2%
	Sometimes	238	43.0%
	Mostly	86	15.6%
	Often whole year	156	28.2%
Sun exposure setting	In the mountain	149	26.9%
	Practicing sports	211	38.2%
	In the pool	49	8.9%
	At the beach	144	26.0%
Professional UV treatment experience	Negative	334	60.4%
	Positive < 10 years	153	27.7%
	Positive > 10 years	66	11.9%
Frequency of artificial UV radiation exposure (tanning beds, UV phototherapy, UV disinfection system)	None	503	91.0%
	1–10	35	6.3%
	11–20	6	1.1%
	21–60	6	1.1%
	More than 60 times	3	0.5%
Age at first exposure to UV treatment	Never	507	91.7%
	Less than 20 years	28	5.1%
	21–40 years	14	2.5%
	More than 40 years	4	0.7%

3.5. Knowledge of Melanoma Risk Factors

Participants exhibited moderate knowledge of melanoma risk factors, defined as factual recall of aetiology and protective actions, with a mean score of 2.28 on a 5‐point Likert scale for true/false items. Notably, 73.2% correctly identified sunlight as a risk factor for skin cancer, though only 54.1% recognised the link between childhood sunburns and adult melanoma (Table 4).

TABLE 4.

Melanoma knowledge (factual accuracy): Participant knowledge and misconceptions about melanoma risk factors.

Item		Answers		Mean	St.dev	Trend
		False	True
Sunlight causes skin cancer	No.	148	405	2.46	0.89	True
	%	26.8%	73.2%
People who only go into the sun for 1–2 weeks a year are not at risk for skin cancer	No.	199	354	2.28	0.96	Neutral
	%	36.0%	64.0%
Sunburns in childhood are not related to skin cancer in adulthood	No.	254	299	2.08	1.00	Neutral
	%	45.9%	54.1%
High‐SPF sunscreens prevent to get sun‐tanned at the end of the holiday	No.	133	420	2.52	0.86	True
	%	24.1%	75.9%
Applying high‐SPF sunscreens is enough to prevent damage during summer sun exposure at midday	No.	173	380	2.37	0.93	True
	%	31,3%	68.7%
Sunscreens are needed on cloudy days	No.	242	311	2.12	0.99	Neutral
	%	43.8%	56.2%
High‐SPF sunscreens allow longer sun exposure	No.	239	314	2.14	0.99	Neutral
	%	43.2%	56.8%
Mean and standard deviation		Sun exposure and disease risk knowledge and awareness		2.28	0.44	Neutral

3.6. Awareness of Melanoma Risk Factors

Awareness, defined as perceived risk of melanoma, was also moderate (mean = 3.46), with participants recognising key risk factors such as personal melamona history (mean = 3.89), family history (3.83), sunburns (3.70), and artificial UV exposure (3.81), though moles (> 50) were less strongly associated (mean = 3.48). Non‐relevant factors (e.g., mobile phone radiation) were accurately dismissed (Supporting Information S1: Table 2).

3.7. Attitudes Towards Sun Protection

Attitudes towards sun protection were mildly positive (mean = 3.53). Notably, 31.8% strongly agreed that tanned skin appears healthier, and 51.9% believed that sunburn was inevitable during tanning. Confidence in sunscreen use was high (mean = 3.76), but conflicting beliefs about the necessity of protection persisted (Table 5).

TABLE 5.

Attitudes towards sun protection and tanning: Participant attitudes towards sun protection and tanning behaviours.

Attitude		Answers					Mean	St.dev	Trend
		Strongly disagreement	Mildly disagreement	Neutral	Mildly agreement	Strongly agreement
Believe that sun‐tanned people look healthier	No.	30	49	149	149	176	3.71	1.16	Mildly agreement
	%	5.4%	8.9%	26.9%	26.9%	31.8%
It is worth to get sunburnt to get sun‐tanned.	No.	125	109	118	126	75	2.85	1.36	Neutral
	%	22.6%	19.7%	21.3%	22.8%	13.6%
Confidence of sunscreen use	No.	17	42	145	204	145	3.76	1.02	Mildly agreement
	%	3.1%	7.6%	26.2%	36.9%	26.2%
Believe that sunburn is a must when getting tanned	No.	32	83	151	171	116	3.46	1.15	Mildly agreement
	%	5.8%	15.0%	27.3%	30.9%	21.0%
Concern about the damage caused by sun exposure	No.	20	38	114	201	180	3.87	1.06	Mildly agreement
	%	3.6%	6.9%	20.6%	36.3%	32.5%
Degree of difficulty associated with sun protection	No.	34	78	128	188	125	3.53	1.16	Mildly agreement
	%	6.1%	14.1%	23.1%	34.0%	22.6%
Mean and standard deviation		Sun protection behaviours					3.53	0.74	Mildly agreement

3.8. Adherence to Preventive Behaviours

Adherence to sun‐protective behaviours was suboptimal (mean = 2.67). The use of hats (mean = 2.30) and protective clothing (mean = 2.52) was infrequent, while sunscreen re‐application was poor (mean = 2.16). Sunglasses usage was more consistent (mean = 3.19). High‐SPF sunscreen was never used by 23.9% (Table 6).

TABLE 6.

Adherence to sun‐protective behaviours: Frequency and consistency of sun‐protective behaviours.

Behaviour		Answers					Mean	St.dev	Trend
		Never	Rarely	Sometimes	Often	Always
Hat	No.	183	159	121	43	47	2.30	1.24	Rarely
	%	33.1%	28.8%	21.9%	7.8%	8.5%
T‐shirts:	No.	181	123	112	55	82	2.52	1.41	Rarely
	%	32.7%	22.2%	20.3%	9.9%	14.8%
Sun glasses	No.	100	91	113	102	147	3.19	1.45	Sometimes
	%	18.1%	16.5%	20.4%	18.4%	26.6%
High‐SPF sunscreens	No.	132	94	139	93	95	2.86	1.40	Sometimes
	%	23.9%	17.0%	25.1%	16.8%	17.2%
Timing first sunscreen application	No.	168	119	139	66	61	2.52	1.33	Rarely
	%	30.4%	21.5%	25.1%	11.9%	11.0%
Re‐application sunscreens	No.	211	141	133	36	32	2.16	1.17	Rarely
	%	38.2%	25.5%	24.1%	6.5%	5.8%
Midday sun exposure	No.	61	94	179	127	92	3.17	1.22	Sometimes
	%	11.0%	17.0%	32.4%	23.0%	16.6%
Mean and standard deviation		Extent of compliance with preventive measures					2.67	0.82	Sometimes

3.9. Demographic Influences on Outcomes

3.9.1. Age

Younger participants (aged 18–35 years) exhibited significantly higher awareness of melanoma (p = 0.036) compared to those aged 36–45. No significant age‐related differences were observed in attitudes or adherence (Supporting Information S1: Table 3).

3.9.2. Misconceptions and Gender‐Based Differences

Significant misconception were prevalent, with 35% believing short‐term sun exposure is harmless, 43.8% assuming sunscreen is unnecessary on cloudy days, and only 54.1% recognising the link between childhood sunburns and adult melanoma (Table 4). Overreliance on high‐SPF sunscreen was notable, with 75.9% believing it prevents tanning and 68.7% assuming it suffices during peak UV hours. Gender‐based differences were pronounced, with females (64.4% of the sample) showing higher knowledge (p < 0.001), awareness (p = 0.017), and adherence to preventive behaviours (p < 0.001) compared to males (Supporting Information S1: Table 4).

3.9.3. Demographic and Occupational Influences

Participants who were employed exhibited a significantly higher level of awareness (p = 0.048) in comparison to their unemployed counterparts; however, employment status did not have an impact on adherence, as detailed in Supporting Information S1: Table 5. Of the total 553 participants, 52.3% (n = 289) were employed, and 21.3% (n = 118) identified themselves as healthcare workers. Healthcare professionals demonstrated marginally greater awareness of melanoma (mean score = 2.45 on a 5‐point Likert scale) than non‐healthcare workers (mean score = 2.23); nonetheless, this difference was not statistically significant, likely due to the limited sample size of healthcare workers. Both groups exhibited comparable adherence to sun‐protective practices, indicating that occupational context, as measured, did not substantially influence preventive behaviours. Additionally, the questionnaire was unable to reliably differentiate between indoor and outdoor occupational exposures, thus constraining further analysis of ultraviolet‐related risk based on workplace setting.

3.9.4. Educational Attainment

Higher education levels were associated with greater awareness (p = 0.031), but no significant effects were observed for risk perception or adherence, highlighting a knowledge‐behaviour gap (Supporting Information S1: Table 6).

4. Discussion

This study provides a detailed examination of melanoma knowledge (factual accuracy regarding aetiology, risk factors, and protective actions), risk awareness (perceived susceptibility to UV‐related risks), and adherence to preventive behaviours among adults in Saudi Arabia's western region, which is characterised by high ultraviolet (UV) radiation exposure. The findings address the study's objectives by revealing gaps in knowledge, attitudes, and behaviours, as well as demographic and occupational influences, and prevalent misconceptions that undermine effective melanoma prevention despite moderate knowledge (mean = 2.28).

5. Melanoma Knowledge and Misconceptions

Participants displayed moderate knowledge of melanoma risk factors (mean = 2.28), with 73.2% correctly identifying sunlight as a risk factor, aligning with studies in Riyadh [9]. However, significant misconceptions persist, notably the belief held by 36% that short‐term sun exposure is harmless and by 43.8% that sunscreen is unnecessary on cloudy days. These findings align with global research from Western Europe [10] and North America [11], which has well‐documented public misunderstanding of UV risk under non‐sunny conditions. Furthermore, only 54.1% recognised the link between childhood sunburns and adult melanoma, a concerning gap given the established role of early‐life UV exposure in melanoma aetiology. These misconceptions, particularly overreliance on high‐SPF sunscreen (75.9%), highlight the need for targeted educational campaigns emphasising the cumulative and context‐independent nature of UV damage.

5.1. Risk Awareness and Behavioural Inconsistencies

Risk awareness of UV exposure was moderate (mean = 3.46), with strong perceived susceptibility to personal and family history of melanoma (means = 3.89, 3.83) and sunburns (mean = 3.70). However, attitudes towards sun protection were only mildly positive (mean = 3.53), with cultural beliefs, such as 31.8% strongly agreeing that tanned skin is healthier, posing barriers [15, 16]. Overconfidence in sunscreen (mean = 3.76) and the belief that sunburn is inevitable (51.9%) further hinder adherence. Suboptimal adherence (mean = 2.67) was evident in the low use of hats (mean = 2.30), protective clothing (mean = 2.52), and sunscreen reapplication (mean = 2.16), consistent with findings in high‐UV regions, such as Australia [12]. This knowledge‐action gap underscores the need for behaviour change strategies, such as habit formation and environmental nudges.

5.2. Demographic and Occupational Influences

Significant demographic influences emerged. Females demonstrated higher knowledge (p < 0.001), risk awareness (p = 0.017), and adherence (p < 0.001) than males potentially reflecting greater engagement with health information and aesthetic concerns [13]. This aligns with global trends and prior Saudi studies, potentially reflecting women's greater engagement with health information and aesthetic concerns, such as preventing skin ageing [14, 15, 16, 17]. Younger participants (18–35 years) also showed higher knowledge (p = 0.036) compared to older adults, likely due to their greater exposure to digital health campaigns. However, this awareness did not translate into improved adherence (Supporting Information S1: Table 3).

Education level had a significant influence knowledge (p = 0.031), consistent with the literature that links health literacy to educational attainment. Similarly, employed participants exhibited greater knowledge (p = 0.048), possibly due to workplace health initiatives, but adherence was unaffected (Supporting Information S1: Table 5). Among participants, 21.3% (n = 118) were healthcare workers, showing slightly higher knowledge (mean = 2.45) than non‐healthcare workers (mean = 2.23), though adherence was similar (healthcare workers mean = 2.70, non‐healthcare workers mean = 2.66). The lack of reliable indoor/outdoor occupational data limited further analysis. Neither education nor employment impacted adherence, reinforcing the disconnect between knowledge and action. These findings suggest that while educational and occupational contexts enhance awareness, additional strategies are needed to foster behavioural change.

5.3. Interpreting the Knowledge‐Behaviour Gap

The persistent discrepancy between knowledge and behaviour observed in this study, whereby moderate knowledge about risk factors does not translate into consistent sun‐protective practices, can be more comprehensively understood through behavioural theories such as the Health Belief Model (HBM) [12] and the Theory of Planned Behaviour (TPB) [13]. The HBM suggests that health‐related actions are contingent upon perceived susceptibility, severity, benefits, barriers, and cues to action [14]. In this context, a low perceived susceptibility to melanoma, particularly among male participants (p = 0.017), may account for suboptimal adherence, as individuals might underestimate their personal risk owing to cultural norms that valorise tanned skin (31.8% strongly agreed that tanned skin is healthier).

Similarly, the TPB highlights the role of attitudes, subjective norms, and perceived behavioural control in shaping actions [18]. Cultural norms that associate tanned skin with attractiveness or health, particularly among men, act as subjective norms that discourage sun‐protective behaviours. Gender roles further exacerbate this gap, with males showing lower adherence (p < 0.001), potentially due to social expectations that prioritise ruggedness over health precautions [19]. Psychosocial factors also play a critical role. Cosmetic norms, such as the desire for tanned skin as a status symbol [20, 21], undermine adherence to sun protection, particularly in a region where sun exposure is culturally normalised during outdoor activities like pilgrimages. Perceived susceptibility is further diminished by misconceptions, such as the belief held by 51.9% that sunburn is inevitable during tanning, reflecting a fatalistic attitude that discourages preventive efforts [22]. These findings are indicative that cultural and aesthetic values significantly influence skin cancer prevention behaviours [23, 24]. Addressing this gap requires that enhanced perceived susceptibility through vivid, relatable messaging (e.g., testimonials from melanoma survivors) and challenging cultural norms by reframing sun protection as a socially desirable practice for both genders.

5.4. Implications for Psycho‐Oncology Across the Cancer‐Care Continuum

This study's findings have significant implications for psycho‐oncology in Saudi Arabia, addressing melanoma prevention and management across the cancer care continuum. For primary prevention, gender‐targeted sun‐safety counselling in primary‐care and mosque settings can address the gender gap in knowledge (p < 0.001) and adherence (p < 0.001), leveraging cultural venues to promote sun‐protective behaviours, as seen in tobacco cessation programs [23]. For secondary prevention and early detection, integrating skin‐self‐examination modules into psycho‐oncology patient‐education programs can enhance early detection, particularly among males with lower risk awareness (p = 0.017), building on successful skin cancer screening initiatives [25]. For survivorship, tailored behavioural‐change support for melanoma survivors, focussing on preventing second primaries through consistent sun protection (e.g., addressing low adherence, mean = 2.67), can be incorporated into psycho‐oncology care, drawing on models for cancer survivor behaviour change [26]. For policy and workforce development, training Saudi psycho‐oncology professionals to deliver culturally adapted UV‐risk communication can strengthen health systems, addressing misconceptions (e.g., 43.8% on cloudy‐day protection) and supporting national cancer control strategies [27]. These strategies align with the study's findings and Saudi Arabia's cultural context, enhancing melanoma prevention and care.

5.5. Cultural and Attitudinal Barriers

Attitudes towards sun protection were mildly positive (mean = 3.53), but cultural beliefs, such as the perception that tanned skin is healthier (31.8% strongly agreed), pose significant barriers. This aligns with studies in other sun‐exposed regions, where tanning is socially valued [28, 29]. Additionally, 51.9% believed sunburn is inevitable during tanning, reflecting a fatalistic attitude that may discourage preventive efforts. Addressing these culturally reinforced beliefs requires tailored campaigns that reframe sun protection as a socially desirable norm, potentially leveraging gender‐specific messaging to engage men and women differently.

5.6. Novel Contributions and Public Health Implications

This study makes several novel contributions to the understanding of melanoma prevention in Saudi Arabia's western region, a high‐UV environment with limited prior research. It provides a region‐specific analysis of melanoma‐related knowledge, attitudes, and behaviours, quantifying prevalent misconceptions, such as an overreliance on high‐SPF sunscreen and underestimating UV risk on cloudy days, that hinder adequate sun protection. Additionally, it highlights a significant knowledge–action gap, particularly among younger and educated participants, offering new insights into the behavioural barriers that persist despite moderate awareness. The identification of gender‐based disparities, with females demonstrating superior knowledge and adherence, informs the development of gender‐sensitive health promotion strategies. These findings establish a foundation for tailored public health interventions that address both cultural beliefs, such as the aesthetic appeal of tanned skin, and demographic‐specific needs, thereby advancing melanoma prevention efforts in Saudi Arabia and similar high‐risk settings.

To translate these findings into actionable interventions, three evidence‐based strategies are proposed, grounded in the study's results and the cultural context of Western Saudi Arabia. First, integrating sun‐safety modules into social awareness campaigns to help disseminate melanoma prevention messages. Second, establishing shaded rest areas with free sunscreen dispensers for outdoor workers during Hajj and Umrah addresses the occupational exposure risks highlighted in the introduction, particularly for those in pilgrimage support roles (21.3% of participants were healthcare workers, a subset of whom work outdoors during pilgrimages). This intervention aligns with findings of suboptimal adherence (mean = 2.67) and could reduce UV exposure in high‐risk settings, drawing on successful models from Australia, where shade improved sun protection among outdoor workers [30]. Third, launching a social‐media sun‐safe campaign targeting young men (aged 18–35 years, 53.9% of the sample) addresses the gender disparity in adherence (male: p < 0.001) and capitalises on the high engagement of younger participants with digital platforms (noted in their higher awareness, p = 0.036). By encouraging young men to participate in these campaigns and understand sun‐protective measures (e.g., hats, sunglasses), this campaign could reframe sun protection as socially desirable, countering cultural norms that value tanned skin (31.8%) and building on successful social media health campaigns [31]. These interventions, tailored to the region's cultural and demographic context, offer practical pathways to reduce melanoma risks and enhance prevention efforts.

5.7. Limitations and Future Directions

This study has several limitations that should be considered when interpreting its findings. Firstly, the utilisation of convenience sampling via online platforms may introduce a digital divide, potentially resulting in the underrepresentation of older adults, rural populations, or individuals with limited internet or technological proficiency. Furthermore, this sampling methodology may be prone to non‐response bias, as individuals with lower engagement in melanoma prevention may have been less inclined to participate. Secondly, dependence on self‐reported behaviours introduces the possibility of social desirability bias, whereby participants might overreport their adherence to sun‐protective practices, thereby artificially inflating estimates of preventive behaviours. Thirdly, the cross‐sectional nature of the study precludes causal inferences, thereby limiting the capacity to ascertain the directionality of relationships among knowledge, attitudes, and behaviours. Lastly, the study's focus on western Saudi Arabia, a region characterised by the nation's highest UV index and unique cultural practices such as pilgrimage‐related exposures, may limit the generalizability of the findings to other regions within Saudi Arabia or the broader Middle East.

Finally, although occupational status was identified as a variable of interest in the context of UV exposure, the questionnaire did not include reliable measures to distinguish between indoor and outdoor occupational settings. While the status of healthcare workers was recorded (n = 118), the limited sample size and absence of detailed occupational exposure data, such as the duration or intensity of UV exposure in workplace environments, restricted the capacity to perform comprehensive analyses beyond descriptive comparisons between healthcare workers and non‐healthcare workers.

Future research should employ longitudinal designs to assess behaviour change over time and interventional studies to evaluate tailored educational and environmental strategies. Qualitative studies could further elucidate the cultural and psychological drivers of sun‐protective behaviours, particularly among men and rural populations. Additionally, exploring the role of healthcare providers in delivering melanoma education could enhance the efficacy of interventions.

In conclusion, this study underscores the necessity for multifaceted interventions to address knowledge gaps, cultural barriers, and behavioural inertia in melanoma prevention. By integrating targeted education, behavioural nudges, and culturally relevant messaging, public health efforts can mitigate melanoma risk and enhance outcomes in Saudi Arabia's high‐UV environment.

6. Conclusion

This study provides critical insights into melanoma prevention in Saudi Arabia's western region, which is characterized by a high ultraviolet (UV) radiation environment. While there is moderate awareness of melanoma as a UV‐related malignancy, significant knowledge gaps—particularly regarding sunscreen efficacy, risks associated with intermittent sun exposure, and the effectiveness of UV protection on cloudy days—persist alongside widespread misconceptions. A notable knowledge–action gap is evident, with modestly positive attitudes towards sun protection (mean = 3.53) failing to translate into consistent adherence to preventive behaviours (mean = 2.67), such as regular sunscreen reapplication or the use of protective clothing. Gender and age significantly influence outcomes, with females and younger adults (18–35 years) demonstrating greater awareness and risk perception; however, these advantages do not consistently lead to improved behavioural compliance. These findings highlight the urgent need for culturally tailored, evidence‐based public health interventions that address psychological, behavioural, and cultural barriers, particularly targeting males, older adults, and those with lower education levels. By quantifying region‐specific misconceptions and disparities, this study provides a foundation for designing targeted melanoma prevention strategies in Saudi Arabia. As global skin cancer incidence rises, future research should prioritize longitudinal studies, behavioural interventions, and digital health tools to promote sustained sun‐protective behaviours, ultimately reducing the melanoma burden in high‐risk populations.

Author Contributions

All authors contributed to the conception and design of the study. A.F.F. and S.M.K. led the development of the questionnaire and the collection of data. S.M.K., H.T.A., and S.N.E. conducted the statistical analysis and interpreted the results. A.A.A., N.M.A., A.A.A., R.A.B., M.K.A., B.M.A., and S.N.E. draughted the manuscript, while A.F.F. and S.M.K provided critical revisions. All authors reviewed and approved the final manuscript.

Ethics Statement

The study received approval from the Institutional Review Board (IRB) of Umm Al‐Qura University [IRB reference number: HAPO‐02‐K‐012‐2024‐05‐2157].

Consent

All participants provided informed consent electronically before completing the questionnaire. Participation was voluntary, and anonymity and confidentiality were maintained throughout the study. Not applicable, as no identifiable individual data is included in this publication.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Supporting Information S1

Flemban, Arwa F. , Kabrah Saeed M., Alabbadi Asmaa A., et al. 2025. “Sun‐Safety Knowledge, Attitudes and Behaviour in Western Saudi Arabia: Implications for Psycho‐Oncology Prevention Services.” Psycho‐Oncology: e70273. 10.1002/pon.70273.

Data Availability Statement

The datasets generated and analysed during this study are not publicly available due to participant confidentiality but are accessible from the corresponding author upon reasonable request, subject to ethical approval.