Relationship and partner moderator variables increase self-efficacy of performing skin self-examination

mySmartCheck, a Digital Intervention to Promote Skin Self-examination Among Individuals Diagnosed With or at Risk for Melanoma: A Randomized Clinical Trial

BACKGROUND

Regular skin self-examination (SSE) reduces melanoma mortality but is not often conducted.

PURPOSE

To promote SSE performance in individuals at increased risk for melanoma.

METHODS

One hundred sixteen individuals at heightened risk for development of melanoma (i.e., personal/family history of melanoma, high-risk mole phenotype) who did not conduct a thorough SSE during in the prior 3 months were randomly assigned to receive either an automated internet-based intervention (mySmartCheck) or usual care (UC). One hundred sixteen participants completed surveys before random assignment and 99 completed the follow-up survey 13-weeks afterward. The primary outcome was participant self-reported examination (SSE) of all 15 parts of the body in the last 3 months. Secondary outcomes were SSE of any part of the body in the last 3 months and number of body parts examined during the last SSE.

RESULTS

More mySmartCheck participants examined all 15 body parts (32.6% vs. 7.1%, p = .001). More individuals in mySmartCheck reported conducting SSE on any body part than those in UC (81.4% vs. 62.5%, p = .04). Effect sizes were large (d = 1.19 all 15 body parts) to moderate (d = 0.55 for any body part). mySmartCheck participants examined more body areas than UC participants (12.7 vs. 10.3, p = 0.003) during the last SSE. Participants in mySmartCheck reported higher levels of knowledge of suspicious lesions, SSE benefits, SSE self-efficacy, and planning for SSE, and lower SSE barriers, than those assigned to UC.

CONCLUSIONS

mySmartCheck had a significant positive impact on SSE performance and behaviors. Additional research with a larger sample size, a longer follow-up, and more varied clinical settings is needed.

TRIAL REGISTRATION

ClinicalTrials.gov registration # NCT03725449 (https://clinicaltrials.gov/ct2/show/NCT03725449).

Melanoma detection by skin self-examination targeting at-risk women: A randomized controlled trial with telemedicine support for concerning moles

Secondary melanoma prevention remains crucial to reduce morbidity and mortality for the 200,000 people in the United States estimated to develop melanoma in 2021. This 3-month randomized controlled trial of online skin self-examination (SSE) education among 1000 at-risk women who received care at Northwestern Medicine in Illinois sought to determine SSE initiation and monthly performance, SSE anxiety and confidence, and health care practitioner (HCP) visits for concerning moles. Positive responses to a personal history of sunburn, a personal or family history of skin cancer, and/or having 10 or more lifetime indoor tanning sessions identified and informed women of their increased risk of melanoma. At one month, 96.2% of women receiving SSE education (SSE women) initiated SSE compared to 48.1% in the active control arm (control) (p < 0.001). More control women sought HCP visits (n = 107) than SSE women (n = 39). Control women seen by HCPs identified benign lesions, especially seborrheic keratosis, more often than SSE women. More atypical nevi (SSE 38.5%, control 8.4%) and melanomas (SSE 25.6%, control 4.7%) were visually identified by SSE women seeing HPCs (p < 0.001). There was no significant difference in SSE anxiety between the control and SSE arms. Confidence increased significantly in the SSE arm whereas there was no change in the control group (p < 0.001). Women checked someone else for concerning moles [315/ 494 (63.8%) of SSE women]. Targeting at-risk women for SSE education may help reduce melanoma mortality, especially in rural communities where incidence and mortality are greater than in urban areas.

Prevalence and correlates of skin self-examination behaviors among melanoma survivors: a systematic review

Melanoma is the most common cause of skin cancer deaths, and individuals who have had melanoma have an increased risk of developing new melanomas. Doing regular self-examinations of skin enables one to detect thinner melanomas earlier when the disease is more treatable. The aim of this systematic review is to characterize and evaluate the existing literature on the prevalence and correlates of skin self-examination (SSE) behaviors among adult melanoma survivors in the USA and Canada. A computerized literature search was performed using PubMed, Google Scholar, and ScienceDirect. The inclusion criteria for the studies were: (a) reported results for adult melanoma survivors in the USA or Canada, (b) papers described empirical research, (c) assessed SSE and related behaviors, and (d) papers were published in a peer-reviewed journal in the past 20 years. Key phrases such as "skin self-examination/SSE in melanoma survivors in the United States" and "correlates of skin self-examination/SSE" were used. Based on the inclusion criteria, 30 studies were included in the systematic review. SSE prevalence varied depending on how SSE was defined. Demographics and factors (gender, education level, patient characteristics, partner assistance, and physician support) associated with SSE were identified. Findings of this review show evidence for the need to have a consistent way to assess SSE and suggest different types of correlates on which to focus in order to promote SSE and reduce the risk of melanoma recurrence in survivors. This systematic review and its protocol have been registered in the international database of prospectively registered systematic reviews in health and social care (PROSPERO; ID: 148878).

Prevalence and correlates of skin self-examination practices among cutaneous malignant melanoma survivors

Melanoma patients are at elevated risk for recurrence of the primary cancer as well as second primary melanomas. Regular skin self-examination (SSE) is recommended as part of follow-up surveillance. In this study, we examined SSE performance and comprehensiveness as well as knowledge and attitudinal correlates of SSE performance and comprehensiveness. Four hundred forty-one melanoma survivors completed measures of SSE performance as well as knowledge and attitudes about SSE and melanoma. Approximately two-thirds of the sample reported having conducted an SSE in the past two months; the average number of body parts examined was 10.64 (out of 15 maximum). Only 7.5% of the sample checked all 15 body parts. Greater worry about recurrence, fewer barriers to SSE, more planning for when to conduct SSE, and more confidence in the ability to conduct SSE and recognize a suspicious growth were associated with both SSE performance and greater SSE comprehensiveness. Physician influence was positively associated with SSE performance. Survivor education efforts may benefit from reminding survivors to check hard-to-see and sensitive areas, develop a plan for how to ask for assistance in conducting exams, as well as use mirrors to see hard-to-reach areas. Addressing perceived SSE barriers, fostering SSE planning, and improving SSE self-efficacy may be important foci for intervention efforts to enhance SSE performance and comprehensiveness.

Operationalization of skin self-examination in randomized controlled trials with individuals at increased risk for melanoma: A systematic review

OBJECTIVE

To investigate how skin self-examination was operationalized and the psychometric properties of the scales used to assess this behavior in randomized controlled trials (RCTs) testing interventions that promote SSE among individuals at increased risk for melanoma.

METHOD

Eight scientific databases (e.g., Medline, EMBASE, CINAHL, PsycINFO) and four trial registries (e.g., Clinicaltrials.gov, UK Clinical Trails Gateway) were searched from inception through April 2, 2019. Three reviewers carried out the selection of relevant trials and conducted data extraction.

RESULTS

The review identified 13 unique RCT's. The definition of skin self-exams, extrapolated from instructions provided to participants during the trials and reported in only 6/13 trials, included periodically checking the skin of the entire body, individually or with partners/mirrors, with or without tracking or monitoring tools, and using the ABCDE criteria to identify early signs of melanoma. There was variability in how skin self-examination behavior was measured with respect to item content, number of items, response format, and type of outcome variable used: continuous or binary). No validity evidence and minimal reliability evidence for the measures were identified.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Future studies are needed to establish the psychometric properties of measures assessing skin self-examination.

Randomized controlled trial of the mySmartSkin web-based intervention to promote skin self-examination and sun protection behaviors among individuals diagnosed with melanoma: study design and baseline characteristics

>1.2 million people in the United States have a personal history of melanoma skin cancer and are at increased risk for disease recurrence and second primary melanomas. Many of these individuals do not follow recommendations to conduct regular, thorough skin self-examinations that facilitate early disease detection and do not sufficiently engage in sun protection behaviors. In this project, we are conducting a randomized controlled trial of an innovative, tailored, theory-driven Internet intervention-called mySmartSkin-to promote these behaviors among melanoma patients. This paper outlines the study design and characteristics of the study sample. A total of 441 patients were recruited (40.9% response rate) and randomized to the mySmartSkin or a Usual Care condition. Participants complete surveys at baseline and 8 weeks, 24 weeks, and 48 weeks later. The primary aim of the project is to examine the impact of mySmartSkin versus Usual Care on skin self-examination and sun protection behaviors. The secondary aim focuses on identifying mediators of the intervention's effects. In an exploratory aim, we will examine potential moderators of the impact of the intervention. At baseline, the recruited participants had a mean age of 61 years, 49% were female, 7.5% met criteria for having conducted a recent, thorough skin self-examination, and the mean score on the index of sun protection behaviors was 3.3 (on a scale from 1 to 5). The results of the project will determine whether the mySmartSkin intervention is efficacious in promoting skin self-examination and sun protection behaviors among individuals diagnosed with melanoma. Trial registration: ClinicalTrials.govNCT03028948.

Skin Self-Examination: Partner Comfort and Support During Examinations as Predictors of Self-Efficacy in Patients At Risk for Melanoma Recurrence

BACKGROUND

Skin self-examination (SSE) is an effective method for melanoma survivors to detect potential cancerous growths sooner.

OBJECTIVES

The purpose of this study was to examine whether the SSE self-efficacy of patients with melanoma and their partners is affected by their partners' comfort and support during skin examinations.

METHODS

100 patient-partner dyads completed a 25-item sociodemographic questionnaire. Fifty-two partners attended an education session with the patient on skin examinations and the early detection of melanoma. All patients attended the education session.

FINDINGS

Having their partners attend the education session, as well as being supportive and comfortable with skin examinations, significantly predicted patients' self-efficacy with SSEs. In addition, male patients were found to be significantly more comfortable with partner-assisted skin examinations and reported feeling more supported by their partner than female patients.

Relationship of parent-child sun protection among those at risk for and surviving with melanoma: Implications for family-based cancer prevention

Preventing melanoma, the most serious form of skin cancer, is an important cancer control priority. This is especially true among children living in families previously affected by the disease because the risks for melanoma typically begin early in life. These risks accrue into adulthood but may be mitigated by parental intervention. Melanoma prevention behaviors that could be associated between adults and their children include use of sunscreen, protective clothing, seeking shade, or limiting sun exposure. This study sought to investigate how parent perceptions and behaviors influence sun protection and avoidance behaviors in their children, among relatives of melanoma survivors. In this cross-sectional study, parents (N = 313), all relatives of people diagnosed with melanoma, were surveyed about their melanoma risk-reduction behaviors and efforts to protect their children from sun exposure. Linear multiple regressions examined associations among parental behaviors, beliefs, and their reports of risk reduction for their children. Parents who practiced high sun protection themselves (i.e., wearing protective clothing, avoiding the sun, using sunscreen) were significantly more likely to report their child also wore protective clothing (B = 0.04, p < .004). Findings suggest that parents' use of risk-reducing behavioral measures extended to protective measures among their children. These findings have implications for the clinical care of melanoma survivors' families, including the design of targeted interventions that alter parental beliefs and behaviors surrounding both their own and their children's cancer prevention strategies.

Influence of Relationship Partners on Self-Efficacy for Self-Management Behaviors Among Adults With Type 2 Diabetes

Individuals with type 2 diabetes must engage in daily self-management behaviors to prevent complications. Given that management may be shared with a person's romantic partner, we examined both patients' and their partners' perceptions of relationship characteristics that were hypothesized to affect patients' self-efficacy for diabetes management. Adults with type 2 diabetes and their partners (n = 52 couples, 104 individuals) completed measures of three aspects of relationships that are theorized to affect self-efficacy: partner investment, partner support, and relationship satisfaction. Patients reported their self-efficacy for diabetes management and weekly frequency of diabetes self-management behaviors. A common fate modeling approach in which constructs were modeled as agreement between partner reports showed that relationship factors (investment, support, and satisfaction) significantly predicted patient self-efficacy (R ² = 0.49), which in turn predicted patient self-management behaviors. This model fit the data well [χ² (41) = 48.60, P = 0.19; comparative fit index (CFI) = 0.96; root mean square error of approximation = 0.06; and standardized root mean square residual = 0.07]. Interventions designed to support patients in their self-efficacy for self-management behavior may be improved through consideration of patients' romantic relationships.

The Berlin Social Support Scales: Validation of the Received Support Scale in a Canadian sample of patients affected by melanoma

The purpose of this study was to examine the reliability and validity of the Received Support Scale of the Berlin Social Support Scales in a Canadian sample of English and French language melanoma patients (N = 137). Participants received a skin self-examination education and completed self-report questionnaires. Exploratory factor analyses, reliability analyses, and independent samples t-tests were conducted. Findings support the unidimensionality of the Received Support Scale of the Berlin Social Support Scales. The psychometric similarities of the French and English versions of the scale, its strong internal consistency, as well as its convergent and discriminant validity support the use of the Received Support Scale of the Berlin Social Support Scales in patients with melanoma.

Self-efficacy and comfort with partner-assisted skin examination in patients receiving follow-up care for melanoma

The objective of this study was to examine the role of interpersonal variables on melanoma survivors' self-efficacy for performing skin self-examinations (SSEs) during melanoma follow-up care. Specifically, the impact of comfort with partner assistance for SSE, SSE support received from one's partner, general partner support, relationship satisfaction, as well as partner attendance at a SSE education session, were examined. One hundred and thirty-seven patients with melanoma between the ages of 18 and 70 years, who also reported being involved in a romantic relationship, received a standardized education on SSE, and completed self-report questionnaires. Results indicate that SSE support and SSE comfort predicted patients' SSE self-efficacy. Partner attendance at the SSE education moderated the relationship between SSE comfort and SSE self-efficacy. In other words, SSE self-efficacy was found to be affected by partner attendance at the SSE education only in cases where the patient reported lower levels of comfort having his or her partner assist with SSE. Results highlight the importance of partner involvement in SSE education, as well as patient comfort with a partner's assistance during skin examinations. Findings inform potential modifications to the follow-up care provided to melanoma survivors by demonstrating the importance of partner involvement in SSE education.

An online skin cancer risk-reduction intervention for young adults: Mechanisms of effects

OBJECTIVE

The study's purpose was to investigate moderator, implementation, and mediator variables related to the efficacy of UV4.me, an Internet intervention that decreased ultraviolet radiation (UV) exposure and increased skin protection behaviors among young adults.

METHOD

A total of 965 18-25 year olds at risk for skin cancer were recruited nationally online. Participants were randomized to an experimental website (UV4.me), a control website, or assessment only. Participant characteristics (moderators), engagement with and perceptions of interventions (implementation measures), and exposure and protection attitudinal variables (mediators) were assessed. Linear regression and mediation analyses were conducted.

RESULTS

Intervention effects on skin protection were greater for participants with a family history of skin cancer (p = .01). Intervention effects on UV exposure were greater among recent indoor tanners (p = .04). Improvements in skin protection (but not UV exposure) were associated with perceiving the interventions as satisfying or helpful (ps < .01). The experimental group had better outcomes if they completed more modules (ps < .01) or set more behavioral goals (ps < .01). Knowledge and exposure decisional balance mediated intervention effects for UV exposure (ps < .05), and protection decisional balance, self-efficacy, and intentions mediated intervention effects for protection (ps < .05).

CONCLUSIONS

The experimental intervention was more efficacious for certain high risk groups. The more individuals liked and engaged with the interventions (e.g., by setting goals), the better their outcomes. Mediation results inform theory about change mechanisms and differed by behavioral outcome. (PsycINFO Database Record

Influence of Quality of Relationship Between Patient With Melanoma and Partner on Partner-Assisted Skin Examination Education: A Randomized Clinical Trial

IMPORTANCE

Melanoma has a high survival rate if it is detected early. Training patients with early-stage melanoma who are at risk of developing new melanomas to perform skin self-examination (SSE) may improve survival.

OBJECTIVE

To examine for whom the intervention works best in a sample composed of dyads of patients with melanoma and skin-check partners who received an SSE intervention vs customary care.

DESIGN, SETTING, AND PARTICIPANTS

For 494 patients with stage 0 to IIB melanoma (mean age, 55 years; 253 [51.2%] females) and their skin-check partners (mean age, 55 years; 280 [56.7%] females), a randomized clinical trial was conducted in ambulatory care dermatologic offices from June 6, 2011, to April 14, 2014. Follow-up assessments were performed at 12 months. Analysis was performed between March 23 and June 25, 2015.

METHODS

Dyads of 494 patients and their partners were randomly assigned to receive the intervention (395 patients) or customary care (control) (99 patients). The main outcome was patient SSE self-efficacy. Partner motivation to assist with SSE and relationship quality (eg, agreeability, activities with partner, and happiness) were assessed for moderation of the influence of the intervention's effect on SSE self-efficacy.

RESULTS

Relationship quality, defined by activities with the partner (β = -0.892, SE = 0.432, t = -2.066; P = .001) and happiness (β = -4.586, SE = 2.044, t = -2.24; P = .001), significantly moderated the intervention effects on patients' SSE self-efficacy. In contrast, patient-partner agreeability (β = -0.262, SE = 0.148, t = -1.773; P = .09) and partner motivation (β = -0.328, SE = 1.024, t = -0.320; P = .10) did not significantly moderate the intervention effects on patients' SSE self-efficacy. Differences between the conditions were highest when activities performed with the partner were below average (mean difference, 6.652; P = .001) and when happiness was below average (mean difference, 7.000; P = .001). Although everyone receiving the intervention experienced some benefit, the findings indicate the greatest increases in self-efficacy were observed for those with below-average activities performed with the partner and happiness.

CONCLUSIONS AND RELEVANCE

The training of patients with melanoma and their partners in early-detection SSE benefited some more than others. Pairs who have low relationship quality, as determined by activities performed with the partner and happiness, may have received the greatest benefits from the training intervention because they were given an activity to perform together.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01432860.

Relationship factors in skin self-examination among couples

OBJECTIVE

Individuals may be more motivated to adopt health-promoting practices if they consider the benefits of these behaviours for their close relationships. The goal of this study was to use the interdependence theory to evaluate the role of relationship factors in skin self-examination (SSE).

DESIGN

The study adopted a cross-sectional survey design.

METHODS

One hundred and eighty-four married couples aged 50 years and older completed measures of skin cancer worry, SSE benefits, SSE barriers, relationship-centred motivations for SSE, discussions about SSE, and SSE practices in the past year.

RESULTS

Couples who discussed SSE with one another were more likely to engage in it. Couples who adopted a relationship-centred motivation for SSE were more likely to discuss SSE, and, ultimately, engage in SSE. One partner's beliefs were associated with the other partner's SSE. Women who adopted a relationship-centred motivation for SSE had husbands who discussed SSE more and also had husbands who were more likely to conduct SSE. Men who adopted a relationship-centred motivation for SSE did not have wives who reported that they discussed SSE more with their husbands and/or wives who were more likely to conduct SSE. These findings suggest that wives' relationship beliefs and discussions with their husbands may have a stronger association with their husbands' SSE practices than the associations between husbands' relationship beliefs and discussions with their wives' SSE practices.

CONCLUSIONS

Behavioural interventions may benefit from encouraging couples to discuss SSE and consider the benefits of SSE for their relationship and for their spouse's health. Statement of contribution What is already known on this subject? Previous studies have shown that people are more motivated to adopt health-promoting behaviours if they consider the benefits of such behaviours for their close relationships. However, little is known about the role of the marital relationship in the engagement in skin self-examination (SSE) practices. What does this study add? This study builds on prior research evaluating the role of relationship factors in cancer screening and surveillance practices. Couples who discuss SSE with one another are more likely to engage in it. Couples who consider the benefits of engaging in SSE for their relationship are more likely to discuss skin examinations and engage in them.

Screening, early detection, education, and trends for melanoma: current status (2007-2013) and future directions: Part I. Epidemiology, high-risk groups, clinical strategies, and diagnostic technology

While most cancers have shown both decreased incidence and mortality over the past several decades, the incidence of melanoma has continued to grow, and mortality has only recently stabilized in the United States and in many other countries. Certain populations, such as men >60 years of age and lower socioeconomic status groups, face a greater burden from disease. For any given stage and across all ages, men have shown worse melanoma survival than women, and low socioeconomic status groups have increased levels of mortality. Novel risk factors can help identify populations at greatest risk for melanoma and can aid in targeted early detection. Risk assessment tools have been created to identify high-risk patients based on various factors, and these tools can reduce the number of patients needed to screen for melanoma detection. Diagnostic techniques, such as dermatoscopy and total body photography, and new technologies, such as multispectral imaging, may increase the accuracy and reliability of early melanoma detection.

Skin self-examination education for early detection of melanoma: a randomized controlled trial of Internet, workbook, and in-person interventions

Background

Early detection of melanoma improves survival. Since many melanoma patients and their spouses seek the care of a physician after discovering their melanoma, an ongoing study will determine the efficacy of teaching at-risk melanoma patients and their skin check partner how to conduct skin self-examinations (SSEs). Internet-based health behavior interventions have proven efficacious in creating behavior change in patients to better prevent, detect, or cope with their health issues. The efficacy of electronic interactive SSE educational intervention provided on a tablet device has not previously been determined.

Objective

The electronic interactive educational intervention was created to develop a scalable, effective intervention to enhance performance and accuracy of SSE among those at-risk to develop melanoma. The intervention in the office was conducted using one of the following three methods: (1) in-person through a facilitator, (2) with a paper workbook, or (3) with a tablet device used in the clinical office. Differences related to method of delivery were elucidated by having the melanoma patient and their skin check partner provide a self-report of their confidence in performing SSE and take a knowledge-based test immediately after receiving the intervention.

Methods

The three interventions used 9 of the 26 behavioral change techniques defined by Abraham and Michie to promote planning of monthly SSE, encourage performing SSE, and reinforce self-efficacy by praising correct responses to knowledge-based decision making and offering helpful suggestions to improve performance. In creating the electronic interactive SSE educational intervention, the educational content was taken directly from both the scripted in-person presentation delivered with Microsoft PowerPoint by a trained facilitator and the paper workbook training arms of the study. Enrollment totaled 500 pairs (melanoma patient and their SSE partner) with randomization of 165 pairs to the in-person, 165 pairs to the workbook, and 70 pairs to electronic interactive SSE educational intervention.

Results

The demographic survey data showed no significant mean differences between groups in age, education, or income. The tablet usability survey given to the first 30 tablet pairs found that, overall, participants found the electronic interactive intervention easy to use and that the video of the doctor-patient-partner dialogue accompanying the dermatologist’s examination was particularly helpful in understanding what they were asked to do for the study. The interactive group proved to be just as good as the workbook group in self-confidence of scoring moles, and just as good as both the workbook and the in-person intervention groups in self-confidence of monitoring their moles. While the in-person intervention performed significantly better on a skill-based quiz, the electronic interactive group performed significantly better than the workbook group. The electronic interactive and in-person interventions were more efficient (30 minutes), while the workbook took longer (45 minutes).

Conclusions

This study suggests that an electronic interactive intervention can deliver skills training comparable to other training methods, and the experience can be accommodated during the customary outpatient office visit with the physician. Further testing of the electronic interactive intervention’s role in the anxiety of the pair and pair-discovered melanomas upon self-screening will elucidate the impact of these tools on outcomes in at-risk patient populations.

Trial Registration

ClinicalTrials.gov NCT01013844; http://clinicaltrials.gov/show/NCT01013844 (Archived by WebCite at http://www.webcitation.org/6LvGGSTKK).

The Influence of Disease Perceptions on the Participation of Melanoma Patients and their Partners in Skin Self-Examination Education

By examining differences between patients who enroll or decline to enroll in a partner-based study, future research can benefit and adapt recruitment strategies to reduce sampling biases. This study examined differences between melanoma patients’ who either declined or enrolled in an intervention aimed at increasing skin self-examination (SSE) with partner assistance. Specifically, differences were assessed for gender, age, perception of likelihood of getting another melanoma, benefits of early detection, and severity of the disease. Additionally, reasons for declining were examined. Among 368 melanoma patients interviewed during their appointment with the treating physician, 187 enrolled in the study and 181 declined to participate. No significant age or gender differences between enrolled and declined patients were observed. However, enrolled participants had significantly higher reports on the likelihood of getting another melanoma, severity of melanoma, and early detection as being beneficial (p<0.001). Among those declining to participate, males reported being “too busy and can’t make follow-up appointments” whereas females reported their “partner won’t assist”. Results indicate perceptions of the benefits of early detection, the severity of melanoma, and patients’ increased risk of developing a melanoma may have influenced patients’ decision to participate. Future studies may benefit by highlighting these topics in order to motivate more patients to participant in partner studies.

Correspondence and correlates of couples' skin cancer screening

IMPORTANCE

Skin cancer is common among older adults. Some national organizations recommend total cutaneous examination (TCE) and skin self-examination (SSE) for skin cancer detection. Although the spousal relationship is a known influence on health behavior, little is known about the level of correspondence in skin screening among couples.

OBJECTIVE

To investigate correspondence of TCE and SSE among older couples, demographic correlates of correspondence, and correspondence among barriers to skin examinations.

DESIGN, SETTING, AND PARTICIPANTS

Cross-sectional online survey of cohabitating partners 50 years or older performed from June 1, 2010, through July 31, 2010, via the nationally representative GfK (Gesellschaft für Konsumforschung or Society for Consumer Research) Internet panel.

MAIN OUTCOMES AND MEASURES

Both TCE in the past 3 years and SSE in the past year. RESULTS Correspondence among partners was high. For TCE, both partners had completed TCE in 23.9%, and both partners had not completed TCE in 47.3%. With regard to SSE, both partners had completed SSE in 39.8%, and both partners had not completed SSE in 38.9%. Correlates of both partners not completing TCE include lower household income, larger household size, nonmetropolitan residence, living in the Midwest, and being in a same-sex relationship. Correlates of both members not completing SSE included larger household size and being in a same-sex relationship. Barriers to screening that members of couples reported were similar to one another.

CONCLUSIONS AND RELEVANCE

Couples were mostly concordant with regard to engagement in skin examinations. Therefore, dyadic interventions to increase screening rates could be useful. Certain sociodemographic groups should especially be targeted.

Skin self-examinations and visual identification of atypical nevi: comparing individual and crowdsourcing approaches

PURPOSE

Skin self-examination (SSE) is one method for identifying atypical nevi among members of the general public. Unfortunately, past research has shown that SSE has low sensitivity in detecting atypical nevi. The current study investigates whether crowdsourcing (collective effort) can improve SSE identification accuracy. Collective effort is potentially useful for improving people's visual identification of atypical nevi during SSE because, even when a single person has low reliability at a task, the pattern of the group can overcome the limitations of each individual.

METHODS

Adults (N=500) were recruited from a shopping mall in the Midwest. Participants viewed educational pamphlets about SSE and then completed a mole identification task. For the task, participants were asked to circle mole images that appeared atypical. Forty nevi images were provided; nine of the images were of nevi that were later diagnosed as melanoma.

RESULTS

Consistent with past research, individual effort exhibited modest sensitivity (.58) for identifying atypical nevi in the mole identification task. As predicted, collective effort overcame the limitations of individual effort. Specifically, a 19% collective effort identification threshold exhibited superior sensitivity (.90).

CONCLUSIONS

The results of the current study suggest that limitations of SSE can be countered by collective effort, a finding that supports the pursuit of interventions promoting early melanoma detection that contain crowdsourced visual identification components.

Recent skin self-examination and doctor visits in relation to melanoma risk and tumour depth

BACKGROUND

Little is known about the potential benefit of skin self-examination for melanoma prevention and early detection.

OBJECTIVES

To determine whether skin self-examination is associated with reduced melanoma risk, self-detection of tumours, and reduced risk of deeper melanomas.

METHODS

We used data from a population-based case-control study (423 cases, 678 controls) to assess recent skin self-examination in relation to self-detection, melanoma risk and tumour depth ( ≤1 mm; > 1 mm). Logistic regression was used to estimate odds ratios (ORs) and confidence intervals (CIs) for associations of interest.

RESULTS

Skin self-examination conducted 1-11 times during a recent year was associated with a possible decrease in melanoma risk (OR 0·74; 95% CI 0·54-1·02). Melanoma risk was decreased for those who conducted skin self-examination and saw a doctor (OR 0·52; 95% CI 0·30-0·90). Among cases, those who examined their skin were twice as likely to self-detect the melanoma (OR 2·23; 95% CI 1·47-3·38), but self-detection was not associated with shallower tumours. Tumour depth was reduced for those who conducted skin self-examination 1-11 times during a recent year (OR 0·39; 95% CI 0·18-0·81), but was not influenced by seeing a doctor, or by conducting skin self-examination and seeing a doctor.

CONCLUSIONS

Risk of a deeper tumour and possibly risk of melanoma were reduced by skin self-examination 1-11 times annually. Melanoma risk was markedly reduced by skin self-examination coupled with a doctor visit. We cannot, however, exclude the possibility that our findings reflect bias or confounding. Additional studies are needed to elucidate the potential benefits of skin self-examination for melanoma prevention and early detection.

Barriers and facilitators of adherence to medical advice on skin self-examination during melanoma follow-up care

BACKGROUND

Melanoma is the fastest growing tumor of the skin, which disproportionately affects younger and middle-aged adults. As melanomas are visible, recognizable, and highly curable while in early stages, early diagnosis is one of the most effective measures to decrease melanoma-related mortality. Skin self-examination results in earlier detection and removal of the melanoma. Due to the elevated risk of survivors for developing subsequent melanomas, monthly self-exams are strongly recommended as part of follow-up care. Yet, only a minority of high-risk individuals practices systematic and regular self-exams. This can be improved through patient education. However, dermatological education is effective only in about 50% of the cases and little is known about those who do not respond. In the current literature, psychosocial variables like distress, coping with cancer, as well as partner and physician support are widely neglected in relation to the practice of skin self-examination, despite the fact that they have been shown to be essential for other health behaviors and for adherence to medical advice. Moreover, the current body of knowledge is compromised by the inconsistent conceptualization of SSE. The main objective of the current project is to examine psychosocial predictors of skin self-examination using on a rigorous and clinically sound methodology.

METHODS/DESIGN

The longitudinal, mixed-method study examines key psychosocial variables related to the acquisition and to the long-term maintenance of skin self-examination in 200 patients with melanoma. Practice of self-exam behaviors is assessed at 3 and 12 months after receiving an educational intervention designed based on best-practice standards. Examined predictors of skin self-exam behaviors include biological sex, perceived self-exam efficacy, distress, partner and physician support, and coping strategies. Qualitative analyses of semi-structured interviews will complement and enlighten the quantitative findings.

DISCUSSION

The identification of short and long-term predictors of skin self-examination and an increased understanding of barriers will allow health care professionals to better address patient difficulties in adhering to this life-saving health behavior. Furthermore, the findings will enable the development and evaluation of evidence-based, comprehensive intervention strategies. Ultimately, these findings could impact a wide range of outreach programs and secondary prevention initiatives for other populations with increased melanoma risk.

The contribution of health services research to improved dermatologic care

To translate scientific discovery into improved health, we must study health care itself: ie, how people access health care, costs or other barriers to the provision of good care, and what happens to patients as a result of this care. Health services research (HSR) is the interdisciplinary field that studies health care and its effects. This paper reviews different types of HSR and highlights some dermatologic examples that have resulted in improved health care systems or have helped us understand access to existing systems. The paper also addresses some of the political and systematic challenges for health services research overall, and for individual investigators and program leaders.

The influence of employer support on employee management of chronic health conditions at work

INTRODUCTION

This study examined the relationship between employer support, self-efficacy and self-management of chronic illness at work.

METHOD

772 employees reporting musculoskeletal pain (n = 230), arthritis and rheumatism (n = 132), asthma (n = 129), depression and anxiety (n = 121), heart disease (n = 80) and diabetes(n = 80) completed a questionnaire distributed across four large organizations. A modified version of the Self-Efficacy to Manage Symptoms Scale and the Self-Management Behaviors Scale were used. Support from line manager and occupational health were assessed.

RESULTS

Structural equation modelling analyses revealed that line managers support was directly related to employees' self-management of symptoms and medication at work. All three self-efficacy measures (beliefs about the ability to make adjustments,take medication and manage symptoms at work) partially mediated the relationship between line manager support and the use of medication at work. Self-efficacy beliefs in taking medication and making work adjustments also partially mediated the relationship between line manager support and self-management of symptoms at work. In contrast, there were no direct relationship between occupational health support and two self-management behaviors. Self-efficacy beliefs about making adjustments at work fully mediated the relationship between support from occupational health and self-management behaviors.

CONCLUSIONS

Employer support in developing both symptom-related and work-related self-efficacy for medication adherence and symptom management is important for those working with a chronic illness.

Thoroughness of skin examination by melanoma patients: influence of age, sex and partner

The aim of this study was to determine the thoroughness of deliberate skin examination by people with a history of melanoma. Patients were randomized into one of two conditions: either to receive the brief educational and skills training intervention alone or as a couple with their spouse or cohabiting partner. Subjects recorded concerning lesions on body maps. At the 4-month visit, a total body skin examination was performed by a dermatologist blinded to the subjects' condition and to their recorded responses. The skin surface was divided according to the region's visibility during skin self-examination and sexual connotations: visible/not sexually sensitive, non-visible/not sexually sensitive and sexually sensitive. The primary point of comparison was missed lesions, defined as the difference between lesions recorded by the subjects and their partners and those recorded by the dermatologist. Among 130 participants, 56 subjects reported partner assistance while performing SSE. Participants missed more lesions in sexually sensitive areas than in the other regions. With the increasing age of the patient, the number of missed lesions in non-visible/not sexually sensitive and sexually sensitive areas decreased. Male patients assisted by female partners missed fewer lesions in all three regions than female patients assisted by male partners. In easily visible areas, male patients missed significantly fewer lesions than female patients (P = 0.01). Older couples performed more thorough partner-assisted skin examinations in non-visible and sexually sensitive areas than younger couples. Male patients who were assisted by female partners performed more thorough partner-assisted skin examinations than female patients assisted by male partners.