An application of a series of theory-based educational intervention based on the health belief model on skin cancer prevention behaviors in female high school students

Background

Cancer is a leading cause of death globally and the second cause of death in developed countries. Having a rising incidence, skin cancer is the most prevalent cancer in Iran. Long-term UV radiations, particularly during childhood and adolescence, is a major cause of skin cancers. The Theory of Planned Behavior as the most precise indicator of behavior, contains motivational factors affecting behavior. This theory has been successful in predicting factors related to chronic diseases, especially cancer. As this model was successful in assessing sun-protective behaviors in previous studies, this study was designed to figure out how a theory-based educational intervention can affect the skin cancer prevention practices of Iranian female high school students.

Methods

This experimental investigation was carried out 2019-2020 using multistage cluster sampling method on 400 female high school students in Fasa, Fars, Iran. A questionnaire consisting of demographic data and a questionnaire including the components of the Theory of Planned Behavior was used to assess skin cancer preventative behaviors of both the trial and control groups of the study. An educational program based on the Theory of Planned Behavior was held for the experimental group for eight weeks regarding skin cancer preventive behaviors. The two groups completed questionnaires three months following the intervention for a second time.

Results

The study's findings revealed that prior to the intervention, there was no considerable distinction between the two study groups with regard to knowledge, attitude, subjective norms, perceived behavioral control, behavioral intentions, and skin cancer prevention behaviors; yet, three months later, the experimental group demonstrated increases in each of the mentioned variables with a significant difference. In contrast, the control group showed no discernible difference.

Conclusions

The findings of this investigation highlighted the success of the Theory of Planned Behavior for designing educational interventions aimed at encouraging skin cancer prevention in a population of female high school students.

Facebook Intervention for Young-Onset Melanoma Survivors and Families: Protocol for a Randomized Controlled Trial

BACKGROUND

Individuals diagnosed with melanoma before the age of 40 years (young-onset melanoma survivors) and their first-degree relatives (FDRs) are a growing population at risk for developing recurrent melanoma or new melanomas. Regular surveillance using clinical skin examination (CSE) and skin self-examination (SSE) and engagement in preventive behaviors including sun protection are recommended. Given the growing population of survivors and their families who are at increased risk, it is surprising that no behavioral interventions have been developed and evaluated to improve risk-reduction behaviors.

OBJECTIVE

We describe the rationale and methodology for a randomized controlled trial evaluating the efficacy of a Facebook intervention providing information, goal setting, and peer support to increase CSE, SSE, and sun protection for young-onset melanoma survivors and their FDRs.

METHODS

Overall, 577 survivors and 577 FDRs will be randomly assigned to either the Young Melanoma Family Facebook Group or the Melanoma Family Healthy Lifestyle Facebook Group condition. Participants will complete measures of CSE, SSE, and sun protection, and mediator measures of attitudes and beliefs before and after the intervention. The primary aim is to evaluate the impact of the Young Melanoma Family Facebook intervention versus the Melanoma Family Healthy Lifestyle Facebook intervention on CSE, SSE frequency and comprehensiveness, and sun protection among FDRs. The secondary aims examine the efficacy of the Young Melanoma Family Facebook intervention on survivors' SSE frequency and comprehensiveness and sun protection behaviors and mechanisms of intervention efficacy for intervention impact on FDR and survivor outcomes. The exploratory aim is to evaluate the efficacy of the 2 interventions on perceived stress, physical activity, and healthy eating.

RESULTS

This project was funded by the National Institutes of Health (R01CA221854). The project began in May 2018, and recruitment started in January 2019. We anticipate completing enrollment by November 2023. Power calculations recommended a sample size of 577 survivors and 577 FDRs. Multilevel modeling treating family as the upper-level sampling unit and individual as the lower-level sampling unit will be the primary data analytic approach. Fixed effect predictors in these models will include condition, role, sex, all 2- and 3-way interactions, and covariates.

CONCLUSIONS

The Young Melanoma Family Facebook intervention aims to improve primary and secondary skin cancer prevention for young-onset melanoma survivors and their family members. The intervention's delivery via a popular, freely available social media platform increases its impact because of the potential for dissemination in many contexts. If efficacious, this program could be disseminated by dermatologist practices, public health or nonprofit organizations focused on melanoma, and existing melanoma and skin cancer Facebook groups, thereby expanding its reach. This project will produce a content library of posts and a moderation guide for others.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03677739; https://clinicaltrials.gov/ct2/show/NCT03677739.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39640.

Habit Facilitates Actioning Sun Protective Behavior Intentions

Skin cancer is highly burdensome, but preventable with regular engagement in sun protective behaviors. Despite modest effectiveness of sun-protective behavior promotional efforts thus far, rates of engagement in sun-protective behaviors remain low. More is needed to understand motivation for using sunscreen, wearing sun-protective clothing, and seeking shade. This study tested whether the links of intention and habit strength with behavior differed between sun-protective behaviors. It was hypothesized that sun protective behaviors would be predicted by both habit and intention and that intention-behavior associations would be weaker for people with stronger habits. Participants residing in Queensland, Australia (N = 203; 75.96% female; M age = 37.16 years, SD = 14.67) self-reported their intentions and habit strength about sun-protective behavior for the next 7 days. Participants were followed-up 7 days later to self-report their sun-protective behavior. Multilevel modeling, accounting for nesting of multiple behaviors within-person, revealed that habit moderated the intention strength - behavior association and this moderation effect did not differ as a function of which behavior was being predicted. People with strong or moderate habit strength tended to act in line with their intentions; however, for people with very weak habits (2 SD < M), there was less alignment between their intention and behavior. These findings suggest that habit plays a facilitative role in the implementation of strong sun protective behavior intentions. Interventions should consider how to encourage intention and habit to enhance sun-protective behaviors and reduce the burden of skin cancer from sun exposure.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.1903380 .

Sunburns among beachgoers in the northern coast of Peru: frequency and factors associated

Background

Overexposure to ultraviolet (UV) radiation has increased skin cancer incidence and the risk of sunburns, especially during the summer months.

Objective

Identify the frequency and factors associated with sunburns in a sample of beachgoers in the northern coast of Peru.

Methods

We conducted a secondary data analysis of a previous study that assessed the awareness, behavior and attitudes concerning sun exposure among beachgoers. We included adults between 18 and 59 years who went to a beach in northern Peru during summer (March 2018). Three generalized linear models of the Poisson family were constructed to evaluate the factors associated with having had at least one sunburn last summer. All regression models reported the adjusted prevalence ratio (aPR) with their respective 95% confidence interval (95% CI).

Results

Of a total of 402 participants, 225 (56.0%) had one to five sunburns and 25 (6.2%) had six or more. Beachgoers who were 1–15 days (aPR: 1.16, 95% CI [1.05–1.27]) or more than 15 days (aPR: 1.22, 95% CI [1.09–1.36]) exposed to the sun on the beach had a higher frequency of at least one sunburn. The non-regular wearing of a hat or cap also increased the frequency of sunburns (aPR: 1.06, 95% CI [1.01–1.12]). In contrast, those who had Skin Phototype III (aPR: 0.94, 95% CI [0.88–0.99]) or IV (aPR: 0.69, 95% CI [0.63–0.75]) had a lower frequency of sunburns.

Conclusion

Three out of five beachgoers had one or more sunburns in the last summer. The factors associated with a higher frequency were the time of sun exposure at the beach and the non-regular use of a hat or cap. Type III–IV skin phototypes were associated with a lower sunburn frequency.

Sun protection and young female beachgoers: A formative theory-based approach to identifying key sun safe beliefs

ISSUE ADDRESSED

The prevalence of skin cancer remains at a high level in Australia. Young female Australian beachgoers are an at-risk population of skin cancer. Research on sun-protective beliefs held by this at-risk group is limited.

METHODS

Based on the Theory of Planned Behaviour (TPB), we conducted a formative study to understand key sun safe messages among young female beachgoers in Queensland, including an elicitation study (Phase 1; N = 21, M_age  = 24.30 years) and a two-wave questionnaire survey (Phase 2; N = 140, M_age  = 23.96 years).

RESULTS

Following content analysis and regression analyses, three key beliefs were identified: "be uncomfortable and/or unstylish" (behavioural belief), "friends and peers" (normative belief) and "lack of motivation to reapply sunscreen" (control belief).

CONCLUSIONS

The results highlight the influences of friends and peers on beachgoers' sun-protective behaviour for this young female adult cohort. Compared to previous findings among the general population, discrepancies in beliefs suggest interventions targeting this cohort should specifically focus on fashionable sun safe images and motivation to reapply sunscreen. SO WHAT?: Future health promotion and public education should utilise various strategies according to specific groups given the discrepancies identified in beliefs. For female beachgoers, sun safe images and motivations should be the primary foci.

Investigating Mothers' Decisions to Give Their 2- to 3-Year-Old Child a Nutritionally Balanced Diet

OBJECTIVE

To identify, using the Theory of Planned Behavior, the sociocognitive factors that influence mothers' decisions toward healthy eating and limiting discretionary choices (eg, lollipops) for their children aged 2-3 years.

DESIGN

Prospective correlational design with a 1-week follow-up.

PARTICIPANTS

A total of 197 mothers completed the main survey; 161 completed the follow-up behavior measure.

VARIABLES MEASURED

Phase 1 assessed intention, attitude, subjective norm, and perceived behavioral control; and 2 additional variables of parental role construction and group norms. Phase 2 assessed follow-up behavior.

ANALYSIS

Hierarchical multiple regressions (changes in multivariate coefficient) were used to predict mothers' intentions and actions for the two target behaviors.

RESULTS

Attitude, subjective norm, and perceived behavioral control predicted intentions; and intentions and perceived behavioral control predicted behavior for healthy eating and discretionary choices. Parental role construction was a significant predictor of intentions for both target behaviors.

CONCLUSIONS AND IMPLICATIONS

Results provide support for the application of the Theory of Planned Behavior in this context, as well as the addition of parental role construction. The findings illustrate the potential importance of developing intervention programs that account for sociocognitive factors to modify mothers' child feeding practices that have implications for lifelong health outcomes.