Children's skin cancer prevention: a systematic review of parents' psychosocial measures

CONTEXT

Parents' knowledge, attitudes, and beliefs may be influenced through intervention to increase children's sun protection. Little is known about measures of these psychosocial characteristics, including psychometric properties. This paper systematically reviews parents' psychosocial measures in children's skin cancer prevention studies.

EVIDENCE ACQUISITION

A search of standard databases conducted in 2008, updated in 2011, yielded 5797 unique citations. A study was eligible if (1) it was published between January 1980 and March 2011; (2) it was published in English; (3) it reported a psychosocial measure relevant to children's skin cancer prevention; and (4) the psychosocial measure was administered to parents, the majority of whom had children aged ≤12 years. Screening yielded 57 eligible studies. Data were analyzed in 2008 and 2011.

EVIDENCE SYNTHESIS

Most studies measured one (n=24) or two (n=18) psychosocial constructs; few (n=7) measured more than three. The most frequently measured constructs were knowledge (n=41); attitudes (n=22); perceived susceptibility/risk (n=11); self-efficacy (n=9); and perceived barriers (n=9). Most studies did not mention theory. Theoretic mechanisms underlying interventions were not examined. There was little description of measure validity. Reliability, usually internal consistency, was reported more often (n=19).

CONCLUSIONS

Few studies assessed more than two parent-related psychosocial constructs, so it was not possible to test theoretic models of parental influences on children's sun protection. Validated measures were lacking. There was conceptual overlap of measures because of the presence of analogous constructs across theories and assessment of multiple constructs within a single measure.

Encouraging sun safety for children and adolescents

The rise in the number of cases of skin cancers, both melanomas and nonmelanomas, has prompted increased awareness and educational efforts to limit sun exposure. Because 80% of lifetime sun exposure occurs before the age of 18, educating parents and adolescents to incorporate sun-protective behaviors into daily routines is particularly important. Education of parents is essential to establishing healthy behavior patterns in children. Educational interventions are recommended that encourage the following: using sunscreen, wearing hats with wide brims and clothing that blocks or absorbs ultraviolet rays, using sunglasses that block ultraviolet radiation, and seeking shade. Continued efforts are important through adolescence to maintain the established behaviors. School nurses are in a position to affect the health education curriculum, as well as school policies that promote sun safety behaviors.