Testing a belief-based intervention encouraging sun-safety among adolescents in a high risk area

doi:10.1016/j.ypmed.2010.07.003

Preventive Medicine

Volume 51, Issues 3–4, September–October 2010, Pages 325-328

https://doi.org/10.1016/j.ypmed.2010.07.003 Get rights and content

Abstract

Objective

To provide a preliminary test of a theory of planned behavior (TPB) belief-based intervention to increase adolescents' sun-protective behaviors in a high risk area, Queensland, Australia.

Methods

In the period of October–November, 2007 and May–June, 2008, 80 adolescents (14.53 ± 0.69 years) were recruited from two secondary schools (one government and one private) in Queensland after obtaining student, parental, and school informed consent. Adolescents were allocated to either a control or intervention condition based on the class they attended. The intervention comprised three, one hour in-school sessions facilitated by Cancer Council Queensland employees with sessions covering the belief basis of the TPB (i.e., behavioral, normative, and control [barrier and motivator] sun-safe beliefs). Participants completed questionnaires assessing sun-safety beliefs, intentions, and behavior pre- and post-intervention. Repeated Measures Multivariate Analysis of Variance was used to test the effect of the intervention across time on these constructs.

Results

Students completing the intervention reported stronger sun-safe normative and motivator beliefs and intentions and the performance of more sun-safe behaviors across time than those in the control condition.

Conclusion

Strengthening beliefs about the approval of others and motivators for sun protection may encourage sun-safe cognitions and actions among adolescents.

Introduction

The effects of exposure to ultraviolet radiation are an important concern for Australians, particularly in the state of Queensland, which has the highest incidence of skin cancer in the world (Giles et al., 1988). Adolescents comprise an important target group for reducing sun exposure as they practice few sun protection behaviors despite high levels of knowledge about the dangers of skin exposure to the sun (Cokkinides et al., 2001).

One model that can be used for intervention development is the theory of planned behavior (TPB; Ajzen, 1991). The TPB proposes intentions as the most proximal predictor of behavior. Intentions are influenced by a person's attitude (positive/negative evaluation), subjective norm (social pressure/approval), and perceived behavioral control (PBC; perceived control or efficacy; also thought to predict behavior) related to behavioral performance. Attitude, subjective norm, and PBC are informed by underlying behavioral (costs and benefits), normative (referents' approval or disapproval), and control (barriers and motivators) beliefs, respectively.

Limitations to previous TPB sun-safety interventions, including deviations from the traditional TPB constructs (Jackson & Aiken, 2006, Mahler et al., 2008) and a lack of assessment of the role of social influence and efficacy in behavior change (Lowe et al., 1999), make it difficult to determine the model's success in changing sun-safety behavior. The present study, therefore, comprised a preliminary test of a TPB belief-based intervention. It was expected that adolescents exposed to a belief-based intervention targeting previously identified (e.g., Robinson et al., 2008, White et al., 2008) costs and benefits, important referents, and barriers and motivators would report a significant improvement in their beliefs, intentions, and behavior for sun-safety from pre- to post-intervention compared to those adolescents in the control condition. For all constructs except for control belief barriers (where a decrease was expected), a significant increase over time on responses for intervention as opposed to control participants was hypothesized.

Section snippets

Participants

Adolescents aged 13–16 years (n = 80; 14.53 ± 0.69 years; 59.5% female; 64% fair-skinned) were recruited from two secondary schools in metropolitan areas in Queensland between October and November, 2007 (n = 26 from a government state secondary school) and May and June, 2008 (n = 54 from a private secondary school), after obtaining student, parental, and school informed consent. Students were allocated to either the intervention (n = 34; 14.59 ± 0.56 years; 53% female; 62% fair-skinned) or control condition (n

Results

Across the intervention period, 26 participants dropped out due to absence from class or failure to return a completed questionnaire at T2 (32.5%, 9/34 in the intervention condition, 14.54 ± 0.59 years, 58% female, 79% fair-skinned; 17/46 in the control condition, 14.24 ± 0.74 years; 62% female, 55% fair-skinned). Analyses did not identify any differences between T1 questionnaire completers and those who completed questionnaires at both T1 and T2 on the pre- and post-intervention constructs, age,

Discussion

This preliminary test of a TPB belief-based intervention found, for the intervention condition, an increase in adolescents' intentions to sun-protect and reported behavior (trend only) from pre- to post-intervention but no corresponding change in the control condition. Together, these results provide some preliminary evidence that the intervention was successful in facilitating change in both the immediate precursor to (intentions) and self-reported behavior.

There was a trend in the

Conclusion

This study provides preliminary evidence for the role of motivators (e.g., fashionable sun-safe products) and normative factors (e.g., the approval of friends and teachers) in encouraging sun-safety among adolescents, and for an intervention that produced changes in intentions and sun-safe behavior. Despite the study's limitations and the absence of stronger differences in findings between the intervention and control groups, the results offer initial support for a TPB-based intervention

Conflict of interest statement

The authors declare that there is no conflict of interest.

Acknowledgments

This study was funded by Cancer Council Queensland. The two Cancer Council Queensland authors on the manuscript were not part of the Committee allocating funding but were involved with the study design, data collection, analysis and interpretation, and the writing and submission of the manuscript. Members of the Committee allocating funding had no further involvement in the study after the allocation of funds.

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Testing a belief-based intervention encouraging sun-safety among adolescents in a high risk area

Abstract

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Participants

Results

Discussion

Conclusion

Conflict of interest statement

Acknowledgments

Organ. Behav. Hum. Decis. Process.

Prev. Med.

Soc. Sci. Med.

Incidence of non-melanocytic skin cancer treated in Australia

Br. Med. J.