Skin cancer prevention : readiness to change sun-related behaviours

The general aim of this thesis was to collect data relevant for skin cancer prevention and to investigate the applicability of the Transtheoretical Model for sun-related behaviour. Also, to assess the readiness to change five different sun-related behaviours in the general population in Stockholm County.

The Transtheoretical Model postulates that behaviour change is not an event but a process that involves a movement through series of stages. Five stages of change have been identified: precontemplation (not thinking of changing), contemplation (considering change), preparation (committed to change), action (initiated a change), and maintenance (sustaining change).

Five populations were investigated using questionnaires: (1) 742 visitors to mobile screening units and 202 beachgoers, age range 18 to 96, (2) 184 students in Stockholm County aged 13 to 14, (3) 52 female nurses attending a course at the Karolinska Institute, (4) a random sample of 1,200 adolescents in Stockholm County aged 18 years, (5) and a random sample of 10,000 residents in Stockholm County aged 13 - 50.

Using sunscreen appeared to be the main sun-protection behaviour for men and women in all age groups in Sweden. However, the present data indicated that sunscreens may be used to extend sun exposure and almost half of the population did not know what the sun protection factor on sunscreen containers indicates. Approximately four out of ten adolescents and three out of ten adults were using no other sunprotection than sunscreen. A majority was in the pre-action stages of change for most sun-related behaviours. A large majority of both adolescents and adults were in the precontemplation stage for avoiding the sun between 11.a.m. and 3 p.m. and giving up sunbathing. Attitudes towards sun exposure had the strongest association with the readiness to change sun-related behaviours. The relations between the stages of change and two other major constructs of the Transtheoretical Model, processes of change and decisional balance, were consistent with data on other health behaviours.

The results suggest that the recommendation to use sunscreen as sun protection needs to be reevaluated. Motivational efforts to affect both attitudes towards tanning and sun exposure may lead to improved sun-related behaviour. Efforts to increase knowledge of UVR exposure and sun-protection behaviour may be important for those in the precontemplation stage. The results in this thesis give support for the single-item algorithm method to measure the stages of change and using the Transtheoretical Model in the attempt to change sun-related behaviours. The model can provide a more sensitive assessment of the effect of interventions. Progress, e.g. from one stage to the next, is not noted by conventional outcome measures. This provides an added dimension where motivational change due to interventions may be registered.

List of scientific papers

I. Kristjansson S, Helgason AR, Rosdahl I, Holm LE, Ullen H (2001). Readiness to change sun-protective behaviour. Eur J Cancer Prev. 10(3): 289-96.
https://pubmed.ncbi.nlm.nih.gov/11432718

II. Kristjansson S, Helgason AR, Mansson-Brahme E, Widlund-Ivarson B, Ullen H (2003). You and your skin: a short-duration presentation of skin cancer prevention for teenagers. Health Educ Res. 18(1): 88-97.
https://pubmed.ncbi.nlm.nih.gov/12608686

III. Branstrom R, Kristjansson S, Ullen H, Brandberg Y (2002). Stability of questionnaire items measuring behaviours, attitudes and stages of change related to sun exposure. Melanoma Res. 12(5): 513-9.
https://pubmed.ncbi.nlm.nih.gov/12394194

IV. Kristjansson S, Branstrom R, Ullen H, Helgason AR (2003). Transtheoretical model: investigation of adolescents sunbathing behaviour. Eur J Cancer Prev. 12(6): 501-8.
https://pubmed.ncbi.nlm.nih.gov/14639128

V. Kristjansson S, Ullén H, Helgason ÁR (2004). The importance of assessing the readiness to change sun-related behaviours: A population based study. [Manuscript]