Real-time sun protection decisions in first-degree relatives of melanoma patients.

Abstract

Objective Melanoma is the most serious skin cancer, and consistent use of sun protection is recommended to reduce risk. Yet, sun protection use is generally inconsistent. Understanding the decisional factors driving sun protection choices could aid in intervention development to promote sun protection maintenance. Methods In 59 first-degree relatives of melanoma patients, an interactive voice response system (IVRS) employing participants’ cell phones was used to assess twice daily (morning, afternoon) real-time sun protection usage (sunscreen, shade, hats, protective clothing) and decision factors (weather, type of activity, convenience, social support) over a 14-day summer interval where morning and afternoon outdoor exposures were anticipated. Generalized estimating equations and hierarchical linear models were used to examine the effect of demographics and decisional factors on sun protection choices over time. Results Sun protection use was inconsistent (e.g., 61% used sunscreen inconsistently). Most strategies were used independently, with the exception of moderate overlap of sunscreen and hat usage. Decision factors were highly relevant for sun protection. For instance, sunscreen use was related to the perception of having adequate time to apply it, whereas shade and hat usage were each related to convenience. Few findings emerged by gender, age, or time of day or year. Significant within-subject variation remained, however. Conclusions The findings support continued examination of decision factors in understanding sun protection consistency in real time. Interventions where cues to action and environmental supports work together in varied settings can be developed to improve sun protection maintenance in populations at risk for this common disease.

Observation Effect in Ecological Momentary Assessments: A Study of Sun Protection Practices

“…Models testing differential reminder by demographic group: interactions of gender, etc., by time. As reported previously for this study, differences in behaviors were seen by gender and age group; for example, men and participants over 50 years of age were more likely to use hats than females or those under 50 (Hay et al, 2017). In this study, however, we assessed differential time and reminder effects by gender and age, across behaviors.…”

“…For HLM analyses, each of the four behaviors at each timepoint are treated as individual outcomes, so that a transposed dataset with a total of 5,248 records is modeled. Further demographic information is reported by Hay et al (2017).…”

Feasibility and acceptability of using an IVRS to assess decision making about sun protection

“…Of the 81 eligible FDRs, 69 (85.2%) consented to participate in the study. An abbreviated report on study adherence was provided in our primary outcome study …”

“…We developed an IVRS to assess real‐time decision making about sun protection to capture variations in sun protection decisions across time in melanoma first‐degree relatives (FDRs) (parents, siblings, and children). Outcome findings are reported elsewhere . In the current paper, we examine adherence to IVRS for three reasons.…”

Daily Minutes of Unprotected Sun Exposure (MUSE) Inventory: Measure description and comparisons to UVR sensor and sun protection survey data

“…For example, a person who “always” uses protective clothing, but “never” uses sunscreen could inappropriately receive a lower score than a person who “often” (but not “always”) practices several methods and remains unprotected some of the time. Similarly, use of individual sun-protection methods is often inconsistent and there is great variability in sun-protection behaviors both within and between persons ( Hay et al, 2017 ). This variability makes it difficult to assess change over time in overall UVR exposure because it is unclear whether changes to individual methods result in changes in overall protection – for instance, a person may reduce their sunscreen use but still retain the same level of protection if using protective clothing to cover exposed areas.…”