Sensitivity to change of the Beach Questionnaire to behaviour, attitudes and knowledge related to sun exposure: quasi-experimental before-after study

Abstract

BackgroundHealth questionnaires must present accredited measurement properties such as validity, reliability and sensitivity to change, the latter being essential for interventions to be planned and for evaluating their effectiveness. The aim of this study was to evaluate the sensitivity to change of a Beach Questionnaire.MethodsQuasi-experimental before-after study carried out in 2011, for a study population of adolescents attending schools in the Costa del Sol. First, the questionnaire was administered to the adolescents, after which a multicomponent educational intervention was carried out; finally, three months later, the same questionnaire was re-administered to the same adolescents. Changes were assessed in the categories of each item, using the McNemar test, and the changes in the scores, standardised to a range of 0–100, using the Student t test for paired samples, and including the mean of the differences and the 95% confidence interval. The level of statistical significance was set at p < 0.05.Results228 adolescents, aged 14–17 years, and 55.3% were girls. Statistically significant changes were observed in sunburn experiences, exposure to the sun at mid-day and attitudes to sun exposure and suncreams. For the seven items related to knowledge about sun exposure, a higher rate of correct answers was observed. The analysis of changes, within the standardised range, revealed a significant improvement in the scores for sun exposure habits (MD 4.33; CI 95% 2.2-6.5), attitudes to sun exposure (MD 2.22; CI 95% 1.2-3.2) and knowledge (MD 9.10; CI 95% 7.1-11.1), but not in those for sun-protection practices (MD 0.23; CI 95% -1.2-1.7).ConclusionsThe Beach Questionnaire on behaviour, attitudes and knowledge related to sun exposure is the first such instrument in Spanish language to provide sufficient sensitivity to change. It constitutes a useful tool for epidemiologic research into photoprotection and for skin cancer prevention programmes.

Prevalence and predictors of sunburn among beachgoers

“…Factorial analysis of the principal components confirmed the construct validity and revealed multiple dimensions with Cronbach α values >0.70. The items on habits and understanding showed intraclass correlation and δ coefficient values >0.70 . The questionnaire contains 42 items on sociodemographic characteristics (age, sex, country of origin, place of residence, educational level, partnership status and parenthood of children <12 years); skin colour (very fair/fair/olive/dark/black); Fitzpatrick skin phototype (I‐IV according to the erythaema and tanning response after the first 60‐minute exposure to the sun in summer); sun exposure habits (number of days spent at the beach each summer, number of hours per day, number of hours at midday, defined as between 11 am and 5 pm ); use of artificial tanning lamps; number of sunburn episodes (defined as painful reddening of the skin) during the previous summer; sun protection measures (avoidance of midday sun, use of shade or beach umbrellas, sunglasses, hats/caps, long‐sleeved shirts/full‐length trousers, or sunscreen with a sun protection factor of 15 or higher [SPF 15+]); attitudes to sun exposure organized into 4 dimensions (sun, tanning, sun protection behaviours and use of sunscreen); and knowledge about sun protection and skin cancer.…”

“…The items included in this instrument are in line with consensus-based guidelines drawn up by experts on the use of subjective instruments to measure exposure to UV radiation. 43 Furthermore, the questionnaire has excellent psychometric properties that support its validity, reliability and responsiveness, 14,15 which are all essential features of any highquality measurement instrument. 44 fact that the study was conducted in situ, in a real-world context, and moreover in a popular tourist resort frequented by visitors from all over the world, facilitates the extrapolation of our results to comparable tourist areas elsewhere.…”

¿Qué Saben Nuestros Adolescentes Sobre La Fotoprotección Solar? A Propósito De Una Intervención Educativa

“…El mismo constaba de 27 preguntas de opción múltiple estructurada en cinco bloques que informaron sobre los cocimientos generales acerca de las radiaciones solares, efectos del sol en la piel, protección solar, tipo de medidas protectoras y actitudes frente a la toma de sol. Este cuestionario se basó en los utilizados en las campañas de Euromelona 2014, Cruz Roja, la Skin Cancer Foundation y el Beach Questionnaire(Academia Española de Dermatología y Venearología, 2014; Cruz Roja Española, 2008;Fernández-Morano et al,2015;The Skin Cancer Foundation,2014).…”

“…De hecho, un estudio en población chilena del año 2005 de Molgó et al, mostró que los jóvenes menores de 25 años eran los que tenían comportamientos más arriesgados con respecto a la exposición solar. Lo mismo ocurre para la población española, en el que si bien tiene conocimientos, sin embargo sus comportamientos y actitudes frente a la protección solar no se corresponden con los mismos (Buendía-Eisman, Feriche-Fernández, Muñoz-Negro, Cabrera-León S. & Serrano-Ortega, 2007;Fernández-Morano,Troya-Martin, Rivas-Ruiz, Blázquez-Sánchez& Buendía-Eisman, 2015). Este dato es muy importante considerando que la fotoexposición es el principal factor de riesgo modificable en el cáncer de piel.Asimismo, éstos jóvenes son el grupo de edad que recibe la mayor parte de la exposición solar, ya que la máxima exposición de una persona ocurre antes de los 18 años, siendo en la infancia cuando se recibe entre el 60 y el 80 por ciento de la exposición solar de toda la vida, sobre todo por el uso del bronceado artificial (Balk, Fisher&Geller, 2013;Boniol et al, 2012;Magliano, Álvarez, Salmentón, Larre & Martínez, 2011;Reed et al, 2012).Hay que tener en cuenta además, que los comportamientos y actitudes de las madres pueden influir sobre las prácticas de bronceado de sus hijos adolescentes (Baker, Hillhouse & Liu, 2010;De Vries, Van Osch,Eijmael, Smerecnik & Candel, 2012;Gefeller, Li, Uter &Pfahlberg, 2014;Hoerster et al, 2007;Stryker et al,2004).…”

“…Diversas organizaciones han desarrollado y desarrollan campañas informativas sobre esta materia (Academia Española de Dermatología y Venearología, 2014; AECC, 2014;Cruz Roja Española, 2008), haciéndolo esporádicamente y de manera temporal en centros escolares, sin que tenga(salvo excepciones)una continuidad reglada dentro de un proyecto curricular del centro educativo (Academia Española de Dermatología y Venearología, 2014; Buendía-Eisman et al,2007;Cruz et al, 2005;Fernández-Morano et al,2015;Gilaberteet al, 2002;Maguire-Eisen, Rothman & Demierre, 2005;Williams, Grogan, Clark-Carter&Buckley, 2013).Por otra parte, se ha comprobado que las campañas masivas a través de diversos medios de comunicación, principalmente la televisión pueden tener efectos puntuales en la población pero que no son suficientes para promover una conciencia de cambio arraigado en los adolescentes, dado que numerosos estudios coinciden que estos chicos disponen de buena información respecto de la protección solar, sin embargo sus conductas y costumbres son contrarias a las buenas prácticas que conocen de exposición solar saludable (Buendía-Eisman et al,2007;De Vries, Mesters, Van´t Reit, Willems & Reubsaet, 2006;Wakefiel, Loken & Hornik,2010;Williams et al,2013).…”