Review and special article
Children's Skin Cancer Prevention: A Systematic Review of Parents' Psychosocial Measures

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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.

Section snippets

Context

Childhood sun exposure increases skin cancer risk.1, 2 Parents' knowledge, attitudes, and beliefs may be influenced through intervention to increase children's sun protection. Measures of these parental psychosocial characteristics play important analytic roles in studies to identify determinants of children's sun protection or understand how interventions work. However, little is known about the psychosocial measures that have been administered to parents, including the psychometric properties

Relevant Measures

This review's conceptual model is derived from the logic framework used by the Task Force on Community Preventive Services (Task Force) to review skin cancer prevention interventions.3 Interventions are expected to affect psychosocial outcomes (e.g., knowledge, attitudes, beliefs, and intentions) that are hypothesized to be associated with sun protection and sun avoidance behaviors,5 which are associated with health outcomes such as decreased incidence of sunburn and skin cancer. The current

Evidence Synthesis

A total of 6480 citations were identified from the database search, which yielded all relevant citations identified by previous searches.3, 4 A total of 57 studies representing 52 data sets were included (Figure 1).

Discussion

Overall, this review revealed that relatively few studies of children's skin cancer prevention assessed more than two parent-related psychosocial constructs; few studies cited theory; there was conceptual overlap of measures; and validated measures are lacking. The lack of standardized measure reporting, including limited information on psychometric properties, restricts the conclusions that can be drawn. Increased attention paid to psychosocial measurement in future research will enhance

References (85)

  • D.L. O'Riordan et al.

    Sunburn reduction through parental role modeling and sunscreen vigilance

    J Pediatr

    (2003)
  • W.R. Stanton et al.

    Sun exposure and primary prevention of skin cancer for infants and young children during autumn/winter

    Aust N Z J Public Health

    (2000)
  • A.T. Foltz

    Parental knowledge and practices of skin cancer prevention: a pilot study

    J Pediatr Health Care

    (1993)
  • R. Branstrom et al.

    Sun exposure and sunburn among Swedish toddlers

    Eur J Cancer

    (2006)
  • N. Balato et al.

    Sun habits in the children of Southern Italy

    J Am Acad Dermatol

    (2007)
  • S. Harrison et al.

    Maternal beliefs about the reputed therapeutic uses of sun exposure in infancy and the postpartum period

    Aust Mid J

    (2005)
  • J.K. Robinson et al.

    Summertime sun protection used by adults for their children

    J Am Acad Dermatol

    (2000)
  • Y.E. Rodvall et al.

    Factors related to being sunburnt in 7-year-old children in Sweden

    Eur J Cancer

    (2010)
  • I. Ajzen

    The theory of planned behavior

    Organ Behav Hum Decis Process

    (1991)
  • E. von Elm et al.

    The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies

    Prev Med

    (2007)
  • S.P. Poorsattar et al.

    UV light abuse and high-risk tanning behavior among undergraduate college students

    J Am Acad Dermatol

    (2007)
  • N. Buscemi et al.

    Single data extraction generated more errors than double data extraction in systematic reviews

    J Clin Epidemiol

    (2006)
  • L. van Osch et al.

    The formation of specific action plans can enhance sun protection behavior in motivated parents

    Prev Med

    (2008)
  • R. Corona et al.

    Risk factors for basal cell carcinoma in a Mediterranean population: role of recreational sun exposure early in life

    Arch Dermatol

    (2001)
  • D.B. Buller et al.

    Skin cancer prevention for children: a critical review

    Health Educ Behav

    (1999)
  • Cancer facts & figures 2012

    (2012)
  • P.D. Mullen et al.

    Measures used in studies of informed decision making about cancer screening: a systematic review

    Ann Behav Med

    (2006)
  • Health behavior constructs: theory, measurement & research

  • J.J. Grob et al.

    Study of sunbathing habits in children and adolescents: application to the prevention of melanoma

    Dermatology

    (1993)
  • J.B. Lowe et al.

    Behavior of caregivers to protect their infants from exposure to the sun in Queensland, Australia

    Health Educ Res

    (2002)
  • J.R. Rodrigue

    Promoting healthier behaviors, attitudes, and beliefs toward sun exposure in parents of young children

    J Consult Clin Psychol

    (1996)
  • C. Fleming et al.

    A study of the impact of Sun Awareness Week 1995

    Br J Dermatol

    (1997)
  • D.B. Buller et al.

    Impact of behavioral intervention on effectiveness of message features: evidence from the Family Sun Safety Project

    Hum Commun Res

    (1998)
  • D.B. Buller et al.

    Long-term effects of language intensity in preventive messages on planned family solar protection

    Health Commun

    (2000)
  • L.R. Turner et al.

    Psychosocial characteristics associated with sun protection practices among parents of young children

    J Behav Med

    (2005)
  • M.K. Tripp et al.

    Validity and reliability of the Parental Sun Protection Scales

    Health Educ Res

    (2003)
  • V.B. Stone et al.

    The relationship between skin cancer knowledge and preventive behaviors used by parents

    Dermatol Nurs

    (1999)
  • R. Parrott et al.

    Communicating about youth's sun exposure risk to soccer coaches and parents: a pilot study in Georgia

    Health Educ Behav

    (1999)
  • K. Glanz et al.

    Factors associated with skin cancer prevention practices in a multiethnic population

    Health Educ Behav

    (1999)
  • L. van Osch et al.

    Predicting parental sunscreen use: disentangling the role of action planning in the intention-behavior relationship

    Psychol Health

    (2008)
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