Elsevier

Preventive Medicine

Volume 39, Issue 5, November 2004, Pages 992-999
Preventive Medicine

Attitudes, subjective norms and perception of behavioural control as predictors of sun-related behaviour in Swedish adults

https://doi.org/10.1016/j.ypmed.2004.04.004Get rights and content

Abstract

Background. Exposure to ultraviolet (UV) radiation is the major preventable cause of skin cancer. The aim of this study was to investigate the explanatory value of attitudes, subjective norms and perceived behavioural control on behaviours related to UV exposure.

Method. A random population-based sample (n = 1752, 18–37 years of age) in the Stockholm County, Sweden, answered a questionnaire with items on sun related behaviours and beliefs. The items concerned issues influenced by the Theory of Planned Behaviour, that is, attitudes, subjective norms and perceived behavioural control. Logistic regression analysis was used to examine the associations between behaviours and beliefs.

Results. Positive attitudes towards being tanned and being in the sun were both strongly associated with time spent in the sun, intentional tanning, sunbed use, going on vacation to a sunny resort, intention to decrease sunbathing and use of protection against the sun. Perceiving sunbathing as risky was associated with using different ways to protect and intending to reduce sun exposure. Having people around oneself who frequently sunbathe was related to intentional tanning and vacations to sunny resorts. Finally, perceived behavioural control was associated with use of sunscreen and use of other ways to protect from the sun among women.

Conclusion. The study identified factors on which primary preventive interventions towards decreasing sun exposure should be focused.

Introduction

Every year approximately 30,000 people in Sweden are diagnosed with skin cancer and approximately 400 die of this condition [1]. A similar development has been seen in many countries with a white population [2]. Malignant melanoma is the most lethal form of skin cancer and the incidence is highest in Australia, for example, the incidence in Queensland (in northern Australia, latitudes 12–28S) is 53.5 per 100,000 and in Victoria (in southern Australia, latitudes 36–38S) 30.3 per 100,000 [3]. The melanoma incidence in the US 1997 were 17.2 for men and 12.0 for women [4]. Exposure to solar ultraviolet (UV) radiation is today the major preventable cause of skin cancer [2]. Even though Sweden has much lower degree of ambient UV radiation, the melanoma incidence is among the highest in Europe, 12.4 for men and 13.0 for women (age adjusted for the world standard population) [1]. Despite several campaigns launched in Sweden with the aim of reducing UV exposure, the average annual increase of melanoma incidence in Sweden is around 2.5% for men and 2.2% for women during the two last decades [5]. A number of Swedish studies on prevalence of sunbathing and sunburns between 1996 and 2001 indicates excessive sunbathing in the population, and so far, there are no signs of a decrease [6]. Thus, there seems to be room for improving the interventions. Until now, most preventive efforts in Sweden have been developed based on the simple notion that ‘if people know the facts, they will change their behaviours’. Few campaigns have been designed based on a theoretical model, taking into account the complexity of UV related behaviours.

A number of models have been developed for description of individual health related behaviour. One of the most widely used models is the Theory of Reasoned Action (TRA) or its extension the Theory of Planned Behaviour (TPB) [7], [8], [9]. The TPB is influenced by the value expectancy tradition but it adds two factors that, alongside beliefs and attitudes, are predicted to affect our behaviour, that is, subjective norms and behavioural control. Subjective norms include both the attitudes of relevant others towards the behaviour and the motivation to meet the expectations of relevant others. Behavioural control is closely related to the term self-efficacy and it includes perception of control over performance of a behaviour [7]. According to TPB, our behaviour is determined by three different considerations: beliefs about a behaviour and thoughts about the consequences of that behaviour (behavioural beliefs), beliefs about the normative expectations of others and motivation to comply with these norms (normative beliefs), and perceptions about the presence of factors that may facilitate or impede performance of the behaviour and the perceived power of these factors (control beliefs) [7]. Together, these three factors or behavioural beliefs constructs: attitudes towards the behaviour, subjective norms and perceived behavioural control, lead to an intention to behave. If enough degree of actual control exists the intention is expected to lead to overt behaviour. The theory is supported in a meta-analysis in which 185 studies were included [10]. In that study, the theory seemed to explain between 27% and 39% of the variance in behaviour and behavioural intention. The theory has been applied to a wide variety of health related behaviours. A few earlier studies have applied the theory on sunbathing habits and sun-protective behaviour but these have used small and non-randomised groups [7], [11], [12]. In addition, these studies were conducted outside Scandinavia, not taking into account the climate and cultural aspects of sun related behaviour in the north with relatively few sun hours as compared to other countries, such as Australia and the US. In the present study, variables measuring constructs derived from the TPB is examined. The aim of this study was to investigate the explanatory value of these variables on UV related behaviour, and to determine which elements that contribute the most in explaining these behaviours. The total sample is analysed as well as men and women separately.

Section snippets

Participants

A random population-based sample (n = 3200, 18–37 years of age) in the Stockholm County, Sweden, stratified by gender and age (in four age strata; 18–22, 23–27, 28–32 and 33–37), was selected from the Swedish census registry. In May 2001, they were mailed a questionnaire in addition to an invitation to participate in a larger intervention study (presented in Ref. [13]). One reminder was sent but no compensation for participation was offered. The present paper contains an analysis of the results

Results

Eight logistic regressions were conducted with ‘time spent in the sun’, ‘frequency of intentional tanning’, ‘frequency of sunburn’, ‘intention to decrease sun exposure’, ‘use of sunbeds’, ‘vacations to sunny resorts’, ‘use of sunscreen’ and ‘use of recommended protection in the sun’ as dependent variables. The independent variables were age, level of education, skin type, ‘attitudes towards being in the sun’ and ‘having a tan’, ‘subjective norm’ and ‘perceived behavioural control’. The results

Discussion

Most respondents reported positive attitudes towards being tanned and being in the sun, and these variables were both strongly associated with all behaviours related to sun exposure examined in this study, except with use of sunscreen. The importance of these variables to sun related behaviours is in line with earlier studies [18], [19], [20]. The relationship was especially strong between these attitudes and intentional tanning and sunbed use. This indicates that attitude change should be a

Acknowledgements

This research was funded by the Swedish Cancer Society and King Gustaf V:s Jubilee Fund.

References (25)

  • K. Glanz et al.

    Health Behaviour and Health Education

    (2002)
  • I. Ajzen et al.

    Understanding Attitudes and Predicting Social Behavior

    (1980)
  • Cited by (0)

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