The Research and Development Unit for Local Health Care, County of Östergötland, 581 85 Linköping, Sweden.
Cancer Epidemiol. 2012 Aug;36(4):e265-9. doi: 10.1016/j.canep.2012.03.004. Epub 2012 Apr 13.
Few attempts to present a comprehensive scoring instrument for sun exposure and protection have been made. The present paper aims to describe a possible set of questions suitable for such an instrument, comprising the most important aspects of sun exposure and protection.
The material from a previously performed intervention study, using a questionnaire based on Likert scales and on the Transtheoretical Model of Behaviour Change (TTM), was utilised. 213 primary healthcare patients filled in the questionnaire and were randomised into two groups receiving sun protection advice, in Group 1 in letter-form, and in Group 2 orally during a doctor's consultation. In the original study, increased sun protection/readiness to increase sun protection was demonstrated for several items in Group 2, at six months. To compose a comprehensive scoring instrument, five questions concerning sun exposure/protection (intentional tanning, sunscreen use, choice of SPF, number of occasions with sunburn, and time spent in the sun at midday), were selected to give a 20 point behavioural score. Similarly, four TTM-based questions (giving up sunbathing, using clothes for sun protection, using sunscreens, and staying in the shade) gave a 16 point "propensity-to-change"-score.
At follow-up, increased sun protection reflected in the behavioural score occurred only in Group 2 (p < 0.001). For the propensity-to-change-score, increased readiness to increase sun protection occurred in both groups, but the change was significantly higher in Group 2 (p < 0.05). Categorisation of the 20 point behavioural score, into three risk levels, revealed a significantly higher shift of subjects moving to a lower risk level in Group 2 compared to Group 1 (p<0.05).
In conclusion, twinning of a summarised Likert scale behavioural score with a TTM-based propensity-to-change-score seems promising for the creation of a questionnaire-based, comprehensive scoring instrument for sun exposure and protection.
目前为止，仅有少数尝试旨在提供全面的阳光暴露和防护评估工具的研究。本研究旨在描述一组可能适用于该工具的问题，这些问题涵盖了阳光暴露和防护的最重要方面。
使用基于 Likert 量表和跨理论行为改变模型（TTM）的问卷进行了一项干预研究，该研究的材料被用于本研究。213 名初级保健患者填写了问卷，并随机分为两组，一组在 Group 1 中以信件形式接受防晒建议，另一组在 Group 2 中在医生就诊时进行口头防晒建议。在原始研究中，Group 2 在六个月时表现出对几个项目的防晒/增加防晒意愿的增加。为了组成一个全面的评分工具，选择了五个关于阳光暴露/防护的问题（有意晒黑、使用防晒霜、选择 SPF、晒伤次数和中午在阳光下的时间），给出了 20 分的行为评分。同样，四个基于 TTM 的问题（放弃日光浴、使用衣服防晒、使用防晒霜和在阴凉处停留）给出了 16 分的“改变倾向”评分。
在随访时，仅在 Group 2 中观察到行为评分的防晒意愿增加（p<0.001）。对于改变倾向评分，两组都观察到了增加的防晒意愿，但 Group 2 的变化明显更高（p<0.05）。将 20 分行为评分分为三个风险级别，发现 Group 2 中向低风险级别移动的受试者比例显著高于 Group 1（p<0.05）。
总之，将简化的 Likert 量表行为评分与基于 TTM 的改变倾向评分相结合，似乎有望为阳光暴露和防护创建基于问卷的全面评分工具。
