Robinson J K, Rademaker A W
Department of Dermatology, Northwestern University Medical School, Chicago, Illinois 60611, USA.
Prev Med. 1995 Jul;24(4):333-41. doi: 10.1006/pmed.1995.1055.
Knowledge-based skin cancer risk and prevention educational interventions by physicians and nurses were directed to subjects who had a nonmelanoma skin cancer. These high-risk patients asked relatives or friends to assist with postoperative care rendered after surgical removal of the skin cancer. The patient's experience with the nonmelanoma skin cancer was expected to raise the awareness of the helper. The study examined whether the patient became a source of information, risk assessment, and skills training for his or her helper.
Sequential patients between 30 and 60 years of age and their designated helpers completed a self-report questionnaire prior to the intervention and 1 year after the intervention. The questionnaire examined: (a) knowledge of skin cancer and sun protection; (b) individual susceptibility as determined by ease of sunburning or tanning; (c) attitudes about self-esteem, sun exposure, and health locus of control; (d) intentions to use sun protection; and (e) behaviors of sun protection used.
Over the course of 1 year, 200 pairs were entered into the study. Both patients and helpers demonstrated an increase in knowledge after the educational intervention with the patients. There was a change in the self-reported intention to use sun protection and the behaviors of sun protection used in both patients and helpers after the intervention; however, there was no attitudinal change demonstrated in pre- and post-tests for either patients or helpers. Among both patients and helpers, gender-specific differences in attitudes, intentions, and behaviors existed. Women expressed a greater likelihood of taking precautions, including the use of sunblock; however, men reported the protective strategy of wearing a hat more than women did. Men valued a tan more than women and had greater outdoor exposure, which they restricted after the intervention. Women helpers ceased using indoor tanning devices after the intervention. Behavioral change in use of sun protection measures, including protective clothing or sunblock use and decrease in hours of outdoor sun exposure or use of indoor tanning devices, was dependent upon the patient or helper's own reported susceptibility as determined by his or her history of poor tanning and ease of sunburning.
Patients transferred knowledge to their helpers. Intention to change behavior and behavioral change were strongly correlated with the individual's reported susceptibility to easy sunburning and poor tanning. Despite a lack of change in attitudes, changes in both intention to change behavior and behavior itself occurred in those who perceived themselves to be at risk. While the attitudes of participants in this study reflected popular beliefs, targeted education of high-risk adults with a nonmelanoma skin cancer caused changes in sun protection behaviors in both the patients and their helpers.
医生和护士针对非黑素瘤皮肤癌患者开展了基于知识的皮肤癌风险及预防教育干预。这些高危患者请亲戚或朋友协助进行皮肤癌手术切除后的术后护理。预计患者患非黑素瘤皮肤癌的经历会提高协助者的意识。该研究调查了患者是否成为其协助者的信息来源、风险评估者及技能培训者。
30至60岁的连续患者及其指定的协助者在干预前和干预后1年完成了一份自我报告问卷。问卷调查了：（a）皮肤癌及防晒知识；（b）由晒伤或晒黑难易程度确定的个体易感性；（c）对自尊、阳光暴露及健康控制点的态度；（d）使用防晒措施的意图；（e）所采用的防晒行为。
在1年的时间里，200对患者和协助者进入了研究。经过对患者的教育干预后，患者和协助者的知识均有所增加。干预后，患者和协助者自我报告的使用防晒措施的意图及所采用的防晒行为均发生了变化；然而，患者和协助者在干预前后的态度测试中均未表现出变化。在患者和协助者中，态度、意图和行为存在性别差异。女性采取预防措施（包括使用防晒霜）的可能性更大；然而，男性报告戴帽子的防护策略比女性更多。男性比女性更看重晒黑，户外活动时间更长，干预后他们减少了户外活动。女性协助者在干预后停止使用室内晒黑设备。包括使用防护服或防晒霜以及减少户外阳光暴露时间或使用室内晒黑设备在内的防晒措施的行为改变取决于患者或协助者自身报告的易感性，这由其晒黑困难和容易晒伤的病史决定。
患者将知识传授给了他们的协助者。改变行为的意图和行为改变与个体报告的易晒伤和晒黑困难的易感性密切相关。尽管态度没有改变，但那些认为自己有风险的人在改变行为的意图和行为本身方面都发生了变化。虽然本研究参与者的态度反映了普遍观念，但针对非黑素瘤皮肤癌高危成年人的针对性教育导致患者及其协助者的防晒行为发生了变化。
