Development and initial validation of the Self-Efficacy for Skin Self-Examination Scale in a Canadian sample of patients with melanoma

Humanizing cancer: The role of anthropomorphism and perceived efficacy in melanoma prevention

This study investigates how melanoma anthropomorphism (i.e., the attribution of humanlike qualities to melanoma) interacts with individual differences in perceived efficacy to influence attitudes and intentions to perform preventive health behaviors. Results suggested that among individuals with lower levels of perceived efficacy, presenting melanoma in anthropomorphic terms (vs. non-anthropomorphic terms) enhanced processing fluency, consequently fostering more favorable attitudes and greater intentions to follow preventive health recommendations. However, this effect was not observed among individuals with higher perceived efficacy. Findings of this study offer important theoretical and practical implications regarding the strategic use of anthropomorphism in health promotion contexts.

Outdoor workers' perceptions of skin cancer prevention: a qualitative study

OBJECTIVES

Outdoor workers are at increased risk for skin cancer and melanoma. This qualitative study aimed to explore outdoor workers' perspectives and experiences of primary (i.e. sun protection) and secondary prevention, i.e. skin self-examination (SSE) of skin cancer.

METHODS

Purposive, snowball, and theoretical sampling was used to recruit outdoor workers in Kentucky and Indiana. Semi-structured interviews via telephone or videoconference of approximately 45 min were conducted with interviewer probes and questions about perceptions of cancer risk, prevention, and screening techniques conducted, perceived barriers and facilitators, and preferences for health dissemination venues. The recordings were transcribed verbatim and de-identified. Analysis involved constructivist grounded theory coding strategies. Using peer debriefing and consensus building around themes, the researcher established a codebook for all interviews to utilize within Dedoose software for systematizing and organizing data.

RESULTS

Eighteen interviews were conducted. Interviewees (N = 18) ranged in age from 35 to 78 yr, with 3 females. Outdoor industries included agriculture, maintenance, and grounds maintenance. Themes derived from the data showed the underlying factors and perceptions that influence outdoor workers to conduct primary and secondary cancer prevention activities. The level of alarm attributed to disease and the level of trust in information contribute to intentions to conduct activities. The intentions and trust toward healthcare institutions and providers drive the primary or secondary prevention behaviors. Cultural and contextual factors included masculinity and self-sufficiency, familial and occupational priorities, and community ties.

CONCLUSIONS

These data provide a basis for developing future communications and interventions to decrease skin cancer incidence in outdoor workers. They indicate that secondary prevention and building self-efficacy in conducting SSE should be emphasized in tandem or over primary skin cancer prevention methods in this population. Trusted local healthcare providers should primarily provide prevention information, and materials should utilize testimonials from the local community to best influence this population. Communications and training interventions are needed in this population to induce a proactive level of alarm about cancer and result in the performance of SSE.

Melanoma prevention using an augmented reality-based serious game

OBJECTIVES

The purpose of this study was to field-test a recently developed AR-based serious game designed to promote SSE self-efficacy, called Spot.

METHODS

Thirty participants played the game and answered 3 questionnaires: a baseline questionnaire, a second questionnaire immediately after playing the game, and a third questionnaire 1 week later (follow-up).

RESULTS

The majority of participants considered that the objective quality of the game was high, and considered that the game could have a real impact in SSE promotion. Participants showed statistically significant increases in SSE self-efficacy and intention at follow-up. Of the 24 participants that had never performed a SSE or had done one more than 3 months ago, 12 (50.0%) reported doing a SSE at follow-up.

CONCLUSIONS

This study provides supporting evidence to the use of serious games in combination with AR to educate and motivate users to perform SSE. Spot seems to be an inconspicuous but effective strategy to promote SSE, a cancer prevention behavior, among healthy individuals.

PRACTICE IMPLICATIONS

Patient education is essential to tackle skin cancer, particularly melanoma. Serious games, such as Spot, have the ability to effectively educate and motivate patients to perform a cancer prevention behavior.

Evaluating a game-based randomized experiment to increase melanoma identification among adults living in the U.S

BACKGROUND

Although cutaneous melanoma diagnoses are rising, morbidity and mortality can be reduced through early detection. This investigation seeks to improve melanoma identification accuracy, attitudes, and intentions among a lay population by comparing the effectiveness of different melanoma identification training strategies and the effect of real-time decisional feedback on a melanoma identification task. We developed an innovative, game-based approach and hypothesize differences among frequently used melanoma identification training modalities (i.e, the Asymmetry/Border/Color/Diameter [ABCD] rule, the Ugly Duckling Rule [UDS], and a modality that combines them both, ABCDF (where the F stands for 'funny looking"), and investigate differences in types of immediate feedback on a melanoma identification task.

METHODS

We conducted a national online randomized experiment to test a 4 (melanoma training strategies: ABCD, UDS, ABCD-F, control) × 3 (feedback: Dermatological, Dermatological + Motivational, control) factorial design on melanoma identification, skin cancer beliefs (perceived susceptibility, severity, response efficacy, self-efficacy), attitudes, and prevention intentions.

RESULTS

ABCD training (p < .001) and UDS training (p = .05) resulted in significantly higher melanoma identification than the control. All training types resulted in significantly higher self-efficacy than the control (p = .02). Both Dermatological (p = .02) and Dermatological + Motivational feedback (p = .01) elicited significantly lower melanoma identification than the control condition, although this effect may be due to differences observed among participants who received UDS training. There was a significant main effect of feedback on self-efficacy (p = .002), where both Dermatological and Dermatological + Motivational feedback elicited higher levels of self-efficacy than the control.

CONCLUSIONS

Our results suggest that game-based ABCD and UDS training strategies could increase melanoma identification accuracy. Real-time feedback reduced accuracy, but was associated with increased self-efficacy related to melanoma detection outcomes.

Validation of Physical Examination Perceived Self-Efficacy Instrument for Undergraduate Nursing Students

BACKGROUND

Numerous studies have revealed that nursing students perceive lack of confidence as one of the key barriers to performing physical examination; however, it is not empirically measured. This study aimed to test the psychometric properties of the Physical Examination Perceived Self-Efficacy Instrument.

METHOD

The study included three phases: in Phase 1, 51 items were constructed; in Phase 2, 7 field experts rated items for relevancy; and in Phase 3, the instrument was piloted to a convenience sample of 238 students.

RESULTS

The analysis yielded six factors with a factor loading >0.40. The corrected item-total correlation ranged from 0.6 to 0.87. Cronbach's alpha ranged from .84 to .98. The interscale correlation of the instrument was statistically significant (p < .001).

CONCLUSION

We found that the instrument is a psychometrically robust measure of self-efficacy of performing physical examination. The instrument could provide a better understanding of the association between perceived self-efficacy and students' academic performance. [J Nurs Educ. 2022;61(1):36-40.].

The impact of physician support on skin self-examination among melanoma patients: A serial mediation model with self-efficacy and intentions to perform skin exams

OBJECTIVE

Melanoma is the most lethal of skin cancers; however, survival rates are excellent if the tumor is detected early. Clinical practice guidelines for melanoma follow-up care recommend regular skin self-examination (SSE) for individuals at high risk for melanoma. The current analyses tested whether self-efficacy for SSE and intention to perform SSE mediate the relationship between physician support for SSE and SSE behavior among a sample of melanoma patients.

METHODS

We ran a serial mediation model on a cross-sectional sample of melanoma patients (n = 154) drawn from an observational study with longitudinal follow-up.

RESULTS

Self-efficacy and intention to perform SSE sequentially mediated the relationship between physician support and SSE behaviors (β = .31, t(152) = 3.61, p < .001 without mediators versus β = .11, t(150) = 1.50, p = .14 with mediators), as supported by a significant total indirect effect (β = .21, [95 % CI = .08-.35]).

CONCLUSION

Self-efficacy for SSE and intention to perform SSE together explain the link between perceived physician support for SSE and the practice of SSE.

PRACTICE IMPLICATIONS

Physician communication about the importance of SSE plays an important role in encouraging patient adherence to SSE recommendations and, thus, supporting early detection efforts.

Parents' knowledge and understanding of skin cancer and skin self-examination and behaviors to protect their children from the sun

PURPOSE

The aim of this study was to determine parents' knowledge of skin cancer and skin self-examination (SSE) and their efforts to protect their school aged children from the sun.

METHODS

This cross-sectional study was conducted between November 2018 and November 2019 in Turkey with 1004 parents of middle school students.

RESULTS

Of the parents, 53.7% did not have knowledge about skin cancer or SSE, and 76% did not conduct SSEs with their 9-14 years old children. A total of 61.3% of the participants prevented their children from standing in the sun, but 56.1% did not apply sunscreen to their children. The total mean score on the Skin Cancer and Sun Knowledge Scale (SCSKS) was 13.16 ± 3.03. There were significant differences in the total SCSKS scores by parental gender, number of children, education level, economic status, use of sunscreen, frequency of application of sunscreen, use of light-colored clothing, prevention of exposure to sunlight, use of sunglasses outside, knowledge about skin cancer and SSE and knowledge about early diagnosis of skin cancer (p < 0.05).

CONCLUSION

This study showed that parents' behaviors related to sun protection and their skin cancer and SSE knowledge levels were not sufficient. In schools, both students and parents should receive health education regarding skin cancer and prevention methods.

Prevalence and correlates of skin self-examination behaviors among melanoma survivors: a systematic review

Melanoma is the most common cause of skin cancer deaths, and individuals who have had melanoma have an increased risk of developing new melanomas. Doing regular self-examinations of skin enables one to detect thinner melanomas earlier when the disease is more treatable. The aim of this systematic review is to characterize and evaluate the existing literature on the prevalence and correlates of skin self-examination (SSE) behaviors among adult melanoma survivors in the USA and Canada. A computerized literature search was performed using PubMed, Google Scholar, and ScienceDirect. The inclusion criteria for the studies were: (a) reported results for adult melanoma survivors in the USA or Canada, (b) papers described empirical research, (c) assessed SSE and related behaviors, and (d) papers were published in a peer-reviewed journal in the past 20 years. Key phrases such as "skin self-examination/SSE in melanoma survivors in the United States" and "correlates of skin self-examination/SSE" were used. Based on the inclusion criteria, 30 studies were included in the systematic review. SSE prevalence varied depending on how SSE was defined. Demographics and factors (gender, education level, patient characteristics, partner assistance, and physician support) associated with SSE were identified. Findings of this review show evidence for the need to have a consistent way to assess SSE and suggest different types of correlates on which to focus in order to promote SSE and reduce the risk of melanoma recurrence in survivors. This systematic review and its protocol have been registered in the international database of prospectively registered systematic reviews in health and social care (PROSPERO; ID: 148878).

Short and long-term barriers and facilitators of skin self-examination among individuals diagnosed with melanoma

Background

Melanoma can be lethal if not detected early and treated. Early detection can be facilitated via skin self-examination (SSE) and as such, SSE is part of melanoma follow-up care for individuals with a prior history, who face a life-long risk of reoccurrence. The objective of the current study was to identify short- and long-term predictors of SSE among melanoma survivors to inform future prevention interventions in high-risk groups.

Method

This is an observational study with longitudinal assessments conducted with adult melanoma patients in active follow-up care.

Primary outcome measures

Behavioral outcomes, comprehensive SSE (checking up to 5 body areas in the last 3 months) and optimal SSE (checking the entire body at least monthly in the last 3 months) were assessed at 3, 12, and 24 months post a dermatological educational session on skin cancer prevention. T tests and chi square analyses were used to examine changes in outcomes from 3 to 12 and 24 months. Linear and logistic regression models were used to examine the association between predictors and the primary outcomes.

Results

Comprehensive SSE did not decrease significantly from 3 (M = 2.7, SD = 1.1) to 12 (M = 2.6, SD = 1.2) and 24 months (M = 2.4, SD = 1.2) post the education session, with the stronger predictor at all timepoints being intentions to perform SSE. Optimal SSE was higher at 3 months (59%) compared to 12 (46%) and 24 months (34%), with key predictors including self-efficacy and intentions to perform SSE and male sex at 3 months post; self-efficacy and reliance on medical advice at 12 months; and (lower) education and self-efficacy at 24 months.

Conclusions

The key findings of this study are that 1) survivors maintain SSE behaviour over time, but rates of SSE performed in agreement with medical recommendations are higher immediately post standard dermatological education (i.e. usual care) and decrease somewhat over a 24-month period; and 2) the strongest psycho-social predictors of SSE are intentions and self-efficacy to perform the behavior, which are highly modifiable, for example via motivational interviewing and goal setting health interventions.