Sun exposure modification programmes and their evaluation: A review of the literature

Abstract

Epidemiological studies have demonstrated a causal link between excessive sun exposure and skin cancer, leading to the development of primary and secondary prevention programmes. In countries where there has been a significant increase in the incidence of melanoma, large amounts of time, effort and money have been spent on the design and implementation of programmes aimed at increasing knowledge about the risks of excessive sun exposure, changing attitudes about the effect of tanning, promoting sun protective behaviours, and modifying sun exposing behaviours. The majority of the evaluations of intervention programmes have focused on changes in knowledge levels and attitudes, with comparatively little attention paid to the impact on sun-related behaviour. This article reviews the studies which have evaluated programmes designed to modify sun exposure. The evaluation studies are grouped according to methodological design; they relate;both to programmes aimed at the general population as well as specific sub-groups such as schoolchildren and outdoor workers. The review demonstrates the considerable variation in the degree of success achieved by the programmes. Attention is drawn to the need for information on costs, and for the greater use of randomised controlled trials. It also shows that the evaluation of these programmes has been quite limited. The review addresses the design issues involved, and ways of improving evaluation are suggested.