Sun Safe Partners Online: Pilot Randomized Controlled Clinical Trial

Sharon Manne, David Buller, Katie Devine, Carolyn Heckman, Sherry Pagoto, Sara Frederick, Anna Mitarotondo, Sharon Manne, David Buller, Katie Devine, Carolyn Heckman, Sherry Pagoto, Sara Frederick, Anna Mitarotondo

Abstract

Background: Harnessing supportive influences in close relationships is an innovative and potentially effective strategy to improve sun protection behaviors.

Objective: This pilot randomized controlled clinical trial evaluates the feasibility and impact of Sun Safe Partners Online, a web-based, couples-focused intervention to improve sun protection behavior.

Methods: A total of 75 couples reporting suboptimal levels of sun protection recruited from Facebook advertisements were randomized to receive a web-based intervention called Sun Safe Partners Online or a Generic Online Sun Safety Information intervention. Sun Safe Partners Online had 4 individual-focused modules and 4 couples-focused modules. Feasibility was assessed by study enrollment, engagement, follow-up survey completion, and intervention evaluation. Participants completed baseline and a 1-month postintervention survey assessing sun protection and exposure, along with individual and relationship attitudes about the importance of sun protection.

Results: Using Facebook as a recruitment strategy resulted in rapid enrollment and higher acceptance than for the prior telephone and print trial. The follow-up survey completion was higher in the Generic Online condition (100%) than in the Sun Safe Partners Online condition (87.2%). Engagement in Sun Safe Partners Online was high, with more than two-thirds of participants completing all modules. Evaluations of Sun Safe Partners Online content and features as well as ease of navigation were excellent. Sun Safe Partners Online showed small effects on sun protection behaviors and sun exposure on weekends compared with the Generic Online intervention and moderate effect size increases in the Sun Safe Partners Online condition.

Conclusions: This study uses a novel approach to facilitate engagement in sun protection by harnessing the influence of relationships among spouses and cohabiting partners. A couples-focused intervention may hold promise as a means to improve sun protection behaviors beyond interventions focused solely on individuals by leveraging the concern, collaboration, and support among intimate partners and addressing relationship-based barriers to sun protection.

Trial registration: ClinicalTrials.gov NCT04549675; https://ichgcp.net/clinical-trials-registry/NCT04549675.

Keywords: behavior intervention; couples; mobile phone; online interventions; skin cancer prevention; sun protection.

Conflict of interest statement

Conflicts of Interest: None declared.

©Sharon Manne, David Buller, Katie Devine, Carolyn Heckman, Sherry Pagoto, Sara Frederick, Anna Mitarotondo. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 17.09.2020.

Figures

Figure 1
Figure 1
Sun Safe Partners’ landing page.
Figure 2
Figure 2
CONSORT diagram. BL: baseline; CONSORT: Consolidated Standards of Reporting Trials; P1: Patient #1; P2: Patient #2.

References

    1. Melanoma of the Skin. Cancer Statistics Center - American Cancer Society. 2018. [2020-07-28]. .
    1. Cancer Stat Facts: Melanoma of the Skin. Surveillance, Epidemiology, and End Results Program. 2019. [2020-07-28]. .
    1. Guy GP, Machlin SR, Ekwueme DU, Yabroff KR. Prevalence and costs of skin cancer treatment in the US, 2002-2006 and 2007-2011. Am J Prev Med. 2015 Feb;48(2):183–7. doi: 10.1016/j.amepre.2014.08.036.
    1. US Department of Health and Human Services. Office of the Surgeon General . The Surgeon General's Call to Action to Prevent Skin Cancer. Washington, DC: US Department of Health and Human Services; 2019.
    1. van der Pols JC, Williams GM, Pandeya N, Logan V, Green AC. Prolonged prevention of squamous cell carcinoma of the skin by regular sunscreen use. Cancer Epidemiol Biomarkers Prev. 2006 Dec;15(12):2546–8. doi: 10.1158/1055-9965.EPI-06-0352.
    1. Green AC, Williams GM, Logan V, Strutton GM. Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol. 2011 Jan 20;29(3):257–63. doi: 10.1200/JCO.2010.28.7078.
    1. What Are the Risk Factors for Skin Cancer? Centers for Disease Control and Prevention. 2019. [2020-01-28]. .
    1. Skin Cancer Prevention. Skin Cancer Foundation. 2020. [2020-08-12].
    1. Fischer AH, Wang TS, Yenokyan G, Kang S, Chien AL. Sunburn and sun-protective behaviors among adults with and without previous nonmelanoma skin cancer (NMSC): a population-based study. J Am Acad Dermatol. 2016 Aug;75(2):371–9.e5. doi: 10.1016/j.jaad.2016.02.1236.
    1. Buller DB, Cokkinides V, Hall HI, Hartman AM, Saraiya M, Miller E, Paddock L, Glanz K. Prevalence of sunburn, sun protection, and indoor tanning behaviors among Americans: review from national surveys and case studies of 3 states. J Am Acad Dermatol. 2011 Nov;65(5 Suppl 1):S114–23. doi: 10.1016/j.jaad.2011.05.033.
    1. Bränström R, Kasparian NA, Chang Y, Affleck P, Tibben A, Aspinwall LG, Azizi E, Baron-Epel O, Battistuzzi L, Bergman W, Bruno W, Chan M, Cuellar F, Debniak T, Pjanova D, Ertmanski S, Figl A, Gonzalez M, Hayward NK, Hocevar M, Kanetsky PA, Leachman SA, Heisele O, Palmer J, Peric B, Puig S, Schadendorf D, Gruis NA, Newton-Bishop J, Brandberg Y. Predictors of sun protection behaviors and severe sunburn in an international online study. Cancer Epidemiol Biomarkers Prev. 2010 Sep;19(9):2199–210. doi: 10.1158/1055-9965.EPI-10-0196.
    1. Calderón TA, Bleakley A, Jordan AB, Lazovich D, Glanz K. Correlates of sun protection behaviors in racially and ethnically diverse US adults. Prev Med Rep. 2019 Mar;13:346–53. doi: 10.1016/j.pmedr.2018.12.006.
    1. Jackson KM, Aiken LS. A psychosocial model of sun protection and sunbathing in young women: the impact of health beliefs, attitudes, norms, and self-efficacy for sun protection. Health Psychol. 2000 Sep;19(5):469–78. doi: 10.1037//0278-6133.19.5.469.
    1. Weig EA, Tull R, Chung J, Brown-Joel ZO, Majee R, Ferguson NN. Assessing factors affecting sunscreen use and barriers to compliance: a cross-sectional survey-based study. J Dermatolog Treat. 2020 Jun;31(4):403–5. doi: 10.1080/09546634.2019.1587147.
    1. Manne SL, Coups EJ, Kashy DA. Relationship factors and couples' engagement in sun protection. Health Educ Res. 2016 Aug;31(4):542–54. doi: 10.1093/her/cyw027.
    1. Hay J, Ostroff J, Martin A, Serle N, Soma S, Mujumdar U, Berwick M. Skin cancer risk discussions in melanoma-affected families. J Cancer Educ. 2005;20(4):240–6. doi: 10.1207/s15430154jce2004_13.
    1. Loescher LJ, Crist JD, Siaki LA. Perceived intrafamily melanoma risk communication. Cancer Nurs. 2009;32(3):203–10. doi: 10.1097/NCC.0b013e31819ae11c.
    1. Prestwich A, Conner MT, Lawton RJ, Ward JK, Ayres K, McEachan RR. Partner- and planning-based interventions to reduce fat consumption: randomized controlled trial. Br J Health Psychol. 2014 Feb;19(1):132–48. doi: 10.1111/bjhp.12047.
    1. Voils CI, Coffman CJ, Yancy WS, Weinberger M, Jeffreys AS, Datta S, Kovac S, McKenzie J, Smith R, Bosworth HB. A randomized controlled trial to evaluate the effectiveness of CouPLES: a spouse-assisted lifestyle change intervention to improve low-density lipoprotein cholesterol. Prev Med. 2013 Jan;56(1):46–52. doi: 10.1016/j.ypmed.2012.11.001.
    1. Bowen DJ, Burke W, Hay JL, Meischke H, Harris JN. Effects of web-based intervention on risk reduction behaviors in melanoma survivors. J Cancer Surviv. 2015 Jun;9(2):279–86. doi: 10.1007/s11764-014-0412-0.
    1. Butterfield RM, Lewis MA. Health-related social influence: a social ecological perspective on tactic use. J Soc Pers Relatsh. 2016 Jun 30;19(4):505–26. doi: 10.1177/0265407502019004050.
    1. Lewis MA, Butterfield RM, Darbes LA, Johnston-Brooks C. The conceptualization and assessment of health-related social control. J Soc Pers Relatsh. 2016 Jun 30;21(5):669–87. doi: 10.1177/0265407504045893.
    1. Lewis MA, Gladstone E, Schmal S, Darbes LA. Health-related social control and relationship interdependence among gay couples. Health Educ Res. 2006 Aug;21(4):488–500. doi: 10.1093/her/cyh075.
    1. Glanz K, Lewis FM, Rimer BK. Health Behavior and Health Education. Med Sci Sports Exerc. 1991;23(12):1404. doi: 10.1249/00005768-199112000-00016.
    1. Manne S, Day A, Coups EJ, Kashy D. Sun safe partners: a pilot and feasibility trial of a couple-focused intervention to improve sun protection practices. Prev Med Rep. 2018 Dec;12:220–6. doi: 10.1016/j.pmedr.2018.10.010.
    1. How to Select a Sunscreen. American Academy of Dermatology. [2020-01-22]. .
    1. Sun-Protective Clothing: A Safe, Simple Way to Keep the Rays at Bay. The Skin Cancer Foundation. [2020-01-22]. .
    1. Glanz K, Yaroch AL, Dancel M, Saraiya M, Crane LA, Buller DB, Manne S, O'Riordan DL, Heckman CJ, Hay J, Robinson JK. Measures of sun exposure and sun protection practices for behavioral and epidemiologic research. Arch Dermatol. 2008 Feb;144(2):217–22. doi: 10.1001/archdermatol.2007.46.
    1. Hillhouse J, Turrisi R, Jaccard J, Robinson J. Accuracy of self-reported sun exposure and sun protection behavior. Prev Sci. 2012 Oct;13(5):519–31. doi: 10.1007/s11121-012-0278-1.
    1. Glanz K, McCarty F, Nehl EJ, O'Riordan DL, Gies P, Bundy L, Locke AE, Hall DM. Validity of self-reported sunscreen use by parents, children, and lifeguards. Am J Prev Med. 2009 Jan;36(1):63–9. doi: 10.1016/j.amepre.2008.09.012.
    1. O'Riordan DL, Nehl E, Gies P, Bundy L, Burgess K, Davis E, Glanz K. Validity of covering-up sun-protection habits: association of observations and self-report. J Am Acad Dermatol. 2009 May;60(5):739–44. doi: 10.1016/j.jaad.2008.12.015.
    1. Janssen E, van Osch L, de Vries H, Lechner L. Measuring risk perceptions of skin cancer: reliability and validity of different operationalizations. Br J Health Psychol. 2011 Feb;16(Pt 1):92–112. doi: 10.1348/135910710X514120.
    1. Manne S, Fasanella N, Connors J, Floyd B, Wang H, Lessin S. Sun protection and skin surveillance practices among relatives of patients with malignant melanoma: prevalence and predictors. Prev Med. 2004 Jul;39(1):36–47. doi: 10.1016/j.ypmed.2004.02.028.
    1. Manne SL, Coups EJ, Jacobsen PB, Ming M, Heckman CJ, Lessin S. Sun protection and sunbathing practices among at-risk family members of patients with melanoma. BMC Public Health. 2011 Feb 21;11:122. doi: 10.1186/1471-2458-11-122.
    1. Glanz K, Schoenfeld E, Weinstock MA, Layi G, Kidd J, Shigaki DM. Development and reliability of a brief skin cancer risk assessment tool. Cancer Detect Prev. 2003;27(4):311–5. doi: 10.1016/s0361-090x(03)00094-1.
    1. Kraemer HC, Mintz J, Noda A, Tinklenberg J, Yesavage JA. Caution regarding the use of pilot studies to guide power calculations for study proposals. Arch Gen Psychiatry. 2006 May;63(5):484–9. doi: 10.1001/archpsyc.63.5.484.
    1. Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res. 2011 May;45(5):626–9. doi: 10.1016/j.jpsychires.2010.10.008.
    1. Lewis MA, McBride CM, Pollak KI, Puleo E, Butterfield RM, Emmons KM. Understanding health behavior change among couples: an interdependence and communal coping approach. Soc Sci Med. 2006 Mar;62(6):1369–80. doi: 10.1016/j.socscimed.2005.08.006.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe