The incidence of cutaneous melanoma is increasing although 80-95% of all deaths caused by melanoma can be avoided through protective behaviours. There is evidence that social marketing as an approach in public health can improve health-related behaviours and encourage sun-safe behaviours.
A multicentre survey was conducted to collect and compare data about cutaneous melanoma risk, knowledge, concern, and protective behaviours across Northern, Central, and Southern Italy, and explore how these data could potentially inform a social marketing intervention to improve sun-safe behaviours. Data were analysed using descriptive and inferential statistics.
A total of 1034 questionnaires were collected. Apart from ‘Personal Risk’ no statistically significant differences were found between the three regions. About 30% (n=344) of the total sample had high levels of personal risk, and low levels of concern and protective behaviour, and over 70% (n=711) gave priority to sun tanning. The worst scores were related to knowledge about melanoma (30% wrong answers, and over 40% ‘don’t know’). Protective behaviour was moderately correlated with age (p=0.03). Personal risk was significantly higher in women (10.84 vs. 10.05), and lower in individuals with a degree (9.46 vs. 11.38; p<0.001).
Over 70% of our sample gave priority to sun tanning, which combined with low levels of concern and knowledge about melanoma, and high levels of personal risk, confirm that much still needs to be done in terms of melanoma prevention, but all these are aspects that could be effectively addressed through social marketing interventions.
2. AGENAS. Diagnosi e terapia del Melanoma. Linee Guida Nazionali di Riferimento. 2012. Available at: http://www.lamiapelle.salute.gov.it. (Last accessed 20 May 2013).
3. CODACONS. Ferragosto al mare. Gli italiani sono tornati a fare vacanze, oltre 30 milioni in ferie. 2016. Available at: https://codacons.it/ferragosto-al-mare-gli-italiani-sono-tornati-a-fare-vacanze-oltre-30-milioni-in-ferie/. (Last accessed 13 February 2017)
4. ISTAT. Rapporto ISTAT 2017. Noi Italia 100 statistiche per capire il Paese in cui viviamo. 2017. Available at: https://www.istat.it/it/archivio/198846 (Last accessed 4 February 2020)
5. Lindqvist, P. G., Epstein, E., Nielsen, K., Landin‐Olsson, M., Ingvar, C., & Olsson, H. Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort. J Intern Med, 2016; 280(4), 375-387.
6. Nikolaou V, Stratigos AJ. Emerging trends in the epidemiology of melanoma. Br J Dermatol 2014;170(1):11-19. doi: 10.1111/bjd.12492
7. Seebode C, Lehmann J, Emmert S. Photocarcinogenesis and skin cancer prevention strategies. Anticancer Res 2016;36(3):1371-1378.
8. Bellamy, R. A systematic review of educational interventions for promoting sun protection knowledge, attitudes and behaviour following the QUESTS approach. Med Teach 2005;27(3):269–275. doi: 10.1080/01421590400029558
9. Andreasen AR. Marketing Social Marketing in the Social Change Marketplace. J Public Policy Mark, 2002; 21(1):3-13. doi: 10.1509/jppm.18.104.22.16802
10. Crowley T, Murphy M. (2015). Does social marketing have a role in skin cancer education and prevention? In: Innovations in Social Marketing and Public Health Communication. Applying Quality of Life Research (Best Practices) (Wymer W, eds). Springer, Cham
11. Gordon R, Gurrieri L. Towards a reflexive turn: social marketing assemblages. J Soc Mark 2014;4(3), 261-278. doi: 10.1108/JSOCM-02-2014-0015
12. Maher CA, Lewis LK, Ferrar K, Marshall S, De Bourdeaudhuij I, Vandelanotte C. Are Health Behavior Change Interventions That Use Online Social Networks Effective? A Systematic Review. J Med Internet Res 2014;16(2): e40. doi:10.2196/jmir.2952.
13. De Vries H, Lezwijn J, Hol M, Honing C. Skin Cancer Prevention: Behaviour and Motives of Dutch Adolescents. Eur J Cancer Prev 2005;14:39-50. doi: 10.1097/00008469-200502000-00006
14. De Vries H, Mesters I, Van’t Riet J, Willems K, Reubsaet A. Motives of Belgian adolescents for using sunscreen: the role of action plans. Cancer Epidemiol Biomarkers Prev 2006;15:1360-1366. doi:10.1158/1055-9965.EPI-05-0877
15. Bandura A. Social Foundation of Thought and Action: A Social Cognitive Theory. New York: Prentice Hall, 1986.
16. Carpenter CJ. A meta-analysis of the effectiveness of the health belief model variables in predicting behaviour. Health Commun 2010;25(8): 661-669. doi:10.1080/10410236.2010.521906
17. Rural Health Information Hub, 2018. Available at: https://www.ruralhealthinfo.org. (Last accessed 13 April 2018)
18. Mytton OT, O’Moore EM, Sparkes T, Baxi R, Abid M. Knowledge, attitudes and beliefs of health care workers towards influenza vaccination. Occup Med 2013;63,189-195. doi:10.1093/occmed/kqt002
19. French J, Blair-Stevens C. Big Pocket Guide. Social Marketing, 2007 Available at: http://www.snh.org.uk/pdfs/sgp/A328463.pdf (Last accessed 10 April 2018)
20. Lee N, Kotler P. Social marketing: Influencing Behaviors for Good. Thousand Oaks, CA: Sage, 2011.
21. Firestone R, Rowe CJ, Modi SN, Sievers D. The effectiveness of social marketing in global health: a systematic review. Health Policy Plan 2017;32:110–124.
22. Johnson KM, Jones SC, Iverson D. Guidelines for the development of social marketing programmes for sun protection among adolescents and young adults. Public Health 2009; 123:e6-e10. doi:10.1016/j.puhe.2009.06.018.
23. McCarthy WH. The Australian experience in sun protection and screening for melanoma. J Surg Oncol 2004;86(4):236-245.
24. Gillespie HS, Watson T, Emery JD, Lee AJ, Murchie P. A questionnaire to measure melanoma risk, knowledge and protective behaviour: Assessing content validity in a convenience sample of Scots and Australians. BMC Med Res Methodol 2011;11:123.
25. Damude S, Hoekstra-Weebers JEHM, van Leeuwen BL, Hoekstra HJ. Melanoma patients' disease-specific knowledge, information preference, and appreciation of educational YouTube videos for self-inspection. Eur J Surg Oncol 2017;43(8), 1528-1535. doi:10.1016/j.ejso.2017.06.008
26. Saiag P, Sassolas B, Mortier L, et al. EDIFICE Melanoma survey: knowledge and attitudes on melanoma prevention and diagnosis. J Eur Acad Dermatol Venereol 2015;29(s2):11-15. doi: 10.1111/jdv.12896