Application of an appearance based intervention to improve sun protection outcomes of outdoor workers in queensland, australia

Application of an Appearance-Based Intervention to Improve Sun Protection Outcomes of Outdoor Workers in Queensland, Australia Katja Saris Bachelor of Science; Master of Science (University of Maastricht) Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy School of Public Health Faculty of Health Queensland University of Technology Brisbane, Australia May 2012 Keywords Appearance-based intervention, behaviour, facial UV-photograph, intention, intervention, leisure time, organisation, outdoor workers, quantitative, risk perception, skin cancer prevention, sun safety policy, theory, work time i|Page ii | P a g e List of Abbreviations ARPANSA Australian Radiation Protection and Nuclear Safety Agency BCC Basal Cell Carcinoma BL Baseline BRAT Brief skin cancer risk assessment tool FU Follow-up GEE Generalised Estimating Equations GP General Practitioner HBM Health Belief Model HPV Human Papiloma Virus H&S Health and Safety i-Change Integrated Model for Change ICNIRP International Commission on Non-Ionizing Radiation Protection MM Malignant Melanoma NCI National Cancer Institute (USA) nm Nanometers NHMRC National Health and Medical Research Council NMSC Non Melanoma Skin Cancer POWER Protection of Outdoor Workers from Environmental Radiation PPE Personal Protective Equipment QUT Queensland University of Technology SCC Squamous Cell Carcinoma SCRAT Skin Cancer Risk Assessment Tool SCT Social Cognitive Theory SPF Sun Protection Factor TTM Transtheoretical model iii | P a g e UV Ultraviolet UVR Ultraviolet Radiation WHO World Health Organisation iv | P a g e Definitions for this Thesis Policy is defined as having work sun protection measures and risk management in place for employees to protect from the risks of sun exposure Current: belonging to the present time Practice: habitual or customary performance regarding sun protection Sun protection: protection of the skin and eyes through the use of shade, clothing and/or sunscreen Outdoor worker: a person that spends at least half of their time outside working day) working in an outdoor environment According to Stepanski and Mayer (1998) outdoor workers typically spend 30 work hours or more per week exposed to UVR Change: a transformation or modification; alteration Intervention group: a group(s) of people that undergo the same study condition which includes the intervention part of the study The intervention part is meant to be the effective changing component of the study Control group: a group(s) of people that undergo the same study condition and not undergo the intervention part of the study Effectiveness: adequate to accomplish a purpose; producing the intended or expected result Impact: to have an effect on; influence; alter v|Page Stringent sun protection policy setting: having an organisational policy that protects employees from the risks of sun exposure that is clear and consciously implemented and reviewed Less stringent sun protection policy setting: not having a stringent organisational policy in place for the protection of employees vi | P a g e Abstract Outdoor workers are exposed to high levels of ultraviolet radiation (UVR) and may thus be at greater risk to experience UVR-related health effects such as skin cancer, sun burn, and cataracts A number of intervention trials (n=14) have aimed to improve outdoor -related sun protection cognitions and behaviours Only one study however has reported the use of UV-photography as part of a multi-component intervention This study was performed in the USA and showed long-term (12 months) improvements in work-related sun protection behaviours Intervention effects of the other studies have varied greatly, depending on the population studied, intervention applied, and measurement of effect Previous studies have not assessed whether: - Interventions are similarly effective for workers in stringent and less stringent policy organisations; - P - Implemented interventions are effective in the long-term; - The facial UV-photograph technique is effective in Australian male outdoor workers without a large additional intervention package, and; - “ -related cognitions and behaviours Therefore, the present Protection of Outdoor Workers from Environmental Radiation [POWER]-study aimed to fill these gaps and had the objectives of: a) assessing outdoor -related cognitions and behaviours at work and during leisure time in stringent and less stringent sun protection policy environments; b) assessing the effect of an appearancebehaviours over time; c) assessing whether the intervention was equally effective within vii | P a g e the two policy settings; and d) assessing the immediate post-intervention effect Effectiveness was described in terms of changes in sun-related risk perceptions and intentions (as these factors were shown to be main precursors of behaviour change in many health promotion theories) and behaviour The study purposefully selected and recruited two organisations with a large outdoor worker contingent in Queensland, Australia within a 40 kilometre radius of Brisbane The two organisations differed in the stringency of implementation and reinforcement of their organisational sun protection policy Data were collected from 154 male predominantly Australian born outdoor workers with an average age of 37 years and predominantly medium to fair skin (83%) Sun-related cognitions and behaviours of workers were assessed using self-report questionnaires at baseline and six to twelve months later Variation in follow-up time was due to a time difference in the recruitment of the two organisations Participants within each organisation were assigned to an intervention or control group The intervention group participants received a one-off personalised Skin Cancer Risk Assessment Tool [SCRAT]-letter and a facial UVphotograph with detailed verbal information This was followed by an immediate postintervention questionnaire within three months of the start of the study The control group only received the baseline and follow-up questionnaire Data were analysed using a variety of techniques including: descriptive analyses, parametric and non-parametric tests, and generalised estimating equations A 15% proportional difference observed was deemed of clinical significance, with the addition of reported statistical significance (p