title: Prevention of skin cancer in primary healthcare: an evaluation of three different prevention effort levels and the applicability of a phototest.
abstract: OBJECTIVE
  The high skin cancer incidence in western society, and its known association with sun exposure habits, makes the area an important target for prevention. We investigated, in a primary healthcare setting, differentiated levels of prevention efforts directed at the propensity of the patient to change his/her sun habits, sun protection behaviour, and attitudes, after information intervention. Additionally, the impact of the performance of a phototest to determine individual sun sensitivity was evaluated.
  
  
  METHODS
  308 patients visiting a primary healthcare centre in southern Sweden completed a questionnaire concerning sun habits, sun protection behaviour, and attitudes, and were randomized into one of three groups, representing increasing levels of prevention effort in terms of resources. Feedback on their questionnaire and general preventive sun protection advice was given, in the first group by means of a letter, and in the second and third groups by a doctor's consultation. Group 3 also underwent a phototest, with a self-reading assessment and a written follow-up of the phototest result. Change of sun habits, behaviour, and attitudes, based on the Transtheoretical Model of Behaviour Change and on Likert scale scorings, was evaluated after 6 months, by a repeated questionnaire.
  
  
  RESULTS
  Prevention mediated by a doctor's consultation had a clearly better impact on the subjects. The addition of a phototest did not further reinforce this effect in the group as a whole, but it did for a subgroup of individuals with high ultraviolet (UV) sensitivity, as determined by the phototest itself, suggesting that this might actually be a tool to improve outcome in this high-risk group.
  
  
  CONCLUSIONS
  A personal doctor's consultation is a valuable tool in the effective delivery of preventive information in the general practice setting. In individuals with high UV-sensitivity and thus high risk for skin cancer the performance of a photo-test reinforces a positive outcome in habits, behaviour and attitudes.
authors.affiliation: Unit of Research and Development in Local Healthcare, County of Ostergotland, Linkoping, Sweden. magnus.falk@lio.se
authors.forename: Magnus
authors.initials: M
authors.lastname: Falk
authors.forename: Chris
authors.initials: C
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D011481:Protective Clothing / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000209:etiology / Q000517:prevention & control*; D055108:Sunbathing; D013471:Sunburn / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control; D013473:Sunscreening Agents / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D013473:Sunscreening Agents