title: Internet based computer tailored feedback on sunscreen use.
abstract: BACKGROUND
  Skin cancer incidence rates signify the need for effective programs for the prevention of skin cancer and for helping skin cancer patients. Internet and computer tailored (CT) technology fosters the development of highly individualized health communication messages. Yet, reactions to Internet CT programs may differ per level of involvement and education level and remain understudied.
  
  
  OBJECTIVE
  First, we identified perceptions concerning sunscreen use in Dutch adults and assessed differences in differences between the general public and skin cancer patients, and between low and high educated respondents. Second, we assessed program evaluations of these groups about a new Dutch CT Internet-based program promoting sunscreen use, and potential differences between groups
  
  
  METHODS
  A cross-sectional research design was used.  In total, 387 respondents participated and filled out an online questionnaire based on the I-Change Model assessing socio-demographics, history of skin cancer, sunscreen use, and beliefs about sunscreen use. The responses were fed into a computer program that generated personal tailored feedback on screen; next we assessed their program evaluations
  
  
  RESULTS
  Of the 132 patients, 92 were female (69.7%) and 40 were male (30.3%). In the general population (N = 225), 139 (54.5%) respondents were female and 116 (45.5%) were male. Men (50.9 years) were 8 years older than women (43.1 years). Most patients were diagnosed with basal cell carcinoma (N = 65; 49.2%), followed by melanoma (N = 28; 21.2%) and squamous cell carcinoma (N = 10; 7.6%); 22% (N = 29) did not remember their skin cancer type. Patients had higher knowledge levels, felt significantly more at risk, were more convinced of the pros of sunscreen, experienced more social support to use sunscreen, had higher self-efficacy, and made more plans to use sunscreen than respondents without skin cancer (N=255; all P's< .01). Low (N=196) educated respondents scored lower on knowledge (P<.003) but made more action plans (P<.03) than higher educated respondents (N=191). The CT feedback was evaluated positively by all respondents, and scored a 7.8 on a 10 point scale. Yet, patients evaluated the CT program slightly more (P<.05) positive (8.1) than non-patients. (7.6). Lower educated respondents were significantly (P<.05) more positive about the advantages of the program.
  
  
  CONCLUSIONS
  First, involvement with skin cancer was reflected in more positive beliefs toward sunscreen use in patients in comparison with non-patients. Second, the CT Internet program was well accepted by both patients and non-patients, and low and high educated respondents, perhaps because higher educated respondents were more knowledgeable about sunscreen use and skin cancer. Third, a pro-active approach as conducted in our study is very well suited to reach various groups of people and is more likely to be successful than a reactive approach.
authors.affiliation: Department of Health Promotion, School for Public Health and Primary Care, CAPHRI, Maastricht University, Maastricht, Netherlands. hein.devries@maastrichtuniversity.nl
authors.forename: Hein
authors.initials: H
authors.lastname: de Vries
authors.forename: Matti
authors.initials: M
authors.lastname: Logister
authors.forename: Gertruud
authors.initials: G
authors.lastname: Krekels
authors.forename: Frits
authors.initials: F
authors.lastname: Klaasse
authors.forename: Verina
authors.initials: V
authors.lastname: Servranckx
authors.forename: Liesbeth
authors.initials: L
authors.lastname: van Osch
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005246:Feedback; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015397:Program Evaluation; D012878:Skin Neoplasms / Q000517:prevention & control; D013473:Sunscreening Agents / Q000008:administration & dosage*
chemical_list: D013473:Sunscreening Agents