title: Mediation of improvements in sun protective and skin self-examination behaviours: results from the healthy text study.
abstract: OBJECTIVE
  Melanoma is on the rise, especially in Caucasian populations exposed to high ultraviolet radiation such as in Australia. This paper examined the psychological components facilitating change in skin cancer prevention or early detection behaviours following a text message intervention.
  
  
  METHODS
  The Queensland-based participants were 18 to 42 years old, from the Healthy Text study (N = 546). Overall, 512 (94%) participants completed the 12-month follow-up questionnaires. Following the social cognitive model, potential mediators of skin self-examination (SSE) and sun protection behaviour change were examined using stepwise logistic regression models.
  
  
  RESULTS
  At 12-month follow-up, odds of performing an SSE in the past 12 months were mediated by baseline confidence in finding time to check skin (an outcome expectation), with a change in odds ratio of 11.9% in the SSE group versus the control group when including the mediator. Odds of greater than average sun protective habits index at 12-month follow-up were mediated by (a) an attempt to get a suntan at baseline (an outcome expectation) and (b) baseline sun protective habits index, with a change in odds ratio of 10.0% and 11.8%, respectively in the SSE group versus the control group.
  
  
  CONCLUSIONS
  Few of the suspected mediation pathways were confirmed with the exception of outcome expectations and past behaviours. Future intervention programmes could use alternative theoretical models to elucidate how improvements in health behaviours can optimally be facilitated.
authors.affiliation: School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
authors.forename: Jannah
authors.initials: J
authors.lastname: Baker
authors.affiliation: School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Finch
authors.affiliation: Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Princess Alexandra Hospital, Brisbane, QLD, Australia.
authors.forename: H Peter
authors.initials: HP
authors.lastname: Soyer
authors.affiliation: School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Marshall
authors.affiliation: Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Baade
authors.affiliation: Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.
authors.forename: Philippa
authors.initials: P
authors.lastname: Youl
authors.affiliation: School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
authors.forename: Monika
authors.initials: M
authors.lastname: Janda
mesh_terms: D000293:Adolescent; D000328:Adult; D055088:Early Detection of Cancer / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000517:prevention & control* / Q000523:psychology; D015397:Program Evaluation; D011793:Queensland; D016353:Self-Examination / Q000523:psychology*; D012878:Skin Neoplasms / Q000517:prevention & control* / Q000523:psychology; D013471:Sunburn / Q000517:prevention & control; D013473:Sunscreening Agents / Q000008:administration & dosage; D011795:Surveys and Questionnaires; D060145:Text Messaging; D014466:Ultraviolet Rays / Q000009:adverse effects; D055815:Young Adult
chemical_list: D013473:Sunscreening Agents
keywords: cancer; early detection; oncology; skin cancer; text messaging