The effect of nurse health education and follow-up programme on sun protection behaviors of children

Background: Approximately 25% of lifelong sun exposure is formed prior to the age of 18. A significant correlation between exposure to ultraviolet radiation in childhood and skin cancer in adulthood draws attention to the importance of sun protection behaviors to be applied in this period. School-age children are easily reachable to promote preventive health behaviors. The aim of the study is to determine the effect of nurse health education and follow up programme on sun protection behaviors of children. Methods: The study as a randomized controlled group trial was implemented in February- October 2014. Purposive non probability sampling was used to select 25 schools in Izmir Karşıyaka district and research was conducted in two schools where attending the children coming from medium families. Risk assessment for skin cancer was performed by Fitzpatrick classification with 260 children before the study. Out of these children, 144 were found to be risky and were randomized to intervention (n = 40) and control (n = 40) groups according to their age, gender, and skin type. In the survey, effect size was identified as 0.73 by a 5% error and 80% confidence. After obtaining the parents' and the children's written consents, data were collected through face-to-face interviews using with, the instruments (stages of change, the decisional balance scale, child and parental sun protection behavior form, self-efficacy form) on sun protection based on the transtheoretical model. Turkish validity and reliability study of the scale was conducted by Aygün and Ergün (2013). Intervention group were trained about sun protection behaviors in six sessions. Each session lasted 45 minutes. Refresher training was organized on the 15th day, on 1st month 2nd month after first session. At the beginning and at the end of the program, decisional balance and self-efficacy of children was evaluated. Data were analyzed by frequencies, regression, Wilcoxon signed-rank test, paired samples t-test, independent samples t-test, Mann-Whitney U test, Friedman's test and Chi-square test. Written consent was taken from children and their parents, schools and from the local ethics committee. Results: 50% of children were girl and the mean age was 8.27±0.44. Skin types were; 22.5% type I, 41.2% type II, 36.3% type III. While pretest mean score of sun protection behavior scale of intervention group was 19.25±5.44, after the research it increased significantly (33.05±4.23, p<.001). In intervention group while self-efficacy pretest mean score was 20.50±6.68, it was found to be 35.85±4.70 (p<.001) in posttest. In intervention group; while pros scores of decisional balance was found 11.82±3.69, for the posttest it was found 16.32±2.81 (p<.001). In intervention group; while cons scores of decisional balance was found 8.87±2.91 in pretest, it was significantly increased in the posttest (8.55±4.72, p<.001). No increase in the mean scores for sun protection behaviors, self-efficacy and the decisional balance was found significantly (p>0.05) in the control group. In both intervention and the control group, the differences of stages of change of sun protection behaviors between the pre and posttest was found statistically very significant respectively –sunscreen (χ2=68.83, p<.001), sun protective clothing (χ2=50.61, p<.001), sunglasses (χ2=61.41, p<.001), stay in the shade (χ2=62.22, p<.001), a wide-brimmed hat usage (χ2=65.13, p<.001). According analyses of the linear regression; self-efficacy, pros and cons of decisional balance were determined as the effective variables on children's sun protection behavior (p<.05) in posttest. Conclusion: This study demonstrated evidence that the interventions of this nurse health education and follow up programme has been effective on increasing sun protection behaviors (usage of sunscreen, hat and sunglasses and stay in shade) through improving self-efficacy and decisional balance. Key Words: Transtheoretical model; child; sun protection; self-efficacy; decisional balance; nurse