Year

2009

Degree Name

Doctor of Philosophy

Department

Faculty of Health and Behavioural Sciences

Abstract

Skin cancer is viewed as a major public health issue throughout the western world. In Australia, skin cancer dominates cancer incidence, causing over 1,500 deaths per year, and costing the health system around AUD$300 million. Public health interventions and campaigns directed at decreasing skin cancer rates have focused on limiting people’s ultraviolet radiation (UVR) exposure through increasing their sun protection behaviours. Adolescents are a key target group for sun protection interventions, as this demographic has the lowest compliance with sun protection recommendations leaving many at high risk for skin cancer in later life.

Social marketing is a program planning process that applies commercial marketing concepts and techniques to promote voluntary behaviour change, however, while widely used in some public health areas, such as smoking cessation and physical activity promotion, little research has been published on its use in sun protection. There is, therefore, little guidance on the most effective strategies and approaches to use when developing social marketing interventions for sun protection.

Aims and objectives This project aimed to provide an evidence-base for the specific application of social marketing and advertising communications theory to sun protection interventions, with the view to informing the development of social marketing programs for the prevention of skin cancer.

Methodology The research aims were addressed through three stages of research. Stage One consisted of a systematic review of sun protection interventions targeting adolescents and young adults, and the results of this analysis were then used as an evidence-base for stage two of the project. Stage Two consisted of a Delphi consensus process with experts in the fields of social marketing and sun protection, conducted in order to develop operational guidelines for social marketing projects in sun protection for adolescents and young adults. Stage Three was conducted in response to a gap in research and practice highlighted through stages one and two, and consisted of survey research into the segmentation of youth for sun protection interventions using the Rossiter-Percy model of advertising theory, incorporating comparisons with the ‘stage of change’ model (TTM).

Results Fifteen guidelines for social marketing practice in sun protection interventions for adolescents and young adults were developed through stages one and two of the project. These guidelines cover recommendations on general structure, settings and timing of interventions, the importance of formative research and segmentation, and the need for strategies to target: the competition to sun protection that comes from social norms surrounding tanning and sun protection, perceived self-efficacy, and skin damage concerns in addition to skin cancer. Additional recommendations include the need for policy and environmental strategies, the use of a broad range of communication channels, and attention to the ‘products’ necessary for sun protection. Most notable among these guidelines is the recommendation of an appearance-based approach to sun protection highlighting the damaging effects of UVR on appearance, rather than a sole focus on a skin cancer prevention message.

Stage Three of the research found that Brand Loyalty segmentation can distinguish between groups as well as, or better than the TTM, and appears to be a better descriptor of the ‘how’ and ‘why’ of sun protection behaviour, providing more clues to appropriate intervention strategies.

Discussion For sun protection interventions targeting adolescents and young adults, this research has suggested that there is a need to move the positioning of sun protection away from a singular focus on the ‘prevention of skin cancer’ to a positioning that includes the ‘prevention of skin damage’. This demographic is significantly different in how it perceives and performs sun protection; it therefore needs interventions which acknowledge this difference, developing messages and strategies to minimise the barriers to sun protection, and providing salient benefits which can be realised in the short rather than long term. At the same time, this study identified that there is a need to improve the methodology for evaluation of sun protection interventions, including the standardisation of sun protection measurement, evaluation timing, follow-up, and reporting.

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.