A 3-Minute Intervention Could Improve Your Patients’ Sunscreen Habits

It is no secret that sun protection is important, as unprotected sun exposure and sunburns are known to raise skin cancer risk, but promoting the use of appropriate protective habits — such as sunscreen use, seeking shade, and wearing protective clothing — is sometimes a difficult task.

A new study published in JAMA Dermatology found that a brief, dermatologist-delivered intervention was associated with improved sun protection behaviors among patients receiving dermatology care.

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The intervention, which is conversation based, lasts only 3 minutes. Its main appeal, though, among dermatologists in the study was that it required no additional time spent per appointment, said lead author Kimberly Mallett, PhD, who is a research professor and the clinical director of the Prevention Research to Optimize (PRO) Health Lab at Penn State University.

Because physicians’ and other providers’ schedules are often crammed with a multitude of patient visits, most providers do not have additional time to spare. This was dermatologists’ number one concern in the study, Dr Mallett explained. The intervention is designed to accommodate this concern.

The Addressing Behavior Change Intervention

The intervention — called an Addressing Behavior Change (ABC) intervention — was developed by Dr Mallett and her research team, and stemmed from Dr Mallett’s experience as a clinical psychologist.

“I had received a lot of training in the area of behavior change, whereas other health care providers were not trained to facilitate conversations in the same way I was,” she explained.

Originating in the area of substance abuse treatment, the intervention is interactive and involves having patients generate their own solutions for sun protection that they feel they can stick to. When coupled with additional suggestions from dermatologists, Dr Mallett found that the model was conducive to behavior change.

With consideration for providers’ busy schedules in mind, she figured out a way to make interventions brief, converting what would normally be a 15-minute-long intervention into a 3-minute one. The conversation-based intervention can be given during a routine skin examination and requires no additional time spent per appointment, making it a convenient option for busy dermatologists.

Perhaps most importantly, even though the interventions were shorter, they were still effective.

“Once I learned how to make these interventions very brief, I realized that other health care providers like dermatologists would benefit from being able to talk to their patients in this way and could hopefully facilitate behavior change,” Dr Mallett said.

The intervention also comes with a small visual aid. Patients are given a magnet to take home with them, which contains cues that help reinforce the sun protection behaviors that dermatologists discuss with them during an appointment.

The Clinical Evidence

To test the effectiveness of the intervention, Dr Mallett and her team evaluated 159 adults receiving dermatology care at 2 clinics within a Northeastern health care system from April 25 to November 6, 2017. Each participant was assigned to either the intervention group (n = 77) or the control group (n = 82).

Participants in the intervention group received a 3-minute ABC intervention delivered by a dermatologist during a skin examination or the suturing phase of skin cancer surgery.

The intervention was comprised of 6 primary components:

• Assess patients’ risk of sun exposure
• Assess patients’ willingness to use sunscreen
• Assess patients’ barriers to using sunscreen
• Facilitate patients’ solution to barriers
• Assess other methods of sun protection
• Offer additional options for sun protection

The results of the study indicated that there were fewer self-reported sunburns among patients in the intervention group vs those in the control group at 1 month after implementation of the intervention.

Compared with the control group, the intervention group reported higher rates of sunscreen use and reapplication on the face and body over a period of several months. In addition, rates of satisfaction with dermatologist-patient communication were more positive among patients in the intervention group vs controls.

Key Takeaways

An important takeaway from Dr Mallett’s study is that the intervention could be expanded to address a multitude of different health behaviors beyond just sunscreen use.

“The foundations of the intervention can really be adapted to any content, whether it is sunscreen use, smoking, or medication adherence,” explained Dr Mallett. “There is an increasing interest in the different applications of the intervention and its potential use for a variety of presenting issues.”

In the future, she hopes to adapt the training so that it could be more easily disseminated, and is looking to make training for the intervention available online.

As the intervention develops a broader reach, physicians and other providers may have an opportunity to quickly learn a new skill that they may not otherwise have learned, which could improve patient care without encumbering providers’ already-busy schedules, Dr Mallett stated.

“The take-home message from this intervention is that it’s not only what you say, it’s how you say it,” said Dr Mallett. “By interacting with patients in this way, their care becomes much more collaborative. Patients often respond better to being part of the conversation rather than just being told what to do.”

—Christina Vogt

Reference:

Mallett KA, Turrisi R, Billingsley E, et al. Evaluation of a brief dermatologist-delivered intervention vs usual care on sun protection behavior [Published online August 8, 2018]. JAMA Dermatol. doi:10.1001/jamadermatol.2018.2331