Novel Intervention for Sun Protection Gets High Marks

Steven Fox

August 15, 2011

August 15, 2011 — Results from a small pilot study of 8 dermatologists demonstrate that they quickly learned a new interview technique for improving patients’ use of sun protection. The study also shows the physicians were able to sustain use of the technique with their patients for 6 months.

Still to be assessed, though, is whether physicians’ use of the technique will actually change patient behavior.

The study is published as a research letter online August 15 in the Archives of Dermatology.

Lead author Kimberly Mallett, PhD, Prevention Research Center, Department of Biobehavioral Health, the Pennsylvania State University, along with colleagues, notes that previous research has shown education alone isn’t an effective strategy for changing patient behavior. "However, communication that incorporates the principles of motivational interviewing (MI), a patient-centered approach that uses empathic communication, has been successful in improving a variety of health-related behaviors," they write.

Further, the study authors say, recent research has shown that dermatologists who viewed video examples of MI-oriented interventions aimed at increasing sun protection thought those interventions would be a useful tool for enhancing communication with patients.

On the basis of that work, Dr. Mallett and her group devised what they call the ABC method for dermatologists to use as a tool for promoting sunscreen use. (The ABC acronym signifies "addressing behavior change.")

"The focus of the current study was to teach a sample of dermatologists the ABC method and assess their ability to deliver it with fidelity as well as their sustained use and satisfaction with using it over a 6-month period," the authors write.

Eight dermatologists affiliated with the Pennsylvania State University School of Medicine participated in the study. They underwent 2 training sessions, each 1 hour long, that were conducted as part of a weekly journal club meeting.

In the first session they learned about the 6 components of the ABC method:

  1. Assessing the patient's ultraviolet risk;

  2. Assessing the patient's use of sunscreen;

  3. Assessing the obstacles to use of sunscreen;

  4. Facilitating removal of obstacles to sunscreen use;

  5. Assessing other methods of sun protection; and

  6. Summarizing patients' motivations and ideas for improved sunscreen use.

Dr. Mallett and her group say that the ABC method is designed to be incorporated into routine office visits and that on average it takes only about 2 or 3 minutes to cover the 6 steps in the interview process.

At the second training session, conducted during the following week's journal club meeting, the participants engaged in role-playing with mock patients. Afterward, as they used the ABC method during interaction with actual patients, they were shadowed by a trainer and received feedback on their use of the method. Then, participants were asked to use the ABC method over the following 6 months with their patients.

To find out whether the dermatologists had successfully picked up the technique, their interactions with patients were coded for fidelity, first at baseline and then 3 and 6 months after training.

The researchers report that at 3-month follow-up the dermatologists reported using the ABC method in 66.3% of interactions with patients. At 6 months, use had increased to 74.5%.

On the basis of the study results, Dr. Mallett and her group concluded overall that the participants used the ABC method with good fidelity, increased their use of the method, gave the method uniformly high marks for enhancing communication with patients, and said they intended to continue routinely using the method when seeing patients.

The researchers stress that the dermatologists learned the ABC method during existing educational sessions and that use of the method did not add to the duration of office visits.

"This method was often used as a way to build rapport with patients and replaced conversation that was less relevant to patient behavior," they write, adding, "Overall, the findings suggest that the ABC method is a feasible way for dermatologists to communicate with patients about sun protection during an office visit."

But they also emphasize that future studies will need to assess whether use of the ABC method actually results in patients paying more attention to sun protection.

The study was supported in part by a grant from the National Cancer Institute. The authors have disclosed no relevant financial relationships.

Arch Dermatol. Published online August 15, 2011.

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