Effect of Sun Protection on Children

Queenie J. Magadia 

Introduction

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Research and evaluation are both characterized by same features that focuses on answering a question using data collection and analysis methods. Evaluation is a set of research process and practice that critically examines the existing programs. The purpose of evaluation is providing judgments about a programs actions, activities and outcomes to improve its effectiveness and policy making (Elliot, 2005).

Health program evaluation is important to ensure the effectiveness of the quality of a program’s goal. It can also help in identifying areas of program design and implementation that needs improvement. Evaluation can demonstrate outcomes or impact of program success and by the health sector to continuously monitor the progress of the programs goal more effectively and efficiently.

Background of the Study

Skin cancer is the most common cancer in New Zealand and they have the highest rates in the world. It is characterized as melanoma or non-melanoma skin cancer. According to Cancer Society (2015), there are 486 New Zealanders died from skin cancer in year 2012 and over 90% skin cancer cases are due to excessive sun exposure. Furthermore, there are about 67,000 new cases of non-melanoma skin cancer a year and it plays around 80% of all new cancers registration each year. As early as possible, early detection is the best chance of treating skin cancer successfully.

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New Zealand high skin cancer rates are due to high level of UV radiation during daylights saving months, low ozone levels, outdoor lifestyle and large number of people with fair skin. Skin cancer is largely preventable by reducing the excessive exposure to ultraviolet radiation coming from the sun or sunbeds through encouraging people to be SunSmart and to ‘slip, slop, slap and wrap’ in the months when UV radiation are very high between September and April from 10am-4pm (Cancer Society, 2015).

This paper will review the five (5) recent evaluation research about skin cancer programmes in different countries and critically evaluate their significance, methodology, and quality that can provide information in identifying its success and effectiveness for every individual. This will also analyze the four (4) audit and evaluation processes and approaches evaluated which are process, economic, impact and outcome process evaluation.

Economic evaluation of the US Environmental Protection Agency’s SunWise program: sun protection education for young children

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This study assessed the clinical or health benefits and economic impact of school-based SunWise sun protection education programme for young children from 5-15 years of age to protect them from overexposure to the sun and prevent them from having skin cancers. The researchers used the quantitative methods to conduct a surveys in a participating school. They also used standard cost/ benefit and cost effectiveness analytical approach as a method to explain any reduction in sun exposure into decrease occurrence of skin cancer and measure the estimated intervention cost to be sustained by the US government which funds the SunWise program (Kyle, et al., 2009).

For results of the study, the economic analysis showed that if the SunWise Educational School Program remains through 2015 at current funding levels, it should prevent more than 50 premature deaths, approximately 11,000 skin cancers and 960 quality adjusted life-years amongst participants (Kyle, et al., 2009). This study contributes to the knowledge of educating children about sun safety for the reduction of incidence and mortality of skin cancer.

Economic evaluation of skin cancer prevention in Australia

This research evaluated the cost effectiveness of SunSmart skin cancer prevention program as an upgraded and ongoing national program in Australia. The significance of the study is to prevent the occurrence of skin cancer using the prevention program. They used the quantitative method to express the results of the reduction of melanoma skin cancer incidence rates used to showed key health outcomes and non-melanoma skin cancer was separately showed based on national survey results (Shih, Carter, Heward, & Sinclair, 2009).

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The results of the study estimated that SunSmart has avoided 28,000 disablity-adjusted life years (DALYs), similar to 22,000 life-years saved since it was introduced in 1988 in addition to saving money from cost balance in skin cancer management (Shih, Carter, Heward, & Sinclair, 2009). This study contributes to prove that a continuous modest investment in skin cancer like sun protection program is possibly provide an excellent value for money.

Evaluation of a health promotion intervention for skin cancer prevention in Spain: The SolSano program.

This study was done to evaluate the effects of SolSano sun protection program on students’ knowledge, practices and attitudes about SunSafety. The researchers used a non-randomized, community intervention without control group, and with schools as the unit of intervention. There are 5845 children from 215 Argonese Primary Schools are participated in the program. The pre and post-test surveys were consisted of two parts, the ‘Draw and Write research strategy’ and the ‘questionnaires’. Majority of interventions are improved and presented a significant change in knowledge and behaviors based on the increase in the total of student’s score of using sun protective methods (Gilaberte, Alonso, Teruel, Granizo, & Gallego, 2008).

This study demonstrates the achievement on improving the knowledge and habits of the children about the sun damage and protection. It contributes the importance of the use of sunscreen for the children to protect them from the effects of radiation coming the sun and to change the sun protection behavior by promoting and developing a well-designed educational programs.

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Australian primary schools’ sun protection policy and practice: evaluating the impact of the National SunSmart Schools Program

This study examined the trends in sun protection policy and practice of Australian primary schools and the impact of the National SunSmart Schools Program. The researchers used the quantitative methods to conduct a survey to all primary schools from all states and territories of Australia. They were surveyed their sun protection policy and practice between September and November 2005 to compared and analyzed it into 1998 and 2001 data using descriptive statistics and chi-square tests (Jone, Beckmann, & Rayner, 2008).

The results of the study, there was an increase to 80% in the percentage of primary schools with written sun protection policy, even though some parts of policy were less expected to be included in 2005 than in 2001(Jone, et al., 2008). The researchers found that the SunSmart Schools have a higher level of protection policy and practice than non-SunSmart schools. This study contributes the need of encouraging the development of complete written sun protection policies in all primary schools and a continuous supporting the primary school sun protection activities.

Continued Impact of SunSmart Advertising on Youth and Adults’ Behaviors

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This research examined whether the exposure to summer campaigns in the past decade has sustained to impact sun protection behavior and to study the age group’s behavioral impact. The researchers used quantitative research method and conducted a cross-sectional weekly telephone survey of Melbourne residents from 1987-1988 to 2010-2011 over summers and evaluated in 2012-2014 to determine the frequency of a particular point of exposure, their sun-related attitudes and sun protection. Furthermore, the exposure level of SunSmart TV advertising campaign with tanning preference and behavioral outcomes was calculated as cumulated weekly target audience rating points (TARPs) in terms of reach and frequency for four (4) weeks (Dobbinson, Volkov, & Wakefield, 2015).

The findings showed that there was an increase TARPs related to increased preference for no tan, sunscreen use, and reduction in the percentage of sun exposure and these effects are inadequately related with age group, gender, skin type or time period (Dobbinson, Volkov, & Wakefield, 2015). This study contributes on the importance of continuous advertising health promotion campaign that focused on adolescents and young adult especially on summer months with reliable useful effect on sun protection behaviors.

Audit and Evaluation Processes

Economic evaluation of the US Environmental Protection Agency’s SunWise program: sun protection education for young children

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Economic evaluation is a type of evaluation that identify and measure the inputs and outcomes of using society’s resources which can be defined as a comparative analysis of different courses of action based on both their costs and consequences (Brouwer & Georgiou, 2012). The researcher’s used the standard cost/benefits and cost effectiveness analysis, a form of economic evaluation to evaluate the SunWise health benefits and regulate the program’s net benefits and cost-effectiveness. The intervention costs were measured as program cost and health outcomes were measured as skin cancer and premature mortalities (Kyle, et al., 2009).

They used the effectiveness evaluation of SunWise to represent the health outcomes based on pretest and posttest surveys administered to students who joined in the program. This evaluation showed that if the SunWise School Program lasts through 2015 with the present funding levels, then it should prevent premature deaths and productivity losses are saved, depending on the funding situation (Kyle, et al., 2009). The study showed the importance of educating children about sunsafety and it may result in decreasing the incidence and mortality of skin cancer.

Economic evaluation of skin cancer prevention in Australia

The researchers used the economic evaluation to evaluate the cost-effectiveness of the ongoing national program of Australia which is SunSmart skin cancer prevention program. The reduction in melanoma rate due to SunSmart was showed as the primary end-point. Melanoma incidence rate were used to modelled the key health outcomes from Australian states and non-melanoma skin cancer was showed separately based on national survey result (Shih, Carter, Heward, & Sinclair, 2009).

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The main purpose of cost-effectiveness analysis is to identify the most effective decision or course of action for accomplishing an objective that is not measurable in economic terms like health goal outcomes relating mortality and morbidity effects of intervention (Brouwer & Georgiou, 2012). The study showed that an upgraded national program SunSmart can saved more life-years and estimated to prevent disability-adjusted life-years (DALYs) with reductions in the use of health care resources for the next 20 years (Shih, Carter, Heward, & Sinclair, 2009).

Evaluation of a health promotion intervention for skin cancer prevention in Spain: The SolSano program.

Outcome evaluation investigates the programme effects in the target population by evaluating the progress in the outcomes or objectives (Trochim, 2006). This study evaluates the effects of SolSano SunSafety health promotion programme on student’s knowledge, attributes and practices. The researcher used pretest and posttest surveys which is composed of two parts: the ‘Draw and Write research strategy’ and questionnaires. Pretest and posttest design are used to compare participant groups and evaluate the degree of change happening or the effectiveness of SolSano on students as an outcome of intervention (Shuttleworth, 2009).

The findings showed that SolSano programme accomplished a reduction in the percentage of reported sunburns and there was a significantly increased in the use of sunsafety resources after the intervention. The evaluation demonstrates that significant knowledge can be learned, attitudes about the healthiness of a tan can be changed and behavior regarding sun protection can be developed by educational programs (Gilaberte, et al., 2008).

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Australian primary schools’ sun protection policy and practice: evaluating the impact of the National SunSmart Schools Program

Impact evaluation is an analysis of how the intervention being assessed affects outcomes of the programme (OECD, 2001). This research evaluated trends of Australian primary schools’ sun protection policy and practice and the impact of the National SunSmart Schools program. The researchers conducted a survey on primary schools from all states of Australia to gather data about their sun protection policy and analyzed the data using descriptive statistics and chi-square (Jone, Beckmann, & Rayner, 2008).

Impact evaluation showed that there has been an increase in the percentage of schools with written sun protection policy and have a higher level of policy and practice found in SunSmart schools compared to non-SunSmart schools. This evaluation highlights the Importance of encouraging and giving support for the development of sun protection policies in primary schools (Jone, Beckmann, & Rayner, 2008).

Continued Impact of SunSmart Advertising on Youth and Adults’ Behaviors.

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The researchers make use of process and impact evaluation to determine the outcome of the study. Through process evaluation, it monitors the process of delivering the programme or technology which is Televised advertising SunSmart campaign and this evaluation showed how accessible and acceptable the program to the youth and adults (Trochim, 2006). This also evaluates the influence of SunSmart campaign to sun protection attitudes and behaviors.

The results of a process evaluation will use to strengthen the program and use to improve the future activities for the good outcomes of the campaign. If the campaign program did not produce the expected outcomes, it may be due to some implementation issues (Trochim, 2006). Therefore, it is useful to conduct process evaluation while implementing impact evaluation. Impact evaluation was done to evaluate the effectiveness of the ssadvertising campaign to the youth and adults since the televised advertisement plays an important role in public education for preventing skin cancer in Australia (Dobbinson, Volkov, & Wakefield, 2015).

Figure 1: Logic Evaluation Model

Source: University of Idaho (1999)

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Retrieved from: http://www.cals.uidaho.edu/edcomm/pdf/CIS/CIS1097.pdf

The Logic Model  

The Logic Model process is a tool similar to evaluation models that has been used by program managers and evaluators to demonstrate the effectiveness of the programs. It explains the logical relationships among programs resources and activities, interventions, audiences, and short and long-term outcomes related to a situation or problem. Logic models demonstrate a system of cause and effect relationship- which is an approach to achieve the desired outcome. This model has four (4) basic essential components, the inputs, activities, outputs and outcomes. (Frye & Hemmer, 2012).

The Inputs evaluation includes all the related resources, skills, funding’s and facilities that delivers an opportunity to communicate the quality of the program. Evaluating the effectiveness of the program is made easier when the prearranged inputs are effectively described. The second component of Logic Model is Activities, it is the set of treatments, strategies or planned for the program. On the other hand, the outputs purpose is to establish the relationships between the problem and the impact or the intended outcome of the program. The outcomes evaluation can be short-term, medium-term or long term results of the program activities. It includes the learner’s skill acquisition, program participant’s implementation of new knowledge or any changes in health status of participants from the effectiveness of the program (Frye & Hemmer, 2012).

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This evaluation model can contribute in the implementation of health promotion campaign programme of preventing skin cancer especially in New Zealand which has the highest rates in the world. It can provide and improve the attitudes, knowledge and behaviours about sun damage and protection policy and practices. Furthermore, this model can identify the critical measures of performance and effectiveness of the skin cancer programme. The Logic model is useful for recognizing the element of the skin cancer program and measuring the progress in the outcomes of the skin cancer prevention.

Conclusions

Evaluation research is an important process of examining and assessing the programs achievements. It is an important tool to provide and achieve the objectives for the improvement and success of the program. Evaluation is important to an organization ensure the effectiveness of quality of the program design and implementation and monitor the progress of the goal more effectively.

Brouwer, R., & Georgiou, S. (2012). Economic Evaluation. Retrieved from World Health Organization: http://www.who.int/water_sanitation_health/publications/2012/ch12.pdf

Cancer Society. (2015, April). About skin cancer. Retrieved from Cancer Society: https://auckland-northland.cancernz.org.nz/en/reducing-cancer-risk-2/what-you-can-do/sunsmart/about-skin-cancer/

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Dobbinson, S., Volkov, A., & Wakefield, M. (2015). Continued Impact of SunSmart Advertising on Youth and Adults’ Behaviors. American Journal of Preventive Medicine, 49(1), 20-28. doi:10.1016/j.amepre.2015.01.011

Elliot, S. (2005). Evaluation Research Methods. Retrieved from Sage Publishing: https://au.sagepub.com/en-gb/oce/evaluation-research-methods/book226796

Frye, A., & Hemmer, P. (2012). Program evaluation models and related. Medical Teacher, 34(5), e288-e299. doi:10.3109/0142159x.2012.668637

Gilaberte, Y., Alonso, J. P., Teruel, M. P., Granizo, C., & Gallego, J. (2008). Evaluation of a health promotion intervention for skin cancer prevention in Spain: the SolSano program. Health Promotion International, 23(3), 209-219. doi:10.1093/heapro/dan020

Jone, S., Beckmann, K., & Rayner, J. (2008, August). Australian primary schools’ sun protection policy and practice: evaluating the impact of the National SunSmart Schools Program. Health Promotion, 19(2), 86-90. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18647119

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Kyle, J., Hammitt, J., Lim, H., Geller, A., Hall-Jordan, L., Maibach, E., . . . Wagner, M. (2009). Economic evaluation of the US Environmental Protection Agency’s SunWise program: sun protection education for young children. Pediatrics, 121(5), 1074-1084. doi:10.1542/peds.2007-1400

OECD. (2001). Outline of principles of impact evaluation. Retrieved from OECD: http://www.oecd.org/dac/evaluation/dcdndep/37671602.pdf

Shih, S. T., Carter, R., Heward, S., & Sinclair, C. (2009). Economic evaluation of future skin cancer prevention in Australia. Preventive Medicine. doi:10.1016/j.ypmed.2017.01.013

Shuttleworth, M. (2009). Pretest-Posttest Designs. Retrieved from Explorable: https://explorable.com/pretest-posttest-designs

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Trochim, W. (2006, October 20). Introduction to Evaluation . Retrieved from Social Research Methods: http://www.socialresearchmethods.net/kb/intreval.php

University of Idaho Extension. (1999). The Logic Model for program planning and evaluation. Retrieved from University of Idaho Extension: http://www.cals.uidaho.edu/edcomm/pdf/CIS/CIS1097.pdf

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