Living life in the sun: using the Prototype Willingness Model to explain incidental sun exposure in a high-risk environment

Townsville, in Northern Australia, is the skin cancer capital of the world (Buettner & Raasch, 1998). The rates of skin cancer observed in this region is likely to be due to a combination of environmental, genetic, and lifestyle factors including an extreme ultra violet radiation (UVR) environment, a predominantly fair skinned population, and a climate that facilitates being outdoors (Xiang et al., 2015). Under these conditions, skin damage may be acquired in the course of daily activities via incidental sun exposure. Behavioural approaches to skin cancer prevention have largely focused on sun protection and deliberate sunbathing. In comparison, little attention has been paid to damage acquired via incidental sun exposure. In order to examine the psychosocial factors that relate to incidental sun exposure, an appropriate theoretical framework must be adopted. Chapter 1 provides an introduction to skin cancer risk factors, and an overview of research relating to sun related behaviours.\ud \ud This thesis adopts the prototype willingness (PW) model (Gibbons, Gerrard, & Lane, 2003) as a framework for predicting incidental sun exposure in an extreme ultraviolet radiation (UVR) environment. Chapter 2 provides an overview of the PW model, and a discussion of the empirical evidence for the model. The PW model is a dual process model of health behaviour that includes both reasoned and reactive processes to decision making. The decision making processes underlying reasoned behaviours, such as sunbathing, are deliberative and planned. On the other hand, reactive behaviours, such as incidental sun exposure, are influenced by social and situational cues. Given that incidental sun exposure is unplanned and non-deliberative, the social reactive pathway of the PW model may provide a useful framework for the examination of this behaviour.\ud \ud Social images, or prototypes, are a crucial component in the social-reaction pathway of the PW model. The first study aimed to determine whether social images existed for sun-related behaviours. Chapter 3 reports on the first study of this research project. Using qualitative research methods, the aim of the first study was to examine whether definitive social images existed for each of the sun-related behaviours. Twenty-eight Townsville residents were recruited to participate in semi-structured interviews. Interviews were conducted to establish whether distinct prototypes existed for each of the sun-related behaviours, and to explore the nature of the characteristics associated with each of the prototypes. Results indicated that stable social images existed for all three sun-related behaviours (sun protector, sunbather, incidental exposer). Furthermore, the majority of participants reported that they felt most similar to the incidental exposer prototype.\ud \ud Chapter 4 reports on the second study of this project. A cross-sectional survey was conducted to determine whether the social reactive pathway of the PW model could account for typical incidental sun exposure behaviour. In total, 204 participants from the Townsville region completed a survey about their typical incidental sun exposure, and the PW model variables. Analyses were conducted to determine whether reasoned or reactive decision-making processes were involved in the performance of incidental sun exposure. Results suggested that both intention and willingness contributed unique variance to the prediction of behaviour. Further analyses indicated that prototype perceptions were directly related to incidental sun exposure. These findings suggested that both reasoned and reactive processes contributed toward typical exposure behaviour, and that the prototypical incidental exposer influenced whether the individuals' tend to incidentally expose themselves to the sun.\ud \ud Given that prototype perceptions were directly related to behaviour in Study 2, a third study, presented as Chapter 5, was conducted to examine whether prototype perceptions could be manipulated. A longitudinal prospective design was used to examine whether a brief intervention could change prototype perceptions, and whether such a manipulation impacted upon cognitive precursors to behaviour, or behaviour itself. Repeated-measures factorial analyses were undertaken to examine within- and between-group differences. Results suggested that the manipulation was successful for those in the Negative condition immediately following the intervention, but there were no changes observed for any cognitive variables, or for behaviour at the one-month follow-up. These findings suggested that prototype perceptions of the incidental sun exposer can be manipulated with a brief intervention.\ud \ud Finally, path modelling was conducted to explore the pathways between the variables of the social reaction pathway and incidental behaviour. Chapter 6 presents this investigation. Using the prospective data from Study 3a, variables in the model included past behaviour, perceptions of the typical incidental exposer and the sun protector, and intentions and willingness to incidentally expose. Results indicated that willingness, but not intention, was related to incidental sun exposure. Furthermore, perceptions of the sun protector were more strongly related to willingness to incidentally expose, compared to the incidental exposer prototype. Again, these findings suggested that reactive processes to decision making may be more influential for incidental sun exposure. Furthermore, the results suggested that prototypes relating to the sun protector prototype influenced sun exposure behaviour. Chapter 7 provides a general discussion of this set of research studies, including implications for population level health promotion strategies and future research