Evaluation of `Sun-safe': a health education resource for primary schools

Abstract

The aim of the study was to assess the effectiveness of 'Sun-safe', a computer-based resource designed to promote skin cancer awareness and educate children, aged 10-11 years, about the effects of excessive exposure to the sun and associated skin cancer preventive behaviours. Effectiveness was measured by changes in knowledge, attitudes and behavioural intentions using a self-completed questionnaire. A cluster, controlled evaluation design was used. Twelve schools were randomly allocated to the intervention arms of the study (workbook or computer), with a further four schools acting as controls (no intervention). One school allocated to the computer group had serious technical problems with their computers on the day of the intervention and had to be excluded from the study, leaving six schools in the workbook group and five in the computer group. One class in each of the 15 schools participated. The questionnaire was administered before the intervention, the day after and 6 weeks thereafter. The primary outcome measures were changes in mean scores at 6 weeks. In all, 376 children, 83% of the roll, completed both pre- and 6-week tests. Mixed-model analysis, allowing for pre-intervention score and the cluster effect, showed significant increases in knowledge scores in all three groups [workbook 2.36, 95% confidence interval (CI): 1.66 to 3.05; computer 1.73, 95% CI: 1.00 to 2.46; control 0.93, 95% CI: 0.11 to 1.74], but only the workbook group was significantly better than the control group (1.43, 95% CI: 0.36 to 2.50) and there was no significant difference between the intervention groups (0.63, 95% CI: -0.38 to 1.63). With regard to attitudes, both interventions showed significantly greater increases in scores than the control group, but there was no significant difference between them (workbook 2.37, 95% CI: 1.27 to 3.47; computer 1.92, 95% CI: 0.76 to 3.09; control -0.01, 95% CI: -1.28 to 1.27). Although the mean increases for behavioural intentions scores were small (workbook 0.66, 95% CI: 0.26 to 1.05; computer 1.11, 95% CI: 0.70 to 1.51; control 0.08, 95% CI: -0.37 to 0.52), those for the intervention groups were significantly better than the control group, but were not significantly different from each other. The evaluation showed significant improvements in knowledge, attitudes and behavioural intentions, which were still present 6 weeks after the intervention. This suggests that interventions employing the Sun-safe workbook and computer-based resources could be most usefully put into effect in the week before the start of the summer holidays.