Sun protection in outdoor workers - Development and validation of standardized questionnaires for behavior and knowledge

Henriette Rönsch; Marc Rocholl; Michaela Ludewig; Andreas Staudt; Mathias Langner; Theresa Steeb; Annika Wilke; Swen Malte John; Carola Berking; Stefan Beissert; Andrea Bauer

doi:10.1111/ddg.15378

Sun protection in outdoor workers - Development and validation of standardized questionnaires for behavior and knowledge

J Dtsch Dermatol Ges. 2024 Mar 25. doi: 10.1111/ddg.15378. Online ahead of print.

Authors

Henriette Rönsch¹, Marc Rocholl^{2

3}, Michaela Ludewig^{2

3}, Andreas Staudt^{4

5}, Mathias Langner⁶, Theresa Steeb⁷, Annika Wilke^{2

3}, Swen Malte John^{2

3}, Carola Berking⁷, Stefan Beissert¹, Andrea Bauer¹

Affiliations

¹ Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
² Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany.
³ Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany.
⁴ Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
⁵ Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.
⁶ Institute for Clinical Chemistry und Laboratory Medicine (IKL), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
⁷ Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany.

PMID: 38528320
DOI: 10.1111/ddg.15378

Abstract

Background and objectives: Outdoor workers are at increased risk of developing non-melanoma skin cancer. We aimed to address the lack of validated German-language measurement instruments for outdoor workers' sun safety behavior and knowledge by compiling and validating two questionnaires.

Participants and methods: By expert consensus, items for the assessment of protective behavior (OccuSun) were compiled based on existing instruments. For knowledge, a translation of the Skin Cancer and Sun Knowledge (SCSK) scale was selected. After a pre-test, a validation study including 68 outdoor workers (62% female) was conducted in 2020.

Results: The retest reliability was r = 0.93 (95% confidence interval: 0.86-0.96) for the protection score and r_s = 0.78 (0.67-0.86) for the knowledge score. Protective behaviors were correlated with respective diary data (0.38 ≤ r_s ≤ 0.74, p < 0.001) and skin pigmentation changes (-0.23 ≥ r_s ≥ -0.42, 0.007 ≤ p ≤ 0.165) but not with self-reported sunburn frequency (0.21 ≥ r_s ≥ -0.04).

Conclusions: Among German outdoor workers, two questionnaires for the assessment of sun protection behavior (OccuSun) and knowledge (SCSK) demonstrated good reliability. The OccuSun had generally good validity. Both instruments are fit for subsequent validation to determine their sensitivity to change.