Australian behavioural research in cancer

Behavioural Research and Evaluation Unit (BREU), Cancer Council SA

Sun protection practices and policies implemented by small outdoor workplaces in South Australia: Facilitators and barriers to adherence
Cancer Council Australia’s position statement regarding sun protection in the workplace recommends that workplaces have a comprehensive sun protection program in place. Outdoor workers are identified as an ‘at risk’ group for the development of skin cancer due to high levels of UVR exposure. However, recent systematic reviews have reported that outdoor workers generally do not engage in adequate sun protection. Research further suggests that employees of smaller-sized businesses in the building and construction sectors are least likely to follow sun-safe guidelines.

In view of these indications, Cancer Council SA’s Behavioural Research and Evaluation Unit undertook a qualitative study to document knowledge, attitudes and behaviours related to skin cancer and sun protection among employees, contractors, employers and managers of small outdoor building and construction businesses in South Australia. The principle objective of the investigation was to identify ways in which Cancer Council SA might assist small businesses with sun protection policy implementation, monitoring and adherence.

Semi-structured interviews were undertaken with participants recruited from various businesses across the Adelaide metropolitan region. The findings of the investigation indicated that many participants did not engage in effective sun protection and did not routinely use sun protective measures. The research highlighted that use of sun protection by outdoor workers is influenced by a complex interplay of workplace and individual-level factors, including knowledge and beliefs about sun exposure and skin cancer, subjective perceptions of skin cancer risk and workplace cultural norms related to sun protection practices. A number of misconceptions among outdoor workers were identified, including a prevalent view that sun protection is primarily warranted to minimise the effects of heat stress and a perception that there are limited benefits of using sun protection when working outdoors for extended periods of time. Awareness of the consequences of skin cancer and of workplace sun protection policy requirements among participants was generally poor, and workplace cultural norms related to sun protection appeared to play a significant role in determining individual sun protection practices, personal awareness of skin cancer risk and concern about sun protection.

An encouraging observation from the findings was that both outdoor workers and employers acknowledged the importance of workplace sun protection policy, and perceived a need for this policy to be effectively communicated and enforced, along with education about the risks of skin cancer. The research highlights that there is considerable scope for health promotion initiatives targeting sun protection specifically aimed at workers and owners of small outdoor businesses, including engaging industry stakeholders to facilitate coordinated efforts to support both workers and owners of small outdoor businesses to comply with sun protection policy. 

Centre for Behavioural Research in Cancer (CBRC), Victoria

Self-sampling for human papillomavirus: Could it overcome some of the barriers to cervical screening? 
Self-sampling for human papillomavirus (HPV) is an alternative to conventional cervical screening. This study, led by Robyn Mullins, examined which groups of Victorian women would be most likely to participate in self-sampling, and its perceived benefits and barriers. A random sample of 3000 women aged 18-69 years were interviewed by telephone for a general cervical screening survey, and 2526 answered the questions about self-sampling. The terminology ‘taking their own Pap test’ was used, due to the low understanding of HPV and its link to cervical cancer. One-third of women (34%) indicated they would prefer to self-sample, 57% would not and 9% were unsure. Preference for self-sampling was significantly stronger among women who hadn’t had a Pap test for more than three years (65%) or had never had a Pap test (62%), compared to up-to-date women (27%). Convenience was a key benefit (38%), as was less embarrassment (32%). For those who did not want to self-sample or were unsure, professionals being more skilled (53% and 29%), and doubts about being able to do it properly (29% and 26%) were key barriers. These findings indicate that self-sampling was most popular among women who needed a Pap test, and it has potential to reach women who are not participating appropriately in cervical screening. Key participation barriers could be addressed in communication materials which provide information about the test being for HPV, and it being easier to do properly than a Pap test.  

Food marketing with movie character toys: Effects on young children’s preferences for healthy and unhealthy fast food meals
Movie tie-in premiums are a pervasive method of targeting children with fast food advertising. CBRC is conducting an experimental study to test whether premiums accompanying fast food meals influence young children’s meal choices and their perceptions of these meals. Via an online questionnaire, ~800 Melbourne grade 1 and 2 students will be randomly assigned to one of four conditions: (i) unhealthy v healthy meals (control – no premiums); (ii) unhealthy v healthy meals (both with premium); (iii) unhealthy meals (with premium) v healthy meals (without premium); or (iv) unhealthy meals (without premium) v healthy meals (with premium). Students will be shown a short promotional trailer for the children’s movie ‘How to Train Your Dragon 2,’ followed by an associated fast food advertisement (conditions 2-4) or an advertisement for a children’s leisure activity (control condition). Participants will then be shown four meal options (2 unhealthy and 2 healthy) and asked to choose their preferred meal. They will also complete detailed ratings of one healthy and one unhealthy meal. Analyses will test for differences in meal choice and ratings as a function of the inclusion of the movie tie-in premium. Results will inform a potential regulatory model, whereby movie tie-in premiums would not be permitted to accompany any fast food meals, or the potential for premiums to only be permitted to accompany healthy fast food meals.

Newcastle Cancer Control Collaborative (New-3C), NSW

Improving patient-centred care for lung cancer patients
Patient-centred care is the hallmark of quality health care. However, the delivery of patient-centred care to lung cancer patients is challenging due to a number of factors. Lung cancer patients experience poor prognosis and significant physical and psychosocial burden. Support persons (SPs) of patients are also faced with increased burden and poorer outcomes compared to SPs of other cancer types. There is an urgent need to develop innovative solutions to improve patient-centred care and reduce psychosocial burdens placed on lung cancer patients and their SPs. With funding from the University of Newcastle and the Hunter Medical Research Institute, we are undertaking a cross-sectional study to examine the preferences and experiences of lung cancer patients and their SPs in relation to patient-centred care. Participants are recruited in outpatient clinics and asked to complete a survey of: (i) preferences for involvement in decision-making; (ii) quality of life; (iii) views on discussing life expectancy and end of life care; and (iv) views on research and methods of receiving information. Given the growing contribution of lung cancer to burden of disease, there is a need to re-design health care systems to meet increasing demand and ensure health care providers and organisations are equipped to provide equitable cancer care. This study will provide much needed data about who is most at risk for poorer outcomes, and inform future studies to improve service delivery for lung cancer patients and their SPs.

Patient perspectives on quality of care: A cross cultural comparison
Little is known about  cross cultural differences in patients’ views about and experiences of cancer care and patient psychosocial outcomes. New-3C is conducting a study to compare experiences of care and psychosocial outcomes of cancer patients’ receiving radiotherapy in Japan, South Korea, Australia and Vietnam. Cancer patients who were attending radiation oncology clinics to receive treatment completed a cross-sectional pen-and-paper survey (Japan, South Korea, Australia) or a face-to-face structured interview (Vietnam only). Survey items explored i) patient views across  the Institute of Medicine’s (US) six domains of patient-centred care; ii) patients’ perceptions  of life expectancy discussions with their healthcare provider; iii) congruence between preferred and perceived involvement in medical decision making; iv) patients’ views about the causes of their cancer; v) the frequency with which providers initiated discussions about their physical and emotional symptoms; and vi) their current levels of anxiety and depression (as assessed by the Hospital Anxiety and Depression Scale). A forwards and backwards survey translation process was undertaken to ensure cultural relevance and consistency across international study sites. To date, data collection has been completed in Vietnam (n=300), South Korea (n=299) and is nearing completion in Japan (n=259). Australian data collection is currently in progress (n=77) and is expected to be completed by December 2014. This project will produce new information about cross-cultural differences in  cancer patients’ views and experiences of patient-centred care. Exploring how experiences vary across countries will enable a coherent framework of patient experiences to be developed, and assist in informing improvements in care.

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