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1.
Naylor  MRobinson  JK Sunscreen, sun protection, and our many failures. Arch Dermatol 2005;141 (8) 1025- 1027
PubMed
2.
Emmons  KMRollnick  S Motivational interviewing in health care settings: Opportunities and limitations. Am J Prev Med 2001;20 (1) 68- 74
PubMedArticle
3.
Robinson  JK Compensation strategies in sun protection behaviors by a population with nonmelanoma skin cancer. Prev Med 1992;21 (6) 754- 765
PubMedArticle
4.
Miller  WRRollnick  S Motivational Interviewing: Preparing People to Change Addictive Behavior.  New York, NY Guilford Press2002;
5.
Rollnick  SButler  CCStott  N Helping smokers make decisions: the enhancement of brief intervention for general medical practice. Patient Educ Couns 1997;31 (3) 191- 203
PubMedArticle
6.
Geller  ACColditz  GOliveria  S  et al.  Use of sunscreen, sunburning rates, and tanning bed usage among more than 10 000 US children and adolescents. Pediatrics 2002;109 (6) 1009- 1014
PubMedArticle
Research Letter
February 1, 2008

Enhancing Patient Motivation to Reduce UV Risk Behaviors: Assessing the Interest and Willingness of Dermatologists to Try a Different Approach

Arch Dermatol. 2008;144(2):265-266. doi:10.1001/archdermatol.2007.55

Patients who continue to engage in high-risk UV behaviors despite being informed of the risk of developing skin cancers can be a source of frustration for many dermatologists. Typically, dermatologists attempt to educate and advise their patients about the dangers of UV exposure and the importance of using protective strategies, particularly if the patient has indicators of risk for developing skin cancer. Unfortunately, a substantial number of patients ignore this information and continue to engage in high-risk UV exposure, resulting in dermatologists feeling a sense of inadequacy in changing patients' UV behaviors.1

Physicians generally do not receive formal instruction related to behavioral change during their training and often provide educational information and direct advice to their patients hoping to promote behavior change. However, research from numerous health-related domains has routinely demonstrated that such educational approaches are not as efficacious as alternative approaches that enhance individuals' motivation to change, particularly in modifying resistant behaviors such as smoking, alcohol abuse, exercise, and eating and/or dieting.2 Arguably, UV exposure could be classified as a resistant behavior because a substantial percentage of individuals engage in intentional UV exposure despite known risks, and a significant number of individuals continue to intentionally tan even after being treated for skin cancer.3

Efficacious behavioral interventions based on motivational interviewing (MI)4 have been developed by psychologists to be used in the context of a 50-minute session, which is much longer than physicians typically spend with their patients. Over the years, these interventions have been dramatically condensed and modified to focus on a variety of health behaviors (eg, smoking) and have been successfully used in health care settings by physicians5; however, they have not been adapted by dermatologists for use in preventing UV risk behaviors. Two questions arise: Can dermatologists promote healthy behavior change among their patients, particularly those who are at risk and most resistant to change? And is there an overall interest among dermatologists in learning to use MI techniques with their patients?

Methods

We conducted a focus group to assess dermatologists' interest in learning and using MI. The research protocol was approved by the institutional review board of Northwestern University, and all subjects gave their informed consent prior to participating in the focus group. Twenty dermatology residents and faculty members at a large, urban, academic hospital participated by attending a 1-hour session. A role play example of an adapted dermatological brief negotiation interview (BNI)5 based on the principles of MI4 was demonstrated. The role play lasted for 10 minutes, and the content consisted of a physician discussing UV risk and protection with a teenaged patient seeking treatment for acne. After watching the BNI, focus group participants completed anonymous questionnaires asking about their comfort and willingness to learn and use MI as a behavioral intervention with their patients.

Results

Eighty-five percent of participants reported that they would feel comfortable performing the MI techniques demonstrated (n = 17), and 75% endorsed willingness to try them (n = 15). Furthermore, 100% of the dermatologists reported that they felt MI techniques would be useful when working with 17- to 24-year-old patients (n = 20). In addition, 100% of the dermatologists expressed interest in learning MI techniques and would be willing to spend an average of 2 hours in a formal training (n = 20).

Comment

The results of this brief study highlight both dermatologists' willingness to learn and perceived usefulness of MI behavioral interventions to reduce patient risk behaviors. Dermatologists in the study unanimously felt that MI would be useful when working with patients in high-risk age groups (eg, young adults). These results are not surprising in that college-aged women consistently show high rates of indoor UV tanning despite its association with risk of skin cancers.6

It is important to note that the dermatologists were asked about their comfort and willingness to perform MI techniques without the option of receiving further training on the topic. We believe that had the question been rephrased, participants' willingness and comfort levels would have been even higher. Providing dermatologists with MI interventions that can be used in place of educational strategies may result in patients decreasing UV exposure and increasing UV protective behaviors and has the potential to enhance patient care considerably from both a prevention and treatment standpoint.

Future work should focus on adapting MI interventions to a dermatological framework that will be useful to physicians and patients. More research is needed to compare traditional education- and advice-based interventions with MI interventions in relation to patient UV risk and protective behaviors. In sum, the findings demonstrate that dermatologists are both interested and willing to learn MI to facilitate behavioral change in their patients.

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Article Information

Correspondence: Dr Mallett, Prevention Research Center, The Pennsylvania State University, 204 E Calder Way, Ste 208, University Park, PA 16802 (kmallett@psu.edu).

Financial Disclosure: None reported.

Funding/Support: This study was supported in part by National Cancer Institute grant R21 CA-1-3833 (Dr Robinson).

Disclaimer: Dr Robinson is chief editor of the Archives of Dermatology but was not involved in the editorial evaluation or decision to accept this work for publication.

References
1.
Naylor  MRobinson  JK Sunscreen, sun protection, and our many failures. Arch Dermatol 2005;141 (8) 1025- 1027
PubMed
2.
Emmons  KMRollnick  S Motivational interviewing in health care settings: Opportunities and limitations. Am J Prev Med 2001;20 (1) 68- 74
PubMedArticle
3.
Robinson  JK Compensation strategies in sun protection behaviors by a population with nonmelanoma skin cancer. Prev Med 1992;21 (6) 754- 765
PubMedArticle
4.
Miller  WRRollnick  S Motivational Interviewing: Preparing People to Change Addictive Behavior.  New York, NY Guilford Press2002;
5.
Rollnick  SButler  CCStott  N Helping smokers make decisions: the enhancement of brief intervention for general medical practice. Patient Educ Couns 1997;31 (3) 191- 203
PubMedArticle
6.
Geller  ACColditz  GOliveria  S  et al.  Use of sunscreen, sunburning rates, and tanning bed usage among more than 10 000 US children and adolescents. Pediatrics 2002;109 (6) 1009- 1014
PubMedArticle
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