Journal of Skin Cancer / 2017 / Article / Tab 1

Review Article

Perceptions and Practices of the Iranian Population regarding Skin Cancers: A Literature Review

Table 1

Summary of the included studies.

First author, date, locationData collection method, sample size (), gender, ageKnowledge, attitudes, and beliefs Skin cancer prevention practice

Firooz, 2007, Tehran [9]Interview/questionnaire, (patients), 61% males, mean age: yearsSunscreen: never (87.6%), sometimes (5.6%), often (4.0%), and always (2.8%)
Sunshade usage (cap, etc.): never (86%), sometimes (7.6%), often (4.8%), and always (1.6%)
Daily direct sun exposure: <1 hr (30%), 1–4 h (60.8%), and >5 h (9.2%)

Davati, 2008, Yazd [10]Questionnaire, (clinic attendees), 100% females, mean age: yearsObstacles to sunscreen use:
expensive: 56%, side effects: 34%, change in skin appearance: 29%, not effective: 17.7%, luxury item: 17%, governmental laws and regulations: 8.5%
Obstacles to use of other sun protective items:
cultural-religious beliefs: 62.6%, luxury: 42%, expensive: 23%, not effective: 13.9%, governmental laws and regulations: 9.2%
Sunscreen: 15.8%
Hats: 3.4%
Gloves: 3.4%
Sunglasses: 11.6%
Limit spending time outdoor: 53%
Seeking shades: 94%

Maleki, 2008, Mashhad [11]Questionnaire, (university students), 51% females, age range: 20–25 years45% correct answers to 75% of questions; 92.3% knew that sunlight protection practices are important in skin cancer prevention, and 57% knew sunscreen creams shall be used during all seasons75% no protection behavior

Mazloomy-Mahmoodabad, 2010, Yazd [12]Questionnaire, (secondary school teachers), 61% females, mean age: 37.98 yearsKnowledge (possible range: 0–49): total mean = 24.20 (male mean = 24.05; female mean = 24.29)
Attitude (possible range: 13–39): total mean = 28.10 (male mean = 27.74; female mean = 28.34)
Performance (possible range: 0–16): total mean = 6.35 (male mean = 5.23; female mean = 7.07)
Sunscreen: 56.8%
Clothing: 38.2%
Masked hats: 10.2%
Gloves: 12.3%
Sunglasses: 27.5%
Used none of the above measures: 17%

Baghianimoghadam, 2011, Yazd [13]Questionnaire, (high school students: 180 cases and 180 controls), 100% females, mean age: 16.04 yearsPerceived susceptibility (possible range: 4–20): case 12.77 and control 13.11; perceived threat (possible range: 5–25): case 17.71 and control 18.04; rewards (possible range: 4–20): case 10.59 and control 9.86; threat appraisal (possible range: 5–25): case −19.81 and control −20.22; fear (possible range: 5–25): case 17.18 and control 16.94; self-efficacy (possible range: 4–20): case 14.83 and control 14.98; response efficacy (possible range: 6–30): case 21.63 and control 21.58; response costs (possible range: 5–25): case 15.25 and control 14.06; coping appraisal (possible range: 5–25): case 21.13 and control 22.49; protection motivation (possible range: 7–35): case 27.11 and control 27.05Behavior (possible range: 0–12): case 3.92 and control 4.04

Mazloomy-Mahmoodabad, 2011, Yazd [14]Questionnaire, (university students), 72.2% females, 27.8% males, mean age: 21 yearsKnowledge (possible range: 0–49): total mean = 25.98 (male mean = 27.65, female mean = 25.72, medical students mean = 27.70, and nonmedical students mean = 21.89)
Attitude (possible range: 13–39): total mean = 30.83 (male mean = 30.31, female mean = 29.04, medical students mean = 31.38, and nonmedical students mean = 29.85)
Performance (possible range: 0–16): total mean = 7.67 (male mean = 8, female mean = 6.31, medical students mean = 8.06, and nonmedical students mean = 6.06)
Avoid sun exposure: 77.8%
Sunscreen use: 60%
Clothing: 40.4%
Masked hats: 13%
Gloves: 9.6%
Sunglasses: 19.6%

Mousavi, 2011, Tehran [15]Questionnaire, (general population), 48% females, mean age: 34.7 years90.8% knew that they should protect their skin against sunlight; 89.5% more exposure = more harm; 87.2% knowledge of adverse effects; 80.5% exposure harmful in children; 68.8% tanning harmful; 58.8% sunscreen not an easy task; 61.8%, skin cancer can be prevented; 9.5%, cancer risk is highly probable; 78.5%, tanning makes skin look charmingSunscreen: 31.8%
Clothing: 41%
Sunbathed: 88.8% (<5 times/year)
Never tanned/tanned only once: 87.8%

Movaffagh, 2011, Mashhad [16]Questionnaire, (pharmacists), 52.6% females, mean age (males): 33 years, mean age (females): 36.25 years67.5% knew the correct application time of sunscreen and 15% knew the SPF definition perfectlySunscreen: 68.8% (72.7% females/27.3% males)
Sunscreen correctly: 12.5% (every 2-3 hours)
Sunscreen just in morning and noon: 26.3%
Other times: 28.8%
No sunscreen: 31.2%
Sunscreen just in summer: 12.5%
Sunscreen sometimes: 10%
Sunscreen all seasons: 38.8%

Mirzaee, 2011, Yazd [17]Questionnaire, (mothers of children aged 1–8: 75 in interventional group and 90 in control group), intervention mean age: 30.82 years, control mean age: 31.15 yearsKnowledge
Intervention: 4.80; control: 4.85
Self-efficacy
Intervention: 20.90; control: 21.21
Barriers
Intervention: 10.06; control: 10.05
Norms
Intervention: 31.84; control: 30.26
Expectations
Intervention: 33.68; control: 32.50
Behaviors
Intervention: 5.10; control: 5.15

Askarian, 2013, Shiraz [18]Questionnaire, (medical students), 56.2% females, mean age: 21.5 yearsSunscreen: total = 52% (80.4% females and 13.5% males)

Changizi, 2013, Tehran [19]Questionnaire, (general population), 67% females5.85 are aware of their family history of skin cancer; 57.56% knew about increased risk of skin cancer by using tan machines; 30.32% use different tools for tanningSunscreen: 16.67%
Sunglasses: 45.83%
24 use solarium for tanning

Davati, 2013, Tehran [20]Questionnaire, (female high school students)Knowledge regarding degree of SPF: SPF 15 (3.2), SPF 20 (3.1), SPF 25 (7.7), SPF 30 (24.4), 30 < SPF < 50 (15.9), SPF > 50 (8.8), and do not know (36.4)
Sunscreen cream choice: did not know (39.4), no need to renew (21.8), better to renew every 5 hours (16.6), and better to renew every 2 hours (22.2)
Timing for sunscreen: did not know (26.1), half an hour before exiting home (30.6), right before exiting home (26.5), and 10 minutes before exiting home (16.8)
How much sunscreen applied each time: no specific amount (52.2), more than one knuckle (7.9), one knuckle (20.4), and less than a knuckle (19.6)
Sun avoidance during high sunlight hours: perceived severity (practicing: 17.57; not practicing: 16.93)
Walking in shaded or covered places: perceived sensitivity (practicing: 8.07; not practicing: 7.49) and perceived severity (practicing: 17.48; not practicing: 16.22)
Sunscreen: perceived sensitivity (practicing: 8.32; not practicing: 7.79), perceived severity (practicing: 17.74; not practicing: 16.97), and perceived benefit (practicing: 11.39; not practicing: 10.8)
Gloves: perceived sensitivity (practicing: 6.77; not practicing: 7.96), perceived severity (practicing: 15.58; not practicing: ), and perceived benefit (practicing: 9.58; not practicing: 11.00)
Sunglasses: perceived sensitivity (practicing: 8.28; not practicing: 7.76) and perceived severity (practicing: 17.72; not practicing: 16.90)
Sun avoidance during high sunlight hours: yes (36.1), no (47.1), and not possible (16.8)
Walking in shaded or covered places: yes (74.6), no (16.7), and not possible (8.7)
Sunscreen use: yes (24.7), sometimes (47.4), and no (27.9)
Cap or veil use: yes (10.3), sometimes (29.2), and no (60.5)
Gloves: yes (12.6), sometimes (12.6), and no (83.5)
Sunglass use: yes (32.2), sometimes (36.6), and no (31.2)

Ramezanpour, 2013, Zanjan [21]Questionnaire, (259 hospital personnel and medical and nursing students (case) and 259 laypeople (control)), case: 94.2% females, control: 78.8% females, mean age: 28.68 yearsSunscreen use knowledge (possible range: 0–11): case 7.17 and control 5.60
Attitude towards sunscreen use (possible range: 11–55): case 42.13 and control 41.64
Sunscreen: case (76.8%), control (71%), male (34.3%), and female (80.1%)
Physician (85.7%), nurse (78.7%), student (77.5%), midwife (93.3%), lab tech (82.4%), and nursing assistant (44%)

Tazval, 2013, Ilam [22]Questionnaire, (male farmers), mean age: 42.61 years14.5%, high perceived vulnerability; 30.6%, high perceived severity; 15.7%, low rewards (extrinsic/ intrinsic) from unprotected behaviors; 60.1%, unacceptable threat appraisal; 39.1%, acceptable threat appraisal

Golpour, 2014, Sari [23]Questionnaire, 000 (middle school and high school students), 64% males, mean age: 15.07 yearsMale: 36.99% good knowledge, 58.28% moderate knowledge, 29.3% low knowledge, and 1.41% high knowledge
Female: 20.2% low knowledge, 32.46% medium knowledge, 56.53% good knowledge, and 8.8% high knowledge
Sunblock gels: 38.32% females and 14.61% males
Sunglasses: 35.21% females and 9.58% males

Nadrian, 2014, Yazd [24]Questionnaire, (university students), 100% females, mean age: 20.7 yearsKnowledge: 58.8%
Perception: 66.1%
Stimulant factors: 60.7%
Sunscreen: 65.3%
Long-sleeved shirts: 37.3%
Hats: 16%
Gloves: 14.7%
Sunglasses: 25.3% (not regularly)
Spending time outdoor after maximum sun exposure: 83%
Used none of the above measures: 6.7%
Skin cancer prevention behavior: 48%

Sadeghi, 2014, Kerman [25]Interview/questionnaire, (farmers, 100 in intervention group and 100 in control group), intervention: 79 males, control: 77 males, intervention mean age: 47.92 years, control mean age: 48.42 yearsKnowledge
Intervention: 13.14; control: 12.94
Perceived sensitivity
Intervention: 31.82; control: 30.77
Perceived force
Intervention: 33.94; control: 32.64
Perceived benefits
Intervention: 33.19; control: 32.71
Perceived barriers
Intervention: 33.30; control: 21.58
Guide for action
Intervention: 13.72; control: 13.08
Self-efficacy
Intervention: 29.53; control: 29.31

Tabatabayian, 2014, Isfahan [26]Questionnaire, (high school students), 55.4% males, mean age: 16 years53% knew about harms of sunlight; 31.5% had basic knowledge about skin cancer; 68.5% knew about sun protection methodsSunlight protection tools: 27.5%

Dehbari, 2015, Tehran [27]Questionnaire, (university students), 100% females, mean age: 24.49 yearsSunscreen use: never (11.9%), sometimes (27.4%), often (20.4%), and always (40.3%)
Wearing a hat: never (55.2%), sometimes (32.8%), often (10.9%), and always (1%)
Gloves: never (72.1%), sometimes (15.4%), often (10%), and always (3.5%)
Sunglasses: never (20.9%), sometimes (36.3%), often (26.9%), and always (15.9%)

Hoseini, 2015, Zahedan [28]Questionnaire, (sixth-grade students), 100% malesKnowledge: intervention 9.55% and control 9.7%Intervention
Sunscreen (during sun exposure): 36%
Sunscreen reapplication (after washing hands and face): 19%
Long-sleeved shirts: 10%
Hats: 21%
Sunglasses: 31% (not regularly)
Spending time outdoor during high sun exposure: 9%
Seeking shades: 48%
Intervention: 6.15; control: 6.22

Morowati-Sharifabad, 2015, Kazeroon [29]Questionnaire, (farmers), 75% males, mean age: 47 years72.7%, knowledge about sunlight and skin cancerSunscreen: 9.7%
Long-sleeved shirts: 52%
Hats: 31.7%
Gloves: 7.3%
Sunglasses: 12%

Afshari, 2016, Tuyserkan [30]Questionnaire, (farmers), age range: 18–60 yearsSunscreen: 31.5%
Long-sleeved shirts: 65%
Hats: 53.5%
Gloves: 3%
Sunglasses: 19% (not regularly)

Babazadeh, 2016, Chaldoran County [31]Questionnaire, (farmers), 100% males, mean age: 35.5 yearsPerceived susceptibility: 15.45%, perceived severity: 36.71%, rewards: 32.22%, response efficacy: 29.03%, protection motivation: 21.56%, response cost: 19.57%, self-efficacy: 23.15%Skin cancer preventive behaviors: 21.68%

Zareban, 2016, Zahedan [32]Questionnaire, (high school female students, 120 in intervention group and 120 in control group), intervention mean age: 16.14 years, control mean age: 16.16 yearsKnowledge
Intervention: 6.4; control: 6.01
Perception
Intervention: 23.05; control: 24.12
Stimulants
Intervention: 4.14; control: 3.99
Norms
Intervention: 2.31; control: 2.38
Behaviors:
Intervention: 3.01; control: 3.1

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