The objective of this cross-sectional study was to examine the effectiveness of PMT variables in predicting motivation to change sun protection behavior. The PMT is widely used as a social cognitive model for predicting health behavior by considering threat assessment and coping assessment. Implementing sun protection measures in childhood can significantly reduce the risk of developing skin cancer later in life, making it crucial for prevention efforts. Schools provide a suitable environment for education and the establishment of healthy behavior patterns. The findings of this study contribute to the existing knowledge obtained from previous research on sun protection and prevention behavior (22, 23).
The findings of the study reveal that students have a lower rate of engaging in behaviors such as getting in the shade, wearing sunglasses, and using sunscreen compared to other preventive measures like wearing long-sleeved clothing and wide-brimmed hats. This finding is consistent with a previous study (22) that reported similar results. The low usage of protective equipment by students may indicate the presence of social and cultural barriers that hinder their adoption. However, other studies have highlighted that sunscreen is often the primary form of sun protection, although it is frequently not applied correctly. In contrast, a minority of participants reported using shade and wearing clothing that covers the skin for sun protection (24).
The path analysis revealed that the PMT accounted for 46% of motivation and 30% of the variance in sun protection-preventing behaviors. In a previous study involving students, the application of this theory predicted 39% of intention and 31% of sun protection behavior (16). Another study conducted on students predicted 54% of intention and 41% of behaviors aimed at preventing skin cancer (25). Differences in the predictive power of these theories could be attributed to variations in study populations and statistical methods employed. The results of this study indicate that the protection motivation construct serves as a strong predictor of sun-protecting behavior against skin cancer, aligning with findings from other studies (2, 15). This underscores the pivotal role of motivation in translating the theory into behavioral constructs. The significance of protection motivation in implementing recommended preventive measures for skin cancer cannot be overlooked. Developing educational programs based on PMT may enhance sun protection behavior (26).
Self-efficacy emerges as a crucial factor in predicting protection motivation and sun protection behavior, which is consistent with findings from other studies (27, 28). Essentially, individuals who possess confidence in their ability to engage in sun protection behaviors exhibit stronger intentions to implement these behaviors. Self-efficacy has also been incorporated into other health behavior models, such as the Extended Parallel Process Model (29), highlighting its influential role in enhancing the predictive power of health behavior change models. Therefore, healthcare providers involved in cancer and disease management should actively promote self-confidence among patients and individuals to facilitate adherence to recommended health practices.
Following self-efficacy, response efficacy emerged as the most significant predictor of sun protection behaviors. Individuals who recognize the effectiveness and efficiency of behaviors such as wearing long-sleeved clothing, wide-brimmed hats, sunglasses, and sunscreen demonstrate greater motivation to adopt these behaviors. Similar results were observed in a previous study (30).
The present study revealed that perceived vulnerability had limited predictive power for both protection motivation and sun protection behavior. The students in this study scored below 70% of the maximum perceived susceptibility score, indicating that they did not perceive themselves as highly susceptible to skin cancer. Similar results were found in a previous study (31). One plausible explanation for the students' low perception of susceptibility to skin cancer could be their limited knowledge about the factors contributing to the development of this disease. Consequently, there is a need for comprehensive health promotion programs implemented by the healthcare system to safeguard students against health risks associated with skin cancer and sun exposure.
However, our study is subject to several limitations. Firstly, the survey data were collected during the COVID-19 pandemic when schools were closed, leading to limited sunlight exposure. This circumstance introduces the possibility of bias in our findings. Secondly, reliance on self-reporting for questionnaire data collection may introduce social desirability bias, affecting the accuracy of participants' responses. Thirdly, the majority of the study participants were female students, limiting the generalizability of our findings to the entire population.