A mediator model of sunscreen use: a longitudinal analysis of social-cognitive predictors and mediators

Background Sun safety behaviors to prevent skin cancer, such as sunscreen use, are difficult to adopt and maintain. Purpose Most social-cognitive theories assume that the intention to change a behavior is the best predictor of actual change. But unforeseen barriers emerge, or people give in to temptations, such as getting a tan despite their initial good intentions. The Health Action Process Approach proposed by Schwarzer (Appl Psychol 57:1–29, 1) is used to explore the self-regulatory mechanisms of sunscreen use. Method An international longitudinal survey was conducted with 524 individuals. Intentions, positive outcome expectancies, distal self-efficacy, and risk perception were assessed at time 1, whereas intention, planning, and proximal self-efficacy were measured 2 weeks later at time 2. Sunscreen use was reported at 3-month follow-up (time 3). Results A structural equation model fit the data well. Positive outcome expectancies, risk perception, and selfefficacy predicted the behavioral intention. Self-efficacy and planning predicted sunscreen use, and planning mediated the relation between intended and performed sunscreen use. Conclusion The findings contribute to the understanding of psychological mechanisms in health behavior change. They also point to the particular role of mediator variables in the context of sun protection behaviors, which may have implications for designing skin cancer preventive interventions.