Canadian Journal of Public Health

, Volume 101, Issue 4, pp I28–I32 | Cite as

The Skin Cancer Prevention Framework: A Comprehensive Tool for Population-level Efforts in Skin Cancer

  • J. A. Petersen
  • S. D. Quantz
  • F. D. Ashbury
  • J. K. Sauvé
Mixed Research


The Skin Cancer Prevention Team (SCPT) required a comprehensive approach for guiding its efforts in population-level skin cancer prevention. After identifying and reviewing several models, it concluded that an appropriate population-level model applicable to the Alberta context did not exist. Thus, the SCPT, under the Alberta Health Services — Cancer Prevention Program, developed and evaluated a model for Alberta. Three inclusion criteria for a comprehensive framework were identified: 1) use an ecological approach to population health; 2) function as a dynamic tool for planning, implementing and evaluating population-level efforts; and 3) address weaknesses in existing theory in population health and health promotion. Theoretical constructs were layered together, on the basis of the criteria, to develop an omnibus framework. The resulting Framework represents a layering of several constructs used in popular health promotion and population health theories. It merges principles of the realist approach to scientific enquiry with principles of ecological theory. The Framework outlines a three-step, dynamic process for planning, implementing and evaluating population-level efforts. It also provides insight into the larger, unifying influences for changes in health outcomes and the complex mechanisms of behaviour change processes at the population level.

Key words

Skin cancer prevention population health health promotion population health intervention theory 


Notre équipe de prévention du cancer de la peau (ÉPCP) avait besoin d’une approche globale pour orienter ses efforts de prévention du cancer de la peau axés sur la population. Après avoir recensé et examiné plusieurs modèles, elle a conclu qu’il n’existait pas de modèle axé sur la population pouvant s’appliquer au contexte de l’Alberta. L’ÉPCP, dans le cadre du programme de prévention du cancer des Services de santé de l’Alberta, a donc mis au point et évalué un tel modèle. Nous avons cerné trois critères d’inclusion pour un cadre global. Celui-ci devait: 1) aborder la santé des populations selon une approche écologique; 2) fonctionner comme un outil dynamique de planification, de mise en œuvre et d’évaluation des efforts axés sur la population; et 3) tenir compte des faiblesses des théories actuelles en santé des populations et en promotion de la santé. Les construits théoriques ont été stratifiés, d’après ces critères, pour former un cadre composite. Le cadre résultant est une stratification de plusieurs construits utilisés dans les théories populaires en promotion de la santé et en santé des populations. Il fusionne les principes de l’approche réaliste de la science et les principes de la théorie écologique. Il définit un processus dynamique en trois étapes: planifier, mettre en œuvre et évaluer les efforts axés sur une population. Il donne aussi un aperçu des grands facteurs qui influencent globalement les changements dans les résultats sanitaires, ainsi que des mécanismes complexes des changements de comportement à l’échelle d’une population.

Mots clés

cancer de la peau prévention santé des populations promotion de la santé intervention en santé des populations théorie 


  1. 1.
    Alberta Cancer Board. Alberta Cancer Registry Report. Edmonton, AB, 2006.Google Scholar
  2. 2.
    Krueger H, McLean D, Williams D. The prevention of secondary primary cancers. In: Bertino JR (Ed.), Progress in Experimental Tumor Research. Vol. 40. Basel, Switzerland: S Karger AG, 2008.Google Scholar
  3. 3.
    Glanz K, Rimer BK, Lewis FM. Theory, research, and practice in health behaviour and health education. In: Glanz K, Rimer BK, Lewis FM (Eds.), Health Behaviour and Health Education: Theory, Research and Practice 3rd ed. San Francisco, CA: Jossey-Bass, 2002;22–40.Google Scholar
  4. 4.
    Ferguson C, Vita P. A strategic framework for skin cancer prevention in NSW. New South Wales Public Health Bulletin 2002;12(3):75–77.CrossRefGoogle Scholar
  5. 5.
    Montague M, Borland R, Sinclair C. Slip! slop! slap! SunSmart, 1980–2000: Skin cancer control and 20 years of population-based campaigning. Health Educ Behav 2001;28(3):290–305.CrossRefGoogle Scholar
  6. 6.
    World Health Organization. Solar Ultraviolet Radiation: Global Burden of Disease from Solar Ultraviolet Radiation. Geneva, Switzerland: WHO, 2006.Google Scholar
  7. 7.
    Saraiya M, Glanz K, Briss PA, Nichols P, White C, Das D, et al. Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: A systematic review. Am J Prev Med 2004;27(5):308–16.CrossRefGoogle Scholar
  8. 8.
    Merzel C, D’Afflitti J. Reconsidering community-based health promotion: Promise, performance, and potential. Am J Public Health 2003;93(4):557–74.CrossRefGoogle Scholar
  9. 9.
    Green LW, Kreuter MW. Health Promotion Planning: An Educational and Environmental Approach. Mountain View, CA: Mayfield Publishing Company, 1991.Google Scholar
  10. 10.
    Health Canada. The Population Health Template: Key Elements and Actions That Define a Population Health Approach. Ottawa, ON: Health Canada, 2001.Google Scholar
  11. 11.
    McLaren L, Hawe P. Ecological perspectives in health research. J Epidemiol Community Health 2008;59:6–14.CrossRefGoogle Scholar
  12. 12.
    Thompson B, Kinne S. Social change theory: Applications to community health. In: Bracht NF (Ed.), Health Promotion at the Community Level 2nd ed. University of Minnesota, Twin Cities, MN: SAGE Publications, Inc., 1999.Google Scholar
  13. 13.
    Gatrell AC. Complexity theory and geographies of health: A critical assessment. Soc Sci Med 2004;60(12):2661–71.CrossRefGoogle Scholar
  14. 14.
    Hamilton N, Bhatti T. Population Health Promotion: An Integrated Model of Population Health and Health Promotion. Ottawa, ON: Health Promotion Development Division, Public Health Agency of Canada, 1996.Google Scholar
  15. 15.
    Prochaska JO, DiClemente CC. Toward a comprehensive model of change. In: Miller WR, Heather N (Eds.), Treating Addictive Behaviors: Processes of Change 2nd ed. New York, NY: Plenum Press, 1998;3–27.Google Scholar
  16. 16.
    Hillhouse JJ, Adler CM, Drinnon J, Turrisi R. Application of Azjen’s theory of planned behavior to predict sunbathing, tanning salon use, and sunscreen use intentions and behaviors. J Behav Med 1997;20(4):365–78.CrossRefGoogle Scholar
  17. 17.
    Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall, 1986.Google Scholar
  18. 18.
    Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist Synthesis: An Introduction. Manchester, UK: University of Manchester, August 2004.Google Scholar
  19. 19.
    National Institutes of Health. Theory At a Glance: A Guide For Health Promotion Practice. US: National Institutes of Health, 2005.Google Scholar
  20. 20.
    Chronic Disease Prevention Alliance of Canada. Knowledge Exchange in Health Promotion: Theoretical Models and Examples. Ottawa ON: Public Health Agency of Canada, 2007.Google Scholar
  21. 21.
    Alberta Cancer Board, Tobacco Control Unit. Snapshot of Tobacco Facts: A Resource Guide to Tobacco Control Planning in Alberta. Calgary, AB: Alberta Cancer Board, 2007.CrossRefGoogle Scholar
  22. 22.
    Thurston WE, Potvin L. Evaluability assessment: A tool for incorporating evaluation in social change programs. Evaluation 2003;9(4):453–69.CrossRefGoogle Scholar
  23. 23.
    Glasgow RE, McKay HG, Piette JD, Reynolds KD. The RE-AIM framework for evaluating interventions: What can it tell us about approaches to chronic illness management? Patient Educ Couns 2001;44:119–27.CrossRefGoogle Scholar
  24. 24.
    Rossi PH, Lipsey MW, Freeman HE. Evaluation: A Systematic Approach 7th ed. Thousand Oaks, CA: Sage Publications Inc., 2004.Google Scholar

Copyright information

© The Canadian Public Health Association 2010

Authors and Affiliations

  • J. A. Petersen
    • 1
  • S. D. Quantz
    • 1
  • F. D. Ashbury
    • 2
    • 3
  • J. K. Sauvé
    • 1
  1. 1.Cancer Bureau, Population and Public HealthAlberta Health ServicesCalgaryCanada
  2. 2.Cancer CorridorAlberta Health ServicesCalgaryCanada
  3. 3.Division of Preventive Oncology, Department of OncologyUniversity of CalgaryCalgaryCanada

Personalised recommendations