Habits and Preferences in Sunscreen Usage Among Healthcare Professionals in the UK

Plain Language Summary

Raising awareness about sun protection is an ongoing challenge. In 2018, a Survey Monkey questionnaire was distributed among healthcare professionals in the United Kingdom looking at their own habits of sunscreen usage. A total of 165 responses were collected. Eighty-nine percent of our respondents would use sunscreen when outdoors 11am–3pm on a cloudless, sunny day in August in the UK. However, only 27% of these healthcare professionals would regularly reapply sunscreen every 2 hours. The most important reason for using sunscreen were avoiding sunburn (importance weighted average of 4.71, on a scale from 1 to 5), followed by avoiding skin cancer (4.49) and skin ageing (4.06). On an importance scale from 1 to 5, the most important sunscreen characteristics, when choosing or recommending a product, were the level of UVA protection (importance weighted average 4.48), its stickiness (3.85) and degree of water-resistance (3.77).

Introduction

Raising awareness about sun protection is an ongoing challenge. In 2018, a Survey Monkey questionnaire was distributed among healthcare professionals in the United Kingdom, to investigate if we are providing appropriate advice on sunscreen usage, as per guidelines set by the British Association of Dermatologists (BAD) and WHO.^1,2 The study showed that most healthcare professionals do not routinely discuss sun protection with their patients.³ This paper aims to present data collected from the same Survey Monkey questionnaire about the habits of sunscreen usage of healthcare professionals in the UK. Are we leading by example?

Results

A total of 165 responses were collected. The respondents’ demographics are represented in Figures 1 and 2. The majority of respondents (93%, n=151) work in healthcare while 68% (n=112) do not work in a dermatology-oriented specialty.

Figure 1 The demographics of the survey respondents. The total number of respondents was 165 and here we present their demographics in terms of Gender, Age group, Job Title and Fitzpatrick Skin Phototype. (a) Gender: 84% (n=138) of respondents were females and 16% (n=27) were males. (b) Age group: Majority of respondents belonged in the 51–60 age group (27%, n=45) and the 21–30 age group (24%, n=40). 23% (n=37) of our respondents were 41–50 years old, whereas 19% (n=32) were 31–40 years old. A minority of respondents were 61–70 years old (5%, n=8) or ≤20 years old (2%, n=3). (c) Job Title: 33% (n=53) of our respondents were Hospital Support Staff, followed by Other Healthcare Professionals (20%, n=32) and Consultants (13%, n=21). 11% (n=18) of respondents were Other Junior Doctors, while 6% (n=10) of respondents were Nurses. Of note that 7% (n=11) of respondents were not working in healthcare. The rest were Healthcare Assistants (3%, n=6), Specialist Nurses (2%, n=4), Specialist Registrars/ LAT Registrars (2%, n=3), Specialty Doctors including Clinical Fellow or Staff Grade (2%, n=3) and GPs with Special interest in Dermatology (1%, n=1). (d) Fitzpatrick Skin Phototype: 14% (n=9) of our respondents had Fitzpatrick skin type 1, 31% (n =52) had Fitzpatrick skin type 2 and 34% (n=56) had skin type 3. 15% (n=25) had skin type 4, 9% (n=14) had skin type 5 and 2% (n=3) had Fitzpatrick skin type 6.

Figure 2 Respondents’ Demographics: UK Regions. 130 out of 164 respondents were based in the South East region (79%, n=130). They are followed by respondents based in London (9%, n=15), Scotland (3%, n=6), East (2%, n=3), South West (2%, n=3), North East (2%, n=3). East Midlands, North West, Wales, West Midlands, Yorkshire and The Humber were represented by one respondent each (0.6%, n=1 respectively). There were no respondents based in Northern Ireland.

The habits in sunscreen usage among healthcare professionals in the UK are shown in Table 1.

Table 1 Habits in Sunscreen Usage Among Healthcare Professionals in the UK

The respondents were asked to rate the importance of various reasons for using sunscreen (scale 1–5). Avoiding sunburn had the highest weighted average of 4.71, followed by avoiding skin cancer (4.49) and skin ageing (4.06). Avoiding tanning and having a photodermatosis were given a low weighted average of 1.73 and 1.53, respectively.

Our respondents were asked to rank the factors deemed important when choosing or recommending a sunscreen (Figure 3). On an importance scale from 1 to 5, the most important sunscreen characteristics were level of UVA protection (importance weighted average 4.48), its stickiness (3.85) and degree of water-resistance (3.77). Whether a sunscreen can be prescribed on the NHS was deemed to be the least important consideration.

Figure 3 How much importance do you attach to the following factors when choosing or recommending a sunscreen? Factors were rated by responders on a 1–5 scale from “not important” to “very important” and then graphed based on the weighted average of the importance given. “Level of UVA protection”, “Stickiness” and “Water resistance” were the top three parameters taken into consideration by our responders.

Discussion

As far as we are aware, this is the first study on UK healthcare professionals’ own sunscreen practice. The majority of respondents (77%, n=112) would choose a sunscreen with an SPF of 30 or higher (47% would choose SPF30, 21% would choose SPF 50 and 9% would choose SPF50+), which is in line with BAD and WHO guidelines.^1,2 Sun protection Factor (SPF) is a measure of how much UV radiation is required to produce sunburn on protected skin and refers to the level of protection against UVB. UVB exposure is considered a main risk for skin cancer. In a 2019 study on consumers’ preferences about sunscreens, 72% of participants considered SPF as the most important parameter when choosing sunscreen, rather than the active ingredients in the product.⁴ Additionally in our study, the most important factor when choosing a sunscreen was the level of UVA protection, which is perhaps explained given the educated group surveyed. Increasingly people realise the impact of UVA in the development of both skin cancers and ageing, thus looking for products with balanced protection across the UV spectrum. In the UK, the UV Star Rating System is used as a measurement of the level of protection of a sunscreen against UVA radiation. This rating expresses the degree of UVA protection in comparison with UVB protection of the product.

We found that 89% of our respondents would use sunscreen when outdoors 11am–3pm on a cloudless, sunny day in August in the UK, which is in keeping with the BAD and WHO guidelines.^1,2 However, only 27% of these healthcare professionals would regularly reapply sunscreen every 2 hours on themselves, which is against recommended practice. According to another study among patients receiving sunscreen prescription, factors associated with less compliance with sun protection measures were: age ≤20 or ≥64 years, male gender and less awareness about sun protection/UV-associated risks.⁵ We expected better compliance from our respondents because they have opposite characteristics to the above.

There are several study limitations to be mentioned. Firstly, majority (84%) of our respondents are females and many cosmetic products do already contain SPF. 28% of our respondents work in a dermatology-oriented specialty, which could be a source of bias. Lastly, the study sample size is relatively small (n=165) and it is important to highlight that our survey mainly reflects the preferences of adult population living in the UK.

Conclusion

While the habits and preferences of healthcare professionals around sunscreen usage highlighted in this study do not reflect that of the general population, it is interesting to note that healthcare professionals may not necessarily practise what they preach at times. Sun protection campaigns still have a crucial role to play in our modern society.