Objective: We sought to identify mediating variables that may explain the increased effectiveness of a partner-learning skin self-examination (SSE) skills training program over a solo-learning SSE skills training program in a sample of patients at risk for melanoma. Methods: We conducted a randomized control design with pretest, immediate posttest, and 4-month follow-up measures in a clinical ambulatory care office of a hospital. In all, 130 participants were drawn from a melanoma hospital registry and randomly assigned to a solo-learning control group (n = 65) or a partner-learning group (n = 65). Participants either received the skills training individually in the solo-learning control group or in the partner-learning group in which a partner was actively involved in the training. The intervention consisted of a 10-minute educational presentation and skills training session about the ABCDE rule of early melanoma detection. The main outcome measure was SSE performance as measured by use of a body map. The mediators measured included attitudes toward SSE, self-efficacy/confidence in the ability to effectively perform SSE, comfort with having a partner help with SSE, perceived melanoma/skin cancer risk, concern about developing skin cancer/skin damage, and melanoma/skin cancer knowledge. Results: Attitudes toward SSE, self-efficacy, comfort with having someone help with SSE, and concern about developing sun-damaged skin were found to be significant mediators. Limitations: Study limitations include sample size, the evaluation of short-term program effects, and partner relationship variables that could influence the effectiveness of partner learning. Conclusions: Involvement of a partner in the SSE skills training was more effective than solo learning because of the changes in the above-mentioned mediators. Future SSE skills training programs could benefit through using approaches that produce changes in key variables such as increasing attitudes toward SSE, increasing self-efficacy beliefs in the ability to perform SSE, and making participants feel confident in their ability to examine their skin.
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