Physical factors

A direct plea from a health professional to a patient instructing them to perform selfexamination may be a prime motivator (Weinstock et al., 1999). It is suggested that ‘by directly informing patients of their risk of the development of melanoma and skin cancer during health care visits, physicians or nurses can promote SSE’ (Robinson et al., 1998, p. 755). The literature does not describe which person is best to make this plea or teach self- examination, although both hospital medical and nursing staff may be involved (Poo-Hwu et al., 1999). Persson et al. (1995) suggest that this individual should however be trusted by the individual receiving the request. Previously highlighted as important beneficial factors are the following: having heard or read about self-examination (Petro- Nustus and Mikhail, 2002); possessing knowledge (Champion, 1991); (Hajii-Mahmoodi et al., 2002; Jirojwong and MacLennan, 2003) and being motivated (Petro-Nustus and Mikhail, 2002).

The number of visits made to the health professional has been shown to be associated with increased performance of self-examination (Robinson et al., 2002) and attendance at the outpatient clinic has been found to be strongly associated with the practice of SSE for both females and males (Oliveria et al., 1999a). It may provide an opportunity for health professionals to reinforce the importance of selfexamination and to promote skin awareness for it is known that behaviours that are reinforced are more likely to be repeated (Redman, 1997). Weinstock et al. (1999) reported that one of the reasons given by the general public for not performing self-examination was simply not thinking about it. Having the skin of the body purposely looked at by a health professional, during the physical examination, may be an important factor (Weinstock et al., 1999). It may also act as a reminder. Knowledge of self-examination and feeling confident are important in encouraging an individual to perform self-examination (Celentano and Holtzman, 1983). Having a high level of confidence in performance was one of the three strongest predictors of SSE, although the measurement used to measure this independent variable was not described (Robinson et al., 2002).