Prevention Campaigns for Non-infectious Disease

Q1, Marking guidelines, campaign evaluation (8 marks)

Classification (2 marks). 1 mark for correctly classifying the process measures: sunscreen bottles distributed (410) and the knowledge result, which confirms delivery rather than effect. 1 mark for correctly classifying observed hat wearing, self-reported sunscreen use and reported sunburn as impact measures of behaviour or exposure, and for identifying that no outcome measure is present or could be, since melanoma takes decades to develop.

What is and is not evidence of reduced risk (2 marks). 1 mark for identifying the knowledge jump from 41% to 88% as the weakest evidence available: it is a process result, and the comparison school moved only from 41% to 44%, so the change is attributable to the campaign but tells us nothing about exposure. 1 mark for identifying that the measure closest to actual risk, observed hat wearing, rose only from 19% to 24%, five percentage points, while the comparison school was static, and that reported sunburn fell only from 136 to 129 against 141 in the comparison school, a difference too small to support a claim of reduced risk.

Self-reported versus observed discrepancy (1 mark). 1 mark for explaining that self-reported sunscreen use more than doubled, from 22% to 52%, while observed hat wearing barely moved, and that self-reported behaviour after a campaign is routinely overstated because students report what they have just been told they should do. The observed figure is the stronger measure, so the honest reading is a large knowledge change with only a small behaviour change: the classic knowledge-to-behaviour gap.

Equity (1 mark). 1 mark for using the fee-assistance row: hat wearing in that group moved from 11% to 12%, essentially unchanged, against 19% to 24% school-wide. The campaign therefore delivered its small benefit mainly to students who already had hats and sunscreen, so it risks widening the gap it set out to close, and a school-wide average conceals this.

Judgement and improvement (2 marks). 1 mark for an explicit, data-referenced judgement, for example: the campaign was effective at changing knowledge but has not demonstrated reduced melanoma risk, because the behaviour change was small, the exposure change was negligible and the benefit was inequitably distributed. 1 mark for a specific improvement that follows from the data, such as adding upstream actions, building shade over the courts and supplying free hats and sunscreen to students on fee assistance, so the barrier rather than the knowledge is removed; or extending the evaluation period and reporting observed behaviour disaggregated by fee-assistance status. Generic improvements such as "advertise more" earn no mark.

Band guidance. Band 6 distinguishes the measurement depths by name, resolves the self-report conflict in favour of observed data, uses the equity row, and still reaches a judgement. Band 4 reports that knowledge and sunscreen use rose and concludes the campaign worked.

Q2, Marking guidelines, source critique (8 marks)

Award 1 mark for each error correctly identified and 1 mark for each accurate correction, to a maximum of 6, plus up to 2 marks for the judgement. Expected errors include:

• "Reached 2.3 million people." This is a process measure. It counts what was delivered and confirms the campaign happened, but says nothing about whether exposure or disease risk changed.
• "91 percent now know the sun is dangerous, therefore skin cancer has been prevented." Knowledge change is a process result, not a health result. Disease risk falls only when exposure falls, so prevention claims require an impact measure such as observed sun-protection behaviour, measured UV exposure or sunburn rates. Awareness is the weakest evidence of effectiveness available.
• "Awareness is the whole aim of health education." Campaigns fail in a predictable way precisely because people learn the message, agree with it and do not change what they do. The aim is reduced exposure; awareness is only the first link in the chain.
• "Anyone who still gets sunburnt has chosen to ignore the message." This is blame framing that ignores barriers. Behaviour is shaped by cost, convenience, habit, social norms and the physical environment, so a student can know UV causes melanoma and still have nowhere shaded to sit at lunch.
• "No further spending on shade or subsidised sunscreen is required." This is the opposite of the correct conclusion. Shade and free sunscreen are upstream actions that change the conditions people act in, and pairing them with education is what makes the safer choice the easy one. Removing cost is also one of the three equity design choices, so cutting them would concentrate any benefit among those who can already afford protection.
• Source quality and survey design. The source is the campaign organiser's own media release with no independent evaluation, so the author benefits directly from the conclusion. The 91 percent is self-reported, taken immediately after the campaign, with no baseline and no comparison group, so it may reflect what respondents believe they should say rather than a real change.

Judgement (2 marks). An adequate evaluation would require: a pre-campaign baseline and a comparison population; observed rather than self-reported protective behaviour; an exposure or sunburn measure; results sustained beyond the campaign period rather than measured immediately after it; results reported separately for the highest-risk and lowest-income groups; and melanoma incidence named as the long-term outcome measure that cannot yet be assessed because of the decades-long lag. Full marks require the student to acknowledge that the campaign may have achieved something real, a genuine and attributable knowledge gain, while rejecting the prevention claim built on it.