Validation of the Norwegian Sun Exposure and Protection Index (SEPI) for Skin Cancer Prevention

Background/Aim: Norway is among the countries with the highest incidence of skin cancer. However, to date no established, validated questionnaire on sun exposure/protection habits in Norwegian exists. Therefore, the aim of this study was to assess the validity and reliability of a translated Norwegian version of the Sun Exposure and Protection Index (SEPI), previously validated in multiple languages. Patients and Methods: A study population consisting of 160 medical students in Bergen, Norway completed the two parts of the SEPI (part I mapping sun exposure/protection habits and part II mapping propensity to increase sun protection), together with the Sun Survey, a national health survey mapping sun habits. Validity was assessed using Spearman’s rho to analyze correlation between SEPI and the Sun Survey. For reliability assessment, internal consistency using Cronbach’s alpha was calculated, and stability over time determined through a test-retest, conducted three weeks apart, analyzing intra-individual correlation. Results: Correlations between SEPI and the associated questions in the Sun Survey were generally fair to moderate (p<0.05). The SEPI demonstrated overall stability over time, most items presenting a strong correlation between the two response occasions (Spearman’s rho ranging between 0.56 and 0.88, p<0.01). Internal consistency was acceptable, with Cronbach’s alpha being 0.7 for part I and 0.72 for part II of the SEPI. Conclusion: The Norwegian version of SEPI is a stable and reproducible questionnaire for use in a Norwegian population. Since Norway is a country with a significant burden of skin cancer, an instrument like SEPI could be a valuable tool when assessing individual skin cancer risk and for individualized skin cancer prevention.