The purpose of this review was to synthesise the national and international evidence base on sun safety interventions delivered in the school setting. The review findings were intended to help guide how SunSmart would be delivered in New South Wales (NSW) primary schools and inform future strategies for engaging NSW secondary schools in sun safety.

A total of 46 documents were identified. There were 10 studies conducted in primary schools, 23 in secondary schools, 10 studies conducted across both primary and secondary schools, and three studies conducted in a community setting; which were included as they were deemed to provide parallel evidence of high relevance to the review objectives.

The studies included a broad range of study designs. Nine review articles were included, eight of which were systematic reviews and two of these included meta-analyses. There was one unpublished rapid review. While pre-post studies were the most common type (12 studies), there were also 10 Randomised-Controlled Trials and five longitudinal studies. There were four cross-sectional studies and six mixed method studies.

Of the 46 studies, 18 were categorised as effective, two were categorised as ineffective and 26 were categorised as impactful. In primary schools, many interventions were policy focused (7/10). Whereas in secondary schools, primary and secondary school settings, and community settings, most effective or impactful interventions included targeted behavioural components (34/34), with the majority using education as their main activity.

Notably, all promising interventions shared common mechanisms for success: they were theoretically informed and clearly articulated “how” and “why” they intended to achieve outcomes; they recognised the importance of taking an inter-disciplinary approach, so that both education and health perspectives were considered, and they often tailored their interventions to be age appropriate.

Based on the available evidence at the time, policy implementation support (e.g. engaging with school staff to review their sun safety policies and tailoring policy implementation support via coaches) is a promising strategy to engage NSW primary schools in sun safety. Strategies such as interactive education with outdoor elements and training of pre-service teachers are promising strategies which could be further evaluated for effectiveness before implementing them at scale. For secondary schools, the most promising sun safety interventions were those behavioural interventions which incorporate messaging around appearance (often linked to technology), and environmental strategies such as shade provision. Messaging around the immediate effects of sunburn could be considered as an alternative to appearance focused messaging, although further research is needed to determine if this is effective for promoting sun safety.

Citation

Petrunoff N, Harley, S, du Toit A, Lo M, Garg A, Wilson E, Goldberg E, Gordon R, King E, Osborne C, Ray T, Stephens C, Knight A, Sax Institute, Cancer Council NSW. 2024, Sun safety intervention effectiveness in primary and secondary school settings: A realist review. The Sax Institute, Sydney.

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