Australia has one of the highest skin cancer incidences globally. Quality shade, which is a well-designed and correctly positioned combination of natural and built shade, can reduce solar ultraviolet radiation exposure by up to 75%. Existing shade in playgrounds in NSW was benchmarked in 2020-2021; this demonstrated a clear need for improvements to be made. This realist review sought to find evidence of shade targets and other complex strategies to increase shade in playgrounds. Fifty-nine documents (31 peer reviewed and 28 grey literature) contributed data to address the evidence review questions. Twenty-five examples of strategies, with a description of their implementation and/or reporting of outcomes, used to increase shade in playgrounds were located. Six types of strategies were identified: policies, guidelines and recommendations; settings-based site audits and site plans; city-level tree and shade site masterplan; monetary incentives; targets and other metrics; and multi-component interventions. For the strategies themselves, the review found evidence of intermediate changes such as the adoption of the strategy, but a lack of evidence of strategies leading to increased shade in playgrounds. Five enablers, five barriers and one barrier/enabler to the implementation of strategies to increase shade in playground were found in the literature. Expert opinion from reviews suggests that shade provision for skin cancer prevention is best affected through integration with other policies.
Petrunoff N, Dominello A, Hamer A, King L, Woolley N, Rudge S, Sax Institute, Cancer Council NSW, Cancer Institute NSW. 2022, Strategies to increase shade in public playgrounds: A realist review. The Sax Institute, Sydney.