Sun Protection in Primary Schools: Applying the Health Promoting Schools Framework to Explore the SunSmart Phenomenon

Despite the presence of numerous national skin cancer prevention programs, Australia has one of the highest rates of skin cancer in the world (Australian Institute of Health and Welfare [AIHW], 2016; Volkov, Dobbinson, Wakefield & Slevin, 2013). It has been established by the World Health Organization ([WHO], 2003) that preventative measures are more likely to reduce the burden of skin cancer than curative measures, particularly in relation to health and economic costs. As such, primary schools have been identified by a number of leading health and cancer prevention organisations, such as the WHO (2003) and the Cancer Council (Montague, Borland & Sinclair, 2001), as appropriate sites to target skin cancer prevention programs. Their potential as health promoting contexts lies in their ability to create lifelong sun protection behaviours and subsequently lower children’s future risk of skin cancer.The SunSmart Program is a resource that supports primary schools’ adoption of the Health Promoting Schools (HPS) concept as a framework for skin cancer prevention efforts (Montague et al., 2001). As advised by the HPS concept, the SunSmart Program advises the coordinated integration of sun protection practices within all facets of schooling, including curriculum, policy and the home environment (Cancer Council NSW [CCNSW], 2015). While previous studies relating to SunSmart have focused on specific elements, such as policy comprehensiveness (Jones, Beckman & Rayner, 2008) or hat-wearing behaviour (Dudley et al., 2017), the holistic implementation of the SunSmart Program within a school community has not been previously examined.Therefore, the aim of this study was to provide the most in-depth, exploratory investigation of the SunSmart Program that had been conducted. The HPS concept was adopted as a methodological framework to investigate the application of the SunSmart Program in two case study sites (Stake, 2003), while phenomenology was overlayed as the theoretical framework to explore stakeholders’ understanding of the SunSmart phenomenon. The dual application of these frameworks ensured a comprehensive examination of the case study schools, and gave meaning to participants’ decisions and reported behaviour (Babbie, 2016). Interviews were conducted with a number of students, staff, and community members from the two case study schools, and relevant school documents were collected, to determine how SunSmart was perceived, implemented and experienced. The interview data were analysed using thematic analysis techniques, while the school documents were analysed using a combination of content and thematic analysis techniques.The findings of this research indicated that the enactment of the SunSmart Program within a school community is heavily dependent on the community’s contextual features, specifically whether their interpretations of the SunSmart phenomenon align with their perceived needs, desires and priorities. The influence of these contextual features on school procedure outweighed documented policy, which was found to have little influence on attitudes, perceptions or reported behaviours. Overall, it was evident that the enactment of the SunSmart Program in the two case study sites supported their existing practices relating to sun protection but did not facilitate a holistic approach to sun protection, as advised by the HPS framework.The implications for these findings are substantial for the future of health promotion in schools. Firstly, it was evident that students’, staff members’ and community members’ perceptions and experiences of the SunSmart phenomenon affected their motivations to enact the SunSmart Program within their school setting. Therefore, future efforts to enhance the enactment of the SunSmart Program in NSW primary schools should focus on these areas. Secondly, the unique methodology adopted by this research provided a comprehensive insight into the contextual features that impact schools’ enactment of a health promotion program. Future school-based health promotion research could employ this methodology to support the understanding of contextual features that may impact health promotion efforts. A deeper understanding of these features could support the development of a context-specific health promotion initiative, which would likely improve the opportunities for successful health promotion in schools.