Sun protective behaviours during maximum exposure to ultraviolet radiation when undertaking outdoor activities: an integrated literature review

Aim: The aim of this review is to describe current patterns of adolescent and adult sun-protective behaviours in Australia and overseas. Subjects and methods: A systematic search of electronic databases was conducted in CINAHL, ProQuest, Medline, PubMed and Informit (Australian) for studies that included participants aged ≥12 years and reported proportions of participants’ sun-protective behaviours. The search period covered 14 years from January 2004 to April 2018. Selected studies were critically appraised by two independent reviewers using the Effective Public Health Practice Project Quality Assessment tool. Results: A total of 29 relevant articles were identified. The review found that self-reported sun-protective behaviours differ markedly from observed behaviours, with observed behaviours indicating lower levels of sun protection. Sun-protective behaviours are highest among outdoor workers with mandatory personal protective equipment, boaters and snow skiers. A majority of the studies reviewed revealed that sun-protective behaviour continues to be poor during outdoor activities, indicating people are at risk of developing sun-related skin conditions such as skin cancer. These findings offer important insights for future sun safety campaigns. Conclusion: Despite numerous sun safe campaigns over time, it appears that low perceptions of risk are undermining the messages. Future health promotion campaigns should focus on appearance-based interventions, avoidance of harmful ultraviolet radiation exposure in all climates, and the importance of sun-protective clothing and eye protection necessary during necessary periods of high ultraviolet radiation exposure.