SUN-CHAT is a study funded by Swansea University’s Morgan Advanced Studies Institute (MASI), that  engages with children, parents/carers, and primary school educators to scope current tanning perceptions and the perceived effect tanning has on health. The study addresses some of these challenges with a vision of enabling children’s voice and listening to their views (Shier 2001). This paper is focused on an area of activity of this research, that is, the  work with children to understand their perceptions and experiences. We make the connection between a healthy environment (school) and better health and wellbeing for all generations in Wales, by exploring perceptions of tanning and how healthier attitudes and behaviours can be encouraged and adopted from a young age to build a resilient and hopeful future. This project addresses a health public issue with ongoing education strengths in Wales  by building on the holistic education process proposed in Curriculum for Wales (Welsh Government 2023). We take the known problem of skin cancer and address it by engaging with children through co-constructed activities, to facilitate and prioritise their participation (Dadlani and Orlow 2008; Blaisdell et al. 2018).

Skin cancer, including melanoma and non-melanoma (keratinocyte) now comprises half of all cancers in England and Wales (GIRFT 2021; Public Health Wales 2023). Yet 86% of melanomas can be prevented with safer sun exposure and scientists agree there is no such thing as a ‘safe tan’. As over exposure as a child greatly increases future skin cancer risk, childhood is a critical time for promoting health behaviours such as sun protection. However, both parents (Thoonen et al. 2021)  and children (McAvoy et al. 2020) generally have positive perceptions of tanned skin and work is urgently needed to understand and address the misconceptions of the perceived health benefits of tanning. SUN-CHAT aligns with the agenda of the Welsh Government set out in ‘A Healthier Wales’ (Welsh Government 2018) by prioritising prevention and helping people remain healthier. The project is also aligned with the focus of Well-being of Future Generations (WFG) Act (Welsh Government 2015) which aims to ensure that everyone understands how their health behaviours (such as managing their desire for a tan in a healthy way) can benefit their future health. The Curriculum for Wales (Welsh Government 2023) with its designated area for Health and Well-being and autonomy for schools in designing curriculum content, presents an ideal way to facilitate this exploration. One way in which this is being undertaken is via child-led ‘healthy schools’ clubs. Focusing on understanding how different health dimensions, e.g., physical, emotional, and social well-being play a role in children’s lives.

Aims:

• Gather data regarding perceptions towards tanning to explore the perceived effects of a tan on health.
• Inform the development and testing of a pilot toolkit for integration within the Curriculum for  Wales to encourage positive health behaviours and attitudes of school children towards tanning and sun exposure.

Study Objectives:

 • To understand perceptions, attitudes and behaviours of school-aged children (5-8 years of age) in primary schools in Wales, specifically in relation to sun tanning and sun exposure.

• To gather viewpoints on best ways of engaging with school-aged children (5-8 years of age) and  their parents/carers about health.

• To understand perceptions, attitudes and behaviours of parents/carers of primary school  children in Wales regarding tanning, both for themselves and their children.

• To explore challenges that primary school educators face in engaging with the school community around the Health and Well-being Area of Learning and Experience in Curriculum for Wales, specifically about healthy attitudes to tanning.

• Consolidate evidence to support the development of an educational toolkit for integration  within the Curriculum for Wales.

SUN-CHAT is a mixed methods exploratory study (Caruth 2013) that explore perceptions on tanning comprising three work streams: (a) Workshops with school children; (b) an online multiple-choice survey with parents/carers; (c) a focus group with primary school educators. Three primary schools in South Wales with a Healthy Schools Club were invited to participate in the study using existing networks. These clubs typically consist of 8-10 children across different year groups with an interest in health and well-being. Consent was sought from each of the school’s headteacher, and each school were invited to participate in all three work streams. We received ethical approval to conduct the study from Swansea University’s Medical School Research Sub-Committee (Ref 2022-0089). This paper presents the qualitative methods to work with children (first work stream) and indicative findings of their perceptions to tanning. We approached the workshops from a children’s right perspective (Children’s Commissioner for Wales 2021) talking to children as empowered participants able to make decisions about taking part via ongoing, negotiated assent (Blaisdell, Arnott, Wall and Robinson 2018). We talked children through the informed consent process using appropriate child-friendly language and verbally confirm that they would be audio-recorded prior to beginning the workshop activities (BERA 2018). The study is based on an interpretive research paradigm that enables children’s voices (Boardman 2022). Children’s ways of expressing their views and opinions are diverse, and hence, creative/artistic activities that facilitate the communication with children and expand on spoken language have been designed to collect data (Clark 2017). Data collection activities comprised colouring, role-play, drawing, collage techniques, videos and posters to enhance children’s voices. Each activity aimed to meet the research aims and objectives, first and foremost, to encourage meaningful conversations with children and ensure their voices are heard. As an example, children suggested sharing a poster with schools to spread the voice on sun safety tips to help other children’s healthy behaviours. Children were involved in creating the (anonymised) poster, and it was made available to schools online and printed, and it was publicly shared on the project website. We use NVivo12, an online qualitative data analysis software package to analyse workshop transcripts and children’s outputs using thematic analysis following the recommended 6 step process: familiarisation; coding; generating themes; reviewing themes; defining and naming themes and writing up (Braun and Clarke 2006). We analyse the resources and pictures children create during the workshop using content analysis (Weber 1990).

Data collected in Sun-Chat is being analysed and findings will be presented at the conference in greater detail. Results will be used to inform future studies and interventions with young children across Wales and beyond. By questioning perceptions of tanning and the effects on young children’s health and well-being, we will also raise critical awareness of sun-safety and skin cancer with future young children's interventions. We will explore differences between perceptions, attitudes and reported behaviours towards tanning to identify whether there are any differences between knowledge and healthy practices from each of the activities. Results from this collaborative study will be used to inform development and testing of an educational toolkit to encourage children’s healthy behaviours towards tanning and sun exposure as part of future work. Further findings from all workstreams will be written up for publications in suitable journals. A SUN-CHAT webpage hosted on a Swansea University website have been designed to promote real-time study news and provide public updates of the study progress. Video logs (vlogs) have been created and uploaded online to provide lay-friendly updates and public insights into study activities over the study lifetime.

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