An Intervention to Increase Outdoor Play in Early Childhood Education Centers (PROmoting Early Childhood Outside): Protocol for a Pilot Wait-list Control Cluster Randomized Trial

Abstract

Background Participation in outdoor play has been extensively documented as beneficial for the health, well-being, and development of children. Canadian early childhood education centers (ECECs) are important settings in young children’s lives and provide opportunities to participate in outdoor play. However, there are barriers to the provision of outdoor play opportunities at ECECs, such as adverse weather conditions, poorly designed outdoor spaces, outdoor time policies, and early childhood educator comfort levels. Objective The PROmoting Early Childhood Outside (PRO-ECO) study is a wait-list control cluster randomized trial that evaluates the impact of the PRO-ECO intervention, an innovative outdoor play intervention, on children’s outdoor play behavior. The purpose of this paper was to provide a detailed overview of the pilot study protocol and the methods that will be used to develop, implement, and evaluate the PRO-ECO intervention. Methods A total of 8 ECECs delivering licensed care to children aged 2.5 to 6 years in the Greater Vancouver region of British Columbia, Canada, and operated by the YMCA of Greater Vancouver (YMCA GV) are included in this study. Using a wait-list control cluster randomized trial design, we randomly allocated ECECs to either the PRO-ECO intervention arm (n=4) or the wait-list control arm (n=4). The primary outcome measures include changes in the proportion and diversity of observed outdoor play behavior during dedicated outdoor times at the ECECs as measured through observational behavior mapping. Secondary outcome measures include changes in educator attitudes; quality of ECECs’ outdoor play space; and children’s psychosocial strengths, physical activity levels, and social behaviors. A process evaluation of the acceptability of the PRO-ECO intervention in the 8 YMCA GV ECECs will also be assessed. Outcome data will be collected at baseline, 6-month follow-up, and 12-month follow-up. Mixed effect models will test the effect of the PRO-ECO intervention on quantitative outcomes. Baseline and postintervention data will be included in the analysis, controlling for the cluster design. Qualitative data will support quantitative findings and provide evidence for the acceptability of implementation. Results Participant recruitment for this study began in August 2021, and baseline data collection was completed at all 8 ECECs in November 2021. As of April 2022, a total of 130 children have been recruited to participate in this study. Conclusions The PRO-ECO pilot study will develop, implement, and evaluate the PRO-ECO intervention within 8 YMCA GV ECECs in the Vancouver region of British Columbia, Canada. The findings of this study will be useful for early childhood educators, ECEC providers, and policy makers to consider means for enhancing outdoor play provision and assessing the sustainability of the intervention in ECEC settings. Trial Registration ClinicalTrials.gov NCT05075580; https://clinicaltrials.gov/ct2/show/NCT05073380 International Registered Report Identifier (IRRID) DERR1-10.2196/38365

Capturing children's play behaviours in outdoor environments: A comparative analysis of play in early adolescence at primary school versus high school

“…Since its development in 2020, the TOPO has been used in different settings, including a recent study of a natural environment adjacent a museum (Loebach & Cox, 2022), early childhood education centres (Ramsden et al, 2022), and community‐led play hubs in parks (Naish et al, 2023). To the authors' knowledge, this is the first use of the TOPO in school outdoor environments in Australia.…”

An Outdoor Play Intervention in Early Childhood Education Centers: Results from the PROmoting Early Childhood Outside Pilot Wait-list Control Cluster Randomized Trial

“…A κ value of 0.918 (agreement=95.9%) was achieved prior to beginning data collection. Further information on the PRO-ECO wait-list control randomized control trial and the PRO-ECO intervention can be found in the previously published study protocol (49).…”

“…Structured play, often facilitated by educators, promotes skill-building, cooperative interactions, and cluster randomized controlled trials (46), the SPIRIT (Standard Protocol Items: Recommendations for Intervention Trials) statement for clinical trial protocols (47) and the evaluation framework of the Medical Research Council (48). The detailed PRO-ECO study protocol has been published (49). Ethics certi cation was received from the University of British Columbia and the Children's and Women's Health Centre of British Columbia Research Ethics Board (H20-03912).…”

A Nature’s Way—Our Way Pilot Project Case Assemblage: (Re)Storying Child/Physical Literacy/Land Relationships for Indigenous Preschool-Aged Children’s Wholistic Wellness

“…It is important to follow the child’s lead in their expressions of play (E. Stevenson, Personal Communication, 17 November 2022). However, Carmen sought to enhance a more ‘hands on’ and relational emphasis between the educator and the child and possibilities of play to include a more robust focus on active play (without negating the valuable contributions of all types of play for children’s wholistic health and wellness [ 78 , 79 ]) (movement), as role-modeled through early childhood educator efficacy for personal health and wellness in the development of PL [ 80 ].…”