Outdoor Play Intervention for Child Development

(PRO-ECO2 Trial)

Recruiting at 9 trial locations

Overseen By Mariana Brussoni

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of British Columbia

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

307 Participants Needed

Trial Summary

What is the purpose of this trial?

Licensed early learning and childcare centres (ELCCs) can provide children with rich opportunities for outdoor play that they may not otherwise experience in their home or community. However, many ELCCs struggle to provide high quality and stimulating outdoor play time. The primary aim of this study is to develop, implement and test a comprehensive multi-component project, the PROmoting Early Childhood Outside (PRO-ECO), to build capacity for, and address the complexities of building support for outdoor play in early childcare centre settings. This is to ultimately increase children's access to engaging outdoor spaces for play. The overarching goal of this project is to develop and evaluate a comprehensive multi- component project, called the PROmoting Early Childhood Outside (PRO- ECO). This project is to increase children's outdoor play and the diversity of outdoor play behaviour in Canadian ELCC settings providing full-day licensed care for preschoolers. PRO-ECO integrates development of policies and procedure, early childhood educator (ECE) training and mentorship, outdoor space modifications and, parent/caregiver engagement. The PRO-ECO project will be co-developed, implemented and evaluated in partnership with provincial childcare organizations and ten ELCCs. A wait-list control cluster randomised trial design (RCT) will evaluate the effectiveness of the project and how it can be modified to tackle barriers in diverse settings. This project is an extension of the PRO-ECO pilot study (protocol ID H20-03912-A001, Clinicaltrials.gov ID NCT05073380).

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether participants need to stop taking their current medications.

What data supports the idea that Outdoor Play Intervention for Child Development is an effective treatment?

The available research shows that outdoor play interventions can positively impact children's development. For example, the OutsidePlay-ECE intervention helps early childhood educators support outdoor play by changing their attitudes, which can lead to more outdoor play opportunities for children. Another study, the GOGA trial, suggests that increasing outdoor play time is linked to health and developmental benefits for young children. Additionally, while one study on outdoor loose parts play did not find a direct improvement in movement skills, educators noted that it supports physical, cognitive, and social development. Overall, these findings suggest that outdoor play interventions can be beneficial for children's development. ^{1 2 3 4 5}

What safety data exists for outdoor play interventions for child development?

The Position Statement on Active Outdoor Play, developed by a diverse group of stakeholders, supports the idea that outdoor play, including risky play, is essential for healthy child development. It recommends increasing opportunities for self-directed outdoor play. A systematic review found positive effects of risky outdoor play on health indicators like physical activity and social health, though it also noted the need for more high-quality studies. The OutsidePlay-ECE intervention and other studies focus on changing perceptions of risk in outdoor play, indicating a general consensus on its benefits despite potential risks. ^{1 6 7 8 9}

Is the treatment PROmoting Early Childhood Outside 2.0 a promising treatment for child development?

Yes, the treatment PROmoting Early Childhood Outside 2.0 is promising for child development. Outdoor play is linked to healthy growth, offering benefits like physical activity, socialization, and connection with nature. It helps children develop physically, socially, and emotionally, and encourages appreciation for the environment. ^{1 5 10 11 12}

Research Team

Mariana Brussoni

Principal Investigator

University of British Columbia

Eligibility Criteria

This trial is for licensed early learning and childcare centres (ELCCs) that want to improve outdoor play quality for preschoolers. Centres participate in a program aiming to enhance outdoor spaces, train staff, and engage parents. ELCCs not already providing full-day care or unable to commit to the project's duration are excluded.

Inclusion Criteria

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Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Data Collection

Baseline data collection occurs prior to project implementation to assess initial conditions

1 month

1 visit (in-person)

Project Implementation

Implementation of the PRO-ECO project, including policy modifications, ECE training, outdoor space modifications, and parent engagement

4 months

6-Month Follow-up

Data collection to assess short-term outcomes of the project

1 month

1 visit (in-person)

12-Month Follow-up

Data collection to assess long-term outcomes of the project

1 month

1 visit (in-person)

Treatment Details

Interventions

• PROmoting Early Childhood Outside 2.0

Trial Overview The PRO-ECO Project is being tested against normal daily practices at ELCCs. The project includes policy development, educator training, space modifications, and parent engagement to increase children's diverse outdoor play behaviors. Effectiveness will be measured using a wait-list control cluster randomized trial design.

Participant Groups

Group I: Control Experimental Treatment 1 Intervention

Outdoor play is an essential component of childhood development, including supporting children's cognitive, physical, emotional, and social growth. Currently, the early learning and childcare centres (ELCCs) host children within childcare settings, with outdoor playtime governed by institutional regulations.

Group II: Project Placebo Group 1 Intervention

The PRO-ECO project to increase the quality of outdoor play involves four primary components: 1. Modifying ELCC's outdoor play policies: the ELCC policy on outdoor play requirements and procedures will be modified in conjunction with ELCC management. 2. ECE training and mentorship: ECEs will undergo the Learning Outside Together (LOT) program, which incorporates traditional wisdom into training on Indigenous ways of knowing, learning and experiencing the land as teacher. 3. ELCC outdoor space modification: This includes designing and implementing tailored modifications for each centre's outdoor play space developed by landscape architecture students. 4. Parent engagement: ELCCs will host parent-engagement events and opportunities to increase knowledge of the importance of outdoor play.

PROmoting Early Childhood Outside 2.0 is already approved in Canada for the following indications:

Approved in Canada as PRO-ECO for:

• Increasing children's outdoor play and diversity of outdoor play behavior in early childhood education centers

Who Is Running the Clinical Trial?

University of British Columbia

Lead Sponsor

Trials

1,506

Recruited

2,528,000+

Government of Canada

Collaborator

Trials

13

Recruited

2,400+

Findings from Research

The OutsidePlay-ECE web-based intervention significantly increased early childhood educators' tolerance of risk in outdoor play, with sustained effects observed at both 1 week and 3 months after the intervention, based on a randomized controlled trial involving 563 participants.

However, the intervention did not lead to significant improvements in goal attainment related to outdoor play, indicating that while perceptions of risk can be altered, this may not directly translate to achieving specific outdoor play objectives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of the Web-Based OutsidePlay-ECE Intervention to Influence Early Childhood Educators' Attitudes and Supportive Behaviors Toward Outdoor Play: Randomized Controlled Trial. Brussoni, M., Han, CS., Lin, Y., et al.[2022]

The study will assess the effectiveness of a 6-month implementation strategy aimed at increasing outdoor free play opportunities in 100 Early Childhood Education and Care (ECEC) services in New South Wales, Australia.

The primary outcome will measure the average daily minutes of outdoor free play, with results analyzed at baseline, 6 months, and 18 months, to determine if the strategy significantly enhances children's outdoor playtime compared to usual care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomised controlled trial of an implementation strategy delivered at scale to increase outdoor free play opportunities in early childhood education and care (ECEC) services: a study protocol for the get outside get active (GOGA) trial. Yoong, SL., Pearson, N., Reilly, K., et al.[2023]

A study involving 209 children aged 3-5 years across 19 childcare centers found that integrating outdoor loose parts play did not show a significant effect on improving fundamental movement skills compared to control groups over a 6-month period.

Despite the lack of quantitative improvement in movement skills, educators reported that outdoor loose parts play offered valuable opportunities for children to practice movements, take risks, and support holistic development, highlighting its potential benefits in childcare settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of an outdoor loose parts intervention on Nova Scotia preschoolers' fundamental movement skills: a multi-methods randomized controlled trial. Branje, K., Stevens, D., Hobson, H., et al.[2022]

A systematic review of 21 studies found that several parental factors, such as mothers' ethnicity, employment status, education level, and the importance they place on outdoor play, significantly influence the amount of outdoor play children engage in.

The review highlights that parents' encouragement is particularly important for increasing outdoor play among girls, suggesting that targeted interventions could help improve physical activity levels in children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Parental Correlates of Outdoor Play in Boys and Girls Aged 0 to 12-A Systematic Review. Boxberger, K., Reimers, AK.[2023]

A project in Portugal aimed to enhance outdoor play for young children by shifting educational practices from indoor to outdoor environments, recognizing the importance of nature for healthy growth.

Key dimensions of outdoor play identified included contact with natural elements, the importance of risk-taking, and opportunities for socialization, emphasizing the need for support from both professionals and families to create quality outdoor experiences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The importance of outdoor play for young children's healthy development. Bento, G., Dias, G.[2020]

A collaborative Position Statement was developed emphasizing that active outdoor play, including some risks, is crucial for the healthy development of children aged 3-12 years, based on extensive stakeholder consultation involving nearly 2000 participants.

Over 95% of stakeholders supported the Position Statement, which recommends enhancing opportunities for self-directed outdoor play across various settings, highlighting the importance of play in nature for children's growth.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Position Statement on Active Outdoor Play. Tremblay, MS., Gray, C., Babcock, S., et al.[2022]

The study observed 80 children in early childhood education settings, analyzing 935 two-minute video sequences to understand how outdoor play environments influence risky play.

Findings indicated that risky play was more frequent in areas with fixed equipment and natural elements, as well as with wheeled toys, suggesting that enhancing these features in outdoor play areas can promote safer and more engaging play opportunities for children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Associations between Children's Risky Play and ECEC Outdoor Play Spaces and Materials. Sandseter, EBH., Sando, OJ., Kleppe, R.[2021]

Risky outdoor play is linked to positive health outcomes in children, including increased physical activity and improved social behaviors, despite concerns about safety and injury.

The systematic review of 21 studies suggests that promoting risky outdoor play is beneficial for healthy child development, highlighting the need for more high-quality research and encouraging policies that support such play opportunities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review. Brussoni, M., Gibbons, R., Gray, C., et al.[2022]

A randomized controlled trial involving 501 mothers of children aged 6-12 years is being conducted to evaluate the effectiveness of a digital tool and in-person workshop designed to increase mothers' tolerance of risk in their children's play.

The primary outcome of the study is to measure changes in risk tolerance using the Tolerance of Risk in Play Scale, with secondary outcomes focusing on self-reported behavior change goals, aiming to shift parental perceptions and promote children's opportunities for risky play.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Go Play Outside! Effects of a risk-reframing tool on mothers' tolerance for, and parenting practices associated with, children's risky play: study protocol for a randomized controlled trial. Brussoni, M., Ishikawa, T., Han, C., et al.[2019]

Outdoor play in nature-rich spaces, like The Backyard, promotes healthy development in young children by providing diverse play opportunities that can lead to lifelong appreciation of nature and pro-environmental behaviors.

The study found that physical and exploratory play were the most common types of play observed, with natural loose parts significantly enhancing exploratory activities, indicating that well-designed natural playscapes can foster high-quality play experiences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Playing in 'The Backyard': Environmental Features and Conditions of a Natural Playspace Which Support Diverse Outdoor Play Activities among Younger Children. Loebach, J., Cox, A.[2023]

The Tool for Observing Play Outdoors (TOPO) was developed to better understand and evaluate children's outdoor play behaviors and environments, addressing gaps in existing observation tools.

This new observational protocol allows researchers to effectively study and design outdoor play settings, promoting diverse and high-quality play opportunities that support children's healthy development.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tool for Observing Play Outdoors (TOPO): A New Typology for Capturing Children's Play Behaviors in Outdoor Environments. Loebach, J., Cox, A.[2020]

Play in nature-based environments significantly enhances the quality of play and developmental outcomes for children aged 2-8 years, as evidenced by a systematic review of 28 qualitative studies involving 998 children.

The review identifies key themes related to how nature-based environments support play, including the role of teacher-child interactions, and emphasizes the need for future research to focus on the cognitive benefits of nature play in early childhood education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nature play in early childhood education: A systematic review and meta ethnography of qualitative research. Prins, J., van der Wilt, F., van der Veen, C., et al.[2022]

References

1. Canada pubmed.ncbi.nlm.nih.gov

Evaluation of the Web-Based OutsidePlay-ECE Intervention to Influence Early Childhood Educators' Attitudes and Supportive Behaviors Toward Outdoor Play: Randomized Controlled Trial. [2022]

2. England pubmed.ncbi.nlm.nih.gov

A randomised controlled trial of an implementation strategy delivered at scale to increase outdoor free play opportunities in early childhood education and care (ECEC) services: a study protocol for the get outside get active (GOGA) trial. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Impact of an outdoor loose parts intervention on Nova Scotia preschoolers' fundamental movement skills: a multi-methods randomized controlled trial. [2022]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Parental Correlates of Outdoor Play in Boys and Girls Aged 0 to 12-A Systematic Review. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

The importance of outdoor play for young children's healthy development. [2020]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Position Statement on Active Outdoor Play. [2022]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Associations between Children's Risky Play and ECEC Outdoor Play Spaces and Materials. [2021]

8. Switzerland pubmed.ncbi.nlm.nih.gov

What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review. [2022]

9. England pubmed.ncbi.nlm.nih.gov

Go Play Outside! Effects of a risk-reframing tool on mothers' tolerance for, and parenting practices associated with, children's risky play: study protocol for a randomized controlled trial. [2019]

10. Switzerland pubmed.ncbi.nlm.nih.gov

Playing in 'The Backyard': Environmental Features and Conditions of a Natural Playspace Which Support Diverse Outdoor Play Activities among Younger Children. [2023]

11. Switzerland pubmed.ncbi.nlm.nih.gov

Tool for Observing Play Outdoors (TOPO): A New Typology for Capturing Children's Play Behaviors in Outdoor Environments. [2020]

12. Switzerland pubmed.ncbi.nlm.nih.gov

Nature play in early childhood education: A systematic review and meta ethnography of qualitative research. [2022]