JMIR Publications

ABSTRACT

Background:

Outdoor play is critical to children’s healthy development and well-being; yet children’s opportunities for outdoor play have steadily decreased across generations in many developed countries. Early learning and childcare centers (ELCC) are an important venue for increasing children’s outdoor play opportunities, and, early childhood educators’ (ECE) perception of outdoor play can be a major barrier to outdoor play. The OutsidePlay-ECE risk-reframing intervention is a fully-automated and open access web-based intervention to reframe ECEs’ perceptions of the importance of outdoor play and risk in play, and to promote a change in their practice in supporting it in ELCC settings. We grounded the intervention in social cognitive theory and behavior change techniques.

Objective:

To evaluate the effectiveness of the OutsidePlay-ECE web-based risk-reframing intervention.

Methods:

We conducted a single-blinded randomized controlled trial in Canada between December 2020 to June 2021 to test the OutsidePlay-ECE risk-reframing intervention for ELCC educators. We conducted recruitment using social media and mass emails through our partner and professional networks. We invited ECEs and/or administrators working in an ELCC in Canada, who can speak, read and understand English. We randomized consented participants to the intervention condition or the control condition. Participants allocated to the intervention condition received a link to the OutsidePlay-ECE intervention. Participants allocated to the control condition read the Position Statement on Active Outdoor Play, a 4-page document on research and recommendations for action in addressing barriers to outdoor play. The primary outcome was increase in tolerance of risk in play. The secondary outcome was goal attainment. We collected data online via the Research Electronic Data Capture (REDCap) at baseline, 1-week, and 3-month post-intervention.

Results:

A total of 563 participants completed the baseline survey that assessed participant demographics, and tolerance for risk in play. They were then randomized: 281 in the intervention, and 282 in the control condition. Of these, 136 and 220 participants completed the baseline requirement, in the intervention and control conditions, respectively.. At 1-week post intervention 126 and 209 participants completed follow-up assessments respectively, and at 3-month post intervention, 119 and 195 completed the assessments, respectively. Compared to participants in the control condition, participants in the intervention had significantly higher tolerance of risk in play at 1-week (β=0.320, P= .001) and 3-month post-intervention (β=0.251, P= .009). Intention-to-treat analysis replicated these findings (β=0. 335, P< .001 and β=0.271, P= .004, respectively). No significant intervention effect was found for the goal attainment outcome (OR=1.124, P=.85).

Conclusions:

The results of this randomized controlled trial demonstrate that the OutsidePlay-ECE intervention was effective and had sustained effect in increasing ECEs’ and administrators’ tolerance of risk in play. It was not effective at increasing goal attainment. Clinical Trial: Trial Registration: ClinicalTrials.gov, NCT04624932. Registered on April November 5, 2020 and published on November 10, 2020.26, 2021.”