JMIR Publications

ABSTRACT

Background:

Outdoor play is critical to children’s healthy physical, social, emotional and intellectual 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 are an important venue for increasing children’s outdoor play opportunities because many children spend most of their waking hours in these facilities. Early childhood educators’ perception of outdoor play and its inherent physical risks 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 early childhood educators’ perception of the importance of outdoor play and risk in play, and to promote a change in their practice in supporting for children’s outdoor play in early learning and childcare center settings. We grounded the intervention in social cognitive theory and behavior change techniques.

Objective:

To evaluate the efficacy 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 early learning and childcare center educators. We conducted recruitment primarily through social media and mass emails through our partner and professional networks. We invited those interested in participating to self-assess their eligibility: working as an early childhood educator and/or administrator in an early learning and childcare center in Canada, and able to 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. The OutsidePlay-ECE intervention guided participants through three chapters, consisting of: 1) an introduction to outdoor play, and reflections on their own childhood experiences of play and the experiences of children in their center, 2) a series of interactive video scenarios about outdoor play, and 3) setting a personalized goal for change in their centre. 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 REDCap at baseline, 1-week, and 3-month post-intervention. We conducted randomization using sealedenvelope.com. We concealed allocations from researchers at assignment and during data analysis.

Results:

A total of 563 participants completed baseline survey consisting of sociodemographic questions and a questionnaire that assessed participant tolerance for risk in play, self-efficacy, and stage of change. These participants were then randomized: 281 in the intervention, and 282 in the control condition. Of 281 participants who were allocated to the intervention condition, 199 completed the baseline requirement (i.e., completion of the baseline survey and the intervention, and setting-up their goal). Respectively, of 282 participants who were allocated to the control condition, 221 completed the baseline requirement. At 1-week post intervention 126 and 209 participants completed assessments for each condition, 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=0.323, P= 0.001) and 3-month post-intervention (β=0.342, P= 0.001), after controlling for sociodemographic covariates. Intention-to-treat analysis replicated these findings (β=0.348, P= 0.001 and β=0.35, P= 0.001, respectively). No significant intervention effect was found for the goal attainment outcome.

Conclusions:

The results of this randomized controlled trial demonstrate that the OutsidePlay-ECE intervention was effective and had sustained effect in increasing early childhood educators’ and administrators’ tolerance of risk in play. It was not effective at increasing goal attainment. Clinical Trial: ClinicalTrials.gov, NCT04624932. Retrospectively registered on April 26, 2021.