JMIR Publications

ABSTRACT

Background:

Active outdoor play supports children’s physical, social, and cognitive development, yet opportunities are declining as indoor, screen-based childhoods become the norm. Early Learning and Child Care (ELCC) centres are key settings for promoting outdoor play, but limited evidence exists on the health and developmental outcomes of licensed nature-based ELCC programs, particularly for children with and without disabilities.

Objective:

The SPROUT and SPROUT-able studies aim to examine the impact of one of Canada’s first purposely designed and built licensed outdoor-focused ELCC programs. The primary objective is to examine the health and developmental outcomes of children aged 10–59 months, with and without disabilities, attending an outdoor-focused, full-day licensed ELCC program compared to those in conventional (e.g., not outdoor-focused) ELCC settings. Secondary objectives are to: (1) examine educator job satisfaction, health, wellbeing, and attitudes toward teaching outdoors for children with and without disabilities; (2) examine caregiver beliefs and attitudes toward children’s participation in outdoor play and learning; and (3) identify barriers and facilitators to outdoor play and learning for children with and without disabilities (i.e., the SPROUT-able study) in an outdoor-focused ELCC program.

Methods:

This prospective longitudinal (with replacement) cohort study follows children, caregivers, and educators over three years. Participants are recruited from one outdoor-focused (experimental) and three conventional (usual care) ELCC centres in Ontario, Canada; all sites are licensed. Assessments occur every six months and include direct measures of children (anthropometry, motor skills, accelerometry) and caregiver and educator questionnaires. Mixed-effects modeling will examine changes over time and between groups (experimental vs. usual care).

Results:

As of August 2025, 86 caregiver-child dyads are enrolled in the study (67 experimental, 43 control). Of these, 70 children who enrolled at study initiation have completed baseline, and T1 and T2 assessments (43 experimental, 27 control), while 18 children enrolled at the 6-month timepoint (T1; 13 experimental, 5 control) have completed T1 and T2 (with a missing baseline assessment). Nineteen children from the experimental group were identified as having a disability meeting criteria for the SPROUT-able sub-study: four with a formal diagnosis, three with caregiver-reported functional difficulties, and 12 receiving additional support from an inclusion support worker.

Conclusions:

By combining a holistic and comparative approach with a focus on children with and without disabilities, the SPROUT and SPROUT-able studies will generate comprehensive evidence to inform ELCC practice and policy in Canada and internationally. This model within Canada provides timely evidence on outdoor-focused ELCC delivery, integrating disability inclusive outdoor play into ELCC settings, and has the potential to guide meaningful improvements in child development, educator wellbeing, and community health and wellbeing.