The PRO-ECO intervention included four key components that address common barriers to children’s outdoor play, as supported by existing literature (58–62). This study was not designed to analyze the effect of each intervention component separately on children’s outdoor play participation, but rather the influence of these components collectively. Previous research has focused on interventions that increase specific types of play, such as active or physical play, rather than a comprehensive view that includes the many forms of children’s outdoor play (63–65). To add to the literature, this study considered a holistic definition of outdoor play, encompassing many different forms of play, including physical, exploratory, imaginative, bio, play with rules, and expressive. The results of this pilot randomized control trial revealed no significant change in the proportion of play participation following implementation of the PRO-ECO intervention. We hypothesize two distinct reasons for these findings: i) high rates of play participation prior to the intervention implementation leading to a ceiling effect; and ii) challenges experienced in the implemention and maintenance of the PRO-ECO intervention.
High-levels of Baseline Play Participation at ECECs
This study revealed high proportions of children’s play participation, in comparison to non-play participation, at pre-PRO-ECO intervention data collection time points which may have contributed to a ceiling effect within our data (66). The percent of play participation prior to implementation of the PRO-ECO intervention was 78.9% within the wait-list control group (Group 0) and 83.7% within the intervention group (Group 1).The high proportions of play participation prior to any intervention indicates that there may have been limited opportunity for improvement in overall play participation. To our knowledge, there are limited other studies that have measured play vs. non-play in ECEC settings, therefore it is challenging to understand if the high levels of play exhibited within our study are common across the literature. A recent study by Storli et al. (67) reported that 30.9% of their outdoor video observations in ECECs were non-play behaviours. Additional studies (68, 69) have measured play and non-play behaviours among older children in school settings and found observed play participation rates between 40.9% and 53.0% at baseline. However, it is important to note that the definition of non-play is not universal and is determined by the methodology implemented to categorize children’s behaviours. The methodology for categorizing children’s non-play behaviour (Supplementary Material 2) was unique to our study.
The observed activities and behaviours classified as non-play (e.g. eating, distress, aggression and self-care) had low incidences across our observations. Due to the scheduled nature of outdoor time across participating ECECs, non-play behaviours may not occur as frequently due to the limited amount of time that children have to spend outdoors. Children might have preferred to participate in play behaviours instead of non-play behaviours, such as eating or self-care breaks, because of the short duration of outdoor time they had available. In addition, some non-play behaviours were expected to remain stable in ECEC settings even after implementation of the PRO-ECO intervention, such as scheduled lunch times which would occur regardless of changes to a ECEC program or space. Overall, the high proportion of play participation at pre-intervention time points indicates that additional outcome measures, beyond a dichotomous play participation variable, are required to evaluate comprehensive outdoor play interventions that support children’s outdoor play participation in ECECs.
PRO-ECO Intervention Implementation and Sustainability Challenges
Overall, children’s outdoor play participation, versus non-play participation, did not consistently increase as a result of the PRO-ECO intervention, though the effect size was positive (Table 6). While there was no significant increase in play participation between or within the intervention groups, two centres (1 in Group 1; 1 in Group 0) experienced an increase in children’s outdoor play participation following implementation of the PRO-ECO intervention. Two additional centres in Group 2 (Centre A and C) experienced minimal change in children’s play participation between Time 1 and Time 2. This finding highlights the variability of the intervention in implementation and uptake across ECECs, and that there are important considerations to the planning, implementation and sustainability of outdoor play interventions.
All four components of the PRO-ECO intervention experienced limitations to implementation and sustainability. The primary challenges that impacted the PRO-ECO intervention implementation included the identification of outdoor play values and the implementation of new policy, the engagement of families during the COVID-19 pandemic, and the delivery of ECE professional development and training. All participating ECECs experienced challenges to sustaining the PRO-ECO intervention over the study timeline, as well as beyond the study completion date. In particular, sustaining the uptake of the ECE training and maintaining the built environment modifications was constrained due primarily to ECE turnover, as well as seasonal changes in the physical environment.
As a central component to the PRO-ECO intervention, the identification of outdoor play values and their policy implications was intiatied with all participating centres. However, this process was delayed due to challenges in managing the COVID-19 pandemic, such that it was not distributed to Group 1, the intervention group ECECs, until we began Time 2 data collection, giving insufficient time for implementation. Despite this delay, postiive changes were implemented by the YMCA GV in earlier stages that stemmed from discussions to identify their outdoor play values. For example, encouraging ECEs to implement practices that made it easier for children who wanted to remain outside longer than the time their group had been allotted to do so. The family engagement component of the PRO-ECO intervention also experienced limitations due to COVID-19 restrictions that were present throughout the study timeline. Public health and centre-specific restrictions were in place at the start of the study and curtailed parents’ access to the ECECs, influencing the extent and type of parent engagement opportunities available. Following easing of restrticitons, many families continued to follow their pandemic-related norms and limited their presence within the physical ECE space. These parameters made in-person events limited or impossible in many of the participating ECECs.
The implementation of the ECE professional development and training underwent numerous challenges. In addition, there were challenges related to the sustainability of the training throughout the course of the PRO-ECO intervention, as well as post-project. The length and style of educator training differed between the two intervention groups partly due to COVID-related constraints. Group 1 received an in-person full day training, whereas Group 0 received a half-day online training. The training provided as part of the PRO-ECO intervention was developed and provided by the YMCA of Southwestern Ontario and was in the process of being expanded to include YMCA ECECs across Canada. The ECECs that were part of PRO-ECO were among the first to receive it as part of this expansion. As can be typical with rapid expansions, early adoption reveals ‘growing pains’ that can be addressed in subsequent iterations. Evidence from the first ECECs trained in Ontario, prior to expansion of the training across Canada, demonstrated that the training improved educator self-efficacy but not knowledge or risk tolerance (70). This finding indicates that a more comprehensive and extensive training program is required to create significant and lasting educator behavioural change within ECEC settings.
Another serious challenge to uptake of educator training was staff turnover and attrition, which previous research indicates contributes to the quality of professional practice and pedagogical leadership (71). This study experienced first-hand the ECE shortage among the workforce that was exacerbated by the COVID-19 pandemic, resulting in challenges with retention of ECEs, and consequently the uptake of the ECE training associated with the PRO-ECO intervention. The effect of the PRO-ECO intervention on children’s outdoor play participation may have waned in conjunction with the reduced impact of the training over time. To address staff turnover, a ‘booster’ training session was provided to all new staff prior to the Time 3 data collection. However, staff turnover was so persistent that even this additional training provision may not have been sufficient. An additional training-related challenge experienced in this project was the limited on-going mentorship opportunities for ECEs. The training was designed by the YMCA of Southwestern Ontario to be supplemented by regular check-ins (such as at monthly staff meetings) to raise and address emerging issues and provide mentorship support. These sessions were largely absent due to reduced capacity and staff turnover. Overall, the availability of more frequent opportunities for training of new ECEs, as well as robust ongoing mentorship support may have improved the impact of the training and outcomes for the study, as also identified by previous studies (72, 73).
Changes to the participating ECECs built environment as part of the PRO-ECO intervention aimed to enhance available outdoor affordances, loose parts, natural materials and opportunities for challenge. The implementation of this component was performed in partnership with the UBC School of Architecture and Landscape Architecture, the YMCA GV and each ECEC, and the relevant licensing officer. Previous research has identified important considerations for maintaining sustainable outdoor environment modifications, including implementing low maintenance, native plants compatible to the region (74), providing self-sufficient irrigation systems (74), supporting gardening groups (74), and including the cost of outdoor maintenance within the intervention parameters (75). In addition, when practitioners are included in the development of the outdoor play space built environment modifications, a stronger ownership of the space is established, leading to more care for maintaining the space (76).
The implementation of the PRO-ECO intervention experienced climate change related extreme weather conditions, including atmospheric rivers, hail and snow, and drought, impacting planting. Many of the environment modifications required routine upkeep, such as maintaining planting areas and storing new loose parts and equipment in undercover storage, of which the responsibility fell with each individual centre and was difficult to monitor. While the PRO-ECO intervention strived to follow best practice for built environment modification, the maintenance of the modifications required follow-up from the ECECs that was difficult to sustain and may have contributed to the reduced impact of the PRO-ECO intervention on children’s outdoor play over time. Previous studies have outlined similar challenges, including barriers to storing loose parts within the outdoor play space (77, 78) and maintaining aspects of the outdoor play environment (79). Many natural materials, such as those implemented as part of the PRO-ECO intervention, required continuous replenishment (such as mulch, soil and loose parts) to ensure consistent availability. In addition, the seasonal nature and time required for plantings to fully develop may have not aligned with this study’s scheduled post-intervention data collection time points. Post-intervention data collection in the summer season or at a time period longer then 12-months post-intervention may have illuminated different play behaviour changes among participating children. In addition, further collaboration with the ECEs at each participating ECEC when designing and implementing these components of the PRO-ECO intervention may have supported the sustainability and maintenance of the built environment modifications long-term.
The results of this study show that temperature and weather played a significant role in children’s outdoor play participation. Specifically, higher temperatures increased children’s outdoor play participation, while rainy weather decreased play participation, similar to other studies that have found children’s outdoor physical activity and play increases in higher temperatures (between 0 and 20°C) and weather conditions where there is no precipitation (80–82). While this study aimed to collect data at similar seasonal time points (Fall/Spring), the temperature range varied at each data collection time point. Time 3 data collection experienced cooler temperatures (below 0 oC and light snow) which was not present in Time 1 or Time 2 data collection. The variance in temperature conditions was also seen between the intervention groups, where the wait-list control centres (Group 0) experienced a higher proportion of rainy weather conditions and lower mean temperature than the intervention centres (Group 1). While our analysis controlled for weather and temperature, the impact of the variance in weather conditions across data collection time points and between intervention groups on the ECEC space provision and the ECE practices are less known. In addition, the significant role that weather and temperature have on children’s play participation may influence the success of outdoor play interventions and should be considered within future intervention planning.
Despite the implementation of a comprehensive, evidence-informed outdoor play intervention, the results of this study indicate that barriers continue to exist towards enhancing children’s outdoor play behaviour at ECECs. In particular, there were large differences in outdoor play participation at baseline and following implementation of the PRO-ECO intervention between each participating ECEC. The efficacy and effect of the PRO-ECO intervention appears to be specific to each ECEC, rather than consistently received across all participating centres. However, it is important to consider that each PRO-ECO intervention was tailored to the individual ECEC, resulting in non-uniform aspects of the intervention across the project. For example, Centre C (Group 1) saw increases in children’s play, versus non-play, participation following implementation of the PRO-ECO intervention and this change continued to be present at 12-month follow-up. This participating centre received one of the most innovative built environment modifications with the construction of a unique natural climber in an underutilized open space (see Supplementary Material 1 and (50) for more information). Centre C was the largest participating centre and had the necessary ground surface in place to facilitate this built environment change. The ability to implement a comprehensive structure in this space may have contributed to more sustainable outdoor play behaviour change within children at this centre. In comparison, Centre B had the smallest physical outdoor space that was already largely occupied by fixed structures prior to implementation of the PRO-ECO intervention. This reduced the project team’s ability to implement unique built environment features, beyond planting and loose parts. A component of Centre B’s built environment modification focused on removing an existing fixed structure surrounding the sandbox (see Supplementary Material 1 and (50) for more information) that inhibited children from navigating the play space. The proportion of play participation, in comparison to non-play participation, decreased following implementation of the PRO-ECO intervention, which may be as a result of the limited built environment modifications available within the existing constrained outdoor play space at Centre B. Further analyses within this study will seek to understand and describe the centre-level differences that may have contributed to the diversity of change in children’s play specific to the ECEC-level.
Strengths and Limitations
To our knowledge, this is the first cluster randomized controlled trial to evaluate a comprehensive outdoor play intervention in ECECs. Among the strengths of this study was the interdisciplinary stakeholder committee that was gathered to inform best practices and the primary components of this intervention. The development of the PRO-ECO study and the PRO-ECO intervention included extensive partnership and consultation with each participating ECEC, ECEs, licensing officers, and multidisciplinary experts in early childhood education, landscape architecture, public health, outdoor play, psychology and child development. The research team considered the geographic area and socio-economic characteristics of the community and performed stratified randomization to allocate participating ECECs into the intervention and control arms of the study. This process supported a diverse and representative sample of ECECs, however, we could not account or stratify for all ECEC characteristics.
The YMCA is a large national organization with many ECECs throughout the country and the region. This was a strength of this study in that it could draw on resources that may not be available to smaller organizations or stand-alone ECECs. In addition, partnership with a large national organization offeres opportunities for expansion of practices, like the PRO-ECO intervention, across all of their ECECs. It can also represent a limitation, which was evident in the implementation of the Outdoor Play Policy component of the PRO-ECO intervention. The YMCA GV management team developed the Policy, and then disseminated it to the ECECs, which were then responsible for applying it to ECEC-level policies and procedures. This top-down approach might have limited a sense of understanding and ownership at each ECEC for the sentiments contained in the policy. This, combined with the staffing challenges, may have contributed to limited uptake of the policy. In addition, the sustainability of ongoing mentorship opportunities for participating educators through staff meetings did not happen as often as planned due to staff turnover, the impact of the COVID-19 pandemic, and the complexity of working in partnership with a large organization.
Due to the complexity of this study design, there are limitations that are present within this study. First, this is a pilot study and the sample size was based on feasibility while retaining optimal statistical power. A larger sample may have facilitated identification of the effect size between the intervention and wait-list control groups, particularly as play participation was high in all ELCCs at baseline. An additional limitation of this study was the occurrence of the COVID-19 pandemic that impacted the operations of participating ECECs. Onboarding of ECECs and consenting children occurred in mid-to-late 2021, when many COVID-19 restrictions were in place in BC, thus limiting the research team’s capability to support ECECs in the consenting and data collection practices. In addition, ECECs experienced unusually high staff-turnover during this time and outdoor play practices may have been impacted. To account for the possible limitations due to COVID-19 restrictions, the research team connected with participating ECECs frequently and made field notes to address potential changes in normal routines.
A limitation to this study’s analysis included the dichotomization of children’s play behaviour into a binary play or non-play outcome variable. A dichotomous primary outcome variable was analyzed to assess the impact of the PRO-ECO intervention on children’s play participation, in comparison to non-play participation which included activities such as eating, self-care, distress or aggression. However, this approach masks the heterogeneous nature of chldren’s play and contributed to the ceiling effect apparent in the high proportions of play participation noted at pre-intervention time points. Further, this variable was derived through an extensive process to systematically categorize each observation into either a play observation or non-play observation which may be subject to error (see Supplementary Material 2). Further analyses from this study will seek to understand changes in children’s diversity of play and strive to consider a holistic view of children’s play behaviour that considers the many forms of play that can occur within a given observation.
In conceptualizing and designing this study, data were collected at three time points (baseline, 6-month follow-up and 12-month follow-up) to assess short- and longer-term outcomes of the PRO-ECO intervention. However, the seasonal timing and shorter follow-up time of the data collection time points may have contributed to a limitation of our data collection process. Future studies should consider increasing the number of data collection time points to account for all seasons and collecting data over a longer time period to assess multiple short-term and long-term time points. More frequent data collection may support a more robust understanding of outdoor play behaviour change, while being able to adequately control for the diverse weather and other confounding environmental influences. Lastly, the two-year data collection phase of the PRO-ECO study exhibited a high variability of weather, temperature and precipitation patterns, including heat waves, atmospheric rivers and intense hail, consistent with the increasing effects of climate change. While we controlled for weather conditions and temperature within our analysis, we expect that the extreme weather patterns seen in this study may have contributed to additional effects beyond what can be controlled in a statistical model. Future studies should consider collecting data simultaneaously across participating ECECs to ensure that weather patterns are comparable on data collection days for each centre. The generalizability of our findings are most applicable to geographic areas with similar weather patterns of the Greater Vancouver region.
Implications
The primary findings from the PRO-ECO randomized control trial demonstrate that future considerations for comprehensive outdoor play interventions are required to successfully influence children’s outdoor play behaviour at ECECs. Consideration of the sustainability and scalability of an intervention project is imperative to ensure long-term and viable change that encompasses human behaviour, such as ongoing training and mentorship, and support for landscape maintenance. In addition, building connections with educators, families and children is essential to an ECEC’s sustainable support of outdoor play. Importantly, further analyses will focus on how the PRO-ECO intervention influenced additional child outcomes, including the diversity of play. Future studies should be wary of limiting their primary or solitary outcome measure to a binary play vs. non-play variable.
There is an opportunity for the PRO-ECO intervention to connect with Indigenous Ways of Knowing and Being, which emphasize connection to and learning from the Land. Encouraging children’s time in the outdoors and learning about the land that they are on, including about the local Indigenous communities, is an important part of supporting reconciliation. Collaboration with local Indigenous communities could help weave these principles into each aspect of the intervention to promote children’s and ECEs’ stewardship and care for and connection to the land, such as in the selection of plants, learning about their traditional uses, importance or symbolism. Métis herbalist and educator, Lori Snyder conducted a workshop with the SALA students, sharing her extensive knowledge of and practice with native plants, guiding their selections and donating plant material for the project (50). While a promising first step, future work should partner with Indigenous communities from the outset and weave these principles throughout the project.
Comprehensive outdoor play interventions implemented within ECEC settings can showcase results at the educator-level in addition to the child-level. Observationally, we saw that professional development training with educators supported enhanced excitement for the outdoors and willingness to play outside longer in all weather, which in turn, increased children’s willingness to be outdoors. The PRO-ECO project sparked innovation and ECEs began creating new opportunities to encourage child-directed choices outside. At one participating centre, following the PRO-ECO intervention, educators supported children to ride down a steep slope on their tricycles – an activity that was previously seen as too risky and educators were hesitant to support it.