Child Development, Online Intervention, Risk Assessment
Conditions
Keywords
Risk reframing tool, Children's outdoor play, Children's outdoor risky play, Early childhood education
Brief summary
Outdoor play is important for children as it can promote healthy social and physical development, emotional well-being, self-confidence, risk management and overall physical activity. Yet, opportunities for outdoor play have been decreasing across generations due to perceptions that it is dangerous and unnecessary. Early childhood educators (ECEs) and administrators are struggling to provide children with high quality and stimulating outdoor play time. To help ECEs and administrators, the investigators have developed a Risk Reframing (RR) digital tool, https://outsideplay.ca, which is underpinned by social cognitive theory (SCT) and health behaviour change techniques. The aim of the current study is to test the efficacy of the RR digital tool in: 1) increasing ECEs/administrators' tolerance of risk in play; and, 2) attaining their behavior change goal in promoting children's outdoor play at their early childcare center. The investigators will conduct a single-blind (researchers and outcome assessors) randomized controlled trial and will obtain complete data on at least 206 early childhood educators and administrators currently working in Canada. The RR digital tool is designed for a one-time visit and includes three chapters of self-reflection and experiential learning tasks. The control condition consists of reading the Position Statement on Active Outdoor Play, a 2-page information sheet on children's active outdoor play. Primary outcome is increased tolerance of risk in play, as measured by the Tolerance of Risk in Play Scale - teacher version. Secondary outcome is self-reported attainment of a behaviour change goal that participants set for themselves. The investigators will test the hypothesis that there will be differences between the intervention and control conditions with respect to tolerance of risk in play and goal attainment.
Detailed description
The study uses 2-condition (control and intervention) randomized controlled trial design. Participants will be recruited through advertising on social media, distributing notices throughout networks, and snowball sampling. The aim is to obtain complete data on 206 participants, thus the investigators will try to recruit at least 324 ECEs and administrators at baseline to account for attrition. The investigators considered 75% and 85% retention rate at 1-week post-intervention and 3-months post-intervention, respectively. Interested participants will complete a questionnaire in REDCap electronic data capture tool hosted at British Columbia Children's Hospital Research Institute to answer eligibility questions and provide informed consent. Enrolled participants will be sent a link to the baseline questionnaire package to be completed in REDcap. Demographic questions are asked to understand the general background of participants (e.g., sex, age) and their ECE center (e.g., approximately how many staff are at their center). They will then be randomly assigned to one of the two conditions: 1) Control condition, or, 2) Intervention condition. Neither the researchers nor participants will know in advance which condition participants will be assigned to. There is a 50% chance that they are assigned to either condition. The randomization schedule will be generated beforehand in sealedenvelop.com using blocks of size 2, 4, 6. The list will be then transferred to REDCap. Participants will not be blinded to allocation, because the nature of the intervention does not allow it. Allocation will be concealed to the researchers at participant assignment as well as data analysis. Participants who are assigned to Control condition will be provided with a PDF version of the position statement on active outdoor play, which can take up 20 minutes to read. Then, they will be invited to set a goal that could help them give children at their center more opportunities for outdoor play. Participants who are assigned to Intervention condition will be automatically taken to the online tool, https://outsideplay.ca. The online tool is to reframe participants' perceptions of outdoor play and change their service delivery. It includes a series of interactive video scenarios where participants can make choices, which will result in different endings for each scenario. This can take up to 100 minutes to complete. Then participants will be invited to set a goal that could help them give children at their center more opportunities for outdoor play. Participants who are assigned to Control condition will have access to the online tool upon completion of their participation in the current study. After 1-week, all participants who completed the baseline survey and the intervention (e.g., the Position Statement on Active Outdoor Play or the RR tool) will receive an email inviting them to complete a follow-up survey questionnaire. The investigators will also follow up on whether they had accomplished their goal. After 3-months, all participants who completed the 1-week post-intervention survey will receive another email to complete the same follow-up survey questionnaire for the final time. The investigators will also follow up on whether they had accomplished their goal. The study hypotheses are: 1. Participants in Intervention condition will have a significantly greater increase of tolerance for risk in play than participants in Control condition. 2. A greater proportion of participants in Intervention condition will attain their behavior change goal, than participants in Control condition.
Interventions
BEHAVIORALRR Digital Tool
This is the intervention condition. Participants in this condition will take the RR digital tool available at https://outsideplay.ca.
This is the control condition. Participants in this condition will read the position statement that summarizes the issues and research regarding children's access to outdoor play.
Sponsors
The Lawson Foundation
University of British Columbia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
Allocations will be concealed to the researchers at participant assignment and data analysis.
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
1. Being 19 years of age or older; 2. Currently working or training in the early childhood education field in Canada; and, 3. Being able to speak, read, and understand English. 4. Having access to the internet
Exclusion criteria
n/a
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Tolerance of Risk in Play Across Baseline, 1-week Post-intervention and 3-months Post-intervention | Baseline, 1-week post-intervention, and 3-months post-intervention | This scale measures participants' tolerance of risk in outside play. Teacher Tolerance of Risk in Play Scale has 26 items of yes/no (coded as 1 and 0, respectively) survey questions of risk tolerance. To account for item difficulty and respondent trait, we convert respondents' responses to a psychometric measure that is standardized to z-scores. We standardized the measure to z-scores at each measurement time point. For example, at baseline, all respondents' (including those from control and intervention group) psychometric measures have a population mean of zero/0 and standard deviation of 1. A higher z-score means a higher tolerance of risk in play (in the case of our study, a higher score means a more favorable outcome). In this table, we present the outcome measures as absolute z-score values, rather than change from two time points. We do not consider clinically relevant threshold for this outcome measure as there is no established literature. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Attainment of a Behavior Change Goal | 1-week post-intervention, and 3-months post-intervention | This is a yes/no self-report question asking participants if they think they had attained their behavior change goal. Unit of measure is 'yes' or 'no' to measure incidence of behavior change goal attainment.For the purpose of our analyses the category of Yes is an indication of behaviour change while the category of No is an indication of no behaviour change. |
Countries
Canada
Participant flow
Recruitment details
We recruited participants between December 1, 2020 to March 15, 2021 via social media posts - FaceBook, FaceBook Ads, Twitter and Instagram - and mass email through partner and professional networks.
Pre-assignment details
Eligible participants provided consent by downloading the consent form and selecting a checkbox to participate. Enrolled participants completed the baseline survey (demographic, and, a questionnaire on tolerance for risk in play, self-efficacy, and stage of change) and entered their email addresses. Then, we automatically randomized enrolled participants in the REDCap to one of the two conditions: intervention and control. Participants had an equal likelihood of being assigned to each condition.
Participants by arm
| Arm | Count |
|---|---|
| Position Statement on Active Outdoor Play Position Statement Active Outdoor Play: The position statement summarizes the issues and research regarding children's access to outdoor play and provides recommendations for various stakeholders. It states that access to active play in nature and outdoors - with its risks - is essential for healthy child development and recommends increasing children's opportunities for self-directed play in all settings. The Position Statement includes recommendations for parents, educators, health professionals, administrators and various level of governments to address the barriers to children's outdoor play. It addresses common misconceptions and encourages that danger be differentiated from risk and outdoor play and fun be valued as much as safety (ParticipACTION Canada, 2015; Tremblay et al., 2015). | 282 |
| Risk Reframing (RR) Digital Tool RR Digital Tool: This is the intervention condition. Participants in this condition completed the RR digital tool available at https://outsideplay.ca.
Chapter 1: reflecting on their own childhood play activities; what they got out of these experiences; outdoor play activities of the children at their center; what they do to promote children's outdoor play; what gets in the way in promoting children outdoor play.
Chapter 2: imagining themselves in six video segments where they must decide how to communicate with parents; and, whether they allow children to engage in rough and tumble play, play at heights, play with tools, play at speed/mud play, and resolve conflicts amongst themselves Chapter 3: reflecting on their barriers and things that helped them promote and support the children's outdoor play at their center. Participants to assess whether there is anything they want to change to set a realistic goal, outlining steps for attaining that goal. | 281 |
| Total | 563 |
Baseline characteristics
| Characteristic | Position Statement on Active Outdoor Play | Risk Reframing (RR) Digital Tool | Total |
|---|---|---|---|
| Age, Customized 19-24 years | 26 Participants | 33 Participants | 59 Participants |
| Age, Customized 25-30 years | 72 Participants | 55 Participants | 127 Participants |
| Age, Customized 31-40 years | 71 Participants | 86 Participants | 157 Participants |
| Age, Customized 41-50 years | 66 Participants | 64 Participants | 130 Participants |
| Age, Customized 51 years and older | 46 Participants | 42 Participants | 88 Participants |
| Age, Customized Participant did not provide answer | 1 Participants | 1 Participants | 2 Participants |
| Feeling supported by colleagues in general No or others | 31 Participants | 27 Participants | 58 Participants |
| Feeling supported by colleagues in general Participant did not provide answer | 0 Participants | 4 Participants | 4 Participants |
| Feeling supported by colleagues in general Yes | 251 Participants | 250 Participants | 501 Participants |
| Hours children spent playing outdoors at the center | 2.01 hours STANDARD_DEVIATION 1.15 | 2.14 hours STANDARD_DEVIATION 1.13 | 2.08 hours STANDARD_DEVIATION 1.14 |
| Language English | 263 Participants | 261 Participants | 524 Participants |
| Language Others | 19 Participants | 20 Participants | 39 Participants |
| Number of children at the center Large: >= 49 | 111 Participants | 106 Participants | 217 Participants |
| Number of children at the center Medium: 25-48 | 76 Participants | 78 Participants | 154 Participants |
| Number of children at the center Participant did not provide answer | 4 Participants | 2 Participants | 6 Participants |
| Number of children at the center Small: 1-24 | 91 Participants | 95 Participants | 186 Participants |
| Number of staffs at the center Large: >= 13 | 91 Participants | 82 Participants | 173 Participants |
| Number of staffs at the center Medium: 6-12 | 85 Participants | 91 Participants | 176 Participants |
| Number of staffs at the center Participant did not provide answer | 6 Participants | 6 Participants | 12 Participants |
| Number of staffs at the center Small: 1-5 | 100 Participants | 102 Participants | 202 Participants |
| Quality of the center's outdoor space for children Acceptable | 65 Participants | 60 Participants | 125 Participants |
| Quality of the center's outdoor space for children Good | 95 Participants | 110 Participants | 205 Participants |
| Quality of the center's outdoor space for children Participant did not provide answer | 12 Participants | 12 Participants | 24 Participants |
| Quality of the center's outdoor space for children Poor | 12 Participants | 11 Participants | 23 Participants |
| Quality of the center's outdoor space for children Very good | 96 Participants | 88 Participants | 184 Participants |
| Quality of the center's outdoor space for children Very poor | 2 Participants | 0 Participants | 2 Participants |
| Race and Ethnicity Not Collected | — | — | 0 Participants |
| Region of Enrollment Canada British Columbia | 129 Participants | 129 Participants | 258 Participants |
| Region of Enrollment Canada New Brunswick | 52 Participants | 44 Participants | 96 Participants |
| Region of Enrollment Canada Ontario | 64 Participants | 66 Participants | 130 Participants |
| Region of Enrollment Canada Others | 36 Participants | 40 Participants | 76 Participants |
| Region of Enrollment Canada Participant did not provide answer | 1 Participants | 2 Participants | 3 Participants |
| Role Early childhood educator (ECE) | 203 Participants | 189 Participants | 392 Participants |
| Role ECE administrator | 75 Participants | 90 Participants | 165 Participants |
| Role Others | 4 Participants | 2 Participants | 6 Participants |
| Sex/Gender, Customized Female | 272 Participants | 272 Participants | 544 Participants |
| Sex/Gender, Customized Non-female | 10 Participants | 9 Participants | 19 Participants |
| Whether the center has a designated outdoor space for children No | 8 Participants | 9 Participants | 17 Participants |
| Whether the center has a designated outdoor space for children Participant did not provide answer | 4 Participants | 2 Participants | 6 Participants |
| Whether the center has a designated outdoor space for children Yes | 270 Participants | 270 Participants | 540 Participants |
| Whether the center is licensed No | 7 Participants | 7 Participants | 14 Participants |
| Whether the center is licensed Participant did not provide answer | 9 Participants | 10 Participants | 19 Participants |
| Whether the center is licensed Yes | 266 Participants | 264 Participants | 530 Participants |
| Years working at the current center | 6.09 years STANDARD_DEVIATION 7.41 | 5.18 years STANDARD_DEVIATION 5.98 | 5.63 years STANDARD_DEVIATION 6.74 |
| Years working in the field | 10.22 years STANDARD_DEVIATION 9.51 | 10.05 years STANDARD_DEVIATION 9.16 | 10.14 years STANDARD_DEVIATION 9.33 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Change in Tolerance of Risk in Play Across Baseline, 1-week Post-intervention and 3-months Post-intervention
This scale measures participants' tolerance of risk in outside play. Teacher Tolerance of Risk in Play Scale has 26 items of yes/no (coded as 1 and 0, respectively) survey questions of risk tolerance. To account for item difficulty and respondent trait, we convert respondents' responses to a psychometric measure that is standardized to z-scores. We standardized the measure to z-scores at each measurement time point. For example, at baseline, all respondents' (including those from control and intervention group) psychometric measures have a population mean of zero/0 and standard deviation of 1. A higher z-score means a higher tolerance of risk in play (in the case of our study, a higher score means a more favorable outcome). In this table, we present the outcome measures as absolute z-score values, rather than change from two time points. We do not consider clinically relevant threshold for this outcome measure as there is no established literature.
Time frame: Baseline, 1-week post-intervention, and 3-months post-intervention
Population: A total of 563 participants with baseline demographic and other survey data completed was included at baseline. Of 563 participants, 282 were randomized to the control group and 281 to the intervention group. At 1-week post-intervention, 335 participants were included; and at 3-month post-intervention, 314 participants were included in the analysis.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Position Statement on Active Outdoor Play | Change in Tolerance of Risk in Play Across Baseline, 1-week Post-intervention and 3-months Post-intervention | Baseline outcome | 0.040 score on a scale | Standard Deviation 1.207 |
| Position Statement on Active Outdoor Play | Change in Tolerance of Risk in Play Across Baseline, 1-week Post-intervention and 3-months Post-intervention | 1-week post-intervention | -0.156 score on a scale | Standard Deviation 1.304 |
| Position Statement on Active Outdoor Play | Change in Tolerance of Risk in Play Across Baseline, 1-week Post-intervention and 3-months Post-intervention | 3-month post-intervention | -0.118 score on a scale | Standard Deviation 1.4 |
| Risk Reframing (RR) Digital Tool | Change in Tolerance of Risk in Play Across Baseline, 1-week Post-intervention and 3-months Post-intervention | Baseline outcome | -0.040 score on a scale | Standard Deviation 1.243 |
| Risk Reframing (RR) Digital Tool | Change in Tolerance of Risk in Play Across Baseline, 1-week Post-intervention and 3-months Post-intervention | 1-week post-intervention | 0.262 score on a scale | Standard Deviation 1.117 |
| Risk Reframing (RR) Digital Tool | Change in Tolerance of Risk in Play Across Baseline, 1-week Post-intervention and 3-months Post-intervention | 3-month post-intervention | 0.200 score on a scale | Standard Deviation 1.211 |
Secondary
Change in Attainment of a Behavior Change Goal
This is a yes/no self-report question asking participants if they think they had attained their behavior change goal. Unit of measure is 'yes' or 'no' to measure incidence of behavior change goal attainment.For the purpose of our analyses the category of Yes is an indication of behaviour change while the category of No is an indication of no behaviour change.
Time frame: 1-week post-intervention, and 3-months post-intervention
Population: We included 335 participants with complete secondary outcome data (goal) at 1-week post-intervention, and 314 participants at 3-month post-intervention.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| Position Statement on Active Outdoor Play | Change in Attainment of a Behavior Change Goal | 1-week post-intervention | Yes | 141 Participants |
| Position Statement on Active Outdoor Play | Change in Attainment of a Behavior Change Goal | 1-week post-intervention | No | 68 Participants |
| Position Statement on Active Outdoor Play | Change in Attainment of a Behavior Change Goal | 3-months post-intervention | Yes | 163 Participants |
| Position Statement on Active Outdoor Play | Change in Attainment of a Behavior Change Goal | 3-months post-intervention | No | 32 Participants |
| Risk Reframing (RR) Digital Tool | Change in Attainment of a Behavior Change Goal | 3-months post-intervention | No | 13 Participants |
| Risk Reframing (RR) Digital Tool | Change in Attainment of a Behavior Change Goal | 1-week post-intervention | Yes | 94 Participants |
| Risk Reframing (RR) Digital Tool | Change in Attainment of a Behavior Change Goal | 3-months post-intervention | Yes | 106 Participants |
| Risk Reframing (RR) Digital Tool | Change in Attainment of a Behavior Change Goal | 1-week post-intervention | No | 32 Participants |