PROmoting Early Childhood Outside (PRO-ECO)
Condition: Child Development
Study type: Interventional

Summary: 
      Licensed early learning and childcare centres (ELCCs) can provide children with rich
      opportunities for outdoor play that they may not otherwise experience in their home or
      community. However, many ELCCs struggle to provide high quality and stimulating outdoor play
      time. The primary aim of our study is to develop, implement and test a comprehensive
      multi-component intervention, the PROmoting Early Childhood Outside (PRO-ECO), to build
      capacity for, and address the complexities of building support for outdoor play in early
      childcare centre settings. This is to ultimately increase children's access to engaging
      outdoor spaces for play.

      Our overarching goal is to develop and evaluate a comprehensive multi-component intervention,
      called the PROmoting Early Childhood Outside (PRO-ECO). This intervention is to increase
      children's outdoor play and the diversity of outdoor play behaviour in Canadian ELCC settings
      providing full-day licensed care for preschoolers. The PRO-ECO integrates development of
      policies and procedure, early childhood educator (ECE) training and mentorship, outdoor space
      modifications and, parent/caregiver engagement.

      The PRO-ECO intervention will be co-developed, implemented and evaluated in partnership with
      the YMCA of Greater Vancouver (YMCAGV). A wait-list control cluster randomised trial design
      (RCT) will evaluate the effectiveness of the intervention and how it can be modified to
      tackle barriers in diverse settings.
    

Detailed description: 
      The design of this study is a pilot wait-list control cluster randomised trial (RCT) with two
      arms. The two arms consist of 1) a PRO-ECO intervention group and 2) a wait-list control
      group. A mixed-methods approach will be used to collect qualitative and quantitative data
      designed to meet the study objectives. Quantitative data collection will support evaluation
      of the primary outcome variables and qualitative data will be collected to assess the
      acceptability, effectiveness, and feasibility of the implementation of the intervention.
      Qualitative data will be collected concurrently with quantitative data and will allow
      researchers to explore how participants experience the intervention.

      Participant inclusion and exclusion criteria is divided into three distinct sets of levels-
      1) organization level, 2) adult individual participation, and 3) child participation.

        1. Organization level Inclusion criteria of the ELCCs include approving participation in
           this study. Following this, sites will be selected based on geographic area and
           demographics of neighbourhood served, physical characteristics of the ELCC outdoor space
           (e.g., size, at grade or not), readiness of program (as assessed by YMCA senior staff),
           and time spent participating in outdoor play. These variables will be measured based on
           a pretrial inventory and infrastructure survey, and census subdivision. ELCCs that do
           not meet the inclusion characteristics based on these measurements may be excluded.

        2. Adult individual participation Inclusion criteria for adult participants include being
           ECEs or staff (administrators, directors, and supervisors) at the participating YMCAGV
           ELCCs that provide full day childcare for preschool children.

        3. Child individual participation Inclusion criteria for child participation includes being
           between the ages of 2.5-6 years, currently enrolled in one of the participating YMCAGV
           ELCCs, and obtaining parental consent for their participation in the study. Children
           will be excluded from the measurement portion of the study if their parent does not
           provide informed consent, however, all children attending the program will be exposed to
           the intervention.

      The RCT will be conducted in 8 ELCCs operated by the YMCA GV. Individual ELCCs will serve as
      the unit of randomization, with 4 intervention sites and 4 wait-list control sites composing
      the final sample. Intervention sites will receive the intervention immediately following
      baseline data collection, whereas wait-list control sites will receive the intervention 6
      months later. Data on outcome measures will be collected at three time points- 1) Time 1 -
      Baseline, prior to intervention implementation, 2) Time 2 - 6-month follow-up (4 months
      following implementation of the intervention within the intervention group, and 3) Time 3 -
      12-month follow-up (10 months post-intervention for intervention group, 4 months
      post-intervention for the wait-list control group). Thus, outcome data will assess short-term
      and long-term outcomes within the intervention group and short-term outcomes within the
      wait-list control group. Baseline and post-intervention data will be included in the
      analysis, controlling for the cluster design.

      Baseline and post-intervention data collection will occur during the Fall and Spring seasons
      to ensure similar weather patterns at all time points, which in Metro Vancouver involves
      extensive rain fall, as weather has been shown to impact outdoor play time.

      As per study inclusion criteria, study participants will include children aged 2.5-6 years at
      8 selected YMCA GV sites. This also includes the engagement of ECEs, supervisors, and
      managers. Parents of children will also be invited to participate in focus groups, consent
      provision, and information sharing. ELCCs will appoint a staff research lead to work closely
      with the research team on all phases of the project. Recruitment of children and parents will
      occur through the staff research lead at each ELCC. Letters and/or emails home and
      face-to-face conversations will promote recruitment. The research team will be actively
      involved with staff at each site to ensure they are provided information and direction on
      participant recruitment policies and procedures. The staff research lead at each ELCC will
      administer consent forms to families.

      We will inform parents/caregivers of children enrolled in the participating YMCA GV ELCCs
      about our study in various ways within the YMCA GV organization. This includes via online
      communications and info sessions. Adult participants for the qualitative focus group be
      recruited internally through the YMCA GV. When contacted by prospective participants
      including ECEs and staff, we will provide details of the study through phone or via email. On
      the interview day, the consent and the overall interview procedure will be further explained
      to participants. The focus groups will be conducted through Zoom. Once procedures are
      explained and consent reviewed, we will invite participants to sign the consent forms and
      complete the demographic survey, and email scanned copies to the UBC research team.

      For the primary outcome, proportion of play occurrence, in comparison to non-play occurrence,
      child play behaviours will be assessed utilizing observational behaviour mapping methods. To
      conduct observational behaviour mapping, two research staff will be on site at each of the 8
      ELCCs to collect pre-determined data related to play behaviour during outdoor free play.
      Behaviour mapping assessments will be performed through scanning identified quadrants
      throughout the outdoor play space. Simultaneous to the in-situ coding, the research staff
      will be taking video recordings of the quadrants they are observing. Videos will be coded at
      15-second intervals for play type, including functional play, play with rules, imaginative
      play, constructive play, exploratory play, restorative play, and non-play. The proportion of
      play occurrence (vs. non-play occurrence) will be summarized by treatment group using
      frequency and percentages. We will compare proportions at baseline and follow-ups.

      The diversity of children's play behavior when participating in outdoor play is a secondary
      outcome, and will be coded in situ and via review of the videos. We will compare the
      diversity of types of play occurring at baseline and follow-up by comparing proportions of
      the various play types, including physical play, expressive play, play with rules,
      imaginative play, exploratory play, restorative play, bio play, digital play and non-play.

      ECEs' attitudes toward outdoor risky play is a secondary outcome, and will be assessed using
      the Teacher Tolerance of Risk in Play Scale (T-TRiPS).

      The quality of outdoor spaces will be an additional outcome. The Seven Cs audit tool will
      form the basis for the assessment of quality of outdoor space at all early childhood
      education centre sites, guide development of the plan for modification of the outdoor
      environment, and to reassess at intervention early childhood education centre sites after
      implementation of the PRO-ECO intervention.

      The same procedures described above will be followed to collect post-intervention data. We
      will also collect ECEs and staff's acceptability of the PRO-ECO intervention. This will be
      done utilizing a combination of focus group discussion and administrative data.
    

Intervention name(s): Intervention Group - PRO-ECO Intervention; Wait List Group - Normal Daily Practice
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The PRO-ECO intervention will be tailored to individual sites. Through collection of focus group and baseline data, the intervention will be further refined to provide site-specific adjustments, such as specific materials in the built environment design modification or targeted training. Identified features of effective interventions outlined in the literature have informed the development of the intervention foundation and potential tailoring.; ELCCs that are randomly assigned to the waitlist group will participate in their normal daily practice, including standard curriculum and outdoor play time. Once post-data collection is complete, wait list sites will be given the PRO-ECO intervention.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Children's outdoor play; Children's outdoor risky play; Early childhood education