A Web-Based and In-Person Risk Reframing Intervention to Influence Mothers’ Tolerance for, and Parenting Practices Associated With, Children’s Outdoor Risky Play: Randomized Controlled Trial
Authors: Brussoni Mariana , Han Christina S , Lin Yingyi , Jacob John , Pike Ian , Bundy Anita , Faulkner Guy , Gardy Jennifer , Fisher Brian , Mâsse Louise 
Published: March 2021

Background
Outdoor risky play, such as climbing, racing, and independent exploration, is an important part of childhood and is associated with various positive physical, mental, and developmental outcomes for children. Parental attitudes and fears, particularly mothers’, are a major deterrent to children’s opportunities for outdoor risky play.

Objective
The aim of this study was to evaluate the efficacy of 2 versions of an intervention to reframe mothers’ perceptions of risk and change parenting behaviors: a web-based intervention or an in-person workshop, compared with the control condition.

Methods
The Go Play Outside! randomized controlled trial was conducted in Canada from 2017 to 2018. Participants were recruited through social media, snowball sampling, and community notices. Mothers of children aged 6-12 years were self-assessed through eligibility questions, and those eligible and consented to participate in the study were randomized into a fully automated web-based intervention, the in-person workshop, or the control condition. The intervention was underpinned by social cognitive theory, incorporating behavior change techniques. Participants progressed through a series of self-reflection exercises and developed a goal for change. Control participants received the Position Statement on Active Outdoor Play. The primary outcome was increase in tolerance of risky play and the secondary outcome was goal attainment. Data were collected online via REDCap at baseline, 1 week, and 3 months after the intervention. Randomization was conducted using sealed envelope. Allocations were concealed to researchers at assignment and data analysis. We conducted mediation analyses to examine whether the intervention influenced elements of social cognitive theory, as hypothesized.

Results
A total of 451 mothers were randomized and completed baseline sociodemographic assessments: 150 in the web-based intervention, 153 in the in-person workshop, and 148 in the control condition. Among these, a total of 351 mothers completed the intervention. At 1 week after the intervention, 113, 85, and 135 mothers completed assessments for each condition, respectively, and at 3 months after the intervention, 105, 84, and 123 completed the assessments, respectively. Compared with mothers in the control condition, mothers in the web-based intervention had significantly higher tolerance of risky play at 1 week (P=.004) and 3 months after the intervention (P=.007); and mothers in the in-person workshop had significantly higher tolerance of risky play at 1 week after the intervention (P=.02). No other significant outcomes were found. None of the potential mediators were found to significantly mediate the outcomes.

Conclusions
The trial demonstrates that the web-based intervention was effective in increasing mothers’ tolerance for risk in play.

Trial Registration
ClinicalTrials.gov NCT03374683; https://clinicaltrials.gov/ct2/show/NCT03374683

International Registered Report Identifier (IRRID)
RR2-10.1186/s13063-018-2552-4