A Playground Training to Improve Children's Health After-school and During Recess: The PLAYground Project

Study Overview
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Brief Summary
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Schools are critical settings to foster children's health. The purpose of this two-year cluster-randomized trial is to enhance both the after-school and recess settings to provide children with knowledge and skills to facilitate active and inclusive play. The primary aim of the project is to assess the impact of a playground curriculum intervention on children's physical, social, emotional, and behavioral health. The secondary aim of the project to understand the appropriateness, feasibility, fidelity, and sustainability of implementing a playground curriculum in after-school and recess settings.

Detailed Description
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Physical, social, and emotional health are critical for children and predict good health later in life. Schools are essential settings to foster children's health as they provide access to the majority of children during crucial stages of development. In particular, recess and before/after school programming are critical sources of children's health and well-being, and core components of a whole school approach to health and wellness. The purpose of this two-year cluster-randomized trial is to enhance the quality of these existing settings through the integration of a playground curriculum designed to promote active and inclusive play. Based on Social Cognitive Theory aligned with the Theory of Expanded, Extended, and Enhanced Opportunities, it is hypothesized that active and inclusive play through a playground curriculum intervention will improve enjoyment, knowledge, and self-efficacy (personal conditions), social and emotional learning (behavioral conditions), and the development of peer relationships (environmental conditions) among children, leading to increased physical activity and reduced behavioral incidents. The implementation (appropriateness, feasibility, fidelity, and sustainability) of the playground curriculum intervention to improve children's health will be assessed as a secondary outcome. Participants will be recruited from elementary schools in Mesa Public Schools (Arizona) that offer after-school programming (N=14). The intervention includes the delivery of a curriculum aimed at providing students with knowledge and skills to initiate activities using playground structures. Trainings will be delivered to staff (after-school staff, recess aides, and Physical Education teachers) and students in the after-school setting. Students attending the after-school program will become Play Leaders to transfer the knowledge and skills they learn from PlayOn! to the recess setting. The impact of the playground curriculum intervention on children's physical, social, emotional, and behavioral health after school and during recess will be measured using surveys, observations, interviews, physical activity devices, and de-identified school behavioral information. Data will be collected at all 14 school sites each fall and spring semester. In year one, seven schools will receive the intervention. Schools will be stratified to either the intervention or control group by Title 1 status - an indicator of school-level income. In year two, the seven control schools will receive the intervention to allow all schools the opportunity to benefit from the project.

Official Title
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A Cluster Randomized Controlled Trial of an After-school Playground Intervention to Improve Children's Physical, Social, and Emotional Health: The PLAYground Project

Conditions
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Physical Inactivity, Social Skills, Behavior, Child

Intervention / Treatment
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* Behavioral: PlayOn! playground curriculum


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Students enrolled an after-school program in Mesa Public Schools Exclusion Criteria: Students in grades kindergarten or first grade will be excluded due to their young age.

Ages Eligible for Study
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Minimum Age: 7 Years
Maximum Age: 13 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Playground Curriculum Arm<br>Staff (after-school staff, recess aides, and physical education teachers) receive training to implement a playground curriculum in an after-school program; children receive a training to use the curriculum during recess | Behavioral: PlayOn! playground curriculum<br>* A staff and student training to implement a playground curriculum in after-school and recess settings<br>|
| No Intervention: Program As Usual<br>Staff and students receive no training and participate in after-school programs and recess as usual | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean change in accelerometer-derived physical activity from baseline to six months | Accelerometer counts of sedentary, light-, and moderate-to-vigorous physical activity levels will be segmented and processed separately to determine physical activity during recess, during school, during after-school programming, out of school, and on weekends. | Baseline (month 0) and Post-intervention (approximately 6 months) | 
| Mean change in accelerometer-derived physical activity from baseline to 12 months | Accelerometer counts of sedentary, light-, and moderate-to-vigorous physical activity levels will be segmented and processed separately to determine physical activity during recess, during school, during after-school programming, out of school, and on weekends. | Baseline (month 0) and Post-intervention (approximately 12 months) | 
| Mean change in accelerometer-derived physical activity from baseline to 18 months | Accelerometer counts of sedentary, light-, and moderate-to-vigorous physical activity levels will be segmented and processed separately to determine physical activity during recess, during school, during after-school programming, out of school, and on weekends. | Baseline (month 0) and Post-intervention (approximately 18 months) | 
| Mean change in student-reported personal (emotional) health from baseline to 6 months | Child-reported personal health (enjoyment, knowledge, and self-efficacy) will be collected through questionnaire with Discrete Emotions in Physical Education Scale (DEPES). | Baseline (month 0) and Post-intervention (approximately 6 months) | 
| Mean change in student-reported personal (self-efficacy) health from baseline to 6 months | Child-reported personal health (enjoyment, knowledge, and self-efficacy) will be collected through questionnaire with Metacognitive Process in Physical Education Questionnaire. | Baseline (month 0) and Post-intervention (approximately 6 months) | 
| Mean change in student-reported personal (social) health from baseline to 6 months | Child-reported personal health (enjoyment, knowledge, and self-efficacy) will be collected through questionnaire with Saunders psychosocial influences on physical activity scale. | Baseline (month 0) and Post-intervention (approximately 6 months) | 
| Mean change in student-reported environmental health from baseline to 6 months | Child-reported environmental health (peer relationships) will be collected through questionnaire with the ECLS-K peer relationship scale. | Baseline (month 0) and Post-intervention (approximately 6 months) | 
| Mean change in student-reported behavioral health from baseline to 6 months | Child-reported behavioral health (social and emotional learning) will be collected through questionnaire with the Social and Emotional Learning module of the California Healthy Kids Survey. | Baseline (month 0) and Post-intervention (approximately 6 months) | 
| Mean change in student-reported personal (emotional) health from baseline to 12 months | Child-reported personal health indicators (enjoyment, knowledge, and self-efficacy) will be collected through questionnaire with Discrete Emotions in Physical Education Scale (DEPES). | Baseline (month 0) and Post-intervention (approximately 12 months) | 
| Mean change in student-reported personal (self-efficacy) health from baseline to 12 months | Child-reported personal health indicators (enjoyment, knowledge, and self-efficacy) will be collected through questionnaire with Metacognitive Process in Physical Education Questionnaire. | Baseline (month 0) and Post-intervention (approximately 12 months) | 
| Mean change in student-reported personal (social) health from baseline to 12 months | Child-reported personal health indicators (enjoyment, knowledge, and self-efficacy) will be collected through questionnaire with Saunders psychosocial influences on physical activity scale. | Baseline (month 0) and Post-intervention (approximately 12 months) | 
| Mean change in student-reported environmental health from baseline to 12 months | Child-reported environmental health (peer relationships) will be collected through questionnaire with the ECLS-K peer relationship scale. | Baseline (month 0) and Post-intervention (approximately 12 months) | 
| Mean change in student-reported behavioral health from baseline to 12 months | Child-reported behavioral health (social and emotional learning) will be collected through questionnaire with the Social and Emotional Learning module of the California Healthy Kids Survey. | Baseline (month 0) and Post-intervention (approximately 12 months) | 
| Mean change in student-reported personal (emotional) health from baseline to 18 months | Child-reported personal health indicators (enjoyment, knowledge, and self-efficacy) collected through questionnaire with Discrete Emotions in Physical Education Scale (DEPES). | Baseline (month 0) and Post-intervention (approximately 18 months) | 
| Mean change in student-reported personal (self-efficacy) health from baseline to 18 months | Child-reported personal health indicators (enjoyment, knowledge, and self-efficacy) collected through questionnaire with Metacognitive Process in Physical Education Questionnaire. | Baseline (month 0) and Post-intervention (approximately 18 months) | 
| Mean change in student-reported personal (social) health from baseline to 18 months | Child-reported personal health indicators (enjoyment, knowledge, and self-efficacy) collected through questionnaire with Saunders psychosocial influences on physical activity scale. | Baseline (month 0) and Post-intervention (approximately 18 months) | 
| Mean change in student-reported environmental health from baseline to 18 months | Child-reported environmental health (peer relationships) will be collected through questionnaire with the ECLS-K peer relationship scale. | Baseline (month 0) and Post-intervention (approximately 18 months) | 
| Mean change in student-reported behavioral health from baseline to 18 months | Child-reported behavioral health (social and emotional learning) will be collected through questionnaire with the Social and Emotional Learning module of the California Healthy Kids Survey. | Baseline (month 0) and Post-intervention (approximately 18 months) | 
| Change in number of school-reported behavioral incidents from baseline to 6 months | School-reported number of children referred to administrators for behavioral incidents | Baseline (month 0) and Post-intervention (approximately 6 months) | 
| Change in number of school-reported behavioral incidents from baseline to 12 months | School-reported number of children referred to administrators for behavioral incidents | Baseline (month 0) and Post-intervention (approximately 12 months) | 
| Change in number of school-reported behavioral incidents from baseline to 18 months | School-reported number of children referred to administrators for behavioral incidents | Baseline (month 0) and Post-intervention (approximately 18 months) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean perceived implementation appropriateness | Staff-reported appropriateness and feasibility of intervention collected through questionnaire with Intervention Appropriateness Measure (IAM). | Post-intervention (approximately 6 months) | 
| Mean perceived implementation feasibility | Staff-reported appropriateness and feasibility of intervention collected through questionnaire with Feasibility of Intervention Measure (FIM). | Post-intervention (approximately 6 months) | 
| Mean observed implementation fidelity | Researcher-reported fidelity of intervention (adherence, exposure/dose, quality of delivery, component differentiation, and participant involvement) collected using researcher-developed protocol for monthly systematic observations. | Monthly post-intervention through end of school year | 
| Mean observed implementation sustainability | Researcher-reported fidelity of intervention (adherence, exposure/dose, quality of delivery, component differentiation, and participant involvement) collected using researcher-developed protocol for monthly systematic observations. | Post-intervention (approximately 12 months) | 
| Mean observed implementation sustainability | Researcher-reported fidelity of intervention (adherence, exposure/dose, quality of delivery, component differentiation, and participant involvement) collected using researcher-developed protocol for monthly systematic observations. | Post-intervention (approximately 18 months) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Physical Activity, Schools