A Web-Based Risk Reframing Intervention to Influence Early Childhood Educators’ Attitudes and Supportive Behaviors Toward Outdoor Play: Randomized Controlled Trial (Preprint)

BACKGROUND Outdoor play supports children’s physical, social, emotional and intellectual development, yet opportunities for outdoor play are declining in many societies. Early learning and childcare centers (ELCCs) can offer young children critical opportunities for quality outdoor play. There are multiple actual and perceived barriers to outdoor play in ELCCs, ranging from safety fears and lack of familiarity with supporting play outdoors to challenges around diverse perspectives on outdoor play among colleagues, administrators, licensing officers and parents. Building on OutsidePlay.ca, our previous web-based intervention to change parents’ attitudes and behaviors toward risky play, we sought to develop a web-based intervention for Canadian ELCC stakeholders. OBJECTIVE Our study objective was to develop and evaluate a web-based intervention that influences early childhood educators’ (ECEs) and ELCC administrators’ perceptions and practices in support of children’s outdoor play in ELCCs. METHODS Our study was guided by the intervention mapping process. We first completed a needs assessment through focus groups of ELCC educators, administrators and licensing officers. We identified key issues, needs and challenges, opportunities to influence behavior change, and intervention outcomes and objectives. This enabled us to develop design objectives and identify features of the OutsidePlay.ca web-based intervention that are central to addressing ECEs and ELCC administrators’ issues, needs and challenges. We used social cognitive theory and behavior change techniques to select methods, applications and technology to deliver the intervention. A mock-up of the intervention was created and revised based on ELCC stakeholders feedback and recommendations. We will use a two-parallel-group randomized controlled trial (RCT) design to evaluate the efficacy of the intervention. We will recruit 324 ECEs and ELCC administrators to randomize into the intervention or the control group. The control group is reading the Position Statement on Active Outdoor Play. RESULTS The primary outcome is increased tolerance of risk in children’s play, as measured by the Teacher Tolerance of Risk in Play Scale. The secondary outcome is self-reported attainment of a self-developed behavior change goal. We will test the hypothesis that there will be a difference between the experimental and control groups with respect to tolerance of risk in children’s play using mixed-effects models. Differences in goal attainment will be tested using logistic regression. CONCLUSIONS The OutsidePlay.ca web-based intervention guides users through a personalized journey that is split into three chapters. An effective intervention that addresses the barriers to outdoor play in ELCC settings has the potential to improve children’s access to outdoor play and support high quality early childhood education. CLINICALTRIAL ClinicalTrials.gov PRS – NCT04624932