'Active play may be lots of fun, but it's certainly not frivolous': the emergence of active play as a health practice in Canadian public health

Ecological validity of the PERF-FIT: correlates of active play, motor performance and motor skill-related physical fitness

Background

Active games are important health enhancing physical activities in children with and without developmental disorders and will help children to develop fundamental motor skills, while inactivity exacerbates coordination difficulties and increases the risk of obesity. Regular engagement in active play promotes physical, social and cognitive development. It is therefore important to know if children have the capabilities for healthy behavior. Motor skills and muscular fitness are both important components to participate in play, sport and leisure. The Performance and Fitness (PERF-FIT) test battery integrates motor skills (running, jumping, hopping, catching, bouncing, throwing, balance) and muscular fitness (explosive power and muscular endurance) needed in many forms of active play.

Aim

To test the ecological validity of the PERF-FIT test battery; a field-based test integrating motor skill proficiency and muscular fitness.

Methods

Seventy-five children were assessed on the PERF-FIT, Movement Assessment Battery for Children (MABC)-2 and performance in 6 active games was scored. Of these children, 52 children scored in the normal range and 23 (or 30.3%) below the 16^th percentile of the MABC-2. Association between the outcomes of the two tests and the 6 games was calculated.

Results

High to moderate associations were found between game scores and PERF-FIT items; moderate to low associations between game scores and MABC-2 items. Principle axes factor analysis with oblique rotation revealed communalities between the explosive power and agility items of the PERF-FIT and the running and ball catching games but not between the games and the balance items.

Conclusions and implications

Scores on the PERF-FIT are significantly related to performance in active play. The tool is able to measure aspects of motor skills, muscle endurance and explosive power needed in children's active games and could be used as an additional tool to measure requirements for participation in everyday physical activity in children with and without developmental disorders.

Health Promotion Practices and Michel Foucault: A Scoping Review

OBJECTIVE

To analyze Health Promotion (HP) practices in different settings worldwide, presented in studies that employed the Foucauldian framework.

DATA SOURCE

Scoping review performed on LILACS, MEDLINE, IBECS, BDENF, SciELO, CINAHL, Embase, Web of Science, and Scopus databases.

STUDY INCLUSION AND EXCLUSION CRITERIA

We included original articles, review articles, reflection articles, and case studies published in English, Portuguese, and Spanish, which addressed HP practices, analyzed using the Foucauldian framework.

DATA SYNTHESIS

In the numerical synthesis, the characteristics of the included studies were described: number of studies, types of method, year of publication, characteristics of the study population, origin countries, and the HP practices addressed in the articles. The thematic synthesis was organized according to the nature of the HP practices presented and the Foucauldian analysis matrix used.

RESULTS

The review covered 34 studies, published between 2006 and 2019, whose analysis resulted in 2 thematic synthesis: 1) HP as a biopolitical strategy in the neoliberal context; 2) HP as an expression of resistance and counter-conduct, presenting tensions, struggles, and power games.

CONCLUSION

The field of HP mostly consists of governmentality practices that reinforce the neoliberal health perspective. Some practices show resistance and counter-conduct in the face of governmentality practices, which explains the power relationships in the field of HP.

Can Functionalised Play Make Children Happy? A Critical Sociology Perspective

The functionalisation of play basically stems from the diagnosis of a global childhood inactivity crisis, the so-called "children's obesity pandemic." Hence, in the context of the activity-related guidelines, children's play appears no longer to be unproductive and purpose-free. It is rather considered an anti-obesity tool that will help children to meet physical activity recommendations. It is questionable whether such a functionalised tool can also provide what has been called the salience of the pleasures of free-play for children. Furthermore, a "normalization" of functionalised practices of play, in turn, could stigmatize children who do not or cannot adhere to these practices. Based upon this background, this paper will take a critical sociology perspective to analyse the functionalisation and medicalisation of children's play in an individualized, mediatized, and pedagogised society. In this sense, the paper aims to pay attention to how the primary goal of play in the sense of "simply make children happy" has given way to the goal of making them healthy and functional.

Children's active outdoor play: 'good' mothering and the organisation of children's free time

This qualitative study draws on the Foucault-inspired notion of biopedagogies to examine and problematise the salient factors of contemporary motherhood impacting children's active outdoor play (AOP). The study positions mothering as a practice, through which children's health and bodies are constructed and disciplined. A discourse analysis of 21 interviews with Canadian mothers identified three discursive constructions of the 'good mother': mothers as time managers, risk managers and screen-time managers. Each was characterised by discursive conflicts that compromised the provision of AOP by mothers. This study provides data necessary for successfully including AOP as a leisure practice within family-centred health promotion.

Child-Centred Care in HIV Service Provision for Children in Resource Constrained Settings: A Narrative Review of Literature

INTRODUCTION

Child-centred care approaches are increasingly gaining traction in healthcare; and are being applied in the delivery of HIV care for children in resource constrained settings. However, very little is known about their potential benefits.

METHODS

We synthesised literature from primary and secondary publications exploring the philosophical underpinnings of the concept of child-centred care, and its application to HIV service delivery for children in resource constrained settings. We concluded the review by suggesting a conceptual framework for mainstreaming and integrating child-centred care approaches in the management of HIV in resource constrained settings.

RESULTS

The philosophical underpinnings of child-centred care stem from human rights (child-rights), holism, the ecological model, and life-cycle approaches. Although there is no standard definition of child-centred care in the context of HIV, the literature review highlighted several phrases used to describe the "child-centredness" of HIV care for children. These phrases include: (i) Respect for child-healthcare rights. (ii) Using the lifecycle approach to accommodate children of different ages. (iii) Provision of age-appropriate HIV services. (iv) Meaningful participation and inclusion of the child in the healthcare consultation process. (v) Using age-appropriate language to increase the child's understanding during healthcare consultations. (vi) Age-appropriate disclosure. (vii) Primary caregiver (PCG) participation and preparation (equipping the PCGs with information on how to support their children). (viii) Creation of a child-friendly healthcare environment. (ix) Consideration of the child ecological systems to have a holistic understanding of the child. (x) Partnership and collaborative approach between children, PCGs, and healthcare workers (HCWs).

CONCLUSION

Child-centred care approaches can potentially increase child-participation, promote positive health outcomes and resilience in children living with a communicable, highly stigmatised and chronic condition such as HIV. More evidence from controlled studies is required to provide concrete results to support the application of child-centred care approaches in HIV care services.

Healthy habits are no fun: How Dutch youth negotiate discourses about food, fit, fat, and fun

In this article, we use the notion of "biopedagogical practices" to explore how Dutch youth respond to health messages that focus on body weight. Previous studies suggest that such health messages encourage body dissatisfaction in youth. Few studies, however, focus on the local/cultural specificity of youth's responses to these biopedagogical practices. In this article, we address questions about the re-interpretation of and resistance to health messages that Dutch youth engage in and how these can be understood in their local context. The data were drawn from two previously conducted studies in which a total of 64 Dutch teenagers (aged 12-18 years) took part. We employed a variety of qualitative data collection methods and a feminist poststructuralist perspective to analyze how Dutch youth negotiate biopedagogical practices about health. The results show that our participants constructed health in terms of appearance and reproduced negative constructions regarding fat embodiment. Yet they also often circumvented "healthy" lifestyle behaviors prescribed by biopedagogies of health. They did so first by avoiding physical activities because they were afraid of displaying fat embodiment in the settings of sport and physical education where surveillance is omnipresent. Second, they disregarded advice about healthy eating by drawing on having fun as an alternative discursive resource. We argue that having fun is both part of youth culture and characteristic of the discourse about sociability ( gezelligheid) that is a central element of Dutch culture.

Beyond Physical Activity: The Importance of Play and Nature-Based Play Spaces for Children's Health and Development

The reduction of child obesity continues to be a challenge worldwide. Research indicates that playing outdoors, particularly in natural play spaces, boosts children's physical activity, potentially decreasing childhood obesity. We present evidence that natural play spaces also provide for more diverse forms of play for children of varying ages and competencies. This is crucial because play spaces designed expressly for physical activity may not increase physical activity among less active children. Moreover, when researchers only examine physical activity in play, they overlook the valuable contributions that play makes to other aspects of children's health and development. To enhance research on children and their play environments, we introduce the theory of play affordances. To assist in the creation of more natural play spaces, we describe the Seven Cs, an evidence-based approach for designing children's play spaces that promotes diverse play. We end with some preliminary insights from our current research using the Seven Cs to illustrate the connections between play, nature, and children's healthy development.

'You have to do 60 minutes of physical activity per day … I saw it on TV': children's constructions of play in the context of Canadian public health discourse of playing for health

Public health institutions in many industrialised countries have been launching calls to address childhood obesity. As part of these efforts, Canadian physical activity campaigns have recently introduced children's play as a critical component of obesity prevention strategies. We consider this approach problematic as it may reshape the meanings and affective experiences of play for children. Drawing on the analytical concept of biopedagogies, we place Canadian public health discourse on play in dialogue with children's constructions of play to examine first, how play is promoted within obesity prevention strategies and second, whether children take up this public health discourse. Our findings suggest that: (i) the public health discourse on active play is taken up and reproduced by some children. However, for other children sedentary play is important for their social and emotional wellbeing; (ii) while active play is deemed to be a solution to the risk of obesity, it also embodies contradictions over risk in play, which children have to negotiate. We argue that the active play discourse, which valorises some representations of play (that is, active) while obscuring others (that is, sedentary), is reshaping meanings of play for children, and that this may have unintended consequences for children's wellbeing.

A meta-study of qualitative research examining determinants of children's independent active free play

PURPOSE

To produce a meta-study by completing a systematic review of qualitative research examining determinants of independent active free play in children.

METHOD

Following systematic electronic and manual searches and application of inclusion/exclusion criteria, 46 studies were retained and subjected to meta-method, meta-theory, and meta-data analyses, followed by a final meta-synthesis.

RESULTS

Identified determinants of independent active free play were child characteristics (age, competence, and gender), parental restrictions (safety concerns and surveillance), neighborhood and physical environment (fewer children to play with, differences in preferences for play spaces between parents and children, accessibility and proximity, and maintenance), societal changes (reduced sense of community, good parenting ideal, changing roles of parents, privatization of playtime and play spaces), and policy issues (need to give children voice). An ecological model depicting these factors, and the relationships therein, was created.

CONCLUSIONS

This comprehensive meta-study helps establish a knowledge base for children's independent active free play research by synthesizing a previously fragmented set of studies. Parents' perceived safety concerns are the primary barrier to children's active free play. These safety concerns are moderated by child-level factors (age, competence, gender) and broader social issues. Interventions should focus on community-level solutions that include children's perspectives. From a methods perspective, the reviewed studies used a range of data collection techniques, but methodological details were often inadequately reported. The theoretical sophistication of research in this area could be improved. To this end, the synthesis reported in this study provides a framework for guiding future research.

Problematizing "play-for-health" discourses through children's photo-elicited narratives

There are growing concerns in many industrialized Western societies about declining opportunities for children to play, and fears that this will have adverse health consequences for them. Informed by anti-obesity efforts, public health institutions have recently begun to advance active forms of play as a way of improving children's physical health; however, promoting play for physical health might reshape meanings of play for children. We conducted photography and interview sessions with 25 Canadian children aged 7 to 11 years to examine their representations of play. Our findings suggest that for children, (a) play is an end in itself, (b) play involves but is more than active play, (c) there is ambivalence about scheduled play, and (d) risk is considered a pleasurable component of play. These findings point to a dissonance between children's play promoted for physical health and the meaning of play for children as emotionally contingent, intrinsically motivated, and purposeless.

Turning the World Upside Down: Playing as the Deliberate Creation of Uncertainty

Risk is big business. It has assumed almost universal acceptance as an ever-present reality of life, something out there waiting to cause harm (most notably to political, economic and health systems). It commands vast resources to develop preventative measures that are the preserve of experts issuing often contradictory advice and warnings. Children’s play is caught up in this account. No longer something that children just do, it is subject to adult scrutiny that simultaneously and paradoxically attempts to manage risk and promote “risk-taking” for its perceived instrumental benefits, primarily the development of risk assessing skills. Adults thus guide children’s play, rendering children passive and needy recipients of expertise. This article takes a broader perspective to consider how this contemporary understanding of risk plays out in material discursive practices in relation to childhood, play, health and wellbeing. It then draws on conceptual tools of relationality, materiality and performativity to reconfigure playing as an emergent co-production of entangled bodies, affects, objects, space and histories in ways that make life better for the time of playing. Such moments produce health-affirming potential as an intra-dependent phenomenon rather than an individual achievement. Finally, it considers implications for “health promotion” and health enabling environments.