Systematic review of the impact of unstructured play interventions to improve young children's physical, social, and emotional wellbeing

The effectiveness of play as an intervention using International Classification of Functioning outcome measures for children with disabilities - a systematic review and meta-synthesis

PURPOSE

Over 240 million children worldwide experience inequities due to disablement/disability. Play is important for children's global development, to enable participation in life, and has been used in therapeutic settings. The purpose of this systematic review is to determine the effectiveness of play used in therapy for children with disabilities, to explore ways that play is used in therapy, and to classify and map outcome measures used in play-based interventions to the International Classification of Functioning.

METHODS

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

The search yielded 22 articles eligible for inclusion. A meta-analysis found significant heterogeneity for play-based intervention outcomes, precluding estimates of effectiveness. Body function and structure outcomes accounted for 61% of reported outcome measures.

CONCLUSION

There is a trend towards a small positive effect of play used in therapy for children with disabilities, but certainty of the effect is poor, and replication difficult due to heterogeneous reports of how play is used. Research aims and outcome measures focusing on meaningful aspects of activity and participation in addition to body function and structure domains of the International Classification of Functioning should be considered for play-based interventions for children with disabilities.

Examining associations between physical activity context and children meeting daily physical activity guidelines: the role of outdoor play, sports, and other organized activities

Background

Less than one-quarter of US children meet physical activity (PA) guidelines. Understanding the context in which PA occurs and how these contexts may play a role in meeting PA guidelines is an essential step toward developing effective behavioral interventions. The purpose of this study was to examine associations between PA context (sports participation, participation in other organized physical activities, active travel to school, and outdoor play) and the number of days children met PA guidelines in a representative sample of children living in Texas.

Methods

We analyzed cross-sectional data from a statewide sample of fourth-grade children in Texas who completed the 2019-2020 Texas School Physical Activity and Nutrition (Texas SPAN) survey. The Texas SPAN survey was designed to monitor the statewide prevalence of overweight/obesity among school children and assess habitual self-reported obesity-related behaviors, including diet and PA. Weighted Poisson regression models were employed to examine the associations between PA contexts (sports participation, participation in other organized physical activities, active travel to school, and outdoor play) and the number of days children met PA guidelines, adjusting for sex, race/ethnicity, overweight/obesity, urban-rural status, and economic disadvantage.

Results

A total of 16.7% of fourth-grade children met physical activity guidelines every day during the week (mean age = 9.4 ± 0.6 years; female = 48.7, 51.8% Hispanic, mean days meeting PA guideline = 3.6 ± 2.3 days). One in ten (11.2%) children did not meet daily PA guidelines on any day of the week, and 72.1% met them between 1 and 6 days. Participating in sports (b = 0.22, 95%CI:0.14, 0.30), any other organized physical activities (b=0.13, 95%CI:0.017, 0.19), and playing outdoors 1-3 days (b = 0.25, 95%CI:0.04, 0.46) and 4-7 days in the past week (b = 0.77, 95%CI:0.57, 0.97) was significantly and positively associated with the number of days children met PA guidelines.

Conclusion

Participating in sports, participating in other organized physical activities, and playing outdoors may beneficially influence the number of days children meet PA guidelines. PA programs should consider these contextual factors and investigate how to promote organized activities and outdoor play effectively and appropriately among children.

Physical Activity and Motor Skill Development During Early Childhood: Investigating the Role of Parent Support

PURPOSE

This study examined the relationship between parent physical activity (PA) support and children's motor skill development and PA during early childhood and explored the potential moderating effect of child PA and motor skills on these relationships.

METHODS

Participants (N = 589, 250 girls, meanage = 4.93 [0.59] y) were part of a larger, longitudinal cohort study. Motor skills were assessed using the Movement Assessment Battery for Children-Second Edition. Moderate to vigorous PA (MVPA) was measured using ActiGraph accelerometers. Five items were used to measure parent support frequency (1 = none, 3 = 3-4 times, 5 = daily). Moderation analyses were conducted to examine the moderating effect of MVPA and motor skills on the relationship between parent support and motor skills and MVPA, respectively.

RESULTS

Parent support was significantly related to motor skills (B = 14.45, P = .007), and child MVPA significantly moderated this relationship (B = -0.17, P = .021). The relationship between parent support and child MVPA did not reach significance (B = 2.89, P = .051); however, motor skills had a significant moderating effect (B = -0.08, P = .022).

CONCLUSIONS

These novel findings suggest parent PA support is related to child motor skills and PA during early childhood, but this relationship is context dependent. Child-level characteristics should be considered in future parent PA support research.

Advocacy for Equitable Recess in Washington State

Recess in schools is a critical opportunity for children to engage in important behaviors that can promote their health and well-being, and daily recess is recommended by the American Academy of Pediatrics and other national organizations. In Washington state, school recess is not equitably provided, with parents reporting a wide range from as little as 10 minutes to >45 minutes daily. State laws can help promote equitable and high-quality recess, but most states in the United States do not have recess laws. In 2023, a bill (Senate Bill 5257) mandating a minimum of 30 minutes of daily recess for all elementary students with provisions for other recess best practices (including not withholding recess as punishment and encouraging movement breaks for middle/high-schoolers) passed with bipartisan support in the Washington state Legislature and was signed into law. In this case study, we describe the process undertaken and lessons learned by the cross-sector coalition that spearheaded the advocacy efforts, which included pediatricians, parents, educators, community organizations, and youth.

Mitigating the effects of climate change in children's outdoor play environments

BACKGROUND

For many children, public playgrounds represent environments that are playful and important in developing good health. Without efforts to facilitate climate change adaptation of outdoor playgrounds there may be a negative impact on children's health and well-being.

AIM

With a special focus on play value, to explore the reasoning and described strategies among professionals responsible for development, planning and solutions concerning outdoor playgrounds in the context of climate change.

MATERIALS AND METHODS

Eight semi-structured interviews were held with purposefully selected interviewees. Analysis was conducted with manifest content analysis.

RESULTS

Four themes with supporting categories; 1: a new design paradigm for outdoor play environments, 2: a need for updated regulation- and security guidelines for outdoor play environments, 3: nature-based play environments are more climate change resilient, and 4: maintenance and construction of nature-based outdoor play environments. The findings showed an overall awareness and a will to use innovative and nature-based strategies and planning to deal with climate change implications for outdoor play environments.

CONCLUSIONS AND SIGNIFICANCE

The findings suggest that the strategies employed lean towards implementation of increased ecosystem services and natural elements. Ensuring strengthened resilience against hazardous climate change effects may positively facilitate diverse play activities with high play value.

Healthcare providers' promotion of physical activity among child and adolescent cancer survivors: strategies and challenges

PURPOSE

This study aims to investigate how healthcare providers (HCPs) promote physical activity (PA) to child and adolescent cancer survivors.

METHODS

Semi-structured interviews were conducted with HCPs (n = 16; women n = 12; men n = 4) who provide care for cancer survivor youth (age 3 to 18). Participants represented 7 professions, including child life specialists, oncologists, nurse practitioners, physical therapists, and social workers. A reflexive thematic analysis was conducted to explore the techniques that HCPs use to promote PA for this patient population and ways PA promotion can improve.

RESULTS

HCPs use five strategies to promote PA to cancer survivor youth: (1) broadening the definition of PA, (2) tailoring PA recommendations, (3) including families, (4) connecting patients to programming, and (5) promoting patient motivation.

CONCLUSIONS

This research highlights techniques that HCPs use to promote PA to young cancer survivors and reveals the need for additional ways to support HCPs to improve PA promotion for child and adolescent cancer survivors. While HCPs emphasized the importance of PA for this patient population, they navigate barriers that limit the quality of PA discussions.

IMPLICATIONS FOR CANCER SURVIVORS

Further research should explore interventions to improve PA promotion and PA participation among child and adolescent cancer survivors. By understanding the perspectives of HCPs, patients, and their families, PA promotion strategies can be improved, and more programs that support both patients and practitioners may be developed.

Current evidence and opportunities in child and adolescent public mental health: a research review

BACKGROUND

A public mental health lens is increasingly required to better understand the complex and multifactorial influences of interpersonal, community and institutional systems on the mental health of children and adolescents.

METHODS

This research review (1) provides an overview of public mental health and proposes a new interactional schema that can guide research and practice, (2) summarises recent evidence on public mental health interventions for children and adolescents, (3) highlights current challenges for this population that might benefit from additional attention and (4) discusses methodological and conceptual hurdles and proposes potential solutions.

RESULTS

In our evidence review, a broad range of universal, selective and indicated interventions with a variety of targets, mechanisms and settings were identified, some of which (most notably parenting programmes and various school-based interventions) have demonstrated small-to-modest positive effects. Few, however, have achieved sustained mental health improvements.

CONCLUSIONS

There is an opportunity to re-think how public mental health interventions are designed, evaluated and implemented. Deliberate design, encompassing careful consideration of the aims and population-level impacts of interventions, complemented by measurement that embraces complexity through more in-depth characterisation, or 'phenotyping', of interpersonal and environmental elements is needed. Opportunities to improve child and adolescent mental health outcomes are gaining unprecedented momentum. Innovative new methodology, heightened public awareness, institutional interest and supportive funding can enable enhanced study of public mental health that does not shy away from complexity.

An exploration of parent perceptions of a take-home loose parts play kit intervention during the COVID-19 pandemic

The restrictions introduced in response to the COVID-19 pandemic affected the regular routines of Canadians, including access to play and physical activity opportunities, while limiting social connections. In response to this, a recreation centre created take-home play kits that contained loose parts with the aim of facilitating unstructured play. Between August 2021 and January 2022, ten parents participated in semi-structured interviews via telephone or videoconferencing platforms that captured their experiences of the take-home play kits. Using Thematic Analysis, we identified themes and subthemes reflecting parent perceptions and experiences of the take-home play kit. Three themes emerged: (1 A forced renaissance of play; (2) Bringing unstructured play home, and; (3) Parenting is child's play. Parents shared how the pandemic resulted in decreased physical activity and social opportunities for their children. The parents described how the take-home play kits supported unstructured play as well as their perspectives on the importance of unstructured play. Parents in our study suggested that a take-home loose parts play kit could be a useful resource to help engage children in unstructured play in both indoor and outdoor environments.

Consensus statement on Singapore integrated 24-hour activity guide for early childhood

Introduction

Early childhood is a critical period for growth and development. Adopting healthy lifestyle behaviours during this period forms the foundation for future well-being and offers the best protection against non-communicable diseases. Singapore studies have shown that many young children are not achieving the recommendations on physical activity, sedentary behaviour and sleep. A workgroup was set up to develop recommendations for caregivers of infants, toddlers and preschoolers (aged <7 years) on how to integrate beneficial activities within a daily 24-hour period for optimal development and metabolic health.

Method

The Grading of Recommendations Assessment, Development and Evaluation (GRADE)- ADOLOPMENT approach was employed for adoption, adaption or de novo development of recommendations. International and national guidelines were used as references, and an update of the literature reviews up to September 2021 was conducted through an electronic search of PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases.

Results

Four consensus statements were developed for each age group: infants, toddlers and preschoolers. The statements focus on achieving good metabolic health through regular physical activity, limiting sedentary behaviour, achieving adequate sleep and positive eating habits. The 13th consensus statement recognises that integration of these activities within a 24-hour period can help obtain the best results.

Conclusion

This set of recommendations guides and encourages caregivers of Singapore infants, toddlers and preschoolers to adopt beneficial lifestyle activities within each 24-hour period.

Improving the Scope of Child Mental Health Interventions in Our Modern World

Twenty years ago, an important systematic review showed that the empirical research evidence for interventions available for children and young people with mental health problems were rarely developed with their specific developmental needs in mind [...].

An Observational Study on Play and Physical Activity Associated with a Recreational Facility-Led Park-Based "Loose Parts" Play Intervention during the COVID-19 Pandemic

Play is a human right, yet opportunities for unstructured play are declining. The COVID-19 pandemic further reduced children's play opportunities. We conducted an observational study of a novel community-based intervention (play hubs) that facilitated unstructured play by offering loose parts in parks (Calgary, Canada) during the pandemic. Our descriptive study included systematic observation using the System for Observing Children's Activity and Relationships During Play (SOCARP) and Tool for Observing Play Outdoors (TOPO) to capture physical activity, play, and social and environment interactions among children participating in the play hubs for 10-weeks in 2021 (n = 160) and 2022 (n = 147). Play hub attendance was low. Most children observed were aged 5 to 12 years (2021: 93% and 2022 98%), with boys and girls represented (2021: 58% male/42% female and 2022: 52% male/48% female). Standing, sitting, and moderate activity were common activities. Physical, exploratory, and expressive play were common, while digital, bio, and rule-based play were less common. Children typically played alone or in small groups and engaged with loose parts or played in the open spaces. The play hubs encouraged unstructured play and promoted positive social interactions among children, despite the challenges of implementing a community-based intervention under pandemic public health restrictions.

The feasibility of using the Körperkoordinationstest fur Kinder (KTK) in a U.S. elementary physical education setting to assess gross motor skills specific to postural balance

Introduction

For the past ten years, falls have been the leading cause of nonfatal injuries for all age groups less than 15 years old. A significant rise in childhood sedentary behavior in schools and limited opportunities to be outside has led to motor coordination deficits which have contributed to fall injuries.

Method

A German assessment tool, the Körperkoordinationstest fur Kinder (KTK), which has been used for decades in Western European countries, allows researchers and physical education teachers to evaluate typical and atypical children's motor coordination competencies related to dynamic postural balance successfully. No research has been published on the use of this assessment tool in the United States. If its use were found to be feasible in this country for identifying motor coordination deficits in typical and atypical children, it would close the gap in determining motor coordination. Therefore, this study sought in Phase 1 to determine the feasibility of using the KTK assessment in U.S. children and Phase 2 sought to determine the adaptability of the scoring protocol from use in other countries to the United States.

Results

The Phase 1 results revealed the KTK assessment was feasible to administer in U.S. physical education class by addressing three challenges for U.S. schools: 1) KTK implementation, 2) time to assess each skill, and 3) the equipment availability and cost to implement the test in a physical education setting. In Phase 2, the researchers were able to determine the raw scores and motor quotient scores in this population and then were able to show similar scoring trends between U.S. children and Flemish children from a previous study.

Conclusion

This assessment tool was deemed feasible and adaptable which is the first step to use the KTK in U.S. physical education elementary school settings.

Changes in social interaction, social relatedness, and friendships in Education Outside the Classroom: A social network analysis

Introduction

Social interaction is associated with many effects on the psychological level of children such as mental health, self-esteem, and executive functions. Education Outside the Classroom (EOtC) describes regular curricular classes/lessons outside the school building, often in natural green and blue environments. Applied as a long-term school concept, EOtC has the potential to enable and promote social interaction. However, empirical studies on this topic have been somewhat scant.

Methods

One class in EOtC (N  = 24) and one comparison class (N = 26) were examined in this study to explore those effects. Statistical Actor-Oriented Models and Exponential Random Graph Models were used to investigate whether there are differences between EOtC and comparison class regarding changes over time in social interaction parameters; whether a co-evolution between social interaction during lessons and breaks and attendant social relatedness and friendships exists; whether students of the same gender or place of residence interact particularly often (homophily).

Results

Besides inconsistent changes in social interaction parameters, no co-evolutional associations between social interaction and social relatedness and friendships could be determined, but grouping was evident in EOtC. Both classes showed pronounced gender homophily, which in the case of EOtC class contributes to a fragmentation of the network over time.

Discussion

The observed effects in EOtC could be due to previously observed tendencies of social exclusion as a result of a high degree of freedom of choices. It therefore seems essential that in future studies not only the quality of the study design and instruments should be included in the interpretation - rather, the underlying methodological-didactic concept should also be evaluated in detail. At least in Germany, it seems that there is still potential for developing holistic concepts with regards to EOtC in order to maximize the return on the primarily organizational investment of implementing EOtC in natural environments.

The relationship between physical exercise and subjective well-being among Chinese junior high school students: A chain mediating model

Objective

This study aims to help understand the mechanism behind the relationship between physical exercise and the subjective well-being among Chinese junior high school students, and it is of great significance for the intervention measures to improve the subjective well-being of junior high school students.

Methods

Using stratified cluster sampling method, 1,510 junior high school students (727 males and 783 females) were measured by physical exercise rating scale, perceived social support scale, physical exercise self-efficacy scale, and subjective well-being scale. For data analysis, Pearson's correlation analysis, structural equation model test, and bias-corrected percentile Bootstrap method were carried out in turn.

Results

Common method biases can be accepted in this study. (1) There is a positive correlation between physical exercise and subjective well-being, and physical exercise has a significant predictive effect on subjective well-being(β = 0.367 t = 9.415 p < 0.01); (2) Perceived social support partially mediated the relationship between physical exercise and subjective well-being (β = 0.08, t = 3.083, p < 0.01), and its effect ratio is 78.047%; (3) Physical exercise self-efficacy plays a partial mediating role between physical exercise and subjective well-being(β = 0.181, t = 5.132, p < 0.01), accounting for 50.632%; (4) The chain mediating effect of perceived social support and physical exercise self-efficacy was significant (the mediating effect value was 0.028), and the effect amount was 7.629%.

Conclusion

(1) Physical exercise can significantly positively predict the subjective well-being of junior high school students; (2) Physical exercise can also indirectly affect the subjective well-being of junior high school students through the mediating effect of perceived social support and physical exercise self-efficacy. The intermediary effect includes three paths, namely, the individual intermediary effect of perceived social support and physical exercise self-efficacy and the chain intermediary effect of perceived social support physical exercise self-efficacy.

Play therapy in children with autism: Its role, implications, and limitations

Play is a pleasurable physical or mental activity that enhances the child’s skills involving negotiation abilities, problem-solving, manual dexterity, sharing, decision-making, and working in a group. Play affects all the brain's areas, structures, and functions. Children with autism have adaptive behavior, adaptive response, and social interaction limitations. This review explores the different applications of play therapy in helping children with autism disorder. Play is usually significantly impaired in children with autism. Play therapy is mainly intended to help children to honor their unique mental abilities and developmental levels. The main aim of play therapy is to prevent or solve psychosocial difficulties and achieve optimal child-healthy growth and development. Play therapy helps children with autism to engage in play activities of their interest and choice to express themselves in the most comfortable ways. It changes their way of self-expression from unwanted behaviors to more non-injurious expressive behavior using toys or activities of their choice as their words. Play therapy also helps those children to experience feeling out various interaction styles. Every child with autism is unique and responds differently. Therefore, different types of intervention, like play therapy, could fit the differences in children with autism. Proper evaluation of the child is mandatory to evaluate which type fits the child more than the others. This narrative review revised the different types of play therapy that could fit children with autism in an evidence-based way. Despite weak evidence, play therapy still has potential benefits for patients and their families.

Asia-Pacific consensus statement on integrated 24-hour activity guidelines for the early years

Background

Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia-Pacific region, NCDs are significant causes of healthcare burden and mortality. Furthermore, there is also a high prevalence of adverse metabolic risk factors and unhealthy lifestyle behaviours among these children.

Method

Representatives from 19 Asia-Pacific nations and/or jurisdictions developed a consensus statement on integrated 24-hour activity guidelines for the early years using the GRADE-ADOLOPMENT framework.

Findings

These guidelines apply to all infants, toddlers and pre-schoolers below 5 years of age. The guidelines aim to provide a holistic and practical approach to lifestyle activities by framing physical activity, sedentary behaviour and sleep within a 24-hour period. Dietary patterns were included as they play an integral role in metabolic health and energy balance.

Interpretation

Aligned with the World Health Organization's Global Action Plan for the Prevention and Control of NCDs through health promotion interventions in early life, through cultivating healthy lifestyle behaviours in the children's early years, we aim to provide children with the best start in life and reduce the burden of future NCDs in the Asia-Pacific region.

Funding

Funded by Integrated platform for research in advancing metabolic health outcomes of women and children.

Children's Usage of Inclusive Playgrounds: A Naturalistic Observation Study of Play

Inclusive playgrounds that are designed to be physically accessible and welcoming to children with disabilities may provide equal and equitable access to play for all children. Using a naturalistic observational design, this study examines children's use of a playground designed to be accessible and inclusive for all ages and abilities. A modified version of the System for Observing Play and Recreation in Communities was used to collect child data on observed gender, age, play behaviour types, social interactions, and activity levels. A relatively equal number of female (52%) and male (48%) observations was made, and the majority (96%) of children observed appeared to be under 12 years of age. Most children (71%) were observed to be engaging in active play. Functional play (e.g., climbing, swinging, running) was the predominant play behaviour observed on the playground (88%), and the majority of social interactions were with peers (48%) or an adult (26%). These findings provide information on how children use a playground designed to be inclusive for children of all ages and abilities. This information can be used to help inform the design of inclusive play spaces as well as types of programming that may occur within such settings.

Urban Environment, Green Urban Areas, and Life Quality of Citizens-The Case of Warsaw

The increased migration of people from rural areas to cities has prompted researchers to take an interest in the problem of the quality of life (QOL) of the urban population in different contexts. The aim of the study was to determine the relationship between the level of satisfaction of Warsaw residents with urban infrastructure (SUI) and their QOL, the impact of the SUI on the perception of a neighborhood as an ideal place to live and the relationship between the amount of green areas and and the SUI of Warsaw residents and their QOL. The quantitative survey was conducted using the CAWI method on a sample of 381 adults. The WHOQOL-BREF questionnaire was used to measure QOL, the scale used in earlier surveys was used to assess SUI, areas of of Warsaw with different amounts of green space were distinguished using cluster analysis. The study showed a relationship between the SUI declared by residents and their QOL, mainly in the environmental domain. The discriminant analysis showed that satisfaction with greenery is one of the most important determinants of the subjective perception of a neighborhood as an ideal place to live. There was no direct effect of the amount of green areas in objective terms on the QOL of Warsawians, but a relationship was noted between the amount of green areas and SUI, with the highest level of satisfaction noted for the Green-balanced Cluster, characterized by the most favorable combination of quality and utility of urban area.

Parent-mediated play-based interventions to improve social communication and language skills of preschool autistic children: A systematic review and meta-analysis protocol

Early years interventions have shown to be effective in improving the social communication and language skills of autistic children. Therefore, various play-based interventions have been developed to support those developmental areas of autistic children. Although researchers have previously reported the overall effectiveness of different types of play-based interventions on the social communication and language skills of autistic children, no previous systematic reviews have yet evaluated the effectiveness of parent-mediated play-based interventions in preschool autistic children. The overarching aims of the study will be to (i) report the key characteristics and (ii) synthesise the results of studies evaluating parent-mediated play-based interventions targeting the social communication and language skills of preschool autistic children using experimental designs. A comprehensive search for and screening of the relevant studies published between 2000 and 2021 will be undertaken. To be included, studies will have to (i) use either a randomised control trial or quasi-experimental design, (ii) focus on preschool autistic children aged six years old or younger, (iii) deliver a play-based intervention in non-educational settings, and (iv) include at least one parent as the mediator of the intervention. Data extraction of all included studies will be undertaken using a specially devised template and they will also be assessed for risk of bias using an adapted form from the Cochrane Risk of Bias tool. The overall characteristics of the included studies will be reported and a narrative synthesis of the results of the included studies will be undertaken. A meta-analysis may be performed (if justified) to report the pooled effect size of the parent-mediated play-based interventions on the social communication and language skills of preschool autistic children. Trial registration: The current study protocol was pre-registered with the international prospective register of systematic reviews (PROSPERO: CRD42022302220).

Playground Inclusivity for Children With a Disability: Protocol for a Scoping Review

BACKGROUND

Although playgrounds are designed to promote outdoor play, children with disabilities may be unable to engage in these spaces due to intrinsic and extrinsic factors. Previous research has examined inclusive/accessible playground design when developing new playgrounds; however, it is unclear if there is a best-practice tool for evaluating the inclusivity of existing playground structures.

OBJECTIVE

A scoping review of both peer-reviewed and grey literature will be employed to explore evaluation tools for playground inclusivity, to enable the participation of children with disabilities.

METHODS

The conduct of this study will adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A search for peer-reviewed research studies will be conducted in the following electronic databases: MEDLINE, Scopus, CINAHL, and Embase. Grey literature will be examined via a three-step process: (1) a search in the Canadian Health Research Collection Database; (2) a targeted Google search; and (3) reference list searching. Titles, abstracts, keywords, and full texts of identified studies will be independently screened for inclusion by two reviewers. A synthesis of included articles will describe the publication and auditing tool details. A summary of the findings will highlight the types of playgrounds measured, types of disability considered, measures of inclusion used, and psychometric properties.

RESULTS

Database searches for peer-reviewed articles were completed in December 2021. A total of 1471 unique records were returned after the removal of 559 duplicate records. Full texts of 167 studies meeting eligibility criteria will be reviewed. The peer-reviewed research search will guide the grey literature search. The scoping review is planned for completion in 2022.

CONCLUSIONS

A rigorous search of the literature will determine the availability of tools for evaluating existing playground structures for the inclusivity of children with disabilities. The results will inform recommendations on tool applications, and applicable knowledge translation activities.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/37312.

A Socioecological Perspective of How Physical Activity and Sedentary Behaviour at Home Changed during the First Lockdown of COVID-19 Restrictions: The HomeSPACE Project

The COVID-19 pandemic forced school closures, resulting in home schooling, more time spent at home and fewer opportunities for physical activity (PA). This study explored factors influencing PA and sedentary behaviours (SB) within the home environment during the first lockdown, starting in March 2020. Twenty semi-structured interviews (20 parents and 23 children, 12 years ± 1.25) were conducted. Data were coded using thematic analysis on NVivo© and concepts from McLeroy’s socioecological model for health promotion were used to analyse the data. Findings indicate that children’s PA and SB at home were influenced by: (i) individual-level factors (e.g., gender, competence, attitudes and motivation); (ii) interpersonal-level factors (e.g., siblings, parents, pets, friends and coaches); (iii) organisation-level factors (e.g., school, clubs and societies), (iv) community-level factors (e.g., home and local environment, access to facilities, social norms, time constraints and home equipment), and (v) policy-level factors (e.g., lockdown restrictions). Stay-at-home mandates resulted in perceived reductions in PA and increases in SB within the home; however, this provided alternative positive opportunities for families, including more time to spend together and exploring green and blue spaces in the local area.

Adverse childhood experiences are important but not the only risk to child development: Revisiting a full risk/resilience matrix

Much research has sought to distinguish key interacting factors affecting children as they develop which influence later outcomes. Some factors, notably adverse childhood experiences (ACEs), pose serious risks for later health or mental health problems for the children or predispose them for involvement in offending behaviours. However, other experiences, alongside ACEs, also pose risks and yet others offer protection. A matrix showing interacting influences from the mother's pregnancy onwards was published earlier; a revised matrix has been developed, showing a fresh picture of cumulative risk and protective factors.

The Pursuit of Happiness: Leadership Challenges of Recognising and Supporting Child Health and Wellbeing in the Early Years

This study examined the leadership approach to child health and wellbeing within the early-years sector; it drew upon the evidence from thirty-two practitioners and ten nursery managers. Practitioners evidenced the challenges in recognising the signs and symptoms of low wellbeing and in monitoring progress. A constructivist paradigm enabled qualitative data to be collected from an interactive questionnaire and three focus groups of nursery managers. Analysis was supported by two wellbeing models: the PERMA model (Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment) and the SHANARRI wheel (Safe, Healthy, Achieving, Nurtured, Active, Respected, Responsible, Included). The findings accentuated the lack of confidence of practitioners in identifying the precursors of health and wellbeing, and their ability to monitor the progress to support children. In conclusion, a clear definition of health and wellbeing should be adopted by managers; their leadership is vital to support the training of practitioners sharing their knowledge and experience to less-qualified staff. The main issues to transpire highlighted that clear mandatory guidance should be available for early-years practitioners, and the creation of a bespoke early-years model to measure child health and wellbeing.

Impact of an outdoor loose parts intervention on Nova Scotia preschoolers' fundamental movement skills: a multi-methods randomized controlled trial

Development of fundamental movement skills in early childhood supports lifelong health. The potential for outdoor play with loose parts to enhance fundamental movement skills has not been investigated. A multi-methods randomized controlled design was used to determine the efficacy of integrating outdoor loose parts play into Nova Scotia childcare centers (19 sites: 11 interventions, 8 control). Movement skills (n = 209, age 3-5 years) were assessed over a 6-month period to investigate changes in fundamental movement skills over time and between groups. Qualitative data was also collected on the educators' perceptions of outdoor loose parts play. Quantitative data (fundamental movement skills) revealed a non-intervention effect, however, educators spoke of outdoor loose parts play providing opportunities to combine/ repeat movements and take risks; supporting physical, cognitive and socio-emotional (holistic) development; and increasing awareness of children's physical development and how to support it. Our findings demonstrate value in outdoor loose parts play for the development of fundamental movement skills in childcare settings.