Project nature: promoting outdoor physical activity in children via primary care

Georgia M Griffin; Carolina Nieto; Kirsten Senturia; Marshall Brown; Kimberly Garrett; Elizabeth Nguyen; Danette Glassy; Emily Kroshus; Pooja Tandon

doi:10.1186/s12875-024-02297-5

Project nature: promoting outdoor physical activity in children via primary care

BMC Prim Care. 2024 Feb 23;25(1):68. doi: 10.1186/s12875-024-02297-5.

Authors

Affiliations

¹ Department of Pediatrics, University of Washington, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA. georgia.griffin@seattlechildrens.org.
² Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, USA.
³ University of Washington School of Public Health, 3980 15th Ave NE, Seattle, WA, 98195, USA.
⁴ Department of Primary Care & Rural Medicine, Texas A&M School of Medicine, 2900 E 29th Street, Suite 100, Bryan, TX, 77802, USA.
⁵ BestStart Washington, PO Box 318, Mercer Island, WA, 98040, USA.
⁶ Department of Pediatrics, University of Washington, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA.

Abstract

Background: Families face a range of barriers in supporting their children's active play in nature including family circumstances, environmental constraints, and behavioral factors. Evidence-based strategies to address these barriers are needed. We aimed to develop and pilot test a primary care-based family-centered behavioral intervention to promote active outdoor play in 4-10 year-old children.

Methods: Project Nature, a provider-delivered intervention that provides informational resources and an age-appropriate toy for nature play, was initially developed for children ages 0-3. With stakeholder input, we adapted existing materials for 4-10 year-olds and conducted usability testing at an urban clinic serving families from diverse backgrounds. Subsequently, we conducted a mix-methods pilot study to evaluate intervention feasibility and acceptability. Parents of 4-10 year-olds completed pre- and post-surveys (n = 22), and a purposive subset (n = 10) completed qualitative interviews. Post-intervention, pediatric providers (n = 4) were interviewed about their implementation experiences.

Results: The majority (82%) of parents liked the information provided and the remaining (18%) were neutral. Qualitatively, parents reported that: the toy provided a tangible element to help children and parents be active, they did not use the website, and they wished the intervention emphasized strategies for physical activity during cold and wet seasons. Providers felt the materials facilitated discussion about behavior change with families. There were no statistically significant changes in PA and outdoor time pre- and post-intervention.

Conclusions: Project Nature was welcomed by providers and families and may be a practical intervention to promote outdoor active play during well-child visits. Providing an age-appropriate nature toy seemed to be a critical component of the intervention, and may be worth the additional cost, time and storage space required by clinics. Building from these results, Project Nature should be revised to better support active outdoor play during suboptimal weather and evaluated to test its efficacy in a fully-powered trial.

Keywords: Health equity; Nature contact; Outdoor play; Physical activity; Primary care; Well-child care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Behavior Therapy
Child
Child, Preschool
Exercise*
Humans
Parents*
Pilot Projects
Primary Health Care