A pilot randomised controlled trial to increase the sustainment of an indoor-outdoor free play program in early childhood education and care services following the introduction of outdoor free play guidelines: a study protocol for the Sustaining Play, Sustaining Health (SPSH) trial

Abstract

Abstract Background: Early Childhood Education and Care (ECEC) settings are an important environment to support child physical activity (PA). Increasing the time children have outdoors is associated with increased activity levels. As such, ECEC guidelines recommend that childcare services provide indoor-outdoor free play programs (periods of free play located in both the indoor and outdoor environments) as a way to increase outdoor free play opportunities. In 2021, such recommendations were supported by COVID-19 regulations as a way of reducing the transmission of the virus and increasing social distancing, resulting in an increased uptake of this practice by ECEC services. As the context changes, research suggests that ECEC services could cease the implementation of such practices. The aims of this pilot randomised controlled trial (RCT) therefore, is to examine the feasibility, acceptability, and impact of a sustainment strategy to ensure ongoing implementation (sustainment) of ECEC delivered indoor-outdoor free play programs. Methods: Twenty ECEC services located in one state (New South Wales), Australia that have implemented indoor-outdoor free play programs since the release of COVID-19 related health advice will be recruited to participate. Services will be randomly allocated to receive either the sustainment strategy (intervention group) or usual care (control group). The “Sustaining Play, Sustaining Health” program consists of eight strategies, developed to address key barriers and facilitators to sustainment of health promotion programs in ECEC settings informed by the Integrated Sustainability Framework. The 6-month sustainment strategy will be delivered remotely and will target ECEC staff responsible for supporting the implementation of PA programs in the ECEC service. The outcomes are feasibility, acceptability, and impact of the sustainment strategy, which will be measured at 6-months post-baseline. Outcomes will be assessed via internal project records, staff surveys, and a self-reported measure of the amount of indoor-outdoor free play provided. Feasibility and acceptability will be assessed using descriptive statistics and impact will be compared between groups. Discussion: This study will provide important data to support the conduct of a fully powered trial within Australian ECEC settings and inform the development of future strategies to sustain population health programs in the setting. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12622001089729). Prospectively registered 5th August 2022, ANZCTR - Registration.