A Playground Training to Improve Children's Health After-school and During Recess: The PLAYground Project

A Cluster Randomized Controlled Trial of an After-school Playground Intervention to Improve Children's Physical, Social, and Emotional Health: The PLAYground Project

Schools are critical settings to foster children's health. The purpose of this two-year cluster-randomized trial is to enhance both the after-school and recess settings to provide children with knowledge and skills to facilitate active and inclusive play. The primary aim of the project is to assess the impact of a playground curriculum intervention on children's physical, social, emotional, and behavioral health. The secondary aim of the project to understand the appropriateness, feasibility, fidelity, and sustainability of implementing a playground curriculum in after-school and recess settings.

Study Overview

• Status: Completed
• Conditions: Social Skills; Physical Inactivity; Behavior, Child
• Intervention / Treatment: Behavioral: PlayOn! playground curriculum

Detailed Description

Physical, social, and emotional health are critical for children and predict good health later in life. Schools are essential settings to foster children's health as they provide access to the majority of children during crucial stages of development. In particular, recess and before/after school programming are critical sources of children's health and well-being, and core components of a whole school approach to health and wellness. The purpose of this two-year cluster-randomized trial is to enhance the quality of these existing settings through the integration of a playground curriculum designed to promote active and inclusive play.

Based on Social Cognitive Theory aligned with the Theory of Expanded, Extended, and Enhanced Opportunities, it is hypothesized that active and inclusive play through a playground curriculum intervention will improve enjoyment, knowledge, and self-efficacy (personal conditions), social and emotional learning (behavioral conditions), and the development of peer relationships (environmental conditions) among children, leading to increased physical activity and reduced behavioral incidents. The implementation (appropriateness, feasibility, fidelity, and sustainability) of the playground curriculum intervention to improve children's health will be assessed as a secondary outcome.

Participants will be recruited from elementary schools in Mesa Public Schools (Arizona) that offer after-school programming (N=14). The intervention includes the delivery of a curriculum aimed at providing students with knowledge and skills to initiate activities using playground structures. Trainings will be delivered to staff (after-school staff, recess aides, and Physical Education teachers) and students in the after-school setting. Students attending the after-school program will become Play Leaders to transfer the knowledge and skills they learn from PlayOn! to the recess setting.

The impact of the playground curriculum intervention on children's physical, social, emotional, and behavioral health after school and during recess will be measured using surveys, observations, interviews, physical activity devices, and de-identified school behavioral information. Data will be collected at all 14 school sites each fall and spring semester. In year one, seven schools will receive the intervention. Schools will be stratified to either the intervention or control group by Title 1 status - an indicator of school-level income. In year two, the seven control schools will receive the intervention to allow all schools the opportunity to benefit from the project.

• Study Type: Interventional
• Enrollment (Actual): 294
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Arizona
    • Mesa, Arizona, United States, 85201
      • Mesa Public Schools

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 7 years to 13 years (Child)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Students enrolled an after-school program in Mesa Public Schools

Exclusion Criteria:

• Students in grades kindergarten or first grade will be excluded due to their young age.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Playground Curriculum Arm; Staff (after-school staff, recess aides, and physical education teachers) receive training to implement a playground curriculum in an after-school program; children receive a training to use the curriculum during recess	Behavioral: PlayOn! playground curriculum; A staff and student training to implement a playground curriculum in after-school and recess settings
No Intervention: Program As Usual; Staff and students receive no training and participate in after-school programs and recess as usual

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean change in accelerometer-derived physical activity from baseline to six months	Accelerometer counts of sedentary, light-, and moderate-to-vigorous physical activity levels will be segmented and processed separately to determine physical activity during recess, during school, during after-school programming, out of school, and on weekends.	Baseline (month 0) and Post-intervention (approximately 6 months)
Mean change in accelerometer-derived physical activity from baseline to 12 months	Accelerometer counts of sedentary, light-, and moderate-to-vigorous physical activity levels will be segmented and processed separately to determine physical activity during recess, during school, during after-school programming, out of school, and on weekends.	Baseline (month 0) and Post-intervention (approximately 12 months)
Mean change in accelerometer-derived physical activity from baseline to 18 months	Accelerometer counts of sedentary, light-, and moderate-to-vigorous physical activity levels will be segmented and processed separately to determine physical activity during recess, during school, during after-school programming, out of school, and on weekends.	Baseline (month 0) and Post-intervention (approximately 18 months)
Mean change in student-reported personal (emotional) health from baseline to 6 months	Child-reported personal health (enjoyment, knowledge, and self-efficacy) will be collected through questionnaire with Discrete Emotions in Physical Education Scale (DEPES).	Baseline (month 0) and Post-intervention (approximately 6 months)
Mean change in student-reported personal (self-efficacy) health from baseline to 6 months	Child-reported personal health (enjoyment, knowledge, and self-efficacy) will be collected through questionnaire with Metacognitive Process in Physical Education Questionnaire.	Baseline (month 0) and Post-intervention (approximately 6 months)
Mean change in student-reported personal (social) health from baseline to 6 months	Child-reported personal health (enjoyment, knowledge, and self-efficacy) will be collected through questionnaire with Saunders psychosocial influences on physical activity scale.	Baseline (month 0) and Post-intervention (approximately 6 months)
Mean change in student-reported environmental health from baseline to 6 months	Child-reported environmental health (peer relationships) will be collected through questionnaire with the ECLS-K peer relationship scale.	Baseline (month 0) and Post-intervention (approximately 6 months)
Mean change in student-reported behavioral health from baseline to 6 months	Child-reported behavioral health (social and emotional learning) will be collected through questionnaire with the Social and Emotional Learning module of the California Healthy Kids Survey.	Baseline (month 0) and Post-intervention (approximately 6 months)
Mean change in student-reported personal (emotional) health from baseline to 12 months	Child-reported personal health indicators (enjoyment, knowledge, and self-efficacy) will be collected through questionnaire with Discrete Emotions in Physical Education Scale (DEPES).	Baseline (month 0) and Post-intervention (approximately 12 months)
Mean change in student-reported personal (self-efficacy) health from baseline to 12 months	Child-reported personal health indicators (enjoyment, knowledge, and self-efficacy) will be collected through questionnaire with Metacognitive Process in Physical Education Questionnaire.	Baseline (month 0) and Post-intervention (approximately 12 months)
Mean change in student-reported personal (social) health from baseline to 12 months	Child-reported personal health indicators (enjoyment, knowledge, and self-efficacy) will be collected through questionnaire with Saunders psychosocial influences on physical activity scale.	Baseline (month 0) and Post-intervention (approximately 12 months)
Mean change in student-reported environmental health from baseline to 12 months	Child-reported environmental health (peer relationships) will be collected through questionnaire with the ECLS-K peer relationship scale.	Baseline (month 0) and Post-intervention (approximately 12 months)
Mean change in student-reported behavioral health from baseline to 12 months	Child-reported behavioral health (social and emotional learning) will be collected through questionnaire with the Social and Emotional Learning module of the California Healthy Kids Survey.	Baseline (month 0) and Post-intervention (approximately 12 months)
Mean change in student-reported personal (emotional) health from baseline to 18 months	Child-reported personal health indicators (enjoyment, knowledge, and self-efficacy) collected through questionnaire with Discrete Emotions in Physical Education Scale (DEPES).	Baseline (month 0) and Post-intervention (approximately 18 months)
Mean change in student-reported personal (self-efficacy) health from baseline to 18 months	Child-reported personal health indicators (enjoyment, knowledge, and self-efficacy) collected through questionnaire with Metacognitive Process in Physical Education Questionnaire.	Baseline (month 0) and Post-intervention (approximately 18 months)
Mean change in student-reported personal (social) health from baseline to 18 months	Child-reported personal health indicators (enjoyment, knowledge, and self-efficacy) collected through questionnaire with Saunders psychosocial influences on physical activity scale.	Baseline (month 0) and Post-intervention (approximately 18 months)
Mean change in student-reported environmental health from baseline to 18 months	Child-reported environmental health (peer relationships) will be collected through questionnaire with the ECLS-K peer relationship scale.	Baseline (month 0) and Post-intervention (approximately 18 months)
Mean change in student-reported behavioral health from baseline to 18 months	Child-reported behavioral health (social and emotional learning) will be collected through questionnaire with the Social and Emotional Learning module of the California Healthy Kids Survey.	Baseline (month 0) and Post-intervention (approximately 18 months)
Change in number of school-reported behavioral incidents from baseline to 6 months	School-reported number of children referred to administrators for behavioral incidents	Baseline (month 0) and Post-intervention (approximately 6 months)
Change in number of school-reported behavioral incidents from baseline to 12 months	School-reported number of children referred to administrators for behavioral incidents	Baseline (month 0) and Post-intervention (approximately 12 months)
Change in number of school-reported behavioral incidents from baseline to 18 months	School-reported number of children referred to administrators for behavioral incidents	Baseline (month 0) and Post-intervention (approximately 18 months)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean perceived implementation appropriateness	Staff-reported appropriateness and feasibility of intervention collected through questionnaire with Intervention Appropriateness Measure (IAM).	Post-intervention (approximately 6 months)
Mean perceived implementation feasibility	Staff-reported appropriateness and feasibility of intervention collected through questionnaire with Feasibility of Intervention Measure (FIM).	Post-intervention (approximately 6 months)
Mean observed implementation fidelity	Researcher-reported fidelity of intervention (adherence, exposure/dose, quality of delivery, component differentiation, and participant involvement) collected using researcher-developed protocol for monthly systematic observations.	Monthly post-intervention through end of school year
Mean observed implementation sustainability	Researcher-reported fidelity of intervention (adherence, exposure/dose, quality of delivery, component differentiation, and participant involvement) collected using researcher-developed protocol for monthly systematic observations.	Post-intervention (approximately 12 months)
Mean observed implementation sustainability	Researcher-reported fidelity of intervention (adherence, exposure/dose, quality of delivery, component differentiation, and participant involvement) collected using researcher-developed protocol for monthly systematic observations.	Post-intervention (approximately 18 months)

Collaborators and Investigators

• Sponsor: Arizona State University
• Investigators: Principal Investigator: Allison Poulos, PhD, Assistant Professor, College of Health Solutions, Arizona State University; Principal Investigator: Pamela Kulinna, PhD, Professor, Mary Lou Fulton Teachers College, Arizona State University

Publications and helpful links

General Publications

• Saunders RP, Pate RR, Felton G, Dowda M, Weinrich MC, Ward DS, Parsons MA, Baranowski T. Development of questionnaires to measure psychosocial influences on children's physical activity. Prev Med. 1997 Mar-Apr;26(2):241-7. doi: 10.1006/pmed.1996.0134.
• Jackson SL, Cunningham SA. Social Competence and Obesity in Elementary School. Am J Public Health. 2015 Jan;105(1):153-158. doi: 10.2105/AJPH.2014.302208.
• Poulos A, Kulinna PH. A cluster randomized controlled trial of an after-school playground curriculum intervention to improve children's physical, social, and emotional health: study protocol for the PLAYground project. BMC Public Health. 2022 Sep 1;22(1):1658. doi: 10.1186/s12889-022-13991-3.
• Simonton KL, Garn AC, Mercier KJ. Expanding the Discrete Emotions in Physical Education Scale (DEPES): Evaluating Emotions With Behavior and Learning. Res Q Exerc Sport. 2023 Mar;94(1):35-44. doi: 10.1080/02701367.2021.1935434. Epub 2021 Dec 14.

Helpful Links

• WestEd, California Department of Education. Using CALSCHLS to assess social-emotional learning and health [Internet]. San Francisco, CA: WestEd; 2015.

Study record dates

Study Major Dates

• Study Start (Actual): August 22, 2022
• Primary Completion (Actual): December 30, 2023
• Study Completion (Actual): December 30, 2023

Study Registration Dates

• First Submitted: July 18, 2022
• First Submitted That Met QC Criteria: July 20, 2022
• First Posted (Actual): July 22, 2022

Study Record Updates

• Last Update Posted (Estimated): February 5, 2024
• Last Update Submitted That Met QC Criteria: February 1, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: Physical Activity; Schools
• Other Study ID Numbers: STUDY00015985

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: All IPD that underlie results in a publication will be de-identified and available
• IPD Sharing Time Frame: Data will become available 6 months after publication and remain available as stored in repository
• IPD Sharing Access Criteria: A link to an open-access data repository will be included in all publications. Interested parties can also contact the principal investigators of the study for data access.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No