Promoting Children's Active Play in Nature via Primary Care

To assess the feasibility, acceptability, and utility of Project Nature (PN), an intervention during well-child checks, to promote children's active play in nature from the perspectives of parents and clinic staff.

Six primary care clinics in Washinton State implemented PN, including anticipatory guidance from a clinician, a nature-based toy, and written/internet based family resources, during well-child checks for 1-10 year olds. We conducted quantitative surveys of different groups of parents before (control group, n = 154) and after (intervention group, n = 131) the implementation of PN at each clinic. We analyzed differences between the 2 groups using chi-square and Mann-Whitney U tests. Postintervention, we conducted qualitative interviews with 11 clinic staff members about implementation, coded the data, and conducted thematic analysis.

The proportion of parents reporting that their child's clinician encouraged daily outdoor time was higher postintervention than the control group (85% vs 54%, P = .02). A higher proportion of parents in the intervention compared with the control group reported that the clinician encouraged daily physical activity (86% vs 71%, P = .09). Families generally reported strong satisfaction with all the intervention components. Clinic staff felt PN facilitated conversation around active outdoor play and believed that PN was feasible within their existing workflows.

PN is a feasible and acceptable approach for supporting children's active play in nature via primary care clinics. These results provide a foundation for a larger evaluation assessing the impact of PN on families' physical activity and nature-based experiences.