Prospective acceptability, feasibility and outcomes of a primary school-led outdoor play intervention for young...

BACKGROUND: Outdoor play benefits children’s mental wellbeing, social and cognitive development and physical activity levels. However, children’s outdoor play and physical activity have declined in recent years and barriers exist within their physical and social environment. Forest Schools (FS) can encourage outdoor play through familiarisation with local green spaces, but suitable spaces are limited in dense urban areas. The Play in Urban Spaces for Health (PUSH) intervention is a concept involving the use of primary school staff to support familiarisation of and regular play in local outdoor urban spaces for children aged 4–7 years. This could facilitate sustained behaviour change, whereby children use these sites with their families and have the capability and motivation to create opportunities for play within other outdoor urban spaces. The aim of this research study was to explore the prospective acceptability and feasibility of the school-led outdoor play intervention element of PUSH considering: (1) The acceptability of PUSH among primary school teaching staff and their perceived barriers and facilitators to implementation, and (2) The learning from people involved in strategic oversight and delivery of FS in urban areas, and perceived outcomes of FS. METHODS: 18 semi-structured interviews were conducted in Bradford, Yorkshire and Tower Hamlets, London UK using co-created topic guides: eight with teachers and headteachers at primary schools near potential urban play spaces to explore acceptability, and barriers and facilitators to potential future implementation of PUSH; and ten with staff involved in strategic oversight or delivery of FS through primary schools (either primary school staff or staff from private FS providers who are commissioned by schools) to capture learning and outcomes from taking children to local green spaces for outdoor play. Interview audio files were transcribed verbatim and coded deductively to explore acceptability using the theoretical framework of acceptability and inductively drawing on whole systems thinking to explore feasibility. This was subsequently followed by generation and revision of feasibility themes. The findings were used alongside insight from the broader PUSH research and academic literature to subsequently develop a theory of change and logic model. RESULTS: PUSH was generally found to be acceptable. Anticipated outcomes of PUSH aligned with those perceived by participants involved in FS. Potential barriers to implementing PUSH included curriculum pressures and safety of public spaces. However, the learning from staff involved in delivering FS provided potential solutions to incorporate into the intervention design. This included linking outdoor play to the curriculum, implementing safety rules with children when at public sites, and ensuring parents are informed of where children are being taken and of the importance of outdoor play for academic learning. The findings informed the intervention theory of change and logic model for the purpose of identifying potential mechanisms of change and guiding future implementation and evaluation. CONCLUSIONS: This study offers preliminary evidence to support the delivery of the PUSH intervention within primary schools, which may support children’s habitual outdoor play. The findings emphasise the need to incorporate activities to ensure parent and staff buy-in prior to a pilot project.