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Participation in outdoor play is beneficial for the health, well-being, and development of children. Early childhood education centers (ECECs) can provide equitable access to outdoor play. The PROmoting Early Childhood Outside (PRO-ECO) study is a pilot randomized trial that evaluates the PRO-ECO intervention on children’s outdoor play participation. The PRO-ECO intervention included four components: ECEC outdoor play policy; educator training; ECEC outdoor space modification; and parent engagement. This study included eight ECECs delivering licensed care to children ( n  = 217) aged 2.5 to 6 years in Greater Vancouver, British Columbia, Canada. Using a wait-list control cluster randomized trial design, ECECs were randomly allocated to either the intervention arm ( n  = 4) or the wait-list control arm ( n  = 4). Change in the proportion and diversity of observed outdoor play behaviour during scheduled outdoor time was measured. Outcome data were collected at baseline, 6-month follow-up, and 12-month follow-up. The intervention effect on children’s outdoor play participation was examined using logistic regression mixed effect models. Controlling for gender, weather and temperature, there were no changes in children’s outdoor play participation following implementation of the PRO-ECO intervention in the between-group analysis. Within-group comparisons also revealed no change in play participation following the PRO-ECO intervention, however, the intervention group showed a positive effect (OR = 1.28, 95% CI = 0.97, 1.70) in play participation 6 months after implementation of the intervention. The findings indicate that further analyses on child- and ECEC-level outcomes collected as part of the PRO-ECO study, including the diversity of children’s play, is required to effectively assess the impact of this intervention.

Outdoor play is a fundamental part of childhood. Children's participation in outdoor play connects them to nature and the land, and supports their role in the natural world. Early learning and child care (ELCC) centers provide opportunities for outdoor play; however, barriers toward the provision of outdoor play exist, including educator attitudes, policies and procedures, outdoor space limitations, and adverse weather conditions. The Promoting Early Childhood Outside (PRO-ECO) 2.0 study is a community-based research partnership with Indigenous Knowledge Keepers and Elders, Indigenous and early childhood organizations, early childhood education faculty, ELCC centers, and families, aiming to expand outdoor play in ELCC centers. This paper provides an overview of the community-based design process, guided by the 5 R's-Respect, Relevance, Responsibility, Reciprocity, and Relationship-and the resulting study protocol for the mixed methods waitlist control cluster randomized trial. This study considered a 5 R's research approach from its inception, beginning with the formation of a Steering Committee and over a year of relationship building before formal study activities commenced. A key early focus was collaboratively identifying project values through an iterative process. Collectively, we worked to promote equity, disrupt power dynamics, and embed Indigenous data sovereignty principles into research agreements, marking a significant departure from traditional Western research processes. The PRO-ECO program and study protocol are implemented in partnership with 10 ELCC centers delivering licensed full-day, year-round care to children aged 2.5-6 years in rural and urban areas of British Columbia, Canada. The PRO-ECO program includes 4 components to address common barriers to outdoor play in ELCC settings. Primary outcome measures include the proportion and diversity of observed nature play behavior during dedicated outdoor times at ELCC centers as measured through observational behavior mapping. Secondary outcomes include changes in educator attitudes, quality of ELCC outdoor play space, and children's perspectives of their experiences at ELCC centers. Outcome data are collected at baseline, and 6 months and 12 months post baseline. The community's perspectives (educators, children, and families) on the project are assessed qualitatively to understand the acceptability of the PRO-ECO program. Mixed-effect models will test the effect of the PRO-ECO program on quantitative outcomes. Qualitative data will support the interpretation of quantitative findings and provide evidence on project acceptability. Participant recruitment for this study began in August 2023, and data collection was completed in March 2025. A total of 229 children, 91 staff and early childhood educators, and 40 family members were recruited to participate in this study. The PRO-ECO 2.0 study uses a rigorous experimental design within a community-based research project. The 5 R's approach grounded our work in shared values, disrupting traditional academic power relations and weaving together Indigenous and Western worldviews in the context of academic research. ClinicalTrials.gov NCT05626595; https://clinicaltrials.gov/study/NCT05626595. DERR1-10.2196/77956.

Background: Participation in outdoor play has been extensively documented as beneficial for the health, well-being, and development of children. Canadian early childhood education centers (ECECs) are important settings in young children’s lives and provide opportunities to participate in outdoor play. However, there are barriers to the provision of outdoor play opportunities at ECECs, such as adverse weather conditions, poorly designed outdoor spaces, outdoor time policies, and early childhood educator comfort levels. Objective: The PROmoting Early Childhood Outside (PRO-ECO) study is a wait-list control cluster randomized trial that evaluates the impact of the PRO-ECO intervention, an innovative outdoor play intervention, on children’s outdoor play behavior. The purpose of this paper was to provide a detailed overview of the pilot study protocol and the methods that will be used to develop, implement, and evaluate the PRO-ECO intervention. Methods: A total of 8 ECECs delivering licensed care to children aged 2.5 to 6 years in the Greater Vancouver region of British Columbia, Canada, and operated by the YMCA of Greater Vancouver (YMCA GV) are included in this study. Using a wait-list control cluster randomized trial design, we randomly allocated ECECs to either the PRO-ECO intervention arm (n=4) or the wait-list control arm (n=4). The primary outcome measures include changes in the proportion and diversity of observed outdoor play behavior during dedicated outdoor times at the ECECs as measured through observational behavior mapping. Secondary outcome measures include changes in educator attitudes; quality of ECECs’ outdoor play space; and children’s psychosocial strengths, physical activity levels, and social behaviors. A process evaluation of the acceptability of the PRO-ECO intervention in the 8 YMCA GV ECECs will also be assessed. Outcome data will be collected at baseline, 6-month follow-up, and 12-month follow-up. Mixed effect models will test the effect of the PRO-ECO intervention on quantitative outcomes. Baseline and postintervention data will be included in the analysis, controlling for the cluster design. Qualitative data will support quantitative findings and provide evidence for the acceptability of implementation. Results: Participant recruitment for this study began in August 2021, and baseline data collection was completed at all 8 ECECs in November 2021. As of April 2022, a total of 130 children have been recruited to participate in this study. Conclusions: The PRO-ECO pilot study will develop, implement, and evaluate the PRO-ECO intervention within 8 YMCA GV ECECs in the Vancouver region of British Columbia, Canada. The findings of this study will be useful for early childhood educators, ECEC providers, and policy makers to consider means for enhancing outdoor play provision and assessing the sustainability of the intervention in ECEC settings. Trial Registration: ClinicalTrials.gov NCT05075580; https://clinicaltrials.gov/ct2/show/NCT05073380 International Registered Report Identifier (IRRID): DERR1-10.2196/38365

ObjectivesThe objective of this study was to explore parent perspectives of and interest in an interactive knowledge translation platform called Child-Sized KT that proposes to catalyse the collaboration of patients, families, practitioners and researchers in patient-oriented research at British Columbia Children’s Hospital (BCCH).MethodsAn explanatory sequential mixed methods design was used over 1 year. Over 500 parents across BC completed an online survey, including a subsample of 102 parents who had accessed care at BCCH within the past 2 years. The survey explored parent perspectives about the value of their engagement at all stages of the research process and their interest in and concerns with using an online platform. Following the online survey, two focus groups were held with parents in the Vancouver area to explore themes emerging from the survey.ResultsParents expressed keen interest in engaging in research at BCCH. Parents perceived benefit from their input at all stages of the research process; however, they were most interested in helping to identify the problem, develop the research question and share the results. Although parents preferred online participation, they had concerns about protecting the privacy of their child’s information.ConclusionsParents see value in their involvement in all stages of child health research at BCCH. Their input suggests that Child-Sized KT, a hypothetical online platform, would facilitate meaningful stakeholder engagement in child health research, but should offer a customised experience and ensure the highest standard of data privacy and protection.

Elevated laughing and smiling is a key characteristic of the Angelman syndrome behavioral phenotype, with cross-sectional studies reporting changes with environment and age. This study compares levels of laughing and smiling in 12 participants across three experimental conditions [full social interaction (with eye contact), social interaction with no eye contact, proximity only] at two data points. No differences were noted in frequency of laughing and smiling over time in any condition. However, with age as a covariate, the frequency of laughing and smiling decreased over time in the full social interaction (with eye contact) condition only. As this is the first longitudinal study to explore these behaviors in Angelman syndrome, the results suggest a gene–environment–time interaction within the behavioral phenotype.