Randomized Controlled Trial of a Risk Reframing Tool to Change Mothers' Parenting Associated With Children's Risky Play

• Sponsor: University of British Columbia (Other)
• Overall Status: Completed
• CT.gov ID: NCT03374683
• Collaborator: The Lawson Foundation (Other)
• Enrollment: 451
• Location: 1
• Arms: 3
• Actual Duration (Months): 10
• Patients Per Site Per Month: 45.3

Study Details

Study Description

Brief Summary

Children's risky play is associated with a variety of positive developmental, physical and mental health outcomes, including greater physical activity, self-confidence and risk management skills. Children's opportunities for risky play have eroded over time, limited by parents' fears and beliefs about risk, particularly among mothers. We have developed a digital and in-person workshop version of a tool to reframe parents' perceptions of risk. We examined whether the tool increased mothers' tolerance for risky play and influenced parenting behaviour change, in the short and long term, and whether these changes were greater than those in the control group.

We conducted a single-blind (researchers and outcome assessors) randomized controlled trial and recruited a total of 410 mothers of children aged 6-12 years. The risk reframing (RR) digital tool is designed for a one-time visit and includes three chapters of self-reflection and experiential learning tasks. The RR in-person tool is a 45-90 minute facilitated workshop in which participants were guided through discussions of the same tasks contained within the digital tool. The control condition consisted of reading the Position Statement on Active Outdoor Play.

Primary outcome was increased tolerance of risk in play, as measured by the Tolerance of Risk in Play Scale. Secondary outcome was self-reported attainment of a behaviour change goal that participants had set for themselves. We tested the hypothesis that there would be differences between the experimental and control groups with respect to tolerance of risk in play and goal attainment.

Condition or Disease	Intervention/Treatment	Phase
Risk Assessment; Parenting	Behavioral: RR Digital Tool; Behavioral: RR In-Person Workshop; Behavioral: Position Statement on Active Outdoor Play	N/A

Detailed Description

The study used 3-group parallel randomized controlled trial design.

Participants were recruited through advertising on social media, distributing notices through our networks, snowball sampling, and posting notices in community centres. The aim was to obtain complete data on 375 participants. Interested participants completed a questionnaire in REDCap electronic data capture tool hosted at British Columbia Children's Hospital Research Institute to answer eligibility questions and provide informed consent. Enrolled participants received a link to the baseline questionnaire package to be completed in REDcap.

Once participants were deemed eligible for the study, they were allocated to one of the three conditions: 1) Control group; 2) RR digital tool; and 3) RR in-person workshop. Participants in Condition 1 were provided with a link to the Position Statement on Active Outdoor Play, which included information on research and recommendations for action. Participants in Condition 2 were provided with a link to the RR digital tool to complete at their leisure. Participants in Condition 3, were scheduled to attend the RR in-person workshop. The randomization schedule was generated beforehand in sealedenvelop.com using blocks of size 3, 6, and 9. The list was then transferred to REDCap.

Honoraria were paid at each time point as compensation for participation. Participants attending in-person RR workshops were provided with an additional honorarium to compensate them for any expenses incurred in attending, such as travel or childcare.

Participants had an equal likelihood of assignment to each condition (33%). The nature of the intervention did not permit participant blinding but they were informed of their allocated treatment after completing the baseline questionnaires. The in-person workshop facilitator could not be blinded to allocation as the other two arms did not have a facilitator. Likewise, research staff who coordinated in-person workshop schedules could not be blinded to the allocation of the in-person workshop. However, allocations were concealed to the researchers at participant assignment and data analysis.

Participants completed a questionnaire package at three time points: Baseline, 1-week post-intervention, and 3-months post-intervention. Survey data were collected and managed using REDCap.

The study hypotheses were:

1. Mothers completing the RR digital tool will have a significantly greater increase of tolerance for risk in play than mothers in the control condition.

2. Mothers completing the RR in-person workshop will have a significantly greater increase of tolerance for risk in play than mothers in the control condition.

3. A greater proportion of mothers completing the RR digital tool will attain their behaviour change goal, than mothers in the control condition.

4. A greater proportion of mothers completing the RR in-person workshop will attain their behaviour change goal than mothers in the control condition.

Study Design

• Study Type: Interventional
• Actual Enrollment: 451 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Double (Investigator, Outcomes Assessor)
• Primary Purpose: Prevention
• Official Title: Go Play Outside! Effects of a Risk Reframing Tool on Mothers' Tolerance for and Parenting Practices Associated With Children's Risky Play - a Randomized Controlled Trial
• Actual Study Start Date: Dec 1, 2017
• Actual Primary Completion Date: Sep 30, 2018
• Actual Study Completion Date: Sep 30, 2018

Arms and Interventions

Arm	Intervention/Treatment
Experimental: RR Digital Tool Participants in the RR digital tool were provided with a link to the web-based intervention (https://outsideplay.ca) to complete within one week.	Behavioral: RR Digital Tool; Participants proceed through three chapters in the tool: https://outsideplay.ca. Chapter 1: most important attributes they want for their child; their child's favourite play activities; their own childhood play activities; how their child's and their own play activities compare. Chapter 2: imagining themselves in three video segments where they must decide whether they allow their child to climb a tree, walk home from school, and use box cutters to build a fort. They reflect on their barriers and things that helped them let go. Chapter 3: revisiting the most important attributes they want for their child and whether there is anything they want to change, setting a realistic goal, outlining steps for attaining that goal, and setting start date.
Active Comparator: RR In-Person Workshop Participants in the in-person workshop attended the 45-90 minute in-person workshop.	Behavioral: RR In-Person Workshop; Participants engage in a facilitator guided discussion of the same tasks as the RR digital tool. Participants are taken through each task using PowerPoint slides that include the videos from the digital tool. The facilitator guide contains detailed guidance on discussion for each component and length of time to be dedicated to each slide. Participants are provided with a paper booklet to complete that mimics the online tasks.
Sham Comparator: Position Statement on Active Outdoor Play Participants in the control condition were provided with a web link to the Position Statement on Active Outdoor Play, which includes information on research and recommendations for action.	Behavioral: Position Statement on Active Outdoor Play; The position statement summarizes the issues and research regarding children's access to outdoor play and provides recommendations for various stakeholders. It states that "access to active play in nature and outdoors - with its risks - is essential for healthy child development" and recommends increasing children's opportunities for self-directed play in all settings. The Position Statement includes recommendations for parents, educators, health professionals, administrators and various level of governments to address the barriers to children's outdoor play. It addresses common misconceptions and encourages that danger be differentiated from risk and outdoor play and fun be valued as much as safety (ParticipACTION Canada, 2015; Tremblay et al., 2015).

Outcome Measures

Primary Outcome Measures

1. Change in Tolerance of Risk in Play Scale (TRiPS) [Baseline, 1-week-post-intervention, 3-month-post-intervention]

   The primary outcome measure was increase in the total score on the Tolerance for Risk in Play Scale (TRiPS), a 31-item measure examining adults' tolerance of risk during children's play. This analysis was conducted using mirt package in R software (Chalmers, 2012). Rasch analysis of the baseline data resulted in dropping one item ("Do you allow this child to play-fight, testing who is strongest?") due to local dependence. Theta standardized scores from the Rasch analysis of the final 30-item TRiPS total scale ranged from -3.372 to 1.975, with a mean of 0.000 (SD 0.974). A higher standardized score indicates higher tolerance of risky outdoor play.

Secondary Outcome Measures

1. Self-reported Behaviour Change [1-week-post-intervention, 3-month-post-intervention]

   The secondary outcome measure was self-reported behavior change, measured by participants' self-reported progress on attaining the goal they set for themselves within the risk reframing intervention. At each follow-up, participants were reminded of their goal (by asking "at the beginning of the study, you set a goal for yourself regarding something you wanted to change to give your child more opportunities for risky play. Have you made progress toward this goal?") and asked "Did you accomplish your goal?" with "Yes" and "No" response options. For the purpose of our analyses the category of "Yes" is an indication of behaviour change while the category of "No" is an indication of no behaviour change.

Eligibility Criteria

Criteria

• Ages Eligible for Study: N/A and Older
• Sexes Eligible for Study: Female
• Accepts Healthy Volunteers: Yes

Inclusion Criteria:

• Being a mother with primary custody of a child/children aged 6-12 years

• Residing in the Metro Vancouver Regional District

• Being able to speak, read and understand English

Exclusion Criteria:

• Being a father

• Not having a child between the ages of 6-12 years

• Not having primary custody of the child

• Not residing in Metro Vancouver Regional District

• Limited English skills

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	British Columbia Children's Hospital Research Institute	Vancouver	British Columbia	Canada	V6H 3V4

Sponsors and Collaborators

• University of British Columbia
• The Lawson Foundation

Investigators

• Principal Investigator: Mariana Brussoni, PhD, University of British Columbia

Study Documents (Full-Text)

• Study Protocol and Statistical Analysis Plan - Dec 31, 2018
• Informed Consent Form - Dec 5, 2018

More Information

Additional Information:

• Canadian Position Statement on Active Outdoor Play
• Risk Reframing Digital Tool

Publications

• Brussoni M, Ishikawa T, Han C, Pike I, Bundy A, Faulkner G, Mâsse LC. Go Play Outside! Effects of a risk-reframing tool on mothers' tolerance for, and parenting practices associated with, children's risky play: study protocol for a randomized controlled trial. Trials. 2018 Mar 7;19(1):173. doi: 10.1186/s13063-018-2552-4.
• Hill A, Bundy AC. Reliability and validity of a new instrument to measure tolerance of everyday risk for children. Child Care Health Dev. 2014 Jan;40(1):68-76. doi: 10.1111/j.1365-2214.2012.01414.x. Epub 2012 Jul 30.
• ParticipACTION. The Biggest Risk Is Keeping Kids Indoors: ParticipACTION Report Card on Physical Activity for Children and Youth. Toronto, Ontario; 2015.
• Sandseter EB. Characteristics of risky play. J Adventure Educ Outdoor Learn. 2009;9(1):3-21. doi:10.1080/14729670802702762.
• Tremblay MS, Gray C, Babcock S, Barnes J, Bradstreet CC, Carr D, Chabot G, Choquette L, Chorney D, Collyer C, Herrington S, Janson K, Janssen I, Larouche R, Pickett W, Power M, Sandseter EB, Simon B, Brussoni M. Position Statement on Active Outdoor Play. Int J Environ Res Public Health. 2015 Jun 8;12(6):6475-505. doi: 10.3390/ijerph120606475. Review.

• Responsible Party: Mariana Brussoni, Principal Investigator, University of British Columbia
• ClinicalTrials.gov Identifier: NCT03374683
• Other Study ID Numbers: H15-03271
• First Posted: Dec 15, 2017
• Last Update Posted: Jun 28, 2021
• Last Verified: Jun 1, 2021

• Individual Participant Data (IPD) Sharing Statement: Yes
• Plan to Share IPD: Yes
• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No
• Keywords provided by Mariana Brussoni, Principal Investigator, University of British Columbia: Risky play; Physical activity; Injury prevention; Outdoor play

Study Results

Participant Flow

Recruitment Details	Participants were recruited through advertising on online forums and social media, distributing notices through our networks, snowball sampling and posting notices in community centers. Recruitments were active from December 2017 to May 2018 in the Metro Vancouver area.
Pre-assignment Detail	Participants were randomized to a condition when they were deemed eligible. After being randomized, participants received the socio-demographic questionnaire and the intervention. A total of 451 participants who completed the socio-demographic questionnaire were included in the study.

Arm/Group Title	Position Statement Active Outdoor Play	Risk Reframing (RR) Digital Tool	RR In-Person Workshop
Arm/Group Description	Position Statement Active Outdoor Play: The position statement summarizes the issues and research regarding children's access to outdoor play and provides recommendations for various stakeholders. It states that "access to active play in nature and outdoors - with its risks - is essential for healthy child development" and recommends increasing children's opportunities for self-directed play in all settings. The Position Statement includes recommendations for parents, educators, health professionals, administrators and various level of governments to address the barriers to children's outdoor play. It addresses common misconceptions and encourages that danger be differentiated from risk and outdoor play and fun be valued as much as safety (ParticipACTION Canada, 2015; Tremblay et al., 2015).	RR Digital Tool: Participants proceed through three chapters in the tool: https://outsideplay.ca. Chapter 1: most important attributes they want for their child; their child's favourite play activities; their own childhood play activities; how their child's and their own play activities compare. Chapter 2: imagining themselves in three video segments where they must decide whether they allow their child to climb a tree, walk home from school, and use box cutters to build a fort. They reflect on their barriers and things that helped them let go. Chapter 3: revisiting the most important attributes they want for their child and whether there is anything they want to change, setting a realistic goal, outlining steps for attaining that goal, and setting start date.	RR In-Person Workshop: Participants engage in a 2-hour facilitator guided discussion of the same tasks as the RR digital tool. Participants are taken through each task using PowerPoint slides that include the videos from the digital tool. The facilitator guide contains detailed guidance on discussion for each component and length of time to be dedicated to each slide. Participants are provided with a paper booklet to complete that mimics the online tasks.
Period Title: Overall Study
STARTED	148	150	153
1-week Post-intervention	135	113	85
COMPLETED	123	105	84
NOT COMPLETED	25	45	69

Baseline Characteristics

Arm/Group Title	Position Statement on Active Outdoor Play	Risk Reframing (RR) Digital Tool	RR In-Person Workshop	Total
Arm/Group Description	Position Statement Active Outdoor Play: The position statement summarizes the issues and research regarding children's access to outdoor play and provides recommendations for various stakeholders. It states that "access to active play in nature and outdoors - with its risks - is essential for healthy child development" and recommends increasing children's opportunities for self-directed play in all settings. The Position Statement includes recommendations for parents, educators, health professionals, administrators and various level of governments to address the barriers to children's outdoor play. It addresses common misconceptions and encourages that danger be differentiated from risk and outdoor play and fun be valued as much as safety (ParticipACTION Canada, 2015; Tremblay et al., 2015).	RR Digital Tool: Participants proceed through three chapters in the tool: https://outsideplay.ca. Chapter 1: most important attributes they want for their child; their child's favourite play activities; their own childhood play activities; how their child's and their own play activities compare. Chapter 2: imagining themselves in three video segments where they must decide whether they allow their child to climb a tree, walk home from school, and use box cutters to build a fort. They reflect on their barriers and things that helped them let go. Chapter 3: revisiting the most important attributes they want for their child and whether there is anything they want to change, setting a realistic goal, outlining steps for attaining that goal, and setting start date.	RR In-Person Workshop: Participants engage in a facilitator guided discussion of the same tasks as the RR digital tool. Participants are taken through each task using PowerPoint slides that include the videos from the digital tool. The facilitator guide contains detailed guidance on discussion for each component and length of time to be dedicated to each slide. Participants are provided with a paper booklet to complete that mimics the online tasks.	Total of all reporting groups
Overall Participants	148	150	153	451
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	40.7 (5.3)	40.8 (5.5)	39.6 (5.0)	40.29 (5.51)
Sex: Female, Male (Count of Participants)
Female	148 100%	150 100%	153 100%	451 100%
Male	0 0%	0 0%	0 0%	0 0%
Race/Ethnicity, Customized (Count of Participants)
White	101 68.2%	112 74.7%	117 76.5%	330 73.2%
Other	47 31.8%	38 25.3%	36 23.5%	121 26.8%
Marital status (Count of Participants)
Married/Common-law	118 79.7%	125 83.3%	131 85.6%	374 82.9%
Other	30 20.3%	25 16.7%	22 14.4%	77 17.1%
Education (Count of Participants)
< university / college	36 24.3%	36 24%	33 21.6%	105 23.3%
University / college	66 44.6%	80 53.3%	72 47.1%	218 48.3%
> university college	46 31.1%	32 21.3%	46 30.1%	124 27.5%
Missed data	0 0%	2 1.3%	2 1.3%	4 0.9%
Employment (Count of Participants)
Employed for wages/self employed	115 77.7%	107 71.3%	44 28.8%	266 59%
Unemployed	33 22.3%	43 28.7%	109 71.2%	185 41%
Home dwelling (Count of Participants)
Single-detached	69 46.6%	77 51.3%	72 47.1%	218 48.3%
Others	79 53.4%	73 48.7%	81 52.9%	233 51.7%
Income (Count of Participants)
< $63,300	36 24.3%	40 26.7%	33 21.6%	109 24.2%
$63,300-$103,299	49 33.1%	40 26.7%	50 32.7%	139 30.8%
>=$103,300	52 35.1%	54 36%	55 35.9%	161 35.7%
Prefer not to answer	11 7.4%	16 10.7%	15 9.8%	42 9.3%
Exposure to risky play information (Count of Participants)
No	126 85.1%	122 81.3%	117 76.5%	365 80.9%
Yes	22 14.9%	28 18.7%	36 23.5%	86 19.1%
Child age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	8.4 (1.7)	8.1 (1.7)	8.0 (1.9)	8.1 (1.8)
Child sex (Count of Participants)
Boy	85 57.4%	82 54.7%	85 55.6%	252 55.9%
Girl	60 40.5%	68 45.3%	67 43.8%	195 43.2%
Missing data	3 2%	0 0%	1 0.7%	4 0.9%
Child's disability/chronic condition (Count of Participants)
No	143 96.6%	140 93.3%	148 96.7%	431 95.6%
Yes	5 3.4%	10 6.7%	5 3.3%	20 4.4%
Outdoor time (hours) [Mean (Standard Deviation) ]
Weekday	3.0 (3.6)	2.8 (3.2)	2.6 (2.8)	2.80 (3.20)
Weekend	2.7 (2.2)	2.8 (2.0)	2.9 (2.8)	2.79 (2.36)

Outcome Measures

1. Primary Outcome

Title	Change in Tolerance of Risk in Play Scale (TRiPS)
Description	The primary outcome measure was increase in the total score on the Tolerance for Risk in Play Scale (TRiPS), a 31-item measure examining adults' tolerance of risk during children's play. This analysis was conducted using mirt package in R software (Chalmers, 2012). Rasch analysis of the baseline data resulted in dropping one item ("Do you allow this child to play-fight, testing who is strongest?") due to local dependence. Theta standardized scores from the Rasch analysis of the final 30-item TRiPS total scale ranged from -3.372 to 1.975, with a mean of 0.000 (SD 0.974). A higher standardized score indicates higher tolerance of risky outdoor play.
Time Frame	Baseline, 1-week-post-intervention, 3-month-post-intervention

Outcome Measure Data

Analysis Population Description

Included was 451 mothers with baseline demographic data; and, 351 mothers with baseline outcome data (TRiPS) at baseline, 333 mothers at 1-week-post-intervention, and 312 mothers at 3-month-post-intervention.

Arm/Group Title	Position Statement on Active Outdoor Play	Risk Reframing (RR) Digital Tool	RR In-Person Workshop
Arm/Group Description	Position Statement Active Outdoor Play: The position statement summarizes the issues and research regarding children's access to outdoor play and provides recommendations for various stakeholders. It states that "access to active play in nature and outdoors - with its risks - is essential for healthy child development" and recommends increasing children's opportunities for self-directed play in all settings. The Position Statement includes recommendations for parents, educators, health professionals, administrators and various level of governments to address the barriers to children's outdoor play. It addresses common misconceptions and encourages that danger be differentiated from risk and outdoor play and fun be valued as much as safety (ParticipACTION, 2015; Tremblay et al., 2015).	RR Digital Tool: Participants proceed through three chapters in the tool: https://outsideplay.ca. Chapter 1: most important attributes they want for their child; their child's favourite play activities; their own childhood play activities; how their child's and their own play activities compare. Chapter 2: imagining themselves in three video segments where they must decide whether they allow their child to climb a tree, walk home from school, and use box cutters to build a fort. They reflect on their barriers and things that helped them let go. Chapter 3: revisiting the most important attributes they want for their child and whether there is anything they want to change, setting a realistic goal, outlining steps for attaining that goal, and setting start date.	RR In-Person Workshop: Participants engage in a facilitator guided discussion of the same tasks as the RR digital tool. Participants are taken through each task using PowerPoint slides that include the videos from the digital tool. The facilitator guide contains detailed guidance on discussion for each component and length of time to be dedicated to each slide. Participants are provided with a paper booklet to complete that mimics the online tasks.
Measure Participants	148	150	153
Baseline outcome	0.05 (1.03)	-0.14 (0.97)	0.18 (0.87)
1-week-post-intervention outcome	-0.09 (1.03)	-0.06 (1.05)	0.22 (0.80)
3-month-post-intervention outcome	-0.03 (0.92)	-0.09 (0.93)	0.15 (0.80)

2. Secondary Outcome

Title	Self-reported Behaviour Change
Description	The secondary outcome measure was self-reported behavior change, measured by participants' self-reported progress on attaining the goal they set for themselves within the risk reframing intervention. At each follow-up, participants were reminded of their goal (by asking "at the beginning of the study, you set a goal for yourself regarding something you wanted to change to give your child more opportunities for risky play. Have you made progress toward this goal?") and asked "Did you accomplish your goal?" with "Yes" and "No" response options. For the purpose of our analyses the category of "Yes" is an indication of behaviour change while the category of "No" is an indication of no behaviour change.
Time Frame	1-week-post-intervention, 3-month-post-intervention

Outcome Measure Data

Analysis Population Description

Included was 333 mothers with complete secondary outcome data (Goal) at 1-week post-intervention - which represents the first time we collected these data; and 312 mothers at 3-month-post intervention.

Arm/Group Title	Position Statement on Active Outdoor Play	Risk Reframing (RR) Digital Tool	RR In-Person Workshop
Arm/Group Description	Position Statement Active Outdoor Play: The position statement summarizes the issues and research regarding children's access to outdoor play and provides recommendations for various stakeholders. It states that "access to active play in nature and outdoors - with its risks - is essential for healthy child development" and recommends increasing children's opportunities for self-directed play in all settings. The Position Statement includes recommendations for parents, educators, health professionals, administrators and various level of governments to address the barriers to children's outdoor play. It addresses common misconceptions and encourages that danger be differentiated from risk and outdoor play and fun be valued as much as safety (ParticipACTION, 2015; Tremblay et al., 2015).	RR Digital Tool: Participants proceed through three chapters in the tool: https://outsideplay.ca. Chapter 1: most important attributes they want for their child; their child's favourite play activities; their own childhood play activities; how their child's and their own play activities compare. Chapter 2: imagining themselves in three video segments where they must decide whether they allow their child to climb a tree, walk home from school, and use box cutters to build a fort. They reflect on their barriers and things that helped them let go. Chapter 3: revisiting the most important attributes they want for their child and whether there is anything they want to change, setting a realistic goal, outlining steps for attaining that goal, and setting start date.	RR In-Person Workshop: Participants engage in a facilitator guided discussion of the same tasks as the RR digital tool. Participants are taken through each task using PowerPoint slides that include the videos from the digital tool. The facilitator guide contains detailed guidance on discussion for each component and length of time to be dedicated to each slide. Participants are provided with a paper booklet to complete that mimics the online tasks.
Measure Participants	135	113	85
Yes	76 51.4%	81 54%	47 30.7%
No	59 39.9%	32 21.3%	38 24.8%
Yes	99 66.9%	90 60%	62 40.5%
No	24 16.2%	15 10%	22 14.4%

Adverse Events

Adverse Event Reporting Description	Adverse events were not monitored/assessed because this RCT was not clinical-based. It was to test the efficacy of a web-based intervention to change participants' perception of risk in children's outdoor play.
Arm/Group Title	Risk Reframing (RR) Digital Tool		RR In-Person Workshop		Position Statement on Active Outdoor Play
Arm/Group Description	RR Digital Tool: Participants proceed through three chapters in the tool: https://outsideplay.ca. Chapter 1: most important attributes they want for their child; their child's favourite play activities; their own childhood play activities; how their child's and their own play activities compare. Chapter 2: imagining themselves in three video segments where they must decide whether they allow their child to climb a tree, walk home from school, and use box cutters to build a fort. They reflect on their barriers and things that helped them let go. Chapter 3: revisiting the most important attributes they want for their child and whether there is anything they want to change, setting a realistic goal, outlining steps for attaining that goal, and setting start date.		RR In-Person Workshop: Participants engage in a facilitator guided discussion of the same tasks as the RR digital tool. Participants are taken through each task using PowerPoint slides that include the videos from the digital tool. The facilitator guide contains detailed guidance on discussion for each component and length of time to be dedicated to each slide. Participants are provided with a paper booklet to complete that mimics the online tasks.		Position Statement Active Outdoor Play: The position statement summarizes the issues and research regarding children's access to outdoor play and provides recommendations for various stakeholders. It states that "access to active play in nature and outdoors - with its risks - is essential for healthy child development" and recommends increasing children's opportunities for self-directed play in all settings. The Position Statement includes recommendations for parents, educators, health professionals, administrators and various level of governments to address the barriers to children's outdoor play. It addresses common misconceptions and encourages that danger be differentiated from risk and outdoor play and fun be valued as much as safety (ParticipACTION, 2015; Tremblay et al., 2015).
All Cause Mortality
	Risk Reframing (RR) Digital Tool		RR In-Person Workshop		Position Statement on Active Outdoor Play
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)		0/0 (NaN)
Serious Adverse Events
	Risk Reframing (RR) Digital Tool		RR In-Person Workshop		Position Statement on Active Outdoor Play
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)		0/0 (NaN)
Other (Not Including Serious) Adverse Events
	Risk Reframing (RR) Digital Tool		RR In-Person Workshop		Position Statement on Active Outdoor Play
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)		0/0 (NaN)

Limitations/Caveats

Given the nature of the interventions, it was not possible to blind participants to their allocation, thus potentially introducing sources of bias.

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.