Promoting Children’s Active Play in Nature via Primary Care
Citation
Griffin, G. M., Ellerton, L., Hazlehurst, M. F., Senturia, K., Kroshus, E., Glassy, D., … & Tandon, P. (2025). Promoting Children’s Active Play in Nature via Primary Care. The Journal of Pediatrics, 114810.
Outdoor play and physical activity are essential for children’s physical and mental health, yet most U.S. children don’t get the recommended 60 minutes per day. Lower-income or racially diverse neighborhoods often have even fewer opportunities for outdoor play as parks in these communities tend to be smaller, more crowded, and have fewer amenities. Pediatricians can play a key role in encouraging active play in nature during routine health visits, especially if provided with tools that are easy to share and sensitive to families’ circumstances.
Pediatricians and researchers developed Project Nature, a clinic-based program designed to promote active play in nature during well-child checks. The program includes four components: tailored guidance from pediatricians, an age-appropriate toy that can be used in nature, a brochure, and a website that medical practices can tailor to include information about local parks and outdoor activities. Initially created for toddlers, Project Nature was expanded to serve children up to age 10 and tested in clinics across Washington state. The study aimed to assess whether Project Nature is practical and useful in real-world clinics, and to learn which parts helped clinicians most when discussing outdoor activity with families.
Abstract
Objective
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.
Study Design
Six primary care clinics in Washington 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.
Results
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.
Conclusions
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.