Demographics of ECE directors in aim 2 (<i>n</i> = 27).

Background Toddler physical activity is critical for child health, but little is known about its applications in early childhood education (ECE) centers. The aims of this study were 1) to determine if pragmatic and nature-based modifications to an ECE center’s outdoor setting were feasible and acceptable, and 2) to identify barriers and facilitators of toddler physical activity at ECE centers. Methods A multiphase mixed-methods study (QUANT+QUAL) was conducted. In the QUANT study, a stepped, sequential modification of the outdoor setting, using pragmatic and cost-effective nature-based elements, was conducted with a delayed control group over 10-weeks, with follow-up assessments 3-months later (week-20). Five elements (tree cookies, garden, teacher training, playground stencils, and nature table) were introduced individually. Feasibility was assessed using teacher surveys. Acceptability and engagement were assessed by direct observation of toddler use of outdoor elements. Accelerometers were used to assess toddlers’ physical activity during outdoor sessions. The QUAL study included semi-structured interviews from ECE center directors (n = 27, 55.6% African American, 92.5% female) that were analyzed using content analysis for themes related to 1) toddler physical activity, 2) barriers and facilitators to toddler outdoor environment changes, 3) perspectives on nature-based elements, and 4) provider training. Member check focus groups (n = 2, 7-10/group) were conducted for additional interpretation. All three sources were reviewed for integration. Results Toddlers engaged in physical activity for most of the outdoor sessions (>85%). This limited the effect of the intervention, but aligned with directors’ and members’ sentiments that toddlers were already quite active. Across directors, reported barriers to toddler outdoor environment changes were teacher turnover and finances. All nature-based elements, except the stencils, were feasible and acceptable, even at week-20. Directors and members identified additional age-appropriate elements, and desired pragmatic training with technical assistance and funding to implement these changes. Directors and members also desired a curriculum that could be used outdoors. Conclusions Nature-based elements were feasible and acceptable to toddlers. Directors were enthusiastic about nature-based elements, but barriers exist in linking directors with these elements. Opportunities to combine toddler-age curricula and pragmatic options for outdoor play may improve ECE centers’ outdoor settings and ultimately toddler health.研究背景：学步儿童的身体活动对儿童健康至关重要，但目前针对其在幼儿教育（Early Childhood Education, ECE）机构中的应用研究仍相对匮乏。本研究的目标有二：其一，探究对幼儿教育机构户外环境进行实用化、自然化改造的可行性与可接受性；其二，明确幼儿教育机构中学步儿童身体活动的阻碍因素与促进因素。 研究方法：本研究采用多阶段混合研究方法（QUANT+QUAL）开展。在定量研究（QUANT）部分，研究团队采用实用且具成本效益的自然化元素，分阶段依次对户外环境进行改造，设置延迟对照组，干预周期为10周，并在3个月后（第20周）开展追踪评估。本次改造依次引入了5项元素：原木切片（tree cookies）、种植园、教师培训、游戏场模板（playground stencils）以及自然操作台（nature table）。可行性通过教师问卷进行评估；可接受性与参与度通过直接观察学步儿童对户外元素的使用情况进行评估；采用加速度计（accelerometers）评估学步儿童在户外活动时段的身体活动水平。在定性研究（QUAL）部分，研究团队对27名幼儿教育机构负责人开展半结构化访谈，其中55.6%为非裔美国人，92.5%为女性；采用内容分析法对访谈资料进行编码分析，分析主题涵盖4个方面：1. 学步儿童的身体活动；2. 学步儿童户外环境改造的阻碍与促进因素；3. 对自然化元素的看法；4. 从业者培训相关内容。此外，开展2组成员检验焦点小组讨论（每组7-10人）以补充阐释研究结果，并对三类数据来源进行整合分析。 研究结果：研究显示，学步儿童在绝大多数户外活动时段（占比超85%）都处于身体活动状态。这一情况限制了干预措施的效果，但与机构负责人及参与者的看法一致——学步儿童本身已具备较高的活动活跃度。受访机构负责人均指出，学步儿童户外环境改造的主要阻碍因素为教师流动与资金问题。除游戏场模板外，其余所有自然化元素均具备可行性与可接受性，且在第20周的追踪评估中仍保持这一特点。机构负责人与参与者还提出了更多符合学步儿童年龄特点的改造元素，并希望获得配套技术支持与资金资助的实用型培训，以推动相关改造工作落地。此外，二者均期望能够推出可应用于户外场景的配套课程体系。 研究结论：自然化元素对学步儿童而言具备可行性与可接受性。机构负责人对自然化改造元素抱有较高热情，但在将其与实际工作相结合的过程中仍存在阻碍。将符合学步儿童年龄特点的课程体系与实用型户外游戏方案相结合，或可优化幼儿教育机构的户外环境，最终改善学步儿童的健康水平。