COVID-19 is an emerging, rapidly evolving situation.
Get the latest public health information from CDC:

Get the latest research information from NIH: Menu
Trial record 1 of 1 for:    NCT02715544
Previous Study | Return to List | Next Study

Promoting Healthy Eating and Active Playtime by Connecting Preschool Children to Nature (Play&Grow)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT02715544
Recruitment Status : Recruiting
First Posted : March 22, 2016
Last Update Posted : August 27, 2018
Information provided by (Responsible Party):
Dr. Tanja Sobko, The University of Hong Kong

Brief Summary:
Recent research suggests a majority of Hong Kong's toddlers (aged 2 to 4) are much less active than is recommended and are increasingly engaged in sedentary behaviour, which places them at risk of becoming overweight or obese. The proposed project will test whether connecting families to nature positively influences physical activity (that is, active playtime) and healthy eating routines in children aged 2 to 4. The investigators have recently conducted a pilot study Play & Grow (P&G), a programme based on the most successful international preschool interventions described in the literature. In addition to adopting healthy eating and physical activity intervention elements, the programme was enhanced by including a novel third element: connectedness to nature (CN). To test the effectiveness of this enhanced intervention, the plan is to run a family-based randomised controlled trial (RCT). The intervention will include 240 families with children aged 2 to 4, will take the form of one-hour activity sessions for parents and children held once a week for 10 weeks. The investigators will assess lifestyle-related habits before, immediately after the completion the intervention, at 6 months and one year after the intervention. Created for this purpose, a novel measuring tool for connectedness to nature, Nature Relatedness Scale (NRS), will be validated and tested for reliability prior to the RTC. The results of RCT are intended to be used to understand which components of the intervention were most effective. The objectives of this project will be achieved over a 36-month period, and it is expected to contribute to a close examination of key components of successful healthy lifestyle promotion programme during early childhood. The investigators predict that is that the new element CN will significantly improve the intervention. Finally, the overall aim is that connecting families to nature will result in sustainable lifestyle changes that remain with them for a lifetime.

Condition or disease Intervention/treatment Phase
Sedentary Lifestyle Overweight Eating Disorders Other: Healthy lifestyle Other: physical activity and dietary guidelines Not Applicable

Detailed Description:
Proper nutrition and physical activity are essential for a healthy life. Time spent in nature has also been proven beneficial. Systematic reviews have shown that nature-related activities enhance general well-being as reflected in increased physical activity, a healthier diet, reduced stress and better sleep. However, existing programmes promoting healthy lifestyles in children focus almost exclusively on diet and physical activity. None, to the inestigators's awareness, taken into consideration interactions, or connectedness with nature. Connectedness to nature/nature relatedness is a relatively new concept that, to date, has been investigated primarily in adults.The concept suggests, for example, that engaging in activities in a natural environment can induce a feeling of connectedness to nature. Exposing preschool children to nature and to thinking about nature in different ways could stimulate nature relatedness as a measurable construct. When children are placed in a natural setting, they are more likely to be physically active. Natuxral products such as fruits and vegetables are widely acknowledged to improve health. As noted above, parents are children's role models, and the investigators therefore believe that connecting parents with nature will have benefits for their children. Many habits and attitudes are developed early in life, and those related to the natural world are no exception. In fact, children are inherently interested in their environment and in nature in general. The hypothesis is that both indoor and outdoor nature-related activities may induce connectedness and bring about positive changes in both eating and activity habits (short-term outcomes) in preschool children, in turn leading to a healthier lifestyle (long-term outcomes).The aim of P&G is to encourage healthy eating habits and active play in children from an early age, and to bring about healthy behavioural changes in families. The programme also includes a CN element designed to equip parents with environmental knowledge and skills. The generated re- and post-test comparison data indicated the effectiveness of the programme (not presented here). A detailed manual and full resource kit were created, and each session consisted of: (i) a 15-minute theoretical education component (food, activity, CN), and (ii) a 30-minute component on indoor and outdoor nature-related activities, such as playing with nature objects and searching for natural treasures. Some nature activities were food-related (e.g. growing plants, creating miniature indoor gardens, and healthy cooking). The control group received an information folder containing government-recommended physical activity and dietary guidelines for children. To enhance participation, the sessions were scheduled for weekends. The outcome data was collected using a number of scales and questionnaires addressed eating, active play and nature-related habits before and after the program, and focus group discussions were held at the beginning and end of the programme. The programme proved popular amongst participants and the results demonstrated significant positive changes on number of health-related outcomes, such as food habits and caregiver physical activity levels.

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 240 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Promoting Healthy Eating and Active Playtime by Connecting Preschool Children to Nature
Actual Study Start Date : January 2015
Estimated Primary Completion Date : December 2019
Estimated Study Completion Date : December 2020

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Intervention group
The group will receive healthy lifestyle intervention
Other: Healthy lifestyle
The families will receive a designed for these purposes intervention

Active Comparator: control group
Other: physical activity and dietary guidelines
Other: physical activity and dietary guidelines
The families will receive a designed for these purposes intervention

Primary Outcome Measures :
  1. Eating habits [ Time Frame: 3 years ]
    A short validated Eating and Physical Activity Questionnaire (EPAQ)

  2. Physical activity [ Time Frame: 3 years ]
    Physical Activity Questionnaire for Preschool-aged Children (Pre-PAQ®)

  3. Nature relatedness [ Time Frame: 3 years ]
    a short, age-adjusted NRS scale

Secondary Outcome Measures :
  1. Parental knowledge of nutrition [ Time Frame: 3 years ]
    Nutrition Knowledge Questionnaire (NKQ)

  2. Parental feeding behaviours [ Time Frame: 3 years ]
    The Preschool Child Feeding Questionnaire (PCFQ)

  3. weight [ Time Frame: 3 years ]
    weight in kilograms

  4. height [ Time Frame: 3 years ]
    height in meters

  5. child neophobia [ Time Frame: 3 years ]
    Pliner's Child Neophobia Scale (PCNS)

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

Layout table for eligibility information
Ages Eligible for Study:   2 Years to 6 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • 2-4 year old children
  • With English-speaking parents

Exclusion Criteria:

  • Children with chronic health conditions
  • Families who have recently taken part in a healthy lifestyle promotion programme

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02715544

Layout table for location contacts
Contact: Tanja Sobko, PhD +85251816160

Layout table for location information
Hong Kong
The University of Hong Kong Recruiting
Hong Kong, Hong Kong, 000
Contact: Tanja Sobko    +85251816160   
Sponsors and Collaborators
The University of Hong Kong
Layout table for investigator information
Principal Investigator: Tanja sobko The University of Hong Kong
Additional Information:
Veselinovska SS, Osogovska TL: Engagement of Students in Environmental Activities in School. Procedia - Social and Behavioral Sciences 2012, 46:5015-5020.
Barratt Hacking E, Barratt R, Scott W: Engaging children: research issues around participation and environmental learning. Environmental Education Research 2007, 13:529-544.
Mullis F: Active parenting: an evaluation of two Adlerian parent education programs. Journal of Individual Psychology 1999, 55:225-232.
Liefländer AK, Fröhlich G, Bogner FX, Schultz PW: Promoting connectedness with nature through environmental education. Environmental Education Research 2013, 19(3):370-384
Cutter-Mackenzie A, Edwards S: Toward a Model for Early Childhood Environmental Education: Foregrounding, Developing, and Connecting Knowledge Through Play-Based Learning. The Journal of Environmental Education 2013, 44(3):195-213.
The Biophilia Hypothesis []

Publications automatically indexed to this study by Identifier (NCT Number):
Layout table for additonal information
Responsible Party: Dr. Tanja Sobko, Assistant Professor, The University of Hong Kong Identifier: NCT02715544    
Other Study ID Numbers: P&G 2015
First Posted: March 22, 2016    Key Record Dates
Last Update Posted: August 27, 2018
Last Verified: August 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: Hong Kong Ethics Committee
Keywords provided by Dr. Tanja Sobko, The University of Hong Kong:
Physical activity
Eating habit
Connectedness to nature
Additional relevant MeSH terms:
Layout table for MeSH terms
Feeding and Eating Disorders
Body Weight
Mental Disorders