Implementation Adherence and Perspectives of the Childcare PhysicaL ActivitY (PLAY) Policy: A Process Evaluation.

The Childcare PhysicaL ActivitY (PLAY) policy was an evidence-informed, eight-item institutional-level policy document targeting children's physical activity, outdoor play, and sedentary time. Nine childcare centers in London, Ontario, participated in this cluster, randomized controlled trial. Early Childhood Educators allocated to the experimental group, from five childcare centers in London, Ontario, implemented the policy for young children (18 months to 4 years) for 8 weeks and documented adherence to each policy item (i.e., dose) in daily logs. Program evaluation surveys (n = 21) and interviews (n = 10) were completed postintervention to assess Early Childhood Educators' perspectives of feasibility, context, enjoyment, communication between researchers and childcare staff, and likelihood of future implementation. Descriptive statistics were calculated, and thematic analysis was conducted. Adherence to policy items ranged from 16.5% (for delivery of shorter, more frequent outdoor periods) to 85.9% (for delivery of unstructured/child-directed play). Participants reported effective communication between the research team and childcare centers (0 = not at all effective to 5 = very effective; M = 4.20; SD = 0.83) but noted that they were unlikely to continue the implementation of more frequent outdoor periods (0 = not at all likely to 5 = extremely likely; M = 2.19; SD = 1.21). Interview themes included weather as a prominent barrier and the use of verbal prompts as a solution for implementing the policy. As this was a small and short-term intervention, this pilot study offers important insight on larger scale policy interventions aimed at increasing physical activity and minimizing sedentary time among children enrolled in childcare.