STRENGTHS AND LIMITATIONS OF THIS STUDY

The current study focuses on understanding how to support active play in preschool settings postpandemic.

The main strength of this study was conducting in-depth qualitative interviews with three types of adult caregivers: parents, teachers and administrators.

Limitations of this study include that it sampled a single geographical region, which was mostly from a metropolitan area, limiting the generalisability.

Introduction

In the USA, approximately 88% of 5-year-old children, 69% of 4-year-old children and 40% of 3-year-old children attend some form of preschool.1 The label ‘preschool’ refers to education settings that serve children in the years just prior to kindergarten (ie, ages 3–5).2 Compared with early care and education settings more broadly, preschools often are tasked with competing demands related to preparing young children for formal schooling.3 In preschool, physical activity (PA) is important for health and supports the social-emotional, cognitive and behavioural development of preschool-age children.4 Despite the importance of PA, which typically takes the form of active play in preschoolers, research suggests that preschoolers in the USA are not receiving the recommended opportunities for PA.5 Because preschoolers typically cannot choose when and how often they engage in PA, adult caregivers such as parents play a critical role in promoting PA. As children spend considerable time in preschool settings, preschool teachers and administrators take on a larger role in promoting PA. To best support PA across home and preschool, the interactions between parents and adult caregivers at school (eg, teachers and administrators) may be crucial in promoting adequate PA opportunities throughout the day.6 7 Although the amount of PA at home and in preschool settings has been quantified through direct observations, accelerometry and rating scales,8 9 there is a need to understand how parents, teachers and preschool administrators view the importance of PA and how they promote it in their context with preschoolers.

Promoting PA across home and preschool became more challenging given the recent COVID-19 pandemic, which resulted in abrupt changes to preschool services and family routines across the nation.10 Adult caregivers at home and preschool settings faced an onslaught of information about preventing COVID-19 transmission, social distancing and how to keep children healthy. Preschool teachers and administrators made adaptations to their physical spaces and their curriculum to adapt to the evolving public health guidance. Teachers also faced numerous stressors themselves as they balanced their personal circumstances with the demands of being essential workers during a worldwide crisis. Coming out of the end of the federal COVID-19 public health emergency, there are now increased concerns about learning gaps, kindergarten readiness and an increase in classroom behavioural issues.11 12 Although research suggests that PA can have a positive influence on child behaviour,13 prioritising and promoting PA in preschool postpandemic may be challenging for teachers, who face competing academic demands as well as insufficient resources and high job-related stress.14 15 Due to these increased hardships, administrators and families may be well positioned to support preschool teachers in promoting PA with preschoolers.

Families and preschool teachers have long faced barriers related to working together to promote child PA prior to the pandemic.16 COVID-19 has further impacted communications between home and preschool with parents and teachers listing concerns related to decreased opportunities for interaction.17 While current literature emphasises the need for increased PA in preschoolers, there is a lack of qualitative data postpandemic that explores how different types of adult caregivers view PA and how they work together to promote it. To these ends, we aimed in this study to understand how parents, preschool teachers and administrators: (a) describe the importance of PA in preschool postpandemic? (b) support PA and what challenges do they face in doing so? and (c) interact or collaborate to promote child PA?

MethodRecruitment and participants

Participants were obtained through targeted recruitment to contacts at approximately 20 preschool settings (licensed group-based settings serving children between the ages of 3 and 5 years old) from one (BLINDED CITY) who were asked to distribute setting-wide emails and flyers. To qualify for inclusion, teachers had to be a lead teacher serving children between the ages of 3 and 5 years old in a group-based educational setting or licensed school. Administrators had to be serving in a leading role in a group-based school or educational setting serving children ages 3–5 years old.18 To be eligible, parents had to have a child between the ages of 3 and 5 years currently enrolled in a group-based school or educational setting. Caregivers were not eligible if they were employed by or sent their child to a home-based care setting.

Following initial recruitment interest, participants were directed to fill out an online screener via REDCap to assess eligibility for interviews. 47 people accessed the screener, 35 met eligibility criteria and 21 completed an interview in English (7 in each caregiver type; see table 1 for demographics and inclusion criteria). We a prior set a goal of 21 interviews, 7 in each group, based on qualitative research saturation recommendations.19 20

Table 1

Descriptive statistics for participants

All participants were from a (BLINDED) City and surrounding metropolitan area and gave informed consent online in accordance with the institutional review board at the authors’ institution and received a gift card on completing the survey.

Patient and public involvement

The public was not involved in the design, conduct, reporting or dissemination plans of our research.

Interview procedure

Interviews were conducted over Zoom by trained members of research team in April and May 2023. Interviews consisted of approximately 20 open-ended questions (see online supplemental materials for interview scripts) and ranged from 20 to 60 min based on respondent answers (average parent interviews lasted 14.93 min, average teachers interviews lasted 31.14 min and average administrator interviews lasted 20.64 min). Audio recordings of interviews were captured over Zoom, transcribed professionally and checked for accuracy by the first author.

Analysis procedure

Qualitative analysis adhered to recommended practices.21 22 Qualitative coding was completed in Dedoose V.9.0.107 (2023) using a codebook developed to answer the three research questions of interest. Once the research team felt comfortable and confident with the codebook, the second, third and fourth authors independently coded the same transcript and disagreements were discussed until consensus was reached. They then coded a second training transcript and on agreement, they split up the coding so that all transcripts were coded by at least one coder and 86% were dual-coded by two coders. Throughout this process, the authors engaged in in-depth group discussion to ensure consensus on coded data as the goal was consensus rather than a quantitative measure of inter-rater agreement.23 All coded data were subsequently compared and reconciled by the research team.

Following the close coding of data, the first and second author undertook an intensive framework coding analysis24 of the codes regarding their meaning and frequency across the three groups of caregivers. All codes were reviewed with an eye towards differences between the three types of caregivers. This approach enabled the authors to both engage in thematic analysis and case analysis to formulate a series of what are sometimes called, in the literature, ‘mini-theories.’25 These mini-theories and subsequent hypotheses were then ‘tested’ by the authors by taking another close read of the coded portions of the transcripts. Negative evidence against the interim mini-theories was sought out and where found, resulted in changes to (or abandonment of) some.

Results

Qualitative themes will be described in detail below with quotations labelled with participants’ pseudonyms (p=parent; t=teacher; a=administrator). Specific demographics for each participant by pseudonym can be found in table 2. Table 3 shows the frequency of each code (see online supplemental materials for exemplary quotes).

Table 2

Participant demographics*

Table 3

Frequency of codes

Question 1: how do caregivers describe the importance of PA?Parents

Parents viewed PA as developmentally appropriate, largely connecting it to children’s energy levels and acknowledging its importance during the preschool years; ‘I think it’s especially important for younger kids because they’re still learning things about their body (p02). Two parents were worried that once their child left preschool, they would not get enough PA; ‘I honestly kind of wonder if it’s going to be a hard transition to kindergarten where he’s going to be expected to just sit in one place a lot more than he’s used to’ (p07). Parent satisfaction with PA came from knowing that their child was tired after preschool. This satisfaction was accompanied by decreased concerns about how much PA their child got at home.

Teachers

Like parents, two teachers worried about how much PA children would receive on the transition to elementary school; ‘I’m concerned that next year it’s going to be a lot less’ (t01). Describing the benefits of PA, teachers discussed the pandemic’s impact on child development, delineating its seemingly magnified impact on children postpandemic:

‘We’re seeing a lot of students come to us right now from the pandemic. They really don’t have a lot of fine or gross motor skills because they haven’t had opportunities to go outside or the mom and dad, or family at home are going back to work and so there’s not as much time to go do things and so I’ve seen a huge shift in that from pre-pandemic to now.’ (t05)

Teacher satisfaction came from acknowledging their own efforts to promote PA in classrooms. The one teacher who was dissatisfied with the current level of PA described how certain children would benefit from more; ‘I think a lot of them need more movement and especially the ones that aren’t quite socially mature enough to be in kindergarten’ (t05).

Administrators

When describing benefits of PA, administrators had a high-level knowledge of the connection between PA and domains of child development; ‘movement impacts brain development and a child’s whole well-being that it’s not just isolated to their physical health, that it is related to their mental health and their ability to engage and thrive in the classroom and set themselves up for success.’ (a01). This same administrator went on to describe movement as ‘one of the most essential needs’, describing how ‘a child needs to be fed, needs to have housing, needs to have secure attachments. Right after that a child needs to move their body’ (a01). Administrators also acknowledged the impact of COVID-19 on PA practices: ‘we’re really trying hard to get back to the things that we used to do’ (a02).

How do caregivers support and prioritise PA and what challenges do they face?Parents

Parents’ description of PA in the classroom were vague, with parents assuming their child engaged in PA but not being able to describe specifics: ‘I’m not there, so I don’t really have visibility to every minute of the classroom activity time. But I do see that they’re often doing movement-oriented activities’ (p03).

Parents were better able to identify barriers to PA, mostly describing how barriers inhibited their ability to promote PA at home. One parent noted they were thankful that they could count on their child’s preschool to promote PA: ‘There’s a lot of help that we would need at home. I think what I appreciate is that they go to a school where they get that all day long. So that feels like we’re moving a barrier because I feel less pressure’ (p09).

Teachers

Teachers were very detailed in describing how they promote PA but mainly listed adult-led activities. Even when describing child-led play, it was often within a setting that the teacher purposely created. When promoting PA, teachers described needing to be ‘purposeful’ (t01) or ‘structured’ (t04). This might be related to curriculum requirements: ‘we have to make sure we’re checking our list of all of our other required components of our curriculum’ (t03). As one teacher described: ‘In the preschool settings the academics are shoved so hard that we don’t always get to put the importance on play that some of the kids still need’ (t05).

Barriers related to space often involved having small classrooms, which made it challenging for children to move authentically and freely. Teachers discussed how limited staff made it difficult to promote PA: ‘One teacher cannot take care of child-led play by herself with 10 kids alone’ (t07).

Teachers listed other caregivers as barriers to promoting PA in their classrooms; ‘I think a lot of times teachers feel like the academics is the most important part of school and they feel uncomfortable if a principal walks into your class and the kids are playing. Then they’re like, ‘Oh, shoot, do they think that I’m not doing my job?’’ (t01). This pressure was especially felt from parents; ‘I think a lot of parents are like, why are you providing so much free choice time? Shouldn’t you be educating them? Shouldn’t you be teaching them something?’ (t01). Teachers also listed the actions of families during the pandemic as having a lasting impact: ‘So many aspects of their development got delayed because families who are at home, they’re more lenient and they kind of in a way did everything for their kids when they could have been self-sufficient to do certain tasks’ (t02).

Administrators

Administrators discussed how they promote PA by following the requirements and standards laid out by the state or their funding source: ‘Basically the policy is included in our daily schedule. Then also with licensing, the kids have to have at least, I think it’s 35, 30 to 45 min of PA when they go outside’ (a02). Administrators described how they support teachers in promoting PA by: ‘the orientation process about the values of the school’ (a01), as well as space and equipment: ‘How do I support them? Through buying materials’ (a06). Like teachers, administrators also described the need to be intentional in structuring PA: ‘Although movement and play can happen organically, I think that it’s a good idea for it to be intentional, to really think through it and plan it out’ (a06).

Space or equipment barriers included the location or size of the centre, not having an onsite playground and limited resources. Administrators described weather-related concerns around parents not supplying proper rain gear. Administrators also described families being a barrier: ‘Our biggest barrier has nothing to do with our school. It’s just a societal barrier of how I see children being raised at home and in terms of how much activity they’re used to and what’s the norm for them, compared to how much time they’re getting with screens’ (a01).

How do caregivers interact to promote child PA?Parents

Parents described their interactions with teachers or administrators around PA as ‘minimal’ (p02). The primary way parents engaged with teachers and administrators was through newsletters that included activities to try at home and curriculum outlining the PA requirements. Parents relied on teachers to support these interactions, rarely reaching out themselves. This lack of interactions resulted in parents being unsure what their child was doing at preschool: ‘I mean they talk to us about all the fun hikes they do but I don’t think they actually have a strategy’ (p04). However, parents were open to more information regarding PA: ‘I am always open to more things to keep this kid occupied because she’ll do a million things in a day. And it’s tough coming up with the ideas to engage her’ (p02).

Teachers

Teachers were the primary ones leading interactions with parents, describing things such as sharing written materials and hosting events. Many described how during the pandemic they began to send materials to parents as they were the ones now that needed to promote PA. Teachers listed parent willingness as a barrier to interactions: ‘The barrier is that some parents don’t see it as important. So me telling them it’s important, are they going to change their personality and start playing with their kids more?’ (t06). Teachers also described how they don’t feel like they do a great job of engaging families; ‘That would be an area of growth for me because I haven’t really thought about engaging families in movement activities with the children’ (t01). Teachers discussed how the pandemic impacted family engagement: ‘So one thing about COVID was that we didn’t have much family engagement… it’s still something that we are working through’ (t02). Despite challenges with parent interactions, teachers acknowledged the value: ‘one thing that’s important is for the families and educators to kind of form a partnership to prioritise these types of things’ (t02).

Most mention of interactions with administrators about PA was related to curriculum or requirements that their programme had. Teachers did not describe actively engaging administrators but described instances where the administrators supported them; ‘administrators incorporate and give educators advice on what to do’ (t02).

Administrators

Administrators were limited in their discussion of interactions with other caregivers and rarely described feeling satisfied or dissatisfied with the interactions. Administrators described supporting teachers in promoting PA by providing curriculum and sample activities: ‘I really encourage teachers to do activities with the children by sending emails or ideas’ (a03) or encouraging ‘teachers to participate in the activities with the children’ (a04).

Administrators interacted with parents regarding PA through school handbook guidelines, as well as sharing written information; ‘staff members and our assistant director would put some fun fact of the week in, and a lot of it was about PA and then we also do a monthly newsletter for parents.’ (a05). Administrators acknowledged that the pandemic made parent engagement harder: ‘We haven’t…besides giving strategies to parents about what we did at school so they can also do those things at home. Especially during COVID, we’ve kind of steered away’ (a02). Like teachers, they also listed barriers to interacting with families such as ‘lack of participation’ (a02) and families not ‘wanting to communicate’ (a01).

Discussion

This study found that while parents, teachers and administrators all valued PA postpandemic, there is marked variation in how they promote it and how they characterise the challenges they face in promoting PA. Preschool teachers were the most active in promoting PA, while parents and administrators largely relied on teachers to promote PA. All caregivers described barriers to promoting PA and interacting with each other, with teachers and administrators often listing the actions of parents as barriers. Of note, although this study was focused on PA postpandemic most identified barriers existed prior to the pandemic suggesting that these may be more related to the structure of the US preschool system and/or societal norms and attitudes of caregivers than then the disruption caused by the pandemic. Together, findings highlight the disconnect between the value of PA and how parents, teachers and administrators work together to promote it.

Similar to previous research,9 26 in the current sample, many parents perceived that their child’s preschool setting was providing enough PA, and therefore, did not explore this topic with preschool teachers or try to find ways to promote PA at home. Literature on healthy habits and nutrition in early childhood identify lack of parental awareness as a barrier.27 28 In the current study, parents understood the importance of and valued PA but did not intentionally focus on encouraging PA at home. This points to a potential point of intervention, in that parents want their children to have adequate PA but could benefit from strategies to promote it at home. As families and preschools working together is an important factor in promoting healthy behaviours,29 preschool teachers and administrators may be well suited to provide more easily implemented strategies for parents and even host family events that include PA.

Our findings suggest that postpandemic, teachers value PA, take responsibility for providing PA opportunities and wish they could do more. The focus on teachers being the one promoting PA is a concern given that in preschool settings in the US teachers are already tasked with several competing demands, large classroom sizes and insufficient resources.3 Competing demands related to curriculum, learning losses from the pandemic and increased concerns about behavioural problems and child safety may also be related to teacher focus on adult-led PA. Previous research has identified that outdoor child-led play was the most common form active play opportunity in preschool settings.5 The current study points to the need to support teachers in promoting both adult and child-led PA—indoors and outdoors—postpandemic, especially as they wished they could provide more PA opportunities in their classrooms.

Administrators heavily relied on requirements to provide a metric for assessing if classrooms were providing adequate PA. The National Health and Safety Performance Standards for Early Care30 and Education Programmes suggest that all young children (birth to 6) should participate daily in (a) at least two occasions of active play outdoors, (b) at least two structured or adult-led activities that promote movement over the course of the day and (c) continuous opportunities to develop and practice age-appropriate gross motor and movement skills. Preschool settings may fall short of optimal practices if they rely only on national and state requirements, as such requirements do not always align with best practice guidelines. This finding speaks to the importance of ensuring policy and legislation reflect best practice guidelines that are specific to the needs of young children.

Despite evidence that families and teachers working together is important for supporting PA,31–33 in the current study, caregiver interactions were limited, parents were not given much information about PA, and teachers and administrators perceived that families did not value PA. Interactions between families and preschool staff are often brief (pick-up/drop-off) and non-specific to the child and PA.34 The pandemic may have exacerbated the disconnect between caregivers as in-person interactions were restricted. Given that all caregivers value PA, but all face barriers to promoting it, future interventions could involve families and preschool teachers and administrators actively collaborating to promote PA. Qualitative work by Downing et al 35 suggests that parents would be happy to receive more information about PA, particularly in an online format (ie, text messages or emails). The parents interviewed also discussed the need to have information that is realistic and non-judgemental.35 Taken together with our current findings, finding non- burdensome ways for preschools and parents to share information about PA, potentially through digital media platforms, may improve communication. Further, supporting teachers and administrators in being more sensitive to the perspective of parents and their needs may help them take a more collaborative approach to promoting PA.

Although a strength was highlighting the voices of three groups of caregivers, our study was not conducted in partnership with caregivers, nor did we formally share our findings back with them. Additional limitations include that we sampled a single geographic region, which was most from a metropolitan area, limiting the generalisability. Only certain preschool settings are represented in our sample, therefore, the experiences of caregivers in family or home daycare are not represented. Social desirability and self-selection may also have been apparent in responses. Further, as we did not recruit caregivers of the same child, we were unable to triangulate our findings. Future studies, including speaking to additional caregivers from diverse backgrounds and settings and potentially engaging them in participatory research, are needed to more fully understand barriers and facilitators to promoting PA in preschools.

In conclusion, parents, teachers and administrators all play critical roles in promoting PA in preschools, a key setting for promoting healthy behaviours for children in this age group. Especially in the current postpandemic environment, caregivers need to work together to optimally and collectively support young children to engage in health-promoting active play in all the settings where they spend time.

Data availability statement

Data are available on reasonable request.

Ethics statementsPatient consent for publication

Consent obtained directly from patient(s).

Ethics approval

This study involves human participants and was approved by the Seattle Children's Research Institute Institutional Review Board, PLAY 2 STUDY00000628.