The 5 R’s of Indigenous Research as a Framework to Co-Design and Evaluate an Outdoor Play Program in Early Learning and Child Care Centers: Protocol for the Promoting Early Childhood Outside (PRO-ECO) 2.0 Wait-List Control Cluster Randomized Trial

BACKGROUND: Outdoor play is a fundamental part of childhood. Children's participation in outdoor play connects them to nature and the land, and supports their role in the natural world. Early learning and child care (ELCC) centers provide opportunities for outdoor play; however, barriers toward the provision of outdoor play exist, including educator attitudes, policies and procedures, outdoor space limitations, and adverse weather conditions. OBJECTIVE: The Promoting Early Childhood Outside (PRO-ECO) 2.0 study is a community-based research partnership with Indigenous Knowledge Keepers and Elders, Indigenous and early childhood organizations, early childhood education faculty, ELCC centers, and families, aiming to expand outdoor play in ELCC centers. This paper provides an overview of the community-based design process, guided by the 5 R's-Respect, Relevance, Responsibility, Reciprocity, and Relationship-and the resulting study protocol for the mixed methods waitlist control cluster randomized trial. METHODS: This study considered a 5 R's research approach from its inception, beginning with the formation of a Steering Committee and over a year of relationship building before formal study activities commenced. A key early focus was collaboratively identifying project values through an iterative process. Collectively, we worked to promote equity, disrupt power dynamics, and embed Indigenous data sovereignty principles into research agreements, marking a significant departure from traditional Western research processes. The PRO-ECO program and study protocol are implemented in partnership with 10 ELCC centers delivering licensed full-day, year-round care to children aged 2.5-6 years in rural and urban areas of British Columbia, Canada. The PRO-ECO program includes 4 components to address common barriers to outdoor play in ELCC settings. Primary outcome measures include the proportion and diversity of observed nature play behavior during dedicated outdoor times at ELCC centers as measured through observational behavior mapping. Secondary outcomes include changes in educator attitudes, quality of ELCC outdoor play space, and children's perspectives of their experiences at ELCC centers. Outcome data are collected at baseline, and 6 months and 12 months post baseline. The community's perspectives (educators, children, and families) on the project are assessed qualitatively to understand the acceptability of the PRO-ECO program. Mixed-effect models will test the effect of the PRO-ECO program on quantitative outcomes. Qualitative data will support the interpretation of quantitative findings and provide evidence on project acceptability. RESULTS: Participant recruitment for this study began in August 2023, and data collection was completed in March 2025. A total of 229 children, 91 staff and early childhood educators, and 40 family members were recruited to participate in this study. CONCLUSIONS: The PRO-ECO 2.0 study uses a rigorous experimental design within a community-based research project. The 5 R's approach grounded our work in shared values, disrupting traditional academic power relations and weaving together Indigenous and Western worldviews in the context of academic research. TRIAL REGISTRATION: ClinicalTrials.gov NCT05626595; https://clinicaltrials.gov/study/NCT05626595. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/77956.

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