title: Upgrading Preschool Environment in a Swedish Municipality: Evaluation of an Implementation Process.
abstract: Redesigning outdoor preschool environment may favorably affect multiple factors relevant to health and reach many children. Cross-sectional studies in various landscapes at different latitudes have explored the characteristics of preschool outdoor environment considering the play potential triggering combined physical activity and sun-protective behavior due to space, vegetation, and topography. Criteria were pinpointed to upgrade preschool outdoor environment for multiple health outcomes to be applied in local government in charge of public preschools. Purposeful land use policies and administrative management of outdoor land use may serve to monitor the quality of preschool outdoor environments (upgrading and planning). This study evaluates the process of implementing routines for upgrading outdoor preschool environments in a medium-sized municipality, Sweden, 2008-2011, using qualitative and quantitative analysis. Recorded written material (logs and protocols) related to the project was processed using thematic analysis. Quantitative data (m(2) flat/multileveled, overgrown/naked surface, and fraction of free visible sky) were analyzed to assess the impact of implementation (surface, topography, greenery integrated in play). The preschool outdoor environments were upgraded accordingly. The quality of implementation was assessed using the theory of policy streams approach. Though long-term impact remains to be confirmed the process seems to have changed work routines in the interior management for purposeful upgrading of preschool outdoor environments. The aptitude and applicability of inexpensive methods for assessing, selecting, and upgrading preschool land at various latitudes, climates, and outdoor play policies (including gender aspects and staff policies) should be further discussed, as well as the compilation of data for monitoring and evaluation.
authors.affiliation: Karolinska Institutet, Stockholm, Sweden.
authors.forename: Carolina
authors.initials: C
authors.lastname: Altin
authors.affiliation: University of Linköping, Linköping, Sweden Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden sofia.kvist.lindholm@liu.se.
authors.forename: Sofia
authors.initials: S
authors.lastname: Kvist Lindholm
authors.affiliation: Nature School, Municipality of Nynäshamn, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Wejdmark
authors.affiliation: Nature School, Municipality of Nynäshamn, Stockholm, Sweden.
authors.forename: Robert
authors.initials: R
authors.lastname: Lättman-Masch
authors.affiliation: Karolinska Institutet, Stockholm, Sweden Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Boldemann
mesh_terms: D002675:Child, Preschool; D003159:Community-Institutional Relations; D003247:Conservation of Natural Resources; D004779:Environment Design; D006291:Health Policy; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D009043:Motor Activity; D010988:Play and Playthings; D016730:Program Development; D012574:Schools; D013471:Sunburn / Q000517:prevention & control; D013548:Sweden; D014197:Trees
keywords: cancer prevention and control; physical activity/exercise; process evaluation; program planning and evaluation; strategic planning