Abstract：
Time outdoors and contact with nature are positively associated with a broad range of children\'s health outcomes. Pediatricians are uniquely positioned to promote active play in nature (APN) but may face challenges to do so during well child visits. The objective of this study was to understand barriers to children\'s APN, before and during the COVID-19 pandemic, and how health care providers could promote APN.
Focus groups were conducted with 14 pediatric providers and interviews with 14 parents (7 in English, 7 in Spanish) of children ages 3 to 10 on public insurance. Dedoose was used for coding and content analysis. We contextualized this work within the WHO\'s Commission on Social Determinants of Health conceptual framework.
Parents mentioned a range of material circumstances (time, finances, family circumstances, access to safe outdoor play spaces and age-appropriate activities) and behavioral/psychosocial factors (previous experiences in nature, safety, and weather concerns), many of which were exacerbated by the pandemic, that serve as barriers to children\'s APN. Providers said they were motivated to talk to families about children\'s APN but mentioned barriers to this conversation such as time, other pressing priorities for the visit, and lack of resources to give families.
Many pre-pandemic barriers to APN were exacerbated by the COVID-19 pandemic. Well-child visits may be an effective setting to discuss the benefits of APN during and beyond the pandemic, and there is a need for contextually appropriate resources for pediatric providers and families.
Focus groups were conducted with 14 pediatric providers and interviews with 14 parents (7 in English, 7 in Spanish) of children ages 3 to 10 on public insurance. Dedoose was used for coding and content analysis. We contextualized this work within the WHO\'s Commission on Social Determinants of Health conceptual framework.
Parents mentioned a range of material circumstances (time, finances, family circumstances, access to safe outdoor play spaces and age-appropriate activities) and behavioral/psychosocial factors (previous experiences in nature, safety, and weather concerns), many of which were exacerbated by the pandemic, that serve as barriers to children\'s APN. Providers said they were motivated to talk to families about children\'s APN but mentioned barriers to this conversation such as time, other pressing priorities for the visit, and lack of resources to give families.
Many pre-pandemic barriers to APN were exacerbated by the COVID-19 pandemic. Well-child visits may be an effective setting to discuss the benefits of APN during and beyond the pandemic, and there is a need for contextually appropriate resources for pediatric providers and families.
摘要：
户外时间和与大自然的接触与广泛的儿童健康结果呈正相关。儿科医生在促进自然积极发挥（APN）方面具有独特的优势，但在儿童访视期间可能面临挑战。这项研究的目的是了解儿童APN的障碍，在COVID-19大流行之前和期间，以及医疗保健提供者如何推广APN。
焦点小组对14名儿科提供者进行了调查，并对14名家长进行了访谈（7名用英语，7西班牙语）3至10岁儿童的公共保险。Dedoose用于编码和内容分析。我们将这项工作置于世卫组织健康社会决定因素委员会的概念框架内。
父母提到了一系列物质情况(时间，金融,家庭情况,进入安全的户外游戏空间和适合年龄的活动)和行为/心理社会因素(以前在自然界的经历，安全,和天气问题)，其中许多疾病因大流行而加剧，成为儿童APN的障碍。供应商说，他们有动力与家庭谈论儿童的APN，但提到了这种对话的障碍，例如时间，访问的其他紧迫优先事项，缺乏给家庭的资源。
COVID-19大流行加剧了许多大流行前对APN的障碍。良好的儿童访问可能是讨论APN在大流行期间和之后的好处的有效环境，并且需要为儿科提供者和家庭提供适当的上下文资源。
焦点小组对14名儿科提供者进行了调查，并对14名家长进行了访谈（7名用英语，7西班牙语）3至10岁儿童的公共保险。Dedoose用于编码和内容分析。我们将这项工作置于世卫组织健康社会决定因素委员会的概念框架内。
父母提到了一系列物质情况(时间，金融,家庭情况,进入安全的户外游戏空间和适合年龄的活动)和行为/心理社会因素(以前在自然界的经历，安全,和天气问题)，其中许多疾病因大流行而加剧，成为儿童APN的障碍。供应商说，他们有动力与家庭谈论儿童的APN，但提到了这种对话的障碍，例如时间，访问的其他紧迫优先事项，缺乏给家庭的资源。
COVID-19大流行加剧了许多大流行前对APN的障碍。良好的儿童访问可能是讨论APN在大流行期间和之后的好处的有效环境，并且需要为儿科提供者和家庭提供适当的上下文资源。
