Background: There is limited data on active play both in terms of perceived competence and actual motor performance in children living in low- and middle-income countries. Promotion of active play in children is crucial for enhancing participation in physical activity and reducing the burden of obesity. Regular engagement in active play is important for promoting optimal development and increasing physical activity levels in children. Despite the increased interest in active play and physical fitness worldwide, many children in low-resource settings are thought to be physically inactive due to the lack of physical activity-promoting resources and programmes. The 2018 Ghana Report Card on physical activity reports that a high proportion of Ghanaian children do not achieve recommended physical activity levels and a high percentage of these children have poor motor skills. To date, no published study has examined active play among school-aged children in Ghana. Investigating the nature of active play by assessing perceived and actual motor performance among Ghanaian children can serve to increase our understanding of activity deficits, movement difficulties and associated factors in this population. Aim: The aim of this study was to investigate the nature of active play in children aged 6-12 years in Ghana. Specific Objectives: 1. To determine children and caregivers' perceptions of children's motor performance in active play using the Motor Coordination Questionnaire (MCQ). 2. To determine children and caregivers' perceptions of the importance of active play. 3. To identify additional forms of active play and games (which are not listed on the MCQ) that children and caregivers perceive to be important and meaningful. 4. To determine the relationship between MCQ ratings by caregivers and children. 5. To determine the relationship between children's MCQ and actual motor performance. 6. To determine the relationship between caregivers' MCQ and actual motor performance. Methodology: A cross-sectional descriptive and analytical design was used. Three primary schools were purposively selected for this study. The study recruited 406 children and their caregivers for this study. Ethical approval was sought from the Ethics Review Committee of the Ghana Health Service (GHS-ERC 052/05/19) and the University of Cape Town Faculty of Health Sciences Human Research Ethics Committee (HREC REF: 112/2020). Data was collected from both caregivers and children (aged 6-12 years) using questionnaires and the Performance and Fitness (PERF-FIT) test battery. The MCQ-caregivers and MCQ-children were used to assess perceived motor performance, and the PERF-FIT test was used to measure children's actual motor performance. In using the Statistical Package for Social Sciences (SPSS) version 24.0 (SPSS Inc, IBM Company, Armonk, NY), Pearson or Spearman's correlation coefficient was calculated to determine the relationship between children and caregivers' perceptions as well as the relationship between the perceptions and the actual motor performance of the children. Results: Both children (75.6%-94.2%) and their caregivers (69.3%-95.4%) perceived good motor performance of the children during active play. Children (82.8%-96%) and their caregivers (83.2%-94.4%) also regarded active play as very important. Twenty-four additional games were found to be of importance to Ghanaian children and their caregivers. Weak negative, weak positive and sometimes moderate positive correlation between MCQ items and the PERF-FIT items were found. Conclusions: This study shows that we can't rely solely on perceptions, but need actual motor performance, to accurately measure motor performance during active play. We found that parents and children do not accurately estimate the actual level of motor performance. Further studies should be done to understand confounding variables that may have caused poor relationship between perceived and actual motor performance. There is a need for a valid tool like the PERF-FIT to help in accurate measurement of motor performance.

I förskolans utemiljö är det vanligt att det finns en sandlåda på gården. Den är centralt placerad och barnen är där och leker. Enligt den nya Skollagen och förskolans reviderade läroplan ska verksamhetens innehåll vila på vetenskaplig grund och beprövad erfarenhet. Detta gäller även den verksamhet som pågår i sandlådan. Men vad är det som sker när sanden, barnen och lekredskapen möts i sandlådan? Detta är en kvalitativ studie som utifrån ett intra-aktivt perspektiv syftar till att synliggöra hur sanden i sandlådan, lekredskap och de yngsta barnen (1-3 år) skapar möjligheter och villkor för lek och meningsskapande. Utifrån fotografier, anteckningar och videofilm har nya begrepp skapats för att kunna beskriva och förklara det som sker i sandlådan. Resultaten visar på en ständig rörelse där sand, barn och lekredskap förflyttas, förändras och förvandlas. Barn, sand och lekredskap leker tillsammans i ömsesidiga och sammanvävda intra-aktioner. Studiens resultat bidrar till att visa på dessa komplexa processer och hur små barn, med hela sin kropp och alla sinnen, medvetet tillsammans med sanden och lekredskapen skapar ny mening och nya möjligheter. / In the preschool outdoor environment, it is common that there is a sandbox. It is centrally located and the children are there and play. According to the new Education act and Curriculum for the Preschool Lpfö 98 (Revised 2010) the content should be based on scientific evidence and proven experience. This also applies to the activities being performed in the sandbox. But what is happening in the sand, when the children and play equipment come together in the sandbox? This is a qualitative study based on an intra-active perspective, whose purpose is to visualize how the sand in the sandbox, the playground equipment and the youngest children (1-3 years) create opportunities and conditions for play and meaning. Based on photographs, notes and video, new concepts are created to describe and explain what happens in the sandbox. The results show a continuous movement in which sand, children, and playground equipment is moved, changed and transformed. Children, sand and playground equipment play together in mutual and intertwined intra-actions. The findings in the study help to demonstrate how these complex processes and young children, with the whole body and the senses, consciously together with the sand and play equipment create new meaning and new possibilities.

Family Child Care Homes (FCCHs) are the second largest provider of non-relative care in the U.S. However, despite providing care for nearly 1.9 million children under the age of 5, little is known about the physical activity levels of children attending FCCHs. This dissertation sought to provide new information with regards to physical activity in children attending FCCHs. The purpose of the first study was to objectively measure physical activity in children attending FCCHs. 114 children (60 boys and 54 girls) 3.7 �� 1.1 years of age from 47 FCCHs wore an ActiGraph GT1M accelerometer for the duration of child care attendance during a randomly selected week. Counts were classified as sedentary (SED), light (LPA), or moderate-to-vigorous (MVPA) using the cut-points developed by Pate et al. (2006). Total physical activity was calculated by summing time spent in LPA and MVPA. Non-wear time was estimated by summing the number of consecutive zero counts accumulated in strings of 10 minutes or longer. Children were included in the analyses if they had 2 or more monitoring days in which wear time was ���75% of the attendance time. On average, children accumulated 25.9 �� 5.7 min of SED, 10.1 �� 4.2 min of MVPA, and 34.1 �� 5.7 min of total physical activity per hour of attendance. Further analysis revealed that among healthy weight children, 4 year-olds exhibited significantly lower levels of SED and significantly higher levels of MVPA and total physical activity than 2- and 3- year-olds. Among 4-year-olds, overweight and obese children exhibited significantly higher levels of SED and significantly lower levels of MVPA and total PHYSICAL ACTIVITY than healthy weight counterparts. The results from this study indicated that preschool-aged children attending FCCHs are mostly sedentary and accumulate low levels of MVPA during the child care day. The purpose of the second study was to assess the validity of two proxy report instruments designed to measure physical activity in children attending FCCHs. Valid self-report measures are needed for large scale intervention studies and/or population-based surveillance studies in which more burdensome objective measures are not feasible. In Year 1 of the study, FCCH Providers (N=37) completed the Burdette parent proxy report, modified for the family child care setting, for 107 children aged 3.4 �� 1.2 years. In Year 2, 42 Providers completed the Harro parent and teacher proxy report, modified for the family child care setting, for 131 children aged 3.8 �� 1.3 years. Both proxy-reports were assessed for validity using objectively measured physical activity as a criterion measure (accelerometry). Significant positive correlations were observed between scores from the modified Burdette proxy report and objectively measured total physical activity (r = 0.31, p < 0.01) and MVPA (r = 0.33, p < 0.01). Across levels of Provider-reported activity, both total physical activity and MVPA increased significantly in a linear dose-response fashion. Provider-reported MVPA scores from modified Harro proxy report were not associated with objectively measured physical activity. These findings suggested that the modified Burdette proxy report may be a useful measurement tool in larger-scale physical activity studies involving FCCHs in which objective measures, such as direct observation or accelerometry, are not practical. The purpose of the third study was to evaluate the effects of two strategies to increase the use of portable play equipment in FCCHs ��� a community-based train-the-trainer physical activity intervention (INT), and the same trainer-the-trainer intervention supplemented with monthly emails promoting the use of portable play equipment (INT+). We hypothesized that Providers completing the standard train-the-trainer intervention would report significantly greater portable play equipment use than Providers completing the food allergy control training (CON). We further hypothesized that Providers completing the supplementary email intervention would report significantly greater portable play equipment use than Providers completing standard train-the-trainer intervention or the food allergy control training. A total of 50 FCCH Providers from Marion, Linn, Benton, Washington, and Lane County, Oregon were randomized to the INT or CON conditions. Twelve Providers from Lincoln County were assigned to the (INT+). The type, variety, and frequency of portable play equipment use was measured by means of self-report via a checklist and two items from the previously validated NAP-SACC Self-Assessment instrument. FCCH Providers who completed the INT reported significantly greater use of portable play equipment than Providers completing the CON training. However, portable play equipment use among Providers completing the INT+ was not significantly different from that reported by Providers in the INT or CON. Notably, neither intervention had a significant impact on the amount or variety of portable play equipment. The results showed that a comprehensive trainer-the-trainer intervention to increase physical activity in FCCHs could successfully increase the use of portable play equipment in the home. However, supplementing the intervention with monthly emails encouraging the use of PPE was not effective. / Graduation date: 2013

Syftet med denna studie är att bidra med kunskap kring fysisk aktiv lek i förskolans utemiljö utifrån barns perspektiv. Studien är relevant för förskolan då den kan ge kunskaper som kan påverka planering av verksamheten på ett sådant sätt att de bidrar till barns fysiskt aktiva lek och barns framtida hälsa. Baserat på tidigare forskning framkom faktorer som eventuellt kan påverka barns fysiska aktivitet och motoriska utveckling. I dessa studier har förskollärare intervjuats och barn har endast observerats. Utifrån det formulerades två forskningsfrågor där syftet blev att undersöka hur barn uttryckte fysisk aktiv lek på försöksgården. Studien har ett kvalitativt förhållningssätt och empirin bearbetades och analyserades utifrån den sociokulturella teorin med begreppen medling och appropiering. Resultatet visade på att barnen använder flera redskap i förskolans utemiljö i sin fysiskt aktiva lek. Det blev tydligt i resultatet att förskolan utemiljö har en påverkan på hur barns fysiskt aktiva lek blir. Vidare i diskussionen omsätts resultaten i tidigare forskning och jämför samband mellan denna studie och den tidigare forskningen. / The purpose of this study is to contribute knowledge about physical active play in the preschool's outdoor environment from a child's perspective. The study is relevant for preschool as it can provide knowledge that can influence the planning of the activities in such a way that they contribute to children's physically active play and children's future health. Based on previous research, factors that could potentially affect children's physical activity and motor development were revealed. In these studies, preschool teachers have been interviewed and children have only been observed. Based on this, two research questions were formulated where the aim was to investigate how children expressed physical active play in the experimental yard. The study has a qualitative approach and the empiricwas processed and analyzed based on the sociocultural theory with the concepts of mediation and appropiering. The results showed that the children use several tools in the outdoor environment of the preschool in their physically active play. It became clear in the result that the preschool outdoor environment has an impact on how children's physically active play becomes. Furthermore, the discussion translates the results into previous research and compares the relationship between this study and the previous research.