Internet Explorer is no longer supported by Microsoft. To browse the NIHR site please use a modern, secure browser like Google Chrome, Mozilla Firefox, or Microsoft Edge.

21/570 What are the health and health inequality impacts of being outdoors for children and young people?


Published: 06 December 2022

Version: 1.0

Print this document

Please note: The Public Health Research (PHR) Programme would like to draw researchers’ attention to the commissioning brief below, which was first advertised in Autumn 2021. This is a brief that we have previously advertised as a commissioned funding opportunity. We are still interested in receiving applications in this research area, as it remains a priority in our portfolio. However, please note that the commissioning brief, along with the underpinning literature searches, has not been updated since originally written.

Research question

  • What interventions lead to children and young people spending more time outdoors in ways that improve their health and reduce health inequalities?

Children and young people’s physical and mental wellbeing is of growing concern and research has shown that spending time outdoors can improve emotional and social resilience in children. Nevertheless, in our current society the time for outdoor play is diminishing, due to a plethora of barriers such as access, safety concerns, parental attitudes and competing indoor activities . The outdoors can be described as a spacious open and constantly changing environment, including green spaces and outdoor urban areas. Here it is possible to experience freedom, practice fine and gross motor skills, as well as boisterous movements and connect with natural elements. For centuries children had the freedom to roam in their local area from an early age, however this has gradually disappeared, and it is no longer common for children to have the opportunity to ‘roam freely’ without adults.

Children need time to play outdoors and to be in nature as an essential part of healthy development. While playing outside, children benefit from being exposed to sunlight, natural elements, and open air, which contributes to bones development, stronger immune system and physical activity. Outdoor play is also important for children’s mental and cognitive growth as it contributes to learning, social connectedness, confidence building and resilience. Older children and young people, especially, often replace outdoor play and face-to-face social interaction by accessing their social life via digital devices. This often leads to a more sedentary lifestyle, obesity, and a disconnection from the natural world.

Time spent outdoors varies by socio-demographic characteristics, including differences by ethnicity, socio-economic status, disability, gender, geography and level of deprivation. There are great inequalities in time spent outdoors between population groups, and this was further exaggerated during the Covid-19 pandemic. Restrictions have severely affected the amount of time many children spent outside and children from ethnic minority backgrounds and from low-income families reported spending less time outdoors.

Evidence of the impact of spending time outdoors has on children and young people is limited and therefore building a robust evidence base through well-designed evaluations is required. Due to the Covid-19 pandemic, there are timely opportunities to evaluate natural experiments, as the pandemic meant many childcare facilities, education settings and groups had to change and adapt their procedures. For example, schools Playschemes, holiday clubs and afterschool clubs have spent as much time outdoors as possible, in line with government recommendations. Research findings from these natural experiments is a key learning opportunity to inform recovery plans, and for policy and decision makers to further develop services to improve children’s physical and mental health, child development, learning, and have a lasting effect on reducing health inequalities.

The Public Health Research (PHR) Programme wishes to commission research on the health impact of interventions aimed at increasing the time that children spend outdoors, particularly children from populations less likely to spend time outside. This could be through unstructured, independent, or structured play, organised activities or other reasons for spending time outdoors. Example of activities include uniformed groups, Forest Schools within educational settings, Duke of Edinburgh Award, afterschool and holiday clubs, Play Streets, public bodies, such as the Forest Commission and events organised by environmental charities such as the Wildlife Trusts, National Trust, RSPB and Woodland Trust. The PHR Programme is only interested in interventions operating at a population level rather than at an individual level. Outcomes of interest include health inequalities and the wider determinants of health.

The PHR Programme recognises that this call is broad and invites researchers to be targeted in their research area. Suggested research areas of interest could include (but are not limited to):

  • Evaluation of interventions aimed at tackling the inequalities experienced by different socio-demographic groups in time spent outdoors by children and young people.
  • Evaluation of interventions aimed at bringing children with disabilities outdoors.
  • Evaluation of interventions aimed at improving children and young people’s mental health by spending time outdoors.
  • Investigation of how effective interventions are at tackling cultural preferences for, and perceptions of outdoor activities, green spaces and nature according to different socio-demographic factors, including gender, age, ethnicity and culture of both the children and their parents.
  • Evaluation of local green space design and management to reduce access inequalities and to meet the needs of local families, including considerations of cultural and community needs.
  • Evaluation of the accessibility to the outdoor spaces taking into consideration the lack of transport, feeling of safety, experience of being in nature.
  • Research comparing structured versus unstructured outdoor play/activities.
  • Would evidence-based policy recommendations about the amount of time children should spend in natural settings, result in meaningful promotion of health and well-being/reduction in health inequalities?

A range of study designs and outcome measures can be used. Researchers will need to clearly justify the choice of and describe the population group targeted, as well as justify the most suitable methodological approach. Primary outcomes must be health related, including wellbeing and mental health measures. Outcomes measures of interest include, but not limited to, physical health (e.g. weight, BMI), physical activity, gross motor skills, mental health, emotional health, social, cognitive development, learning, quality of life and/or play behaviour. Researchers are encouraged to consider other outcome measures that may be influential on policy makers as secondary outcome measures. All key outcome measures should be justified, and researchers need to specify how the outcomes will be measured in the medium and long term. It is recognised that the health outcome of interest may only be achieved later in the children’s lifecourse, and researchers will need to specify and justify any proxy health measures used. Cost-effectiveness and policy implications are always of interest to policy makers and the PHR Programme encourages researchers to consider including economic and policy considerations in their application.

Researchers are encouraged to ensure that service users or people with lived experience from the target audience are involved in the design and planning of the intervention and/or as potentially costed members of the research team. Researchers should demonstrate the relevance of their proposed research to decision-makers and they might do this through involving them in the research team. Researchers are encouraged to explain how they will share their findings with policy makers, public health officers, special interest groups, charities, community audiences and other relevant stakeholders. Researchers are expected to be aware of other studies in this area and ensure their proposed research is complementary.

For further information on submitting an application to the PHR Programme, please refer to the supporting information for applicants submitting stage 1 and stage 2 applications.