A Feasibility Study of a Cluster Randomized Controlled Trial of a Nature-based Intervention Enhancing Mental and Physical Well-being Among Kindergarten Children From Deprived Areas: Nurture by Nature

1. Background A newly published report from 2024 highlights significant socioeconomic, geographical, and seasonal disparities in 1-15 years-old Danish children's access to outdoor environments. While the overall time spent outdoors has remained stable since 2018 (averaging 2 hours and 41 minutes on weekdays and 3 hours and 24 minutes on weekends), the distribution of this time has changed. Most children spend their weekdays outdoor time in structured settings such as schoolyards and playgrounds, whereas weekend visits to natural areas have increased, particularly among families from higher socioeconomic status (SES) and in the summer months.

The report reveals persistent socioeconomic and regional differences in how children engage with nature as also shown in other studies. Children in rural areas and smaller towns tend to spend more time outdoors overall, benefiting from the closer proximity to nature. In contrast, children in urban areas, particularly in the Capital Region and Region Zealand, use schoolyards, playgrounds, and urban parks, with fewer opportunities for spontaneous nature experiences. On weekends, however, urban families, particularly those from higher educational backgrounds, are more likely to travel to forests and beaches. Meanwhile, those parents with lower educational levels face greater barriers to nature access, including transportation limitations and fewer nearby green spaces. While their total outdoor time is comparable to other groups, they are significantly less likely to visit public natural areas, especially on weekdays.

Seasonal differences further impact children's outdoor activity, with outdoor activities more prevalent in summer months and higher engagement with nature compared to winter. It is important to highlight a crucial distinction between general outdoor activities which includes playgrounds, yards and streets, and direct engagement with natural environments, emphasising that while children may spend considerable time outdoors, they do not necessarily interact with nature. The Danish Outdoor Council [Friluftsrådet] stresses the unique benefits of nature exposure, extending beyond conventional outdoor play at playgrounds. The outdoor environment can be categorized into two groups, the green outdoor environment which includes nature, and the grey outdoor environment which includes streets and other outdoor environments which are not nature.

A recent Danish health report indicated that 5.2% of children with a mean age of 6.6 years assessed their overall well-being as low. Another Danish report among children aged 0-9 years stated that at least 16% of young children experience mental health issues or psychiatric diseases.

Exposure to green outdoor environments might promote emotional well-being, reduce stress, fostering social connectedness, support cognitive development and better sleep quality among children, all of which are crucial for learning abilities and daily functioning. Furthermore, regular outdoor activities in nature have been shown to reduce ADHD symptoms, improve concentration, and enhance executive functioning. Additionally, it is speculated that nature-connectedness, e.g. the feeling of being emotionally and psychologically part of the natural world, fosters stronger social bonds and greater emotional regulation, all of which contribute to children's psychological well-being. However, the evidence for these benefits among young children is still limited as only few studies have been conducted among this age group.