{
  "abstract": "Introduction An alarmingly low number of children meet public health guidelines for physical activity and dietary behaviours and, therefore, are at increased risk of developing lifestyle-related diseases. This paper describes the protocol of the B-Challenged project, which aims to co-create systemic actions to promote active outdoor play and healthy dietary behaviours before, during or after their outdoor play together with children themselves.Methods and analysis In five European countries, child-centred Participatory Action Research (PAR)—combined with systems dynamics methods—was conducted with 15–20 child co-researchers (aged 9–12 years) and 15–20 adult actors (eg, youth workers, local policy makers). In the first phase, the main drivers of children’s active outdoor play and related dietary behaviours were mapped by (1) analysing existing cohort data, and (2) conducting child-centred PAR. In the second phase, systemic actions targeting the local physical and social environments will be co-created and implemented by child co-researchers and adult actors to promote children’s active outdoor play and related healthy dietary behaviours. A mixed-methods design will be used to evaluate (1) if actions positively contributed to systems change and 6- to 12-year-olds’ outdoor play and related dietary behaviours (140 children per country); (2) the process of conducting multi-actor, child-centred PAR and implementing the co-created actions and (3) if the child-centred PAR positively contributed to child co-researchers’ feelings of empowerment.Ethics and dissemination Ethics approval for the mapping phase was obtained and approval for implementation and evaluation will be obtained from the five local research institutions. Participating children, one of their parents/caregivers and adult actors had given informed consent before participating in the project. Throughout the project, child-friendly methods, materials and language will be applied, and ethical challenges and potential solutions will be discussed. Project results will be disseminated locally and internationally through various channels and activities among the scientific community, professionals—for example, in health and policy making, children and other citizens.Trial registration number NCT07136376.",
  "authors": [
    {
      "affiliations": [
        "Public and Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, Noord-Holland, Netherlands",
        "Health Behaviours and Chronic Disease, Amsterdam Public Health Research Institute, Amsterdam, Netherlands",
        "Methodology, Amsterdam Public Health Research Institute, Amsterdam, Netherlands"
      ],
      "name": "Teatske M Altenburg"
    },
    {
      "affiliations": [
        "University of Southern Denmark, University of Southern Denmark, Odense, Denmark"
      ],
      "name": "Charlotte S Pawlowski"
    },
    {
      "affiliations": [
        "Epidemiological Methods and Etiological Research, Leibniz-Institut fur Praventionsforschung und Epidemiologie - BIPS GmbH, Bremen, Bremen, Germany"
      ],
      "name": "Wolfgang Ahrens"
    },
    {
      "affiliations": [
        "Leibniz-Institut fur Praventionsforschung und Epidemiologie - BIPS GmbH, Bremen, Bremen, Germany"
      ],
      "name": "Tilman Brand"
    },
    {
      "affiliations": [
        "Leibniz-Institut fur Praventionsforschung und Epidemiologie - BIPS GmbH, Bremen, Bremen, Germany"
      ],
      "name": "Christoph Buck"
    },
    {
      "affiliations": [
        "Leibniz-Institut fur Praventionsforschung und Epidemiologie - BIPS GmbH, Bremen, Bremen, Germany"
      ],
      "name": "Claudia Börnhorst"
    },
    {
      "affiliations": [
        "Institute of Mother and Child Department of Child and Adolescent Health, Warsaw, Masovian Voivodeship, Poland"
      ],
      "name": "Anna Dzielska"
    },
    {
      "affiliations": [
        "Health Behaviours and Chronic Disease, Amsterdam Public Health Research Institute, Amsterdam, Netherlands",
        "Public and Occupational Health, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands"
      ],
      "name": "Leonie Klaufus"
    },
    {
      "affiliations": [
        "Growth, Exercise, Nutrition and Development (GENUD-B34_23R) Research Group",
        "Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain",
        "Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), University of Zaragoza, Zaragoza, Spain"
      ],
      "name": "Pilar De Miguel-Etayo"
    },
    {
      "affiliations": [
        "Growth, Exercise, Nutrition and Development (GENUD-B34_23R) Research Group",
        "Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain",
        "Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), University of Zaragoza, Zaragoza, Spain"
      ],
      "name": "Luis Moreno"
    },
    {
      "affiliations": [
        "Institute of Mother and Child Department of Child and Adolescent Health, Warsaw, Masovian Voivodeship, Poland"
      ],
      "name": "Katarzyna Okulicz-Kozaryn"
    },
    {
      "affiliations": [
        "Public and Occupational Health, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands",
        "Public and Occupational Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands"
      ],
      "name": "Tanja G M Vrijkotte"
    },
    {
      "affiliations": [
        "Health Behaviours and Chronic Disease, Amsterdam Public Health Research Institute, Amsterdam, Netherlands",
        "Public and Occupational Health, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands"
      ],
      "name": "Renée Wink"
    },
    {
      "affiliations": [
        "Health Behaviours and Chronic Disease, Amsterdam Public Health Research Institute, Amsterdam, Netherlands",
        "Public and Occupational Health, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands"
      ],
      "name": "Laura S Belmon"
    },
    {
      "affiliations": [
        "Health Behaviours and Chronic Disease, Amsterdam Public Health Research Institute, Amsterdam, Netherlands",
        "Methodology, Amsterdam Public Health Research Institute, Amsterdam, Netherlands",
        "Public and Occupational Health, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands"
      ],
      "name": "Mai J M Chinapaw"
    }
  ],
  "title": "Promoting active outdoor play and healthy dietary behaviours through the co-creation of supporting physical and social environments for and with primary school-aged children living in underserved neighbourhoods in Europe: the protocol of the B-Challenged project",
  "uid": "354148c8-9938-58c6-86fd-01c9d5fba8a5"
}