Due to the societal significance of early childhood education and care (ECEC) as well as the crucial role of children’s early years (0–5 years) experiences for holistic development and wellbeing, there is a substantial interest in assessing ECEC and its environmental quality on child outcomes. To assess this type of quality in ECEC, a set of observational tools called Environment Rating Scales (ERS) are commonly used. However, the ERS field is greatly heterogenous and at times confusing, additionally, questions regarding the contextual alignment and theoretical foundation of the tools are also present. Therefore, to support more precise alignment between scales and their intended contexts, this study conducts a literature review of the ECEC field to identify, organize, and present the main characteristics of the most commonly used ERS tools. The literature search uncovered three main findings which concerns contextual features, theoretical grounding, and psychometric properties of the reviewed ERS tools. These findings are discussed and suggestions for practice and future research are provided. This literature review may guide ECEC researchers, practitioners, and stakeholders to make more informed decisions when evaluating ECEC quality.

Background

 There is solid biological, psychosocial, and economic arguments to promote children’s development as early as possible (Richter et al., 2017), and the evidence to support the immense importance of children’s experiences in the early childhood years (0–5 years) is clear and convincing (Britto et al., 2017; WHO, 2019). The early childhood years is a foundational period for holistic child development, and fundamental aspects of health and wellbeing–with lifelong effects–are laid during this period (Marmot, 2010). For instance, this period is vital for mental and physical health (Irwin et al., 2007) and have been referred to as a “window of opportunity” for promoting life-long healthy habits such as sound physical activity behaviors (Fernandez-Jimenez et al., 2018; WHO, 2019). Early childhood education and care (ECEC) have a central role in children’s early development (Foundation for Child Development, 2020; Irwin et al., 2007) and the quality of these environments is dependent on how practitioners orchestrate and navigate the specific environment in which children’s learning and development take place. For instance, children’s movement and play activities are largely afforded or constrained by the physical and pedagogical environment they are situated in. Besides the basic necessary institutional resources and structures, much of this work rely on how teachers make choices and balance social, psychological and physical aspects of these learning environments. Due to the societal significance of ECEC there is substantial interest in assessing it and its environmental quality on child outcomes. To assess this type of quality, a set of observational tools called Environment Rating Scales (ERS) are commonly used.

ERS have a long history of international use and are frequently used in research, self-assessment, and high-stake settings that help direct the distribution of funding (Brunsek et al., 2017). Leading ERS view quality in ECEC from the children’s perspective (Clifford et al., 2020) whilst increasing observation objectivity, being recognized for their standardization process and ability to measure important environmental characteristics that influence child outcomes (Howard et al., 2018). Still, despite the importance of quality in these early childhood settings, the concept of quality itself is elusive and established tools (like ERS) used to capture this elusive concept have limitations. What we define important to measure (e.g., physical activity, movement, play or other type of activities) and in what way these activities are measured and assessed is of importance for policy creation and ultimately for how institutional settings for young children are organized.

Guiding interventions, targeting educational goals, and child development, quantitative studies and evaluation tools (like ERS) have developed into a distinct research field. These tools are widely heterogenic, at time confusing, and collectively embrace an extensive array of aspects of the ECEC environment. Against this background, this study aims to review the existing literature to identify the relevant characteristics of the most commonly utilized ERS in ECEC. This may serve as a guide for ECEC researchers, practitioners, and stakeholders to make more informed decisions when aiming to evaluate the quality of ECEC settings and for instance organize settings to improve and strengthen children’s opportunities for movement and physical activity.

Methods

 Literature search: To identify ERS used in ECEC research over the past decades, we conducted a structured literature search (2023-12-19) in ERIC via EBSCO, Scopus, PsychInfo, PubMed, ERC, SwePub, and SPORTDiscus, using the Boolean search terms: “Environment Rating Scale*” AND (“Preschool*” OR “Early childhood*” OR “Kindergarten*” OR “Nursery School*” OR “Kindergarden*” OR “Child Care” OR “Day Care”). The search was limited to studies published between 1990-01-01, and 2023-12-31. A PICOS approach (Liberati et al., 2009) was used to specify the search, followed by a pilot search. To complement this initial search, an identical complementary search was performed on 2025-06-09, to retrieve articles published in 2024–2025. 

Inclusion criteria: Included studies had to: (a) use ERS in ECEC, (b) include children in ECEC, (c) have full text availability, (d) be written in English, and (e) be published in a peer reviewed academic journal between 1990 and 2025. ERS focusing exclusively on one-to-one interactions were excluded. To be classified as an ERS, the scale had to assess at least one aspect of the environment and use observations. 

Literature search result: The initial search yielded 1,226 studies, which was reduced to 757 after duplicate screening. These 757 studies (the reference pool, RP) were screened by title, abstract, and method to identify relevant ERS. The complementary search resulted in 39 studies, reduced to 25 after manual duplicate screening and subsequently screened in the same way as the RP of the initial search. During RP screening, an accumulative count of ERS used in original articles was performed, studies analyzing secondary datasets were not included in the count. The complete ERS list contained two sections: section 1 for ERS and section 2 for other mentioned scales/tools requiring additional review. In total, 175 scales were identified (section 1, n=109; section 2, n=66). ERS used ≥5 times in the RP were included in the results, leaving 24 ERS to review. We searched for the original references where these ERS were first described, identifying 7 full texts from the RP and 17 from citation searches. These were read in depth to extract ERS characteristics. Five references were excluded after full text review, leaving 19 for data extraction. 

Data extraction and analysis: From the 19 studies, the following data was extracted: (a) area of assessment, (b) age of targeted population, (c) theoretical basis, (d) design, and (e) country of creation

Conclusions

 Three main findings were identified, firstly, all but one of the reviewed tools originated from an Anglo-Saxon cultural background (and 74% were created in/for a US context), secondly, most of the tools lacked an explicitly stated rigorous theoretical grounding, and lastly, the comparability of the tools psychometric properties is complex. Further, none of the included tools had a specific focus on movement or physical activity. When aiming to measure ECEC quality using observational tools like ERS, we suggest employing tools that are culturally/contextually sound, that is, adapted or created specifically for the particular context of interest. For instance, tools that facilitate practitioners and researchers to develop children’s learning environments with regards to movement and play. This is in line with previous research advocating cultural/context-specific ERS as well as recommending adaptations of already existing ERS when implementing them in new contexts (e.g., Li et al., 2014; Sylva et al., 2006). Further, researchers aiming to assess theoretical constructs by developing new observational tools should employ an explicit rigorous theoretical framework that defines and articulates the constructs of interest since this is a central step in scale construction (e.g., Spector, 1992), something that also could strengthen the validity basis of these tools. To further strengthen these tools, future studies could also focus on validating the tools against relevant outcomes on child level, e.g., objective measures of physical activity. Additionally, since the use of observational tools are resource demanding, in line with previous research (Hay et al., 2024; Ulferts et al., 2019), we recommend streamlining existing ERS or developing less resource-demanding alternatives–that are able to capture quality more practically (e.g., more time efficiently)–for both researchers and practitioners in these environments. Lastly, future research should adopt a meta-analytic approach to enable performing side-by-side comparisons of the psychometric data of ERS.

References 

 Britto, P. R. et al., (2017). Nurturing care: Promoting early childhood development. The Lancet, 389(10064), 91–102. https://doi.org/10.1016/S0140-6736(16)31390-3

Brunsek, A. et al., (2017). The relationship between the Early Childhood Environment Rating Scale and its revised form and child outcomes: A systematic review and meta-analysis. PLOS ONE, 12(6), e0178512. https://doi.org/10.1371/journal.pone.0178512

Clifford, R. M. et al., (2020). Forty years of measuring quality with the Environment Rating Scales. Early Childhood Research Quarterly, 51, 164–166. https://doi.org/10.1016/j.ecresq.2019.08.006

Fernandez-Jimenez, R. et al., (2018). Children present a window of opportunity for promoting health: JACC review topic of the week. Journal of the American College of Cardiology, 72(25), 3310–3319. https://doi.org/10.1016/j.jacc.2018.10.031

Foundation for Child Development. (2020). Getting it right: Using implementation research to improve outcomes in early care and education. https://www.fcd-us.org/assets/2020/06/GettingitRight_UsingImplementationResearchtoImproveOutcomesinECE_2020.pdf

Hay, S. M. et al., (2024). Validating self-assessment measures for quality of center-based childcare: A meta-analysis. Early Education and Development, 36(1), 165–185. https://doi.org/10.1080/10409289.2024.2360882

Howard, S. J. et al., (2018). Measuring interactional quality in pre-school settings: Introduction and validation of the Sustained Shared Thinking and Emotional Wellbeing (SSTEW) scale. Early Child Development and Care, 190(7), 1017–1030. https://doi.org/10.1080/03004430.2018.1511549

Irwin, L. et al., (2007). Early child development: A powerful equalizer (Final report for the World Health Organization’s Commission on Social Determinants of Health). World Health Organization. https://www.who.int/publications/i/item/early-child-development-a-powerful-equalizer-final-report-for-the-world-health-organization-s-commission-on-the-social-determinants-of-health

Li, K. et al., (2014). Chinese early childhood environment rating scale (trial) (CECERS): A validity study. Early Childhood Research Quarterly, 29(3), 268–282. https://doi.org/10.1016/j.ecresq.2014.02.007

Liberati, A. et al., (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ, 339, b2700. https://doi.org/10.1136/bmj.b2700

Marmot, M. (2010). Fair society, healthy lives: The Marmot Review: Strategic review of health inequalities in England post-2010. The Marmot Review. ISBN 9780956487001

Richter, L. M. et al., (2017). Investing in the foundation of sustainable development: Pathways to scale up for early childhood development. The Lancet, 389(10064), 103–118. https://doi.org/10.1016/S0140-6736(16)31698-1

Spector, P. E. (1992). Summated rating scale construction. SAGE Publications. https://doi.org/10.4135/9781412986038

Sylva, K. et al., (2006). Capturing quality in early childhood through environmental rating scales. Early Childhood Research Quarterly, 21(1), 76–92. https://doi.org/10.1016/j.ecresq.2006.01.003

Ulferts, H. et al., (2019). Impact of process quality in early childhood education and care on academic outcomes: Longitudinal meta‐analysis. Child Development, 90(5), 1474–1489. https://doi.org/10.1111/cdev.13296

World Health Organization (WHO). (2019). Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. https://apps.who.int/iris/handle/10665/311664

This study examined pre-service teachers' perspectives on how well their teacher education prepares them to work with children's and students' health, and to what extent they feel responsible to work with this in their upcoming profession. 309 pre-service teachers from preschool, primary school, secondary school and continuing teacher education took part in an online survey. Chi-square tests, Analysis of Variance (ANOVA), post hoc test Tukey's HSD, t-tests and Pearson rank-order correlations were performed to answer the research questions. The findings highlight that pre-service teachers do not feel well prepared but feel responsible for meeting the health needs of children and students. Pre-service teachers in preschool education report significantly higher levels of both preparedness and perceived responsibility compared to pre-service teachers in secondary education. Also, results suggest that pre-service teachers feel more prepared to support children's social and physical health than mental health, highlighting a potential gap in teacher education programs regarding mental health preparedness. Teacher education is seen as stronger in building understanding of mental health than in providing practical tools for health-promoting work, such as communication skills. To better prepare pre-service teachers, programs should include more practice-based exercises that address students' health needs. A key priority is strengthening communication skills and creating a collaborative health communication framework relevant to teachers and other professionals. Future research should further explore health-promoting teaching practices and develop health didactics as a practical classroom tool.

BACKGROUND:This abstract provides a brief blueprint for a doctoral thesis that is connected to the national doctoral program Sustainable movement education (SMOVE) and research project MoveEarly.

INTRODUCTION:There are overwhelming evidence for the numerous positive health benefits of physical activity (PA).^1,2,3,4,5 Meanwhile, it is well known that PA-levels are insufficient in European and Swedish children alike.^6,7,8 Insufficient PA-levels is a substantial societal challenge since being of concern to the immediate and future development, health and well-being of children^9,10  as well as being of great economic burden to society^11,12.  Several policymakers, such as the World Health Organization (WHO),¹³ the Swedish public health agency and Swedish government^14,15 highlights the importance of PA for enhancing health. Further, the Swedish school law¹⁶ and curriculum¹⁷, emphasizes a health promoting school system where preschools and schools are assigned to e.g., provide children with opportunities for daily movement as well as conditions for developing movement capabilities, enjoyment of movement and an interest to be physically active. The early childhood years, often defined as 0-5 years, is regarded as a central period for PA-promotion since being a period that is fundamental for the development of PA-behaviors, overall well-being and health^{18,19,20,21,22} as well being a period where young children can develop PA-behaviors that might track into adulthood^23,24,25. For many Nordic children, much of their early childhood is spent in preschool, and in Sweden and Norway attendance is high, reaching >94% of 3-5 year-olds^26,27 hence, it is important to investigate how to create an ECE-environment that produces enriched opportunities for movement, play, exploration and thus adequate PA. Already in 1996, Siedentop²⁸ argued that effective PA-promotion must include a relationship between school, community, and family and that the school setting is the central point of this relationship, based on the discussion above, one could argue that today, the same goes for the preschool setting. Against this background, combined with the fact that the Swedish curriculum assigns preschools to work health promotive, the Nordic ECE is a setting well suited for PA-promotion, since it is a context encompassing most Nordic children at an age critical for their overall development and health.  

METHODS:The overall aim for this doctoral thesis is to, 1) develop an environment rating scale (ERS) that aligns with the theories of Ecological dynamics (ED), Enriched environment (EE) as well as the constructs of movement, play and exploration in ECE and, 2) evaluate this ERS against outcome effects such as PA, physical fitness, sleep and cognitive tasks from a large-scale intervention in ECE. 

To achieve this, four papers will be produced.I) a literature review on the topic of ERS in general, and on ERS in ECE specificallyII) method development of a new ERS that aligns with EE, ED, movement, play and explorationIII & IV) cross-sectional association studies investigating the associations of the newly developed ERS and outcome effects (e.g., PA and cognitive tasks) of pedagogical interventions in ECE, and  

RESULTS:Tentatively, the result of this dissertation is expected to provide, 

1. an ERS-tool that is able to capture how ECE environments affords, and create opportunities for movement, play and exploration in preschool children and consequently increases PA in this group. 
2. a practical ERS-tool that practitioners within ECE can use to evaluate their own environment and how it relates to creating opportunities for children’s PA via movement, play and exploration.
3. an overview of existing ERS-tools and their characteristics, e.g., validity, reliability, context, advantages and limitations. 
4. associations between the developed ERS-tool and outcome measures on child level such as total amount of PA, physical fitness, cognitive tasks and sleep. 
5. indications of effectiveness of the ERS-tool to promote PA and child development in ECE.
6. guidance for future research connected to PA-promotion, and child development in ECE. 

CONCLUSION:With individual, and public health advancements in mind, there is ample reason to enhance our understanding in the field. It is my hope that this dissertation will contribute to an ECE that advances children’s enjoyment of, and relation to, movement, learning and PA, both in an immediate and life-long perspective. 

INTRODUCTION:There are substantial evidence for the numerous positive health benefits of physical activity (PA) [1]. At the same time, PA-levels in European and Swedish children are insufficient [2]. Inadequate PA-levels, and associated noncommunicable diseases, are regarded as one of the most significant public health challenges confronting us. Hence, it is important to understand how we can promote ways for children to reach adequate PA-levels. Physical Literacy (PL), a theory with potential benefits for PA-behaviors and health, has garnered increasing attention over the last few years. Encompassing physical, affective, and cognitive dimensions PL is often described as an individual’s capacity, confidence, and motivation to partake- and engage in PA [3]. The early childhood years are suggested for PL promotion since this period is regarded as crucial for PA-behaviors, future health, and the opportunity to reach most children via school settings. However, the assessment and status of PL in young children, specifically in Sweden, is at best scarce. Consequently, research is required to assess PL and its connection to PA-levels in young Swedish children.

METHODS:The data for this study will be derived from hip-worn accelerometers (GT3X+, Actigraph) worn for 7 days to assess PA-levels, as well as a modified version of the Canadian Preschool Physical Literacy Assessment to assess PL. The study will include 412 preschool children, aged 3-6, from 20 preschools. The data will be analyzed and presented via descriptive statistics, and multi-level linear regression models will be used to determine associations between total- and intensity stratified PA-levels and PL.

RESULTS:Tentatively, the results of this study are expected to provide: 1) a picture of PL and PA in Swedish preschool children and the connection therein; 2) much-needed data for the fields of PL and early childhood research; 3) Indications on effectiveness of PL for promoting PA; and 4) guidance for future research in PL.

CONCLUSION:With individual, and public health advancements in mind, there is ample reason to enhance our understanding of the relationship between PL and PA-levels of Swedish preschool children, as well as, adding data to the PL-field. The present study has the potential to contribute to these objectives.

References:1. Warburton, D. E., & Bredin, S. S. (2017). Health benefits of physical activity: a systematic review of current systematic reviews. Current opinion in cardiology, 32(5), 541-556.2. Steene-Johannessen J, Hansen BH, Dalene KE, Kolle E, Northstone K, Møller NC, et al. Variations in accelerometry measured physical activity and sedentary time across Europe – harmonized analyses of 47,497 children and adolescents. Int J Behav Nutr Phys Act. 2020;17(1):38.3. Edwards, L. C., Bryant, A. S., Keegan, R. J., Morgan, K., & Jones, A. M. (2017). Definitions, foundations and associations of physical literacy: a systematic review. Sports medicine, 47(1), 113-126.

Introduction

It is well known that muscle strength increases in both the untrained and trained limb after a period of unilateral strength training. However, it is not known how this so called cross-education effect (CE-effect) is affected by a long period of detraining, and if there are any sex differences. Also, there are conflicting results regarding the effect of unilateral training on muscle mass in the untrained limb.

Aim

The primary objective was to study the CE-effect in men and women after a period of unilateral strength training and detraining. The secondary objective was to study if training one limb would affect the muscle mass of the homologous opposite limb.

Method

Sixteen untrained individuals, 9 females and 7 males, completed the study. The training intervention was 10 weeks (34 sessions) of unilateral strength training (leg press (LP) and leg extension (LE) exercise). 1RM and muscle thickness (vastus lateralis) were measured pre-, post- and 20 weeks post-training.

Results

Strength (1RM) in the trained leg increased for both men and woman (LP: ~60%, LE ~20%, p<0.01), with no sex differences. However, only the men had a strength increase in the untrained leg (LP: 26%, LE: 10%, p<0.05) and the non-significant increase observed for the woman (LP: 10%, LE: 3%) was significantly smaller than the increase in the men (p<0.05). Muscle thickness increased similarly for both men and women (trained leg: ~14%, p<0.01; untrained leg: ~4%, p<0.05). The detraining period did not affect strength, but muscle thickness was reduced close to pre-training values in both men and women.

Conclusion

The results of the present study show that the CE-effect is larger in men than women, and that it is long lasting (at least 20 weeks). Further, strength training of one leg can increase the muscle mass of the homologous opposite leg.