Children’s play, health & well-being
: the development and psychometric assessment of a play quality of life scale

  • Laura McQuade

Student thesis: Doctoral Thesis


Patterns of play in childhood are changing across the generations for numerous reasons (Holt et al., 2015). Unstructured outdoor free play opportunities have been declining over time (Gray, 2015; Bassett et al., 2015; Witten et al., 2013), coinciding with growing concerns about child safety, well-being and a rise in childhood obesity (WHO, 2021; The Lancet, 2022). However, unstructured outdoor free play is vital for children’s optimal development (Gleave and Cole-Hamilton, 2012). Despite the significance of unstructured outdoor free play for children in the early years, up until now there has been limited investigation which addresses the influence of changing play practices in childhood, particularly in determining the foundations of long-lasting healthy behaviour patterns in middle childhood and early adolescence (Roberts, 2015; Moore and Lynch, 2018; Howard et al., 2017); and no child self-report measures currently exist with regard to quality of life as a result of being in play. Given its importance, it is essential that government and health professionals understand play patterns in middle childhood and the barriers to participation in play to ensure that all children are provided with sufficient play opportunities as this can have implications for health outcomes in later life (UNCRC, 2013; Telama, 2009). Therefore, the overall aim of this thesis was to examine the role of children’s play patterns on the physical and psychosocial health and well-being of children in middle childhood and adolescence, and to develop and test a child self-report Play Quality of Life (PLAY-QoL) scale to establish its suitability, reliability, and validity for use with this cohort.

An exploratory mixed-method approach was employed, which draws various theoretical perspectives such as the Bioecological Systems theory (Bronfenbrenner, 1979, 1994, 2007), Self-determination theory (Ryan and Deci, 2000, 2006) and PERMA Model (Seligman, 2011). First, a mixed-method systematic review was performed to detect relevant quantitative, qualitative and mixed-method studies which sought to investigate unstructured play patterns in middle childhood and its association with health and well-being outcomes (Chapter 3). Seven electronic bibliographic databases were searched for peer-reviewed articles and methodological quality of studies were assessed using the MMAT (Hong et al., 2018). The systematic review (21articles) identified that unstructured outdoor play was favourably associated with a number of health domains, most notably improved physical activity and reduced sedentary behaviours, with some evidence for improved psychosocial health such as improved social interactions. There was also some initial evidence to suggest that unstructured play may provide protection to counter symptoms of ill mental health for girls. The need for more psychosocial and high-quality studies is warranted. In addition, the systematic literature review yielded no existent measures or instruments which assessed children’s self-reported well-being or quality of life construct with regard to children’s play.

Children’s opportunities to play can be influenced by ecological system factors suggesting that a child’s home and community environment may influence their health and well-being. The second investigation of this thesis adopted an exploratory qualitative approach where 72 children (mean age 10.5 (SD=1.96) years) took part in 8 focus group discussions to explore children’s experiences of unstructured play patterns, and children’s perspective of play with regard to their health and well-being in middle childhood (Chapter 4), where a reflexive thematic analysis approach was employed. Focus group discussions revealed several identified themes: concerning various types of play; barriers and enablers to fully engage in play opportunities; and the importance of play for both physical and psychosocial health and wellbeing was evident.

Formulated on children’s perspectives from the focus group discourse (Chapter 4), a questionnaire measuring various well-being / quality of life characteristics as a result of being in unstructured play was constructed in order to assess play quality of life (Chapter 5). Convenience sampling was employed to recruit 226 children aged between 8 to 14 years in Northern Ireland. Participants completed an initial 31-item Play Quality of Life Scale via an online Qualtrics survey with the support of their parents or carers. To establish psychometric validation of the Play Quality of Life (PLAY-QoL) scale, its properties were analysed such as reliability, construct and face validity and factorial structure of the scale was undertaken. The findings demonstrated that the PLAY-QoL scale had good measures of sampling adequacy and sphericity and a three-factor model was the most suitable fit which included sub-scales of: (1) Physical well-being; (2) Emotional well-being; (3) Social well-being. Initial analysis also showed that significant positive correlations were found between the frequency of outdoor play and total quality of life (p<0.01) and quality of life subscales including physical (p<0.001), emotional (p<0.001), and social well-being (p<0.001), with the greatest correlation found in the physical well-being component. The findings suggest that the more often children engage in unstructured play outdoors, the higher their quality of life and well-being from being in play. Future research to investigate construct validity and criterion validity would be advantageous.

In conclusion, this PhD study is the first comprehensive development and testing of a quality of life in play measurement tool. Its application using an exploratory methodology to examine children’s perspectives in this domain, and the first systematic review on play and physical and psychosocial health and wellbeing at this stage of childhood development, provides a significant original contribution to the knowledge base. The thesis highlights the vital importance of play for the promotion of children’s health and wellbeing, but points to the need for further action to improve and promote children’s play opportunities, whilst also ensuring that children are at the forefront of decision making. The PLAY-QoL Scale has the potential to be a beneficial instrument to provide measurement data in examining gradual changes in children’s quality of life over time as a result of engaging in unstructured free play. The scale also has the potential to be a useful tool in evaluating the effects of unstructured free play programmes on improving children’s physical and psychosocial well-being, in children aged eight to fourteen years.
Date of AwardOct 2023
Original languageEnglish
SupervisorMarian McLaughlin (Supervisor), Melanie Giles (Supervisor) & Tony Cassidy (Supervisor)


  • Children
  • Unstructured
  • Outdoor
  • Play
  • Wellbeing
  • Quality of life

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