Table 4.

Qualitative usability testing and PN adaptation

Core Tool Component	Parent Input	Clinic Staff Input	Adaptation
Written materials	• Should include instructions on how to use the nature toys • Should include additional outdoor activity ideas and community resources (e.g. information about local parks or library scavenger hunts) • Should describe the specific benefits of PA • Pictures are great, but should include representation of children with darker skin tones and pictures of families in different living environments • Should be child-friendly and child-oriented (e.g. encourage them to play outside instead of use technology)	• Should include pictures of children from different racial and ethnic backgrounds and with different disabilities	• Brochure includes pictures of diverse families • Brochure describes the health benefits of active play outdoors and ideas for activities in ways children can understand • Brochure and website emphasize activities that families can do together
Nature toy	• Parents had varied opinions on which toy their child would prefer • Should match children’s varied interests • Should be age appropriate	• Should be not too large to store	• Offer families a choice in toy • Toy options selected: kite; jump rope; bubble wand; frisbee; colored chalk; bug catcher and magnifying glass; shovel and seeds