Knowledge pertaining to the interplay between body image, body compassion, and endometriosis-related symptoms is limited. The current study aimed to elucidate the relationships between body compassion, body image, and endometriosis-related symptoms, and explore whether endometriosis-related factors or body compassion are significant correlates of body image. Individuals with self-reported symptomatic endometriosis (n = 261), aged 18 years and over, provided endometriosis-related information and completed the Body Attitude Test and Body Compassion Scale. Regression analyses determined that the presence nonmenstrual abdominal pain, lower ability to defuse from negative body-related thoughts, lower body-related acceptance, and higher levels of common humanity were significant correlates of body image, as measured by the Body Attitude Test, in the current endometriosis sample. Preliminary support is noted for the potential inclusion of compassion-focused interventions for addressing body image concerns in endometriosis, with nonmenstrual abdominal pain, dyspareunia, nausea, and bloating viewed as important symptoms for consideration.

OBJECTIVE:Premature ovarian insufficiency (POI) and early menopause (EM) can have life-altering physical and psychological impacts, with potential consequences for an individual's sense of self. However, understanding of these potential consequences is limited, with much of the literature generalizing such experiences from naturally occurring menopause. This scoping review aimed to increase understanding around the alteration of self-concept in adults, presumed female at birth, diagnosed with POI or EM. METHODS:In line with the Joanna Briggs Institute (JBI) protocol for scoping reviews, database searches were conducted, with eligible studies consisting of peer-reviewed literature exploring how self-concept and/or its associated constructs are impacted by POI or EM. RESULTS:Database searches identified 473 manuscripts, with 35 full-text manuscripts reviewed and 12 deemed to be eligible for inclusion. Impacts to physical, social and emotional self-concept were indicated across studies, and detailed via content analysis. Contextual factors were suggested to greatly influence the extent of self-concept impact. The impact of spontaneous versus medically induced POI and/or EM on self-concept showed some variation; however, detailed explanation for this was limited across the manuscripts. CONCLUSION:This review provides greater understanding of the disruptive nature of POI or EM, potentially impacting all aspects of self-concept-physical, social and emotional. Such outcomes emphasize the importance of recognizing the unique experiences of POI and EM and the need for individualized understanding and care. Further research is needed to better understand the experiences of these individuals and their support and treatment needs.

OBJECTIVES:Adolescents with inflammatory bowel disease (IBD) experience disruptions to normal adolescent development. Lack of preparation for transition from paediatric to adult care can have negative biopsychosocial outcomes. We aimed to explore adolescents' perspectives on how IBD affects their lives. Additionally, we aimed to understand adolescents and their parents' views on transition from paediatric to adult IBD care. DESIGN:Qualitative study. Adolescents and parents participated in semi-structured interviews together. METHODS:Participants included eight adolescents with IBD (four females; four with Crohn's disease, two with ulcerative colitis and two with IBD-U; mean age = 16) and their parent(s) (n = 9). Data were analyzed using template thematic analysis. RESULTS:Three themes were identified that reflected how IBD conflicts with typical adolescent development because of the need for careful planning to manage the disease and its symptoms (e.g., loss of bowel control, fatigue). They also described the active role parents currently play in managing their child's IBD, from managing medication to organizing appointments and communicating with healthcare professionals. Anxiety and apprehension of adolescent participants towards transitioning from adolescent to adult care were also captured. CONCLUSIONS:Healthcare providers and carers must work together with adolescents with IBD to ensure they are ready for adult care, where they will need to take sole responsibility for managing their chronic condition.

Distressing medical interactions appear common during endometriosis healthcare; however, the types, prevalence, and impacts are not well understood. 468 people with endometriosis completed an online survey about distressing medical interactions and potential impacts. Following template and content analysis, 80.8% of the sample reported distressing endometriosis-related medical interactions. These events represented two themes: Distressing Procedures (experienced by 30.6% of the sample), and Harmful Communication (64.1%). Of those who experienced these distressing interactions, 79.4% reported impacts to their care seeking. Interactions most often occurred with general practitioners and gynecologists. Trauma-informed, patient-centered endometriosis care is needed, focusing on individualized care, believing patients and avoiding damaging communication and behaviors, to prevent psychological harm.

Eating disorders remain complex and costly conditions, and while evidence-based treatments address behavioural and weight-related symptoms, they often neglect embodied aspects of recovery. This study examined consumer and carer experiences of an 8-week Yoga for Eating Disorder Recovery intervention (YEDRi) offered within a regional eating disorder service. A constructivist realist qualitative design was used to recruit twelve consumer–carer pairs (mean age = 17 years); ten completed the program and undertook post-program semi-structured interviews. Template Analysis guided iterative coding, stakeholder templates, and team consensus. Four themes characterised participant experiences. Getting to the Mat showed mixed motivations and early hesitations. On the Mat revealed physical, psychological, and relational benefits. Off the Mat demonstrated how yoga practices supported daily regulation and strengthened family connection. Beyond the Mat identified safety-enhancing features and practical recommendations for future programs. Therapeutic yoga was experienced as a safe and valuable adjunct to treatment, offering benefits in emotional regulation, embodied awareness, and family connection. Carer-inclusive yoga programs show promise within eating disorder care and merit further investigation across settings and stages of recovery. Trial registration: The trial was registered through the Australian and New Zealand Clinical Trials Registry (ANZCTR) (trial ID: ACTRN12625000274471). Many young people with eating disorders want to move their bodies, but exercise can feel unsafe or overwhelming during treatment. Families also carry a heavy emotional load, often feeling stressed, isolated, and unsure how to help. This study explored what it was like for young people and their carers to take part in an eight-week therapeutic yoga program offered alongside regular treatment. Young people said yoga felt gentle, safe, and different from the pressured or exhausting exercise they had experienced in the past. They described feeling calmer, more connected to their bodies, and better able to manage difficult emotions. Carers were surprised to find the sessions also helped them feel more grounded and supported. Doing yoga together strengthened family relationships. Many families continued practising at home, using breathing and grounding techniques during stressful moments. Young people appreciated having their carer with them, and carers valued sharing an activity that wasn’t focused on food or treatment. Overall, yoga offered a supportive space for movement, connection, and emotional wellbeing. Families felt it complemented standard treatment and would be helpful for others at different stages of recovery.

Although pain, poor quality of life and symptoms of anxiety and depression are common in people with endometriosis, consumer views regarding supportive care needs are limited. Using a descriptive phenomenological approach, three focus groups were conducted with 12 participants with endometriosis to understand their needs and priorities for supportive evidence-based healthcare. Template thematic analysis identified three overarching themes: (1) Endometriosis Is a Whole Person Disease, highlighting the physical and psychological challenges of endometriosis; (2) Current Gaps and Unmet Needs - The Disparity Between Individual Requirements and Available Services and Support, emphasising the impact of healthcare practitioner interactions, financial constraints, and information requirements; and (3) Endometriosis Needs Whole Person Solutions, identifying the need for interdisciplinary, person-centred care to enhance individual empowerment and healthcare decision-making. Given the high costs of healthcare and limited availability of practitioners familiar with endometriosis and whole-person approaches, development and evaluation of online supportive care programs may be beneficial.

STUDY QUESTION:Is telehealth cognitive behavioural therapy (CBT) or yoga effective in improving health-related quality of life (HRQoL) and secondary outcomes for endometriosis? SUMMARY ANSWER:Endometriosis-tailored CBT is superior to education for improving HRQoL and pain. WHAT IS KNOWN ALREADY:Endometriosis is a burdensome disease that contributes to diminished quality of life. Current biomedical care including hormonal and analgesic treatment is associated with inconsistent efficacy. Interdisciplinary care is therefore needed to augment the well-being of people with endometriosis. Although studies have suggested that CBT and yoga are promising for relieving pain and other symptoms associated with endometriosis, the evidence remains limited because they are based on small pilot studies. STUDY DESIGN SIZE DURATION:In this parallel 8-week randomized controlled trial (RCT), 334 participants were randomized using a computer-generated sequence with allocation concealment between April 2021 and February 2024. Outcome assessors were blinded to the group. PARTICIPANTS/MATERIALS SETTING METHODS:Participants required a diagnosis of endometriosis with pain for at least 6 months, and access to internet. Participants were randomly allocated to: (i) CBT (8-week telehealth therapist-led group, n = 79); (ii) yoga (8-week telehealth therapist-led group, n = 83); or (iii) education materials via email (n = 84). Primary outcomes: endometriosis-specific HRQoL (Endometriosis Health Profile-30; EHP-30 Total and Pain); general HRQoL (EQ-5D-5L global health) at post-treatment (8 weeks). Secondary outcomes: pain (period pain, bowel pain, bladder pain, and sexual pain), pain catastrophizing, pain self-efficacy, psychological distress, sleep, fatigue, menstrual symptoms, and central sensitization. Mixed-effects models examined group by time differences. MAIN RESULTS AND THE ROLE OF CHANCE:The CBT group reported statistically significant improvements in endometriosis-specific HRQoL (EHP Pain β = -0.58, 95% CI = -0.89, -0.26, P = 0.01), and general HRQoL (EQ-5D-5L global health β = 0.52, 95% CI = 0.21, 0.84, P = 0.02) compared to the education control group. CBT was also superior to education for pelvic pain (menstrual pain, bowel pain, bladder pain, and sexual pain), pain self-efficacy, and pain catastrophizing. Effect sizes for CBT were generally medium to large (Cohen's D = -0.28 to -0.93). Yoga was superior to education for menstrual symptoms and sexual pain, with medium effect sizes (Cohen's D = -0.56 to -0.71). LIMITATIONS REASONS FOR CAUTION:Due to the presence of COVID-19 restrictions during data collection, CBT and yoga were delivered online. As a result, it is unclear whether CBT and yoga would have the same effects if delivered face-to-face, or whether online delivery would show comparable efficacy in a post-pandemic context. WIDER IMPLICATIONS OF THE FINDINGS:Our RCT is the first to test the efficacy of telehealth CBT or yoga for improving outcomes in people living with endometriosis compared to an active control. Telehealth CBT demonstrated efficacy for improving endometriosis-specific and general HRQoL in people with endometriosis, as well as pain outcomes. Yoga demonstrated efficacy for improving menstrual symptoms and pain during sex. We recommend endometriosis-tailored CBT as part of interdisciplinary management for people with endometriosis, including online delivery to address access and mobility barriers. Yoga may be helpful in augmenting pelvic health. STUDY FUNDING/COMPETING INTERESTS:This work is supported by the Australian Government, Canberra under the Medical Research Future Fund grant number MRFF1200214. The authors do not have any conflicts of interest in relation to the present study. TRIAL REGISTRATION NUMBER:ACTRN12620000756921 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379947&isReview=true. TRIAL REGISTRATION DATE:22 July 2020. DATE OF FIRST PATIENT’S ENROLMENT:23 April 2021.

Yoga is commonly used as an adjunct to psychological therapy to support ED recovery as it can improve body responsiveness and awareness, interoception, and embodiment, mindfulness, self-compassion, self-efficacy, body satisfaction, body appreciation and body image. Research suggests that using yoga as an adjunct intervention may augment and reinforce psychology therapy, enhancing recovery outcomes. This research aimed to describe and appraise a systematic, sequential approach to integrating scientific evidence, expert knowledge and experience, and community engagement in co-designing and developing a therapeutic yoga group intervention for young people engaged in ED treatment. A four-phase approach to developing this intervention included planning, conducting, evaluating, and reporting phases. This paper reports on the development of the initial YEDRi prototype and co-design workshop conducted with carers (n = 3), consumers (n = 3) and clinicians (n = 3) to test and iterate the intervention. The resulting program is an 8-week therapeutic group yoga program for ED recovery where consumers and their carers attend together. This is the first study to systematically engage consumers and carers with a lived experience of EDs in a co-design process to develop a therapeutic yoga program for ED recovery.

Endometriosis can significantly affect family and intimate relationships. This mixed-methods study examined the impact of endometriosis on family life, with a focus on parenting. Women completed an online survey including three open-ended questions, analysed using Template Thematic Analysis. Quantitative analyses included t-tests comparing parents and non-parents on mental health and social outcomes, and multiple regressions examining whether variables correlated to endorsement of themes. Fewer participants were parents compared with the general Australian population. Parents and non-parents reported comparable levels of pain and psychological distress. Parents reported greater friend support, while non-parents reported higher relationship satisfaction. Four themes were identified: early family planning influenced by medical advice; functional and emotional consequences for parents and children; challenges to romantic relationships; and ripple effects on family and social life. Pain severity predicted pre-conception impacts, and partner support predicted broader family and social effects, while psychological distress was unrelated to theme endorsement.

PURPOSE:To assess whether pain, psychological distress, and health-related quality of life (HRQoL) differ in individuals diagnosed with endometriosis and those suspected to have endometriosis. METHODS:Cross-sectional online survey of individuals with a confirmed (n = 550) or suspected (n = 103) diagnosis of endometriosis, recruited via the social media of Australian endometriosis organisations. Demographic and endometriosis-specific characteristics as well as measures of pain, psychological distress, and HRQoL were collected. Multivariate Analysis of Covariance was conducted to compare groups on key variables. RESULTS:The suspected endometriosis group reported significantly greater pelvic pain and symptoms of anxiety than the diagnosed group. CONCLUSIONS:When accounting for covariates, individuals suspected to have endometriosis reported significantly higher pain and anxiety symptoms than those diagnosed. This suggests that diagnosis may be associated with lower levels of pain and anxiety, possibly due to improved accessibility to treatment and removal of uncertainty.

Purpose This pilot study was the first of its kind to examine the experiences of people with persistent pain engaging in a six-week iRest for Pain group program as part of multidisciplinary pain care. Method The present study used a qualitative, phenomenological design and reflexive thematic analysis to gain an understanding of the firsthand experience of patients who participated in the iRest for Pain group program. This program was offered in a specialist outpatient pain management service within a regional public hospital in Victoria, Australia. Results Participants reported they experienced iRest Yoga Nidra as personal and therapeutic, that the practice facilitated deep relaxation and restoration; for some participants trauma reprocessing and integration; improved pain self-management and self-efficacy, as well as dis-identification from persisting pain as personal identity. Additionally, some participants reported motivation and confidence to use iRest instead of medication, to reduce dependence on opioid medications. Conclusion The iRest for Pain group program presents a personally therapeutic and innovative mind-body intervention, which could be offered at various phases from primary to tertiary specialised pain care.

Group parenting programs, including emotion-focused programs, are effective at improving children's emotional and behavioral adjustment; however, the impact of these programs may be limited due to parents, typically mothers, attending sessions alone. It is expected that actively involving both caregivers in parenting programs will lead to superior outcomes given family systems are interconnected and when parents feel more supported by one another, they are more likely to have greater emotional availability for their children. Tuning in to Kids Together (TIK-Together) was developed to involve both caregivers and address the coparenting relationship. The current study examined the feasibility and pilot testing of TIK-Together when delivered in a real-world context, specifically assessing program adherence, reliability of measures, and program outcomes. TIK-Together was delivered to 57 participants (27 mother-father dyads, 1 triad) by community services in Australia in an intervention-only design. Facilitators completed attendance sheets and fidelity checklists after each session, and parents completed online questionnaires at pre-intervention, post-intervention, and 6-month follow-up. Adherence across services varied; however, parent attendance and the proportion of content delivered was high. The measures used to assess coparent outcomes demonstrated good to excellent internal consistency in the current sample. After attending the program, parents reported increased supportive/cooperative coparenting of children's emotions, greater dyadic coping, improved emotion coaching beliefs and practices, reduced undermining coparenting of children's emotions, lower emotion dismissing beliefs and practices, and less parent emotion dysregulation. Mothers and fathers reported improved child emotion regulation and decreased behavioral difficulties. The findings are consistent with prior TIK research and pave the way for future research exploring the benefits of integrating coparenting content into this parenting intervention.

Diagnostic delay is a significant issue facing people with endometriosis; however, the Australian perspective and participant voice is missing for why delay occurs. The current study aimed to assess the length of diagnostic delay, whether this is changing over time, correlates of longer delay and the importance of diagnosis. This study utilised a mixed methods cross-sectional online survey of people with endometriosis (n = 506). Individuals with self-reported endometriosis were recruited via social media and websites of Australian endometriosis organisations completing an online, cross-sectional survey. Hierarchical multiple regression, ANOVA and template analysis were conducted. Participants reported an average diagnostic delay of 12.3 years (SD = 7.7), with delay appearing shorter in those who first saw a general practitioner (GP) for their symptoms since 2018 (mean 4.7 years, SD = 3.4). More recent endometriosis-related symptom onset, younger age at diagnosis, and accessing medical care through public healthcare were associated with shorter delays, whilst seeing a higher number of doctors prior to diagnosis and queer identity was associated with longer delays. Participants indicated that diagnostic delay most commonly occurs due to dismissal and disbelief by medical professionals and qualitative accounts revealed that receiving a diagnosis is important for many reasons. Diagnostic delay is perceived as a barrier to receiving timely, effective care for endometriosis. Increased societal and medical professional knowledge regarding symptoms indicative of endometriosis, and early treatment and clinical skills focused on pain validation and acknowledgement are recommended to improve timely diagnosis.

AimThis qualitative study aimed to understand the experiences of participants with endometriosis undertaking a CBT intervention.MethodsFourteen women who completed an eight-week, online, group-based CBT intervention as part of a randomised controlled trial were included in the study. All participants had endometriosis and persistent pain for at least six months. Inductive reflexive thematic analysis was used to explore meaning and areas of interest.ResultsFour themes were generated that described participants' experiences, including 1) The need for psychological care across the endometriosis journey; 2) Psychologists are part of the "village" needed to manage endometriosis; 3) "Breaking the cycle" of symptoms and building self-awareness with CBT; and 4) Reframing and regaining "control" of endometriosis, and living well.ConclusionsCBT was perceived as a needed, and valuable part of endometriosis treatment, and should be offered as part of multidisciplinary endometriosis care. CBT techniques offer an accessible and long-term option for managing endometriosis symptoms.

Children’s ability to regulate their emotions is a critical protective factor for early mental health and development and is strongly influenced by parenting. Parenting programs can improve these outcomes for children, however, most families, particularly those from diverse or disadvantaged backgrounds, never receive evidence-based support. There is a pressing need for parenting programs that are widely accessible and meaningfully tailored to individual needs and real-time parenting challenges to enhance parent engagement. This protocol outlines the design of two staged trials testing Daily Growth, a universal parenting app for parents/carers of children 2–5 years. The first trial will evaluate the app’s effectiveness as implemented in a real-world community-based trial, while the second will develop and test a machine learning system for personalising support based on Trial 1 data. In Trial 1, parents/carers (n = 1,650) will be recruited and randomised to one of five groups: 150 to active control (government parenting website); 100 each to one of three programs (Emotion Coaching, Active Play, or Wayapa Wuurrk); 1,200 to a non-personalised random combination of all three. Trial 2 (non-randomised) will recruit 400 parents/carers to receive personalised support, with program content from the three programs allocated via a machine learning algorithm based on baseline data. Both trials will run for six weeks where participants will receive twice-daily prompts to complete a 1-min pre-ecological momentary intervention (pre-EMI) survey and non-control participants offered three-minute videos tailored to specific parenting challenges. A post-EMI survey will be delivered 15 min later to assess immediate outcomes. Participants in both trials will complete baseline, six-week, and six-month follow-up surveys. Outcomes from the non-personalised trial will be compared to the fully personalised app and control/single program groups via EMI and post/follow-up on parenting and parent/child emotion regulation. This study introduces a novel digital program combining co-designed parenting content, real-time delivery, tailoring to ensure practical relevance, and algorithm-driven personalisation. By testing standardised and personalised app versions, it will evaluate whether real-time personalised parenting support improves parent/child emotion regulation, engagement, and program acceptability. Findings will inform future approaches to scalable, inclusive, and responsive parenting support in early childhood. This trial is registered with ANZCTR, registration number ACTRN12624000937516; ACTRN12624001023549, and includes all items from the WHO Trial Registration Data Set.

There is growing interest in blue space as a natural environment that may foster well-being. Blue space encourages mindful, immersive, and connected ways of being in and interacting with place. A popular blue space activity that may promote well-being is wild swimming (WS). Existing research suggests that swimmers find WS meaningful because it supports well-being. However, the meanings attributed to WS by wild swimmers likely depend on the characteristics of place, such as water conditions and temperature, which may have a unique influence. The present study aimed to explore the meanings ascribed to WS by a Victorian cohort of wild swimmers. Participants comprised 47 wild swimmers (31 women, 15 men, 1 non-binary person, mean age = 55.5 (11.7)). Participants answered demographic items and five open-ended, qualitative questions about WS. Data were analysed using template thematic analysis. Five key themes were identified: 'Always a swimmer': Starting wild swimming; 'You feel euphoric': Psychological well-being; 'Still going strong': Physical well-being; 'Chatting at the buoys': Social connectedness; and 'The sea is my home': Connectedness to nature. Swimmers found WS meaningful because it promoted well-being by (I) allowing continuity of a 'swimmer' identity; (II) promoting positive mood states and possibly facilitating swimmers to feel energised, calm, meditative, focused, authentic and masterful; (III) aiding physical fitness, healthy ageing and physical pleasure; (IV) enhancing social connectedness as swimmers formed friendships and communities; and (V) fostering nature connectedness as swimmers communed with and observed their sea surrounds. The findings indicate that Victorian wild swimmers, like their counterparts elsewhere, value WS because of the enriching ways in which it fosters well-being. Among the first studies to explore WS in Victoria, Australia, this study contributes to a growing body of research which suggests that engaging in blue space promotes wellbeing. Policy implications. WS may have potential as a strategy for improving well-being in the wider population. As an activity that cultivates social connectedness, it could form part of a social prescription for those identified as being at risk of loneliness. Additionally, WS may have potential as a complementary, nature-based therapeutic intervention.Read the free for this article on the Journal blog.

Purpose: To assess whether pain, psychological distress and health-related quality of life (HRQoL) differ in people diagnosed with endometriosis and those suspected to have endometriosis. Methods: This study was a cross-sectional online survey of people with a confirmed ( n = 550) or suspected ( n = 103) diagnosis of endometriosis, recruited via the social media of Australian endometriosis organisations. The survey collected demographic and endometriosis-specific characteristics as well as measures of pain, psychological distress and HRQoL. Analysis of variance was conducted to compare groups on key variables. Results: The suspected endometriosis group reported significantly greater pelvic pain ( F (1, 651) = 8.427, p = .004; partial η2 = .013), symptoms of depression ( F (1, 651) = 4.658, p = .031; partial η2 = .007), symptoms of anxiety ( F (1, 651) = 9.437, p = .002; partial η2 = .014), and HRQoL in the EHP-5 domains of pain ( F (1, 651) = 4.114, p = .043; partial η2 = .006.), control and powerlessness ( F (1, 651) = 4.129, p = .043; partial η2 = .006), and emotional wellbeing ( F (1, 651) = 4.310, p = .038; partial η2 = .00.) than the diagnosed group. Conclusions: People suspected to have endometriosis reported significantly higher pain and psychological distress and poorer HRQoL than those diagnosed. This suggests that diagnosis is associated with lower levels of pain and psychological distress and greater HRQoL, possibly due to improved accessibility to treatment and validation and removal of uncertainty.

Introduction Endometriosis is a chronic condition affecting up to 11% of people presumed female at birth by the age of 44 years, characterised by the growth of tissue similar to the lining of the uterus on other organs. Endometriosis significantly impacts health-related quality of life (HRQoL) and imposes a substantial burden on both individuals and the healthcare system. International guidelines recommend the interdisciplinary management of endometriosis due to its significant biopsychosocial burden; however, research aimed at exploring psychological approaches for endometriosis is limited. This trial aims to evaluate the effectiveness of CodeEndo, an online co-designed interdisciplinary supportive care program, compared with a waitlist control (WLC), on HRQoL and biopsychosocial outcomes in people with a diagnosis of endometriosis.Methods and analysis A hybrid type 1 effectiveness and implementation randomised controlled trial (RCT) will be conducted. Eligible participants will be randomly allocated to either the CodeEndo program (n=176) or WLC group (n=176) for 8 weeks. The primary outcome will be HRQoL, and secondary outcomes will include psychological symptoms (anxiety, depression, stress), self-efficacy, menstrual, bladder and gastrointestinal symptoms, pain, fatigue, sleep, exercise, diet, symptom bothersomeness and physical and psychological well-being, measured at 8 weeks post-randomisation (T2) and 6-month follow-up (T3). Cost-effectiveness will also be examined. Longitudinal qualitative individual interviews (up to n=40) will be conducted with participants who complete the CodeEndo program to explore benefits, barriers and facilitators of ongoing use. Additionally, the CodeEndo program will undergo evaluation by a group of endometriosis healthcare providers, who will assess potential barriers and facilitators to its real-world implementation. Various process evaluation strategies will also be measured to inform future implementation. Data analyses will incorporate mixed-effects regression models on an intention-to-treat basis, cost-consequences and cost-utility, dietary and qualitative thematic analysis.Ethics and dissemination This protocol received ethics approval from Deakin University Research Ethics Committee (DUREC Ref: 2024-157). Dissemination is expected to include peer-reviewed journal articles, reports, conference presentations as well as websites or social media platforms of relevant chronic pain organisations. Participants will be sent a summary of trial results.Trial registration number ACTRN12623000598684p.

Physical activity during early childhood, otherwise known as ‘play-based physical activity’, may support emotion regulation development, thereby contributing to positive mental health outcomes across the lifespan. The current study aimed to explore the current utilisation of play-based physical activity as a parenting strategy during early childhood, and to initiate the co-design of a novel play-based physical activity parenting program. One-hour qualitative interviews (N = 17) were conducted with parents of children aged two to four years that aimed to understand parents’ perspective on the regulatory effects of play-based physical activity and its role in parenting practices. Thematic template analysis identified five themes highlighting that play-based physical activity encompasses various forms and dimensions and is interwoven with learning across multiple domains. Play-based physical activity was reported to offer both preventative and immediate regulatory benefits, and facilitate family connection, and co-regulation. However, variation was found in parents’ utilisation of play-based physical activity for managing child emotion regulation difficulties. Some parents reported using it to respond to child dysregulation sensitively, others used it to distract and promote positive emotions during child dysregulation, and some did not consciously use it as a parenting strategy. Furthermore, several barriers were identified that limit play-based physical activity engagement and effectiveness, such as low parent capacity. Our findings confirm prior evidence of the regulatory benefits of play-based physical activity and physical activity, and extend this literature by showing the role, and effects of play-based physical activity in early childhood parenting practices.