Table 1 Key needs for the adaptation as identified by providers and parents with relevant quotes

Engaging

• Success depends on child and family being engaged

• Toy is engaging for child

… it kind of depends on the family because … that child – who’s 5 years old, whose BMI is not even on the chart – is just glued to his games and his parents iPhone. And I don’t think giving him this would interest him at all…. I think it also has to do with how much enthusiasm the parents bring with it. [1-FG-PR-EN-113]

The bug thing definitely would have been a huge hit with him. He would have wanted to go out and collect bugs all the time. [1-IN-PA-EN-15]

Likable

• Toy is fun and exciting

I can imagine something similar happening with this, it becoming something that’s exciting to look forward to at their well child visit, especially for families without as many resources to provide those things. [1-FG-PR-EN-105]

Getting new stuff in the mail is always exciting and those are all things for outdoors so it might just make them pick them up and run outside. … I don’t think that every family would have bug catching kit. [1-IN-PA-EN-102]

Tangible

• Concrete toy/object is motivating to parents AND children

I feel like families respond really well to getting that concrete thing, because when we’re just telling them do this or do that, I feel like sometimes it’s just another item on the long list of things that various professionals have told them they should be doing that they’re not doing. [1-FG-PR-EN-108]

You feel more encouraged as a parent to do things. ... Having someone say, “This is going to help your daughter with this.” “Okay, let’s go. I will do it.” Especially if you have these materials at hand. [1-IN-PA-SP-96]

Avenue for sharing activity ideas

• Provide ideas for free outdoor activities & instructions

• Share environmental education opportunities

N/A

…different ways of doing what you could do with the shovel and the watering can or bug catcher… to generate conversation that way. [1-IN-PA-EN-101]

…we have to instill in children that we have to take care of nature, it helps us breathe cleaner. [1-IN-PA-SP-05]

Formatted to be child-friendly, accessible, and inclusive

• Inclusive visuals

The pictures are great for kids to do the scavenger. [1-FG-PR-EN-108]

…including kids of different racial and ethnic backgrounds, and including people in hijabs, and including people with mobility challenges or other types of disabilities – development disability, et cetera – I think including different types of families. [1-FG-PR-EN-108]

N/A

Equitable

• Language & literacy

• Sustainability

We have a lot of parents who don’t read in any language, and so having printed materials, even if we can get different languages, is not super helpful. So, having something that’s very graphic and easy to explain. [1-FG-PR-EN-108]

If it all of a sudden goes away that’s pretty disappointing, and so, it would be nice if it was something that we could sustain over a long period of time. [1-FG-PR-EN-105]

N/A