Identifying effective intervention strategies to reduce children’s screen time: a systematic review and meta-analysis

Abstract

Background Excessive screen time ($$\ge$$ ≥ 2 h per day) is associated with childhood overweight and obesity, physical inactivity, increased sedentary time, unfavorable dietary behaviors, and disrupted sleep. Previous reviews suggest intervening on screen time is associated with reductions in screen time and improvements in other obesogenic behaviors. However, it is unclear what study characteristics and behavior change techniques are potential mechanisms underlying the effectiveness of behavioral interventions. The purpose of this meta-analysis was to identify the behavior change techniques and study characteristics associated with effectiveness in behavioral interventions to reduce children’s (0–18 years) screen time. Methods A literature search of four databases (Ebscohost, Web of Science, EMBASE, and PubMed) was executed between January and February 2020 and updated during July 2021. Behavioral interventions targeting reductions in children’s (0–18 years) screen time were included. Information on study characteristics (e.g., sample size, duration) and behavior change techniques (e.g., information, goal-setting) were extracted. Data on randomization, allocation concealment, and blinding was extracted and used to assess risk of bias. Meta-regressions were used to explore whether intervention effectiveness was associated with the presence of behavior change techniques and study characteristics. Results The search identified 15,529 articles, of which 10,714 were screened for relevancy and 680 were retained for full-text screening. Of these, 204 studies provided quantitative data in the meta-analysis. The overall summary of random effects showed a small, beneficial impact of screen time interventions compared to controls (SDM = 0.116, 95CI 0.08 to 0.15). Inclusion of the Goals, Feedback, and Planning behavioral techniques were associated with a positive impact on intervention effectiveness (SDM = 0.145, 95CI 0.11 to 0.18). Interventions with smaller sample sizes (n < 95) delivered over short durations (< 52 weeks) were associated with larger effects compared to studies with larger sample sizes delivered over longer durations. In the presence of the Goals, Feedback, and Planning behavioral techniques, intervention effectiveness diminished as sample size increased. Conclusions Both intervention content and context are important to consider when designing interventions to reduce children’s screen time. As interventions are scaled, determining the active ingredients to optimize interventions along the translational continuum will be crucial to maximize reductions in children’s screen time.

COVID-19 and screen-based sedentary behaviour: Systematic review of digital screen time and metabolic syndrome in adolescents

“…A systematic review and meta-analysis on the effect of behavioural interventions in reducing ST revealed that smaller sample sizes and shorter intervention durations were associated with greater impact. Involvement of healthcare professionals in setting goals, feedback, and planning clusters yielded better outcomes in ST reduction [ 73 ].…”

Predicting the earliest deviation in weight gain in the course towards manifest overweight in offspring exposed to obesity in pregnancy: a longitudinal cohort study

“…Typical for a screening setting, our prediction models show high sensitivity to avoid false-negative cases and high negative predictive values to avoid misclassification as being “not at risk” in offspring with higher-than-normal BMI growth. Furthermore, even a high false-positive rate, i.e., identifying offspring with normal BMI development as being “at risk,” can be considered acceptable since obesity-preventive interventions including exclusive breastfeeding [ 82 ] and improved nutrition (such as healthier complementary and family food choices) as well as supportive environments (such as reducing screen time, increasing physical activity, maintaining a sleep duration of 10 to 14 h per day) [ 94 – 96 ] (Fig. 4 ) are beneficial and safe for young children’s growth in general.…”

“Everything kind of revolves around technology”: a qualitative exploration of families’ screen use experiences, and intervention suggestions

“…The content parents wanted in the program included static information (e.g., the health risks) but also practical help (strategies, tips, advice, and examples from other parents). Importantly, many of the suggestions for the program made by parents align with the characteristics and behaviour change techniques of screen time interventions that have previously been shown to be effective amongst children (0–18 years; e.g., the provision of educational materials, goal setting, planning and monitoring, role-modelling and behaviour substitution [ 16 , 20 , 40 , 41 ]) but are lacking in most commercial apps targeting health behaviours (e.g., diet, physical activity and sedentary behaviour) [ 42 ]. Further, many of these strategies are also elements of ‘gamification’ within Schmidt-Kraepelin’s 2018 Taxonomy of Gamification Concepts for Health Apps [ 43 ], including rewards, goal-setting and reinforcement, which have been shown to support behaviour change while being fun and engaging [ 44 ].…”