JMIR Publications

ABSTRACT

Background:

Excessive screen time among preschool children of lower socioeconomic background is often associated with parental factors. The increase in prevalence, detrimental health effects such as childhood obesity, behavioral disorders and lack of strategies to implement screen time guidelines in addition to conventional methods of delivery demands an urgent need for a technology-based screen time reduction intervention for families.

Objective:

To develop, implement and evaluate the effectiveness of ‘Stop & Play’ digital health education intervention using social cognitive theory to reduce preschoolers excessive screen time among low socioeconomic families in Malaysia.

Methods:

Single-blind two-arm, cluster randomized control trial was conducted among 360 mother-child dyads attending government preschools in Petaling district who were randomly allocated into the intervention and wait list control groups between March and December 2021. This 4-week intervention using newly developed whiteboard animation videos, weekly reinforcement infographics and a problem -solving session was delivered by researcher via WhatsApp. Primary outcome was child’s screen time whilst secondary outcomes were mothers screen time knowledge, perception of screen time on child’s wellbeing, self-efficacy to reduce child’s screen time and increase physical activity, mother’s screen time, and presence of screen device in child’s bedroom. Validated self-administered questionnaires were administered at baseline, immediate and three-months post intervention. Data was analyzed using generalized linear mixed models with significance level at P<.05.

Results:

Total of 352 dyads completed the study, 177 in the intervention group and 175 in the waitlist control group with attrition rate of 2.2% (8/360). At the end of the 3-month intervention, the intervention group significantly reduced child’s screen time compared to the waitlist control group (β=-202.29, 95% CI -224.48 to -180.10, P<.001). Scores of parental factors also improved in the intervention group as compared to waitlist control group. Mother’s knowledge significantly increased (β=6.88, 95% CI 6.11 to 7.65, P<.001), perception towards screen time on child’s wellbeing reduced (β=-0.86, 95% CI -0.98 to -0.73, P<.001), mother’s self-efficacy to reduce screen time (β=1.59, 95% CI 1.48 to 1.70, P<.001) and increase physical activity (β=.07, 95% CI 0.06 to 0.09, P<.001) had improved and mother’ screen time had reduced (β=-70.43, 95% CI -91.51 to -49.35, P<.001).

Conclusions:

The Stop & Play intervention was effective in reducing screen time among low socioeconomic preschool children and improving parental factors associated with child’s screen time. Therefore, it is recommended to be integrated into the maternal-child health programs at primary care settings as well as preschools and day-care facilities as part of their health programs. Future research could test the intervention among other preschool settings to evaluate its effectiveness. Longer follow up is suggested to evaluate sustainability of the intervention. Clinical Trial: Thai Clinical Trial Registry [TCTR], 2020 October (TCTR 20201010002).