JMIR Publications

ABSTRACT

Background:

Despite the many negative health outcomes associated with unhealthy screen media use, patient counseling by pediatricians in the primary care setting remains a challenge. The American Academy of Pediatrics (AAP) developed the Family Media Plan, but its online format may not lend itself to use in the time-constrained clinical setting.

Objective:

This exploratory study describes parent perceptions toward screen media use and family-perceived utility of the Healthy Media Use Contract (HMUC), a simplified, 1-page print version of the AAP HealthyChildren.org Family Media Plan for use in the clinical setting.

Methods:

A qualitative phenomenological approach was used to explore family experience with the HMUC. Families of children ages 6-13 years scheduled for primary care appointments were identified and consented in clinic prior to their appointment. During their appointment, their physician provided the family with the HMUC alongside standard screen media use counseling. Families were encouraged to post the HMUC in a common area within the home (e.g., on the refrigerator). Approximately one month after their clinic appointment, participating families completed a semi-structured interview via phone or Zoom to describe their experience using the HMUC. Families were provided a $25 gift card as a thank-you for participating. Interviews were transcribed and analyzed for themes.

Results:

Eight semi-structured, qualitative interviews were completed (English: 6, Spanish: 2). Saturation was assessed through ongoing, concurrent data analysis, and the point at which no new codes or themes emerged was confirmed through consensus among all team members. Qualitative coding and thematic analysis revealed the following screentime-related themes: 1) Parents identify both the benefits and drawbacks of screen media use, a sentiment we have labeled “nuanced neutrality,” 2) A lack of viable alternative activities is a major driver of screen media use, and 3) a lack of predictable family routines was a major factor for families who did not use the contract. Additionally, the following HMUC-related themes emerged: 1) The HMUC increased awareness of family screen time, 2) Delivery of screen media guidance was viewed favorably by families, 3) Rewards were valuable in prompting behavior change, and 4) The use of a contract promoted commitment.

Conclusions:

This study illustrates the nuanced perspectives contemporary parents hold regarding their children’s screen media use. Further, it delineates the specific attributes of the HMUC and its implementation that are perceived by families as effective.