Children's lives have improved dramatically over the past two decades thanks to health care, public safety, and enhanced support for their physical and mental health. At the same time, in this high-tech era, children have smartphones and access to various opportunities that the digital world offers from an early age; they tend to spend more time watching screens than ever because of their unlimited access to smartphones and the Internet. Consequently, 21st-century children report more psychological, behavioural, and socio-emotional problems and challenges. Screen time is associated with decreased physical activity levels, prolonged sedentary behaviour, and poor sleep patterns in young children (Janssen et al., 2019). Children spend more time on screens than on old-fashioned activities like running and playing outside, leading to concerns about a lack of physical activity; as a result, childhood obesity is increasing (OECD, 2019).
Children must adhere to health norms regarding screen time, physical activity, and sleep. However, 82% of young children in Canada do not meet these standards, which can negatively impact their health and development (Kaur et al., 2021). The time children spend in front of electronic devices is especially concerning. Children spend about six hours per day engaged in screen-related activities, which is a significant amount of time that could be spent engaging in physical activity, talking with friends, or other activities that promote healthy development (Jones, 2021). We can improve children's long-term health and happiness by encouraging healthy behaviours and limiting screen time.
Rationale
Childhood habits can influence long-term health outcomes significantly. As a time of rapid growth and development, childhood is an ideal time to correct excessive sedentary behaviour. Sedentary lifestyles at this time and later in life may have specific health implications (Kaur et al., 2020).
According to the Canadian Paediatric Society, children under the age of two should not use screens; children age 2-5 should use them for no more than an hour a day, and children age six and older should use them for no more than two hours; this recommendation is based on excessive screen usage's numerous negative health effects (Ponti, 2022). There are several health impacts associated with excessive screen time, including physical, behavioural, and language problems, cognitive difficulties; memory and executive function problems; sleep problems, depression, and low self-esteem; as well as lower social competence (Ponti, 2022). Inadequate sleep is another likely mechanism linking screen media exposure, excess energy consumption, and obesity. Physically, children report less sleep; obesity is on the rise in children. One of the most well-documented outcomes of screen media use is obesity (Robinson et al., 2017). Children of all ages are becoming increasingly vulnerable to excessive screen time.
The overuse of screens has become a health concern as Canadian kids and teens spend more time indoors and are sedentary; their lifestyles have changed drastically. Kids' time in front of screens - such as video games, smartphones, tablets, computers, and television - negatively impacts their physical, mental, and social development (Clarke, 2019).
Intervention
PLUMS (Program to Limit Unwanted Media Screens), a household-level initiative, aims to reduce children's excessive screen use. For parents, the program is based on the self-determination theory, and for children, it is based on the social cognitive theory (Ryan & Deci, 2017). The intervention includes a variety of behaviour modification techniques aimed at encouraging the development of positive screen time habits and reducing time spent in front of screens. In addition to classroom-based instruction, PLUMS provides monitoring, tracking, coaching, counselling, peer support, feedback, and planning. (Ryan & Deci, 2017). It also employs social comparison, perception, knowledge, consequences, and repeated behaviour practice. PLUMS employs various strategies to provide a comprehensive and effective intervention for reducing unwanted screen usage. Specific information is provided to primary caregivers as part of the program, and instruction and motivational interviewing are as needed. In addition to movies and posters, children are taught the importance of limiting their screen time and engaging in more physical activities. Caretakers are encouraged to replace digital media devices with enjoyable activities, such as playing outside, participating in sports, or reading books, to encourage children to adopt healthier habits.
One of its distinguishing features is PLUMS's use of social cognitive theory to help children develop a positive attitude toward limiting their screen time. This theory considers the effects of social support, self-efficacy, and observational learning on behaviour (Ryan & Deci, 2017). Children in the classroom-based education program learn about the negative effects of excessive screen time and how to develop healthy screen time habits. Tracking screen time, setting goals, and receiving feedback can help children develop a sense of self-efficacy and behavioural control. In contrast, the caregiver intervention is based on self-determination theory, emphasizing the importance of autonomy, competence, and relatedness in promoting behaviour change (Ryan & Deci, 2017). Information and support are provided to parents to help them understand the benefits of limiting their children's screen time for their physical and mental health. It is recommended that parents involve their children in goal-setting, activity planning, and progress tracking in order to instill a sense of competence and autonomy in their children. Social support from family and peers is also provided to promote a sense of belonging and good behaviour.
Transtheoretical model of behaviour change
Figure 1
Transtheoretical Model of Behaviour Change for Reducing Screen Time
A transtheoretical model (TTM) of behaviour change can be used to modify behaviour. The caregiver can recognize when a stage changes, as shown in figure 1. Caregiver education and guidance programs will aid in the prevention of future relapses. Transtheoretical behaviour modification models are frequently used to influence individual behaviour in health promotion and intervention programs. These models are intended to help people navigate the various stages of change, such as pre-contemplation, reflection, preparation, action, maintenance, and termination (Prochaska, 2020).
Caregivers are critical in promoting positive habits and mitigating the negative effects of excessive screen time on children who use screens frequently. Transtheoretical theories of behaviour change can influence caregivers' actions and persuade them to encourage their healthy behaviours. To determine where they are in the transformation process, caregivers can assess their screen-time habits and how they supervise their children's screen time. With this knowledge, a program of education and assistance can be developed to assist parents in making wise choices and implementing effective screen-time restrictions for their children. The Transtheoretical model's key elements for this method are identifying stages of transformation, developing effective interventions and training programs, and avoiding relapse (Prochaska, 2020). By incorporating these elements, we can assist caregivers in navigating the various stages of transition and teaching their children healthy, long-term behaviours.
Note. The transtheoretical model illustrates behaviour change by modifying caregivers' and children's screen-time behaviours to reduce screen time; the model incorporates concepts from social cognitive theory and self-determination theory, resulting in a reduction in screen time and an increase in physical activity.
Social cognitive theory
The social cognitive theory was one of the concepts investigated in developing PLUMS, a program to reduce children's excessive screen time. According to this theory, human variables (such as cognitive, affective, and somatic events), environmental elements (such as social and physical contexts), and behaviour interact dynamically to determine behaviour (Kaur et al., 2021). According to social cognitive theory, self-efficacy, social support, and observational learning are all important in shaping children's behaviour (Kaur et al., 2021). PLUMS modifies caregivers' and children's screen-time habits to influence pre-schoolers' cognitive development. By providing education, tracking and monitoring, coaching and counselling, social support, goal-setting, and feedback, the intervention aims to increase children's self-efficacy and behavioural control (Kaur et al., 2021). Caregivers are also given instruction and support to understand better the benefits of limiting their children's screen time for their physical and mental health.
The social cognitive theory includes concepts relevant to PLUMS, such as observational learning, self-efficacy, and social support. By teaching their children about screen time and modelling appropriate behaviour, parents can set a good example for their children. Children can develop a sense of self-efficacy and behavioural control by measuring and monitoring their screen use, setting goals, and receiving feedback. Social support from family members and peers can foster a sense of closeness while also encouraging healthy behaviour and fostering a sense of belonging. The self-determination theory, which emphasizes the importance of autonomy, competence, and relatedness in promoting behaviour change, may apply to this issue (Kaur et al., 2021).
Self-determination theory
In addition to social cognitive theory, the self-determination theory is also relevant to PLUMS. The self-determination theory posits that intrinsic motivation, autonomy, and competence are essential to behaviour change (Ryan & Deci, 2017). The theory proposes that when people feel autonomous, competent, and related to others, they are more likely to be motivated to engage in behaviour change. PLUMS uses the self-determination theory to encourage caregivers and modify the home media environment. The intervention provides caregivers with education, videos, posters, and motivational interviews to help them understand the importance of reducing screen time for their children's health and well-being (Ryan & Deci, 2017). The program also offers alternative activities that can replace screen time and keep children engaged in playful activities.
The self-determination theory's components relevant to PLUMS include autonomy, competence, and relatedness (Adams et al., 2017). The program promotes caregivers' autonomy by giving them the knowledge and resources to make informed decisions about their children's screen time (Adams et al., 2017). The program promotes competence by providing caregivers with the tools to implement healthy media habits in the home environment. Finally, involving caregivers in the program and providing them with social support promotes relatedness and a sense of community.
Equity/Diversity/Inclusion/Accessibility (EDIA)
The Transtheoretical Model (TTM) is a model of behaviour change that recognizes the importance of equity, diversity, inclusion, and accessibility (EDIA) in the behaviour change process (Hashemzadeh et al., 2019). The model considers EDIA factors at each stage of behaviour change, from pre-contemplation to maintenance. Regarding equity, the TTM recognizes that individuals may face different barriers and challenges in the behaviour change process. For example, individuals from low-income backgrounds may have limited access to healthy foods or safe places to engage in physical activity. The TTM encourages tailoring interventions to address these unique barriers to promote equitable outcomes.
Regarding diversity and inclusion, the TTM acknowledges that individuals have different values, beliefs, and cultural backgrounds that may impact their readiness to change their behaviour (Hashemzadeh et al., 2019). Therefore, the model emphasizes the importance of culturally sensitive interventions that respect and value diversity and promote inclusivity. The TTM also recognizes the importance of involving diverse individuals in developing and implementing interventions to ensure their effectiveness and relevance. Accessibility is another critical factor considered in the TTM (Elezim et al., 2019). The model acknowledges that individuals may face physical, cognitive, or other disabilities that can impact their ability to change behaviour. Therefore, interventions should be designed to be accessible and inclusive for all individuals, regardless of their abilities.
Outcomes
The Transtheoretical Model (TTM)-based intervention can reduce children's excessive screen use. In order to influence caregivers' and children's screen-time behaviour, the PLUMS program incorporates ideas from social cognitive theory and self-determination theory. The intervention has included classroom-based education programs, monitoring, tracking, coaching, counselling, social support, goal-setting, feedback, planning, social comparison, perception, knowledge, consequences, and behaviour repetition. In addition to promoting self-efficacy and self-control, these methods also encourage alternative activity participation in children, as indicated in figure 1. Treatments based on self-determination promote relatedness, competence, and autonomy, all of which can facilitate behaviour change (Adams et al., 2017). Treatments such as involving caregivers in screen usage decisions, providing interesting alternatives for children, and providing social support may increase intrinsic motivation for healthy behaviour change. Spending less time in front of a computer can lead to more physical activity (Adams et al., 2017). The intervention can result in less screen time, more physical activity, weight loss, healthier eating behaviours, and better sleep. Caregivers' increased autonomy, competence, and relatedness will make choosing how much screen time suits their children more manageable.
Social support from friends, family, and classmates will also enhance positive conduct and a sense of belonging. This method can limit children's excessive screen usage while encouraging good behaviour. Applying the Transtheoretical model will enable the construction of a comprehensive and successful intervention to address this issue. The intervention can successfully support the development of healthy screen-time behaviours and limit screen time.
Conclusion
Excessive screen use has been related to various detrimental health effects, including decreased cognitive function, memory and executive function issues, sleep problems, depression, low self-esteem, and social skill impairment. The first step to addressing excessive screen time is understanding what causes it. The Transtheoretical Model was used to construct an intervention to reduce children's excessive screen use. This model used the social cognition and self-determination theories to influence how much time caregivers and children spent on screens. The benefits of the strategy will include less screen time, more significant physical activity, weight loss, healthier eating choices, and better sleep. Caregivers' increased autonomy, competence, and relatedness will make choosing how much screen time suits their children more manageable. The strategy will successfully reduce children's excessive screen usage while encouraging positive behaviour. The Transtheoretical Model was utilized to build an effective and comprehensive intervention that will aid in developing healthy screen-time behaviours and reducing screen time. This intervention emphasizes the significance of taking equity, diversity, inclusion, and accessibility into account while changing behaviour and devising therapies specifically targeted at specific barriers to produce equitable results.
Figure 2
Framework for Reducing Screen Time
Note. Above is an illustration of the framework that can be used to reduce screen time and increase physical activity.
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