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Effect of intervention on screen time in preschoolers: a systematic review and meta-analysis of randomized controlled
Yan Wu1, Xiaobin Xi1,2, Chunkai Zhang1
1College of Education, Jiaxing University, Jiaxing, China.
Insights
Interventions effectively reduce excessive screen time (ST) in young children, with benefits varying by age and intervention type. Early childhood is an opportune time for implementing strategies to promote healthy screen habits.
Area of Science:
- Pediatrics
- Public Health
- Child Development
Background:
- Excessive screen time (ST) in children is linked to adverse developmental outcomes.
- Habits of ST are formed in early childhood and can persist.
- Previous interventions to reduce ST in preschoolers have yielded inconsistent results.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs) evaluating interventions aimed at reducing ST in preschoolers.
- To identify potential moderators influencing the effectiveness of these interventions.
Main Methods:
- A comprehensive search of multiple databases (e.g., PubMed, Web of Science, EMBASE) was conducted for RCTs published between 2000 and 2024.
- Study quality was assessed using the Cochrane Risk of Bias tool and Jadad scale.
- Meta-analysis, including subgroup analyses based on sample size, child age, gender, and intervention duration, was performed to determine effect sizes (SMD) and identify moderators.
Main Results:
- The meta-analysis included 41 studies with 14,514 participants.
- Overall, ST interventions demonstrated a small but significant beneficial effect (SMD = 0.26, 95% CI: 0.12 to 0.39).
- Intervention effectiveness was significantly moderated by child age, intervention duration, target behavior, and intervention recipient.
Conclusions:
- Interventions to reduce screen time in early childhood are effective in achieving significant reductions.
- Early childhood presents a critical window for intervening to establish healthy screen habits.
- Future research should focus on large-scale implementation, long-term sustainability, theoretical frameworks, and the role of caregivers.
Background:
Excessive screen time (ST) is linked to adverse physical and mental development in children, with habits forming in preschool and solidifying over time. Previous studies on interventions to reduce ST in preschoolers aged 0-7 years have shown inconsistent results. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate intervention effectiveness and identify potential moderators. METHODS: We searched CNKI (Chinese), Wanfang Data (Chinese), SinoMed, Ebscohost, Web of Science, EMBASE, PubMed, and Cochrane Library for RCTs (January 1, 2000-December 31, 2024) targeting ST reduction in preschool children. Study quality was assessed using the Cochrane Risk of Bias Assessment tool and Jadad scale. Effect size were reported as standardized mean difference (SMD) with 95% confidence intervals (CI). Subgroup analyses (e.g., sample size, child age, gender, intervention duration) were conducted, with statistical tests (e.g., the chi-square test) comparing subgroup differences.
Results:
A total of 41 studies with 14,514 participants were included in the meta-analysis. The overall summary of random effects showed a small, beneficial impact of ST interventions compared to controls (SMD = 0.26, 95% CI: 0.12 to 0.39). Subgroup analysis showed that the intervention effect was moderated by child age (χ2 = 6.25, P = 0.04), intervention duration (χ2 = 7.38, P = 0.007), target behavior of the intervention (χ2 = 6.72, P = 0.01) and intervention recipient (χ2 = 10.5, P = 0.01).
Conclusion:
Despite heterogeneity in study methods and results, overall interventions to reduce ST in early childhood show significant reductions, suggesting that this may be an opportune time to intervene. Future research should explore strategies for implementing large-scale interventions and sustaining long-term intervention effects, investigate the potential impact of different theoretical frameworks on intervention outcomes, and examine the role of caregivers in supporting behavior change. These findings provide a robust foundation for developing evidence-based strategies to promote healthy ST habits in young children.
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