IJCRR - 14(19), October, 2022
Date of Publication: 05-Oct-2022
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Awareness Among Parents Working in the Healthcare Sector on Screen Addiction and Its Impact on Children and Adolescents
Author: Sathyanarayana Kondati, Nandhini L., L.S. Thiruneelan, Hilda Solomon, Jayanthi Swaminathan, Anitha Rani A.
Abstract:Introduction: The digital life of our children begins at an early age as they are exposed to a variety of screens (mobile phones, TV screens, tablets and computers). It has become more important for parents to suggest appropriate screen time and type of media exposure for children in recent years. Aim: The present study aimed to understand the awareness of parents who are health care workers on their child's screen timing and associated behavioral changes, post lockdown. Method: A cross-sectional survey was conducted among the health care workers, who are parents of child aged between 3 - 18 years at Apollo Hospitals, between December 2021 - Feb 2022. Results: A total of 105 responses were received from medical and non-medical sectors. In the study, 47.61% were fathers followed by mothers (44.76%) and guardians (7.61%). The majority of the children belong to the age group of 6 to 12 years (42.85%) and were secondary school level (29.52%). The majority of the children watch mobile phones, followed by television. The daily screen time for child was reported as 3 hours in weekdays and > 4 hours on weekends. Among behavioral changes, age groups of 3-6 years and 12-18 years showed lack of concentration, whereas in 6-12 years age group personal hygiene was reduced. Further, there is a change in eating patterns (70%) and sleeping patterns (92%), and an increase in their monthly bills (42%) towards the mobiles/ screen apps due to increased screen time. On the other hand, digital technology increases the understanding of the concept easily and improves the learning outcome. Thus, parents feel that they need to find the right balance in the usage of technology (39.4%) for the prolonged use of digital technology. Conclusion: To conclude, it is fairly impossible to provide techno free zone to children in this digital world. Thus, parents have to focus and limit the screen usage time to reduce the ill effects, further parental screen addiction awareness and co- viewing avoid the behavioral problem.
Keywords: Screen addiction, Digital technology, Parents, health care workers, Awareness, Techno free
The digital life of our children begins at an early age as they are exposed to a variety of screens (mobile phones, TV screens, tablets and computers). It has become more important for parents to suggest appropriate screen time and type of media exposure for children in recent years. Screen time is defined as the time spent interacting with media devices. Both its benefits as well as its harms have been subject to debate.1 Initially, screen time was found to be associated with health problems like obesity, sleep disturbances, and behavior disorders. Currently, digital literacy is being hailed as a way to further the education of children. 2 The population of India's digital consumers (nearly 41%) grew to 560 million in 2018, ranking second only to China among the largest and fastest-growing markets for digital consumers.3 As on 2019, there were about 1161.17 million cell phone users in India.4 Cell phones are known to affect an individual’s overall health.5 They are associated with sleep deprivation, inappropriate food habits, physical inactivity, being overweight, and obesity. 6,7,8
As the confusion on appropriate of screen time for children exists American Academy of Paediatrics (AAP) started updating and providing recommendations.9 AAP initially suggested the restriction perhaps later it suggested limiting the screen timing to not more than two hours per day for children greater than two years and also recommended no screen timing for children less than two years of age.10 Further in 2013 AAP recommended that pediatricians to include the two basic questions in their regular check-ups as the child has a TV in their room and the amount of time spent in front of the screen. As per the newer guideline motivating the parents to interact with their children, limit the media hours, and create a tech-free zone for their kids.11 According to WHO (World Health Organization) there should be absolutely no screen time for children less than five years and stress upon the physical activity of more than an hour to reduce sedentary activity.
In recent times, researchers are focused on the association of parental mobile devices and internet usage and the association of the mobile device and decreased verbal and non-verbal interactions and support.12 Further there is an association between the mobile device. The disruption in parent-child interaction due to technology has even been labeled “technoference”.13 Although internet benefits are innumerable, it also has several negative aspects if used in an unwise manner.14,15 In the eyes of parents, the Internet provides access to the whole world and is a tool for delivering information. In fact, parents are aware of the positive and negative impacts of internet usage. To prevent and manage internet addiction, parents must know how to implement a strategic management plan.
Excessive use of the internet is associated with screen time with hyperactivity, conduct and emotional problems, further, it is associated with a negative impact on academic performance.16,17 The extensive exposure of rapid screen changes and during the brain development period that is between two to six years of age, tuned the mind of the children to expect the higher level of simulations, which can ultimately lead to hyperactivity, cognitive problems, language difficulty in their real-life situation or human interaction.18 The psychological well-being to be progressively reduced from one hour per day to screen timing to greater than or equal to seven hours per day of screen timing.19 Further the viewing of television for more than three hours is associated with increased screen timing of children, it shows that parents influence the screen timing on children.20 Thus, there is a need to study the understanding of parents about the awareness of their child’s screen timing. The present study was conducted to understand the awareness among parents who are health care workers on their child’s screen timing and associated behavioral changes observed in their child/children post lockdown.
A cross-sectional survey was conducted among the healthcare workers, who are parents of child/ children aged between 3 - 18 years at Apollo Hospitals, Chennai, between December 2021 - Feb 2022. A questionnaire was prepared using Google Forms and were shared with the parents who are health care professionals’ workers at Apollo Hospitals Chennai, through various social media platforms and the data collected were analyzed. The study was approved by the Institutional Ethics Committee - BioMedical Research (AMH-DNB-085/11/21), Apollo Hospitals Chennai
A 27-item structured questionnaire was used in the study to obtain the required data. The information related to parents (Father / Mother/ Guardian), details of child such as age, educational status, Types and usage of screen, weekly usage pattern, behavioral change in kids, and related health outcomes of the kids were recorded accordingly. The baseline characteristics of the participants were presented as frequency and percentages. The data was analyzed using SPSS version 22.0 (IBM). P value ≤ 0.05 was considered statistically significant for all analyses.
A total of 128 participants responded, among which 105 were included in the study. The demographic characteristics of the healthcare workers was presented in Table 1. In the current study majority of the healthcare worker responders were fathers (47.61%), followed by mothers (44.76%) and guardians (7.61%). In the study population, Clinical Researchers were higher (39.04%) followed by Paramedics (36.19%), doctors (14.28%) and administrative sectors (10.47%). The daily time spent by parents with their children was 3 hours on average. The number of electronic devices at home was on an average of five devices such as TV, Mobile, desktop, laptop, and tablet) (Table 1).
The children’s demographic details were presented in Table 2. The children aged between 6 to 12 (42.85%) were followed by children aged between 3 to 6 years (37.14%) and 12- 18 years (20%). In the present study majority of the child falls under the secondary school level (29.52%), followed by primary school (27.6%). On average, the child’s screen time is 3 – 3.5 hours. Parents observed that the majority of the children watch Mobile phones, followed by television, laptop, Desktop, and Tablet.
The daily time spent with the child during weekdays were about 3 hours and during weekends it is more than 4 hours both parents follow the same pattern. Further, the screen time shared by parents with the child were less during the weekday and slightly more during the weekends (Table 2). The type of screen usage and duration of usage during weekdays and weekends was presented in Fig 1. In the current study, the healthcare workers reported that their child spends more hours in Online classes, followed by online videos/ movies, gaming, and social media. Likewise, during weekends children concentrates more on online videos/ movies, gaming, social media and competitive exams.
Changes observed by parents in their child’s activities:
Parents' observation in changing a child’s activity was presented in Figure 2a and Figure 2b. In terms of the child’s activity about 27 % the child was engaged in sports, indoor games (27%), followed by yoga (21.3%), Watching movies, and videos, online games (21.35%), playing a musical instrument, singing and dancing, gardening (19.4%), art and craft (15.53%).In the current study Among 3- 6 yrs. age group Children were engaged in Playing games with friends and families (15.38%) and Watching movies, videos, and online games (15.38%); followed by Indoor games (12.82%) and Playing musical instruments, singing and Dancing (12.82%). Among the age group, 6-12yrs children have engaged Indoor games (28.89%), followed by Watching movies, videos, online games (22.22%) and Sports (22.22%). Whereas in the 12-18yrs age group children were engaged in Sports (71.42%), followed by yoga (57.14%), indoor games (47.61%) and gardening (38.09%) (Fig 2a). Parents observed that their child’s concentration has been reduced, followed by decreased personal hygiene, increased anger, Difficulty in problem-solving & creative thinking, lethargy, increased escapism, feeling of loneliness, decreased physical activity, increased irritability, Difficult interacting socially, Not interested in activities. The majority of the Responses were multiple responses (Fig 2b).
Among 3-6 years age group, parents observed there is a lack of concentration (38.8%), Followed by lethargy (33.33%), Angry (33.33%) and reduced physical activity, reduced personal (27.77%), reduced physical activity (27.77%), difficult to interact socially (22.22%), Anxiety (22.22%), Irritability (22.22%), Difficulty in problem-solving & creative thinking (22.22%). Among 6-12 years of age group parents observed that the majority of the children have reduced personal hygiene (56.09%), Angry, and lethargy (48.74%), followed by Difficulty in problem-solving & creative thinking (46.34%). Whereas among 12-18 years age group the changing behavior was seen in lack of concentration and decreased personal hygiene (88.23%), followed by Irritability, escapism and Anxiety (70.58%).
About 70 % of the study population observed changes in their child’s eating pattern. The majority of the parents reported that their child increased their consumption of junk food (43.84%) and consumption of health food is decreased (35.62%), some children showed decreased appetite (41.10%). Majority of the children belonging to 3- 6 years of age group showed decreased appetite (38.7%), whereas in 6 – 12 years age group majority showed decreased consumption of healthy food (51.61%) and 12-18 years group showed Higher consumption of junk food (66.66%). Parents' observation on the child’s eating pattern due to excessive screen usage was depicted in Fig 3.
The sleeping pattern also changed due to prolonged use of screen timing and was presented in Figure 4. There is a significant delay in the bedtime and wake-up time (20.62%), followed by nightmares (20.62%), decreased (18.56%) or increased (16.49%) sleeping pattern, co-sleeping tendency (15.46%), disturbed wake ups (15.46%). The majority of the children belonging to 3- 6 years of age group showed co-sleeping tendency (21.62%) and nightmares (21.62%), whereas in 6 – 12 years age group majority showed significant delay in bedtime and wakeup time (23.25%) and 13-18 years group showed decreased sleep (35.29%).
Parents' observation on the child’s health issue was presented in Figure 5. About 47.61% of the study population observes that their child faced some of the health issues such as eye issues (46%) headache (36%), body ache (30%) and weight loss/ gain (20%, 16%) (Table 2). Eye issues is the major health-related problem in 3-6 yrs (29.41%), 6- 12yrs (43.33%) and 12-18 (50%) years age groups respectively.
Challenges faced by parents due to excessive screen usage was presented in Figure 6. About 42% of the Parents feel that their monthly bills towards the mobiles/ screen apps were increased to on an average of 500rs per month. Nearly 30% of the study participants feels that there is no significant challenge faced by them due to child’s increased screen usage. Perhaps 70% faced issues such as they met the expenses towards frequent recharges for mobile data/ OTT platforms or downloading paid apps, followed by a demand for better gadgets and excessive online shopping and temper tantrums.
The benefits observed in children due to digital technology usage was presented in figure 7. The children were curious to learn new things followed by technological advances, understands the concepts easily, and improved learning outcomes. The majority of the parents feel that they need to find the right balance in the usage of technology (39.4%) for the prolonged use of digital technology and some parents feels that using digital technology by their child is a serious issue (32.38%). About 19.4% of the study population attend the awareness program for screen addiction in their child’s school/college. The parents think that it would be beneficial for parents to attend the awareness session for a better understanding of screen addiction and its impact on the child’s health.
In the current study majority of the healthcare workers who participated in the current study were males, in spite of the gender-based work allotment, especially in a country like India, parents there were aware of their child’s screen timing and their behavioral changes. This might be due to the shift-based system in health care workers. The parents reported that they spent 3 hours on average with their child and they can able to spend quality time with their child at during weekdays and weekends. This helps the parents to observe the pattern and change due to prolonged screen timing of their child.
As healthcare workers parents would be able to pick up the change in their child’s behavior when compared to, parents who were from the non-healthcare sector. Due to exposure to social media through different screens, it’s important to recognize the type of media child is exposed to and how that affects the child physically and emotionally.21 Younger adolescents <15yrs had a higher prevalence of addiction than older adolescents.22
Despite of long screen timing, children are engaged in sports activities, yoga, and some indoor games, some were learning a musical instrument, sing and dancing, but some of the children choose online classes which also increases the screen time. As a parent and also as a health care worker there is a need to create awareness on screen addiction of children among other parents and also children. The increased screen time, significantly affects the eating and sleeping pattern of the child.
In term of eating patterns, appetite was decreased in children blow 6 -years of age, whereas children above the age of 6 years were showed decreased consumption of healthy food and increased consumption of junk foods due to screen addiction. Screen addiction also created a greater impact on sleeping patterns too. The co-sleeping tendency was increased among the children under the age of six and significant delay in bedtime and wake-up time was observed in children greater than six years of age. Eye issues were a major health-related problem in all age groups who were screen-addicted.
Even though the parents are working professionals, they are able to notice their child’s changing behavior. Due to screen addiction, children were not able to focus or concentrate on particular work. In the worst scenario, child’s personal hygiene habits were changed and they face difficulty in problem-solving and creative thinking. In children aged between 6 to 12 years of age, lethargic activities have been increased and due to that escapism behavior was also observed by the parents. In all age group, children showed lack of concentration, and perhaps reduced personal hygiene was specifically observed in children above 6 years of age, this shows that screen addiction create a greater impact on the personal habits of children.
Excessive use of such technologies may put one at risk of adverse effects such as isolation and feeling of loneliness, decreased interpersonal relationships, and social interactions in them.23,24 Psychologically, cell phone use is attributed to loneliness, fatigue, and stress and is a known precursor of consequent mental health problems.25,26 Neha et al. reported that excessive use of mobile phones on 212 young Indian adults is reflecting it a behavioral addiction. 27
In the present, many children faced issues such as headaches, body ache, eye related issues, such as burning sensation, irritation, infection, redness, vision problem was higher among the age group of 12-18years. In the worst case, children face weight-related issues which is high among children greater than 12 years of age. As their food habits change it ultimately relates to the weigh related issuers both in weight gain and weight loss. The monthly bill for mobile/ screen app were increased, which shows that screen addiction add a financial burden for parents. Because of the increased usage of child’s screen time, parents have to spend on frequent recharges for mobile data or children were engaged in OTT platforms or engaged in downloading paid apps, even though some children were demanding for better gadgets. Due to the exposure to various online platforms children were also been engaged in online shopping. In the worst case some children show temper tantrums and violence.
Apart from the harmful effects due to digital technology, children are curious to learn new things, they are technologically advanced and learn new concepts easily, which reflects in their learning outcomes. Further, the child was able to access the learning outcomes and learn to adjust and share with others. The current study report was supported by the previous study conducted by Isil Kabakci.28
In the current study, the parents in the healthcare sector feel that they need to find the correct balance in prolonged usage of digital technology. Perhaps, nearly 32% of the parents feel that the usage of digital technology for a long time is a serious issue and need to focus on the minimization of children engaging in the digital screen and switch to other activities such as physical activities, sports and other activities which keeps the child active, instead of addicted to digital screen. The awareness programs on screen addiction were conducted by some of the schools and colleges and the percentage of parents who attended the program was very less. Thus, there is a need to create an awareness program for a better understanding of the parents about their child’s screen addiction and its impact on the child’s health. The study has various limitations such as the study was conducted among a single site further, and Sample selection was not done based on probability proportional to size.
Screen addiction among the younger age group is of grave concern as it can affect the physical, psychological and mental well-being of the children. Parent awareness on the usage of screen time by their children play a major role in monitoring children’s changing behavior due to screen addiction. Regardless of the study limitations, the current study throws light on the awareness of parents who are healthcare workers and the study has important implications for researchers and practitioners working on health promotion or awareness on screen addiction, especially among parents. A multidisciplinary approach is needed among Health care providers, public health practitioners, and policymakers should support increased public awareness of how screens may affect familial relationships and child development.
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to the authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Source of funding: None
Conflict of Interest: Authors declare no conflict of interest
Nandhini. L, L.S. Thiruneelan, and Hilda Solomon participated in the literature search, conduct of the study, data collection and analysis, and draft manuscript preparation. The concept of the study was by Mr. Sathyanarayana Kondati, who designed the study, Jayanthi Swaminathan and Anitha Rani reviewed, edited, and approved the final manuscript.
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