Better methods to provide stronger evidence on health implications of screen use by children

Background: Digital screen technology use by children has been traditionally used as a surrogate measure of sedentary behaviour exposure. However, poor health outcomes in children are more strongly associated with screen use than with device measured sedentary behaviour. This suggests other aspects of screen use may be important. Better evidence on which aspects of screen use are critical to child health requires measurement methods that can capture the complex interactions between children, technology, the tasks they perform and the context of the interactions, to compare contemporaneously with device measured sedentary behaviour. Such methods can provide clearer and more relevant evidence to guide families and those working with children.
Purpose: The purpose of this study was to evaluate the range of screen use measurement methods available and support researcher selection of the most appropriate method(s).
Methods: A narrative review was conducted, built on recent systematic reviews and literature searches of methods used with children, or with the potential to be used with children, to identify measurement challenges and methods along with aspects researchers should consider in method selection.
Results: Evolution of technology has increased the complexity of child-technology interactions and thus increased the challenge of adequately capturing sufficiently important aspects of this interaction. Self-/proxy- reporting via questionnaire/diary/electronic sampling, direct observation, visual/audio recording devices, screen device onboard capture, network traffic and content capture, proximity sensors and specialised systems were identified as ways to capture particular aspects of children’s screen use, along with examples of use, and advantages and disadvantages.
Conclusions: The complex child-technology interactions may require a combination of methods to provide stronger practical evidence on health implications.
Practical implications: Researchers need to look beyond simple measures of screen time to provide evidence with practical detail of relevance for families.
Funding: The Australian Research Council Centre of Excellence for the Digital Child.