Interventions to control children’s screen use and their effect on sleep: a systematic review and meta-analysis

Abstract

Prolonged viewing of screen-based media is associated with poor sleep in children. Previous systematic reviews have analysed the effectiveness of interventions aiming to limit children’s screen use, however, none have evaluated their effect on sleep. The objective of the systematic review and meta-analysis presented in this thesis was to determine the effect of interventions that incorporate strategies to control children’s screen use on improving screen use and sleep. The databases PubMed, Embase, Eric, Scopus and PsycINFO were searched in October 2017 and updated in February 2019. Studies selected for inclusion used an experimental design to assess interventions to control screen use in children aged two to 14 years and reported outcomes for both screen use and sleep. From 3,872 initial records, 11 studies (six randomised controlled trials [RCT], four cluster-RCTs and one cluster, quasi-experimental) were eligible for inclusion. A total of 4,656 children aged two to 13 years were included. Studies generally inadequately controlled for potential sources of bias, particularly the use of subjective measures for screen-use and sleep. The included interventions focussed on education to control screen-use, delivered to the carer and/or child at school or home, either via face-to-face, online or posted hard-copy. Common behaviour modification strategies to control screen use included use of media budgeting, goal setting, provision on alternative activities, ensuring mealtimes and bedtimes are screen-free and ‘screen-free’ challenges. Interventions ranged from two weeks to 12 months duration. The mean reduction in screen time was 0.56 hours (33 minutes) per day (95% CI = 0.92, 0.20; seven studies) and the mean sleep duration increased by 0.19 hours (11 minutes) per day (95% CI = 0.05, 0.33; nine studies). Weekday bedtime advanced by 0.16 hours (10 minutes) and by 1.0 hour on the weekend. Subgroup analyses indicated that improvements in sleep duration and reduced screen time was greater with interventions of shorter duration (less than three months); that specifically targeted screen use or sleep or had direct participant contact. In conclusion, small improvements in screen time and sleep duration can be achieved in children through interventions designed to control screen use. It is not possible to determine if a reduction in screen time directly improves sleep due to the limited number of studies, the presence of co-interventions, and issues with study methodological quality and heterogeneity. It is recommended that future research employ objective measures of screen use and sleep outcomes and attempt to measure or control factors known to influence these outcomes, such as background screen use and exposure to age-inappropriate or violent content.