The Negative Impact of Excessive Screen Time on Language Development in Children Under 6-Years-Old: An Integrative Review with Screen Time Reduction Toolkit and Presentation for Outpatient Pediatric and Family Health Providers
Creators: name: Kuta, Cristina 
Publisher: name: University of Massachusetts Amherst
Year: 2017

Background. Increased amounts of recreational screen time, defined as time watching television and DVDs, playing videogames, and using computers, tablets, and cellular phones without academic purpose, and the lack of effective media use assessment and patient education being done by primary care providers is associated with increased risk of language developmental delays for young children under 6-years-old.  
Purpose. The purpose of this integrative review is to develop a toolkit that provides education for providers and families on the adverse effects of excessive screen time on language development in children younger than 6-years-old and evidence-based screen time reduction strategies that can be implemented in outpatient primary care clinics at all wellness visits.
Toolkit and Presentation. An integrative review was conducted to describe the effects of excessive screen time on language development for children under age 6 and analyze interventions to decrease screen time. From these results, the Screen Time Reduction Toolkit was created. The toolkit includes the 2-Question Assessment for Screen Time (2-QAST), screen time reduction algorithm, provider and patient education on health risks associated with excessive screen time, screen time recommendations published by the American Academy of Pediatrics (AAP), and evidence-based screen time reduction strategies, provider resources, and patient education handouts. The integrative review findings and toolkit were presented to a group of local pediatric providers, nurses, and medical technicians for education and implementation. 
Outcomes/Discussion. The pre-presentation survey was created after the Health Belief Model (HBM), which served as the framework for this educational intervention. Staff members had high perceived seriousness (83%), perceived susceptibility (83%), and perceived benefit (100%), demonstrating that staff members’ attitudes and beliefs about screen time for young children were in agreement with the principles of this project. Barriers identified included lack of knowledge about health risks from excessive screen time, potential for parental resistance to screen time reduction advice, and time constraints during wellness visits. Regarding cues to action, staff members requested visual aids, handouts, and more education about screen time. The toolkit and patient education resources reduce barriers and address cues to action identified by the staff members. The post-presentation evaluation revealed that 100% of staff members found the toolkit presentation informative and said it increased their knowledge and understanding of the topic.
Conclusion. The toolkit provides the education that providers need to be knowledgeable as well as confident in their ability to discuss screen time with families. Being consistent about providing a few minutes of screen time education at every wellness visit from 2-months-old to 5-years-old sets a solid foundation for parents and children to create healthier screen time habits at home.