Overview
The goal of this clinical trial is to learn if changing the physical environment of a pediatric waiting room can reduce the use of screen devices (such as mobile phones and tablets) by children aged 2 to 8 years while they wait for their appointment. The main questions it aims to answer are:
- Does the proportion of children who use a screen device in the waiting room decrease after the intervention?
- What types of digital content do children use most often in the waiting room, and which sociodemographic factors are associated with screen use? Researchers will compare children seen before the waiting room was changed with children seen after the change to see if fewer children use screen devices.
The intervention consists of posters for parents and caregivers on the benefits of reducing screen time, play and educational materials (books, puzzles, board games, and educational toys), and boards or murals where children and adults can draw or write.
Parents or legal guardians of participating children will complete a short anonymous survey on a tablet in the waiting room.
Description
Excessive screen use in childhood has been associated with obesity, language delay, hyperactivity, and sleep problems, and the American Academy of Pediatrics recommends limiting screen time to a maximum of one hour per day in children under 6 years. Screen devices are frequently used in pediatric waiting rooms, but no intervention studies have focused on the waiting room as a setting to reduce screen exposure.
This quasi-experimental before-and-after study will be conducted in the Pediatrics Service of the Baix a Mar Integrated Primary Care Center (Consorci Sanitari de l'Alt Penedès i Garraf). Two independent samples will be recruited consecutively: one before and one after implementation of the environmental intervention, which is an organizational decision of the service and is independent of participation in the study. Data collection will stop for one month after implementation to allow the intervention to settle in. Parents or legal guardians will complete an anonymous, self-administered 11-item electronic survey (REDCap) designed ad hoc and piloted with 10 parents. Screen use during the consultation will be recorded separately by the healthcare professional.
The primary analysis will compare the proportion of children using screen devices in the waiting room between the pre- and post-intervention periods with the chi-square test or Fisher's exact test, with logistic regression adjusted for age, sex, and waiting time. Based on a pilot survey of 100 parents (21% screen use), 263 participants per period are needed to detect a reduction to 10.5% (two-sided alpha 0.05, power 80%), allowing for 20% non-evaluable questionnaires. Analysts will be blinded to the study period.
Eligibility
Inclusion Criteria:
- Children aged 2 to 8 years attended at the Pediatrics Service of CAPI Baix a Mar (CSAPG)
- Waiting time of at least 5 minutes in the waiting room before the consultation
Exclusion Criteria:
- Severe visual or hearing impairment that limits usual interaction with screen devices
- Diagnosis of a severe neurodevelopmental disorder, according to the investigator's judgment (for example, severe autism spectrum disorder)
- Parent or legal guardian unable to complete the survey because of a language barrier or other limitations
