Screen-Viewing Behaviors Among Preschoolers

Abstract

Background

Childhood obesity has emerged as a public health concern in Canada. It has been suggested that excessive screen viewing (i.e., television, computer, video) is a major factor contributing to the increased risk of obesity in children. Exploring young children’s experiences with this modifiable behavior may be beneficial to the creation of a multifaceted program aimed at the primary prevention of obesity.

Objectives

To seek parents’ perceptions and insights pertaining to their preschoolers’ screen-viewing behaviors.

Methods

This qualitative study targeted a heterogeneous sample of parents with children aged 2.5 to 5 years. Two experienced moderators using a semistructured interview guide conducted the ten focus groups between September and November 2003. All focus groups were audio-recorded and transcribed verbatim. In fall 2003 to spring 2004, inductive content analysis was conducted independently by a minimum of two qualitative researchers.

Results

Many parents were not concerned with the amount of screen viewing their children engaged in, although the content of what was on the screen was of particular interest to them. Very few parents seemed to appreciate the linkage between preschoolers’ screen-viewing habits and their potential risk for obesity.

Conclusions

Public health interventions are needed to increase parents’ awareness with respect to the harmful effects of excessive screen viewing in preschoolers.

Introduction

Worldwide, childhood obesity is a growing public health problem.¹ In Canada, one in three children are either overweight or obese, with onset as early as age 2.^2–5 Due to the potential health consequences and burden on the healthcare system, effective interventions targeting childhood obesity are timely and of top priority.^6–8 It has been suggested that sedentary behavior is a major factor contributing to childhood obesity. Extensive television viewing and computer use have been consistently associated with North American children’s being overweight.^9–14 Although some findings acknowledged only weak associations between sedentary behavior and obesity, limiting screen-related sedentary behaviors seems critical for preventing obesity.^15–18 Sedentary lifestyles are evident among young Canadian children; researchers have found that children aged 2 to 5 typically spend >3 hours each day watching television, exceeding the recommendation by up to 100%.^19,20

Early childhood interventions may promote lifelong healthy behaviors before the development of unhealthy behaviors.^21,22 Studies of school-aged children have identified screen viewing as a ritualized behavior. This finding highlights the importance of establishing appropriate screen-viewing behaviors in early childhood in order for them to become habits later in life.²³ Establishing appropriate screen-viewing behaviors in early childhood (i.e., preschool age) may be key in preventing screen-related sedentary behaviors and promoting long-term healthy lifestyles.

The purpose of this qualitative study was to explore parents’ perceptions of their preschoolers’ health-related behaviors. The longer-term goal is to use this information to develop an intervention aimed at the primary prevention of obesity and promotion of healthy bodyweight in young children. As part of a multipronged study, this paper reports parents’ perceptions and insights with respect to preschoolers’ screen-viewing behaviors. Parents’ perceptions pertaining to physical activity have been reported by Irwin et al.²⁴

Methods

This qualitative study involved ten focus group interviews, conducted between September and November 2003, with parents of preschool-aged children (aged 2.5 to 5 years). Semistructured focus group discussion guides were used to explore parents’ perceptions about their preschoolers’ screen-viewing behaviors, including responses to the current guidelines, and barriers and facilitators to meeting the guidelines. The Canadian Institutes for Health Research funded this project, and ethical approval was obtained through The University of Western Ontario.

Prospective participants were invited to take part in “child health group discussions” through flyers, information sheets, and site visits at community locations frequented by parents of preschool-aged children (five community play groups, three daycare centers, one community resource center, and one workplace). They were informed that participation in the group discussion was volunteer based. Two of the 10 sites were located in rural areas. Sites from different geographic areas were selected to provide a maximum variation sample. An overall sample of parents of preschool-aged children with diverse socioeconomic status (education level, income, employment status) was recruited. Parental income varied, with the majority falling within the ranges of either $25,000 to $59,999 (32%), or $60,000 to $99,999 (35%). (Note: These are Canadian figures; as such, the U.S. conversions at the time of study were US$20,700 to US$49,679 or US$49,680 to US$82,799.) Eighty-five percent of parents had either a college or university education. Of the 71 participants, 65% worked either part-time or full-time, while the remaining participants were unemployed at the time of data collection. Only 20% of the participants had one child; the majority had two children (58%) or more (22%). The mean age of the preschoolers (n =71) was 3.4 years. For those with more than one preschooler, the mean age of the second child (n =15) was 4.5 years. Focus groups were arranged with five to ten homogeneous participants with similar socioeconomic background. To facilitate focus group attendance, childcare, bus tickets, and a meal for parents and children were provided. Focus groups were also planned at times when parents would normally be at the selected location.

All focus group meetings were facilitated by one of two experienced moderators and lasted for approximately 1 to 1.5 hours. In one focus group, the moderator was known by many of the participants; however, it was felt that this had minimal impact on their participation. Focus groups were audiorecorded and transcribed verbatim. Saturation was reached by the tenth and final focus group. Saturation was considered the point at which no new information was emerging. Data collection and analysis took place simultaneously (fall 2003 to spring 2004) using a combination of the editing and template organizing styles according to Miller and Crabtree.²⁵ A number of strategies were employed to ensure trustworthiness of the findings, including member checking, peer debriefing, and multiple coders.²⁶ Methods have been described in detail by Irwin et al.²⁴

Findings

Seventy-one people participated in this study; 68 were women. Participants ranged in age from 21 to 63 with 60% in their 30s. The recruitment strategy seemed to acquire relatively homogeneous focus groups, while providing a sample of participants with various income, education, and employment backgrounds (Table 1). Details of participants’ profiles were described by Irwin et al.²⁶

Table 1.

Parents’ perceived values about screen viewing

Educational tools “I guess when I look at what they are watching on TV or what they are playing on the computer, to me it seems quite beneficial to them. So there is so much learning that goes on…. I think it’s actually a very positive part of their day.” “We just watch shows like Dora, Arthur, Magic School Bus…. I just let him watch the stuff that I think teaches him stuff. He’s two and a half and he’s smart, too smart for his own good.”

Babysitting “My husband uses it (TV) as a babysitter.” “Yes, it (TV) is my toy for her (my daughter), that it works…. I’ll tell her to sit there and watch TV while I do my wash…” “(Letting my child watch TV) is … good parenting coping… (because) I’m not yelling.”

Bedtime coping device “I find TV is sometimes useful when my children need to wind down.” “I can use the TV to wake my daughter up.” “I think it’s important to have wind-down time, and I’m not against them having that time with me laying down and watching a good little appropriate movie.”

Family bonding time “I try to pick up the TV time by sitting down with them to watch TV, and that is sort of my down time and then you’re having some family time too. So you’re cuddling and it’s not just watching TV. You’re talking about the show and end up having some nice snuggle time too.” “Saturday night was movie night and that’s when we would just sit on the couch and cuddle and watch one movie together.”

Background noise “We always had it (TV) as some background noise in our house.” “I’d have the TV on and be upstairs making beds or doing something; I just like the noise.”

Interactive TV watching—a means to encourage physical activity “Because up to a certain age they’re interacting, even when they’re watching educational shows they’re jumping up and down and shouting and being interactive and active.” “I know that on TVO Kids, for the older kids, they do some of the things about get up and go and move and dance…”

TVO, TVOntario

Participants reported that TV viewing was the major type of screen-viewing activity for preschoolers. Occasionally they watched videos, while some, especially the older preschoolers, were learning how to play computer games and video games. In general, participants estimated that the amount of time their preschoolers spent in screen viewing ranged from 1 to 5 hours per day. However, many participants pointed out that their preschoolers would not sit still while watching TV, and therefore, it was not always a sedentary activity. The amount of screen viewing in which preschoolers engaged depended heavily on the weather. For example, if it was cold, raining, or snowing, children spent more time in screen-viewing activities, whereas if the weather was nice, children often played outside.

Four main themes pertaining to preschoolers’ screen-viewing behaviors emerged from the focus group discussions: parents’ perceived values, parents’ attitudes, barriers to appropriate screen-viewing behaviors, and parents’ insights on ways to encourage healthy screen-viewing habits.

Parents’ perceived values about screen viewing

Screens, especially TVs, assisted parents in managing their daily lives. Parents with preschool-aged children used screens for a variety of purposes, including educational means, babysitting, a bedtime coping device, family bonding time, background noise, and as a tool to encourage physical activity. Table 2 provides clarifying comments from participants.

Table 2.

Parents’ attitude toward screen viewing behaviors

Parents were happy with the amount of screen viewing “Yes, I think it’s (the amount of time my child watches TV) pretty okay.” “Some days I wish [kid’s name] would sit down and watch more than he does.”

Parents’ regulation of content on the screens “I think if they watch under supervision then you are less likely to have them exposed to programming that you don’t want them to see.” “In my house we watch actually Tree House…. So ours is like video, so it’s very regulated. We don’t just arbitrarily turn on the television set.” “I tend to be very cautious about what the kids watch, while my husband tends to be like he’s still cautious, not watching something really bad, but he prefers to watch with them (kids) and explain that this is TV/…”

Parents’ guilt “I actually have absolutely no guilt about how much television my child watches. I mean I’m picky about what she watches, but the stuff that she has learned, oh my goodness.” “I have absolutely no guilt with the amount of television.”

Parents perceived no linkage between screen viewing and risk of obesity “I don’t think it’s the TV or the computers or the Nintendo games (that cause obesity).… But it’s more what they are eating and how they are eating.” “It’s not because she (the child) is watching TV.… It’s because of what she is eating. So shouldn’t the focus be more on eating than on TV?” “Preventing obesity is more than just how much TV they’re watching or how energetic they are. It’s also about their diet.”

Across all focus groups, parents indicated that screen-viewing activities were great educational resources. They felt that some TV, video, and computer programs were good learning tools for their preschoolers, and would help prepare them for school. Focus group participants were particularly fond of commercial-free television channels because they did not entice children with toys or food.

The majority of the participants used TV as a “babysitter” or “coping tool” when they were busy doing household chores or were exhausted after work or not feeling well. This kind of babysitting tool was especially useful for parents with multiple children. A few parents discussed the use of TV as a coping tool that was preferable to yelling at children when they misbehaved.

Participants used TV as a tool for waking up or winding down their preschoolers. Some families enjoyed a movie/ show together in the evening or during the weekend; this time was dedicated to being with and often cuddling as a family. Furthermore, TV was used as a background noise in some families. Participants suggested that even though their TV was on all the time, their preschoolers did not always watch it. A few parents pointed out that children’s upbringing of having the TV on as a background noise would pass on to the next generation, although participants did not overtly state that this would be a problem. Finally, participants appreciated that TV could be a means to increase children’s physical activity levels when they watched interactively. When viewing some programs, participants explained that their children imitate, act out, move and dance in front of the TV.

Parents’ attitude toward screen viewing

In general, parents did not worry about their preschoolers’ screen-viewing behaviors. Table 3 provides illustrative comments from participants regarding their attitudes towards preschoolers’ screen-viewing behaviors.

Table 3.

Barriers to appropriate screen viewing behaviors

The TV Viewing Guideline20 is hard to follow “I think it’s nice in theory. My kids watch more than that.” “In the summer time that (the Guideline) is not a problem, but when the weather is bad, e.g., raining, then my oldest spends a lot of time in front of the TV…” “I think when XXX (the name of focus group participant) asked ‘based on what,’ you know, why is TV watching so bad?…. Why did you specifically pick TV watching or screen (viewing)?… I think there’s a whole lot more in it than just television watching. I think it needs to be more clearly defined—what about television watching needs to be limited.”

Pressures from our changing society and peers “Anything that has to do with technology is computers, like TV and video games, and they are inventing more and more things having to do with that, so it is hard to limit the time.” “Yes, they (society) pressure you; ‘You have to,’ I mean yes, we have a television and we have a VCR and DVD.” “I don’t really want him watching that, but everybody else watches. I don’t really know how to curb that.” “The culture in our society today is very different from when we all grew up, where in the morning you could say go outside and play, and I’ll call you when it’s time for lunch…. Safety issues come into play, you don’t want your kids out of your sight for a long period of time.”

Multiple siblings and family “If you have three kids and they are making lots of noise, like it’s very tempting to say to them I’m going to put Shrek on, so you can watch Shrek, or whatever.” “I find that since I’ve had my second, that he’s watching more TV just because of the fact that I’m busy with the little ones….”

Tensions between parents/partners “I would prefer not to have the TV on at all and he (my husband) likes watching it, like he likes having the noise on in the background all the time.” “As soon as my husband leaves the room and walks out, I turn the TV off because I don’t want it on.”

Poor weather “If it is raining or cold or wet or whatever, I give her maybe 2 or 2 and a half hours (of TV watching).” “I think probably in the winter they probably watch more TV than in the summer.” “My oldest, if it’s raining, she is in front of the TV for like 3 or 4 hours.”

Participants were happy with the amount of time their children spent in screen-viewing activities. Some wished children would watch less television, while a few parents wished their preschoolers would watch more television to keep them quiet. Only a few parents limited their preschoolers’ screen-viewing time. In contrast, participants across the focus groups consistently spoke about regulating the content of screen-viewing material watched by their preschoolers. They chose educational programs developed for preschoolers and in most cases limited the amount of violence that their children watched. Generally, female participants described fathers as being less restrictive than mothers. Only a few participants expressed concern about the amount of time their children spent screen viewing. Most participants did not have guilt with respect to their children’s screen-viewing behaviors.

When asked to identify potential factors that might increase risks of obesity in children, most participants were more concerned with diet and its contribution to obesity, while unaware of the link between screen-viewing behaviors and obesity in preschoolers.

Barriers to appropriate screen-viewing behaviors

Key barriers to encouraging appropriate screen-viewing behaviors for their preschoolers are discussed below, and quotations from focus group participants are provided in Table 3.

Many participants expressed that it was difficult to comply with the TV Viewing Guideline recommended by the Canadian Paediatric Society.²⁰ A few participants even questioned the rationale of the Guideline in limiting children’s screen-viewing time.

Participants indicated that society and peer-pressure drive families into purchasing and using media-related equipment such as cable, satellite, and VCR/DVD players. In addition, participants’ concerns about unsafe neighborhoods reduced children’s opportunities to play freely outdoors during their leisure time. It was reported that while indoors, preschoolers spent most of their time engaging in screen viewing. While being indoors, preschoolers’ leisure time was reportedly filled mainly with screen-viewing activities. Many participants used TV to help them cope with meeting the demands of raising multiple children.

Tension between couples with respect to preschoolers’ TV viewing was a barrier to preschoolers’ appropriate screen viewing. Female focus group participants reported that fathers allow their children to watch more TV than mothers. Furthermore, participants stated that poor weather, such as cold and raining days, limit children’s opportunities to go outside and, therefore, they spend much more time in screen-viewing activities

Participants’ insights on encouraging appropriate screen-viewing behaviors

Although most participants were not very concerned about their own preschoolers’ screen-viewing behaviors, many were passionate in offering insights for other parents to encourage appropriate screen-viewing behaviors, as described below and illustrated in Table 4.

Table 4.

Parents’ insights on encouraging appropriate screen viewing

Parents’ opinions regarding developing appropriate screen-viewing behaviors at an early age “If they learn now to do other activities, then it will be better off for them. They won’t rely so much on TV as they get older, they will be able to do other things that are important.” “I just want them to know that there is more than just watching TV. There are other things that you can go out and do. You can be active in sports, you can go for a walk, you can walk through the woods, you can color, you can cut and paste.” “It’s very important (to develop healthy lifestyle in early age), because you don’t want them to become—I call them—couch potatoes…. I want them to be able to come home and start doing homework or whatever they have to do and not rely on flipping the TV.”

Parents’ role modeling “Yes, the child will imitate the parents.” “I think parents should lead by example. If we’re active and we’re doing things, then I think our children will learn that lifestyle…. So if you’re active and trying not to watch too much TV, I think that your children will follow that.”

Promoting positive message, instead of condemning “I would find it fairly offensive if somebody would come and say, ‘You are doing a bad parenting job because your children are watching too much TV.’ I would say well, try it. But if somebody would say maybe you could do this, this, or this instead, of them watching TV for 4 hours.”

Home-based activities “Turn off the TV and turn on Raffi (music).” “Let’s keep them active if they want to watch TV. Get them involved in our chores.” “I’ll use the, ‘Oh, there’s nothing on but news.’ All you do is go to CNN, the Weather Network, and that kind of thing and say there’s nothing on, the cartoons are over.”

Activities to replace TV “For me, it’s getting out of the house. If we’re in the house, it’s really hard for me personally. I’ll just turn the TV on.” “Turn the darned thing (TV) off. Go to the library and…”

Many participants agreed that it was very important to help their children develop appropriate screen-viewing habits at an early age. Participants wanted to show their preschoolers that there were more fun and healthy activities that they could enjoy rather than being “glued” to the TV, with the hope that their preschoolers would then carry on the healthy habits throughout their lives. Some participants suggested that parental role modeling was important to help preschoolers establish appropriate screen-viewing habits, which, in turn, may encourage a more physically active lifestyle.

Participants indicated that it would be offensive if parents were chastised for allowing their children to watch too much TV. Instead, sharing ideas that are practical in daily life would assist parents to encourage appropriate screen-viewing behaviors for children. Participants shared a list of home-based activities to facilitate appropriate screen-viewing behaviors. For example, turning off the TV and turning on the music was offered as a good way to encourage children to dance and move. Getting children to do painting, coloring, reading, crafts, or puzzles were also offered as methods to reduce screen-viewing activities. Some participants had their children help out with chores, while others played with their children. A few participants used tricks such as only turning the TV to the news channel and saying that nothing interesting was on TV.

In an attempt to facilitate appropriate screen-viewing behaviors, participants discussed the importance of getting out of their homes. Some discussed the value of a trip to the mall as an alternative to watching TV, and others suggested going to the library or other facilities in the community.

Discussion and Conclusion

This study sought parents’ perspectives about screen-viewing behaviors in preschoolers. It is the first in this field to qualitatively document parents’ viewpoints that might assist in developing interventions to shape children’s appropriate screen viewing from early childhood. As indicated by parents in the current study, screens play important roles in helping busy parents cope with young children. Across all focus groups, parents valued screen-viewing activities as good educational tools, a babysitter/coping mechanism, and a device to wake up or wind down young children. Pressures from society and peers, bad weather, having multiple children in the family, and tension between parents were barriers to appropriate screen viewing by preschoolers. It seems that many parents rely on screen-viewing activities as a coping tool.

This study additionally sought parents’ perspectives on their preschoolers’ physical activity levels.²⁶ Parents perceived Canada’s Physical Activity Guidelines for Children as inadequate. Parents felt that their preschoolers need more than 30 to 90 minutes of activity daily. One similarity between parents’ views on physical activity and screen-viewing behaviors was their overwhelming belief that early habits must be established during the preschool years. However, parents did not recognize screen viewing as a cause of obesity, and in fact were not concerned with the amount of viewing their child engaged in. Furthermore, many parents identified the screen-viewing guidelines as unattainable, which is contrary to their beliefs regarding the physical activity guidelines. Ironically, parents viewed the television as a way to increase their preschoolers’ physical activity levels.

Future research is needed to address gaps that exist with respect to effective intervention strategies that can help parents overcome barriers, such as society and peer pressure, as well as lack of good parenting coping skills.

What This Study Adds ….

Establishing appropriate TV and other “screen time” -related behaviors in childhood may be an important contributor to physical and psychological health.

This qualitative study among a group of Canadian parents of two- to five-year-old children suggests that concerns about the content of what is viewed are greater than concerns about the amount of screen time.