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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 6
| Issue : 4 | Page : 332-338 |
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Knowledge and attitudes of parents, teachers, and doctors regarding screen overuse and its addiction in children, adolescents, and young adults: A survey focusing towards possible solutions
Shirish Ravichandra Rao1, Prashant Harish Saraf1, Shilpa Amit Adarkar2, Gayatri Sachin Inamdar1, Pauras Pritam Mhatre1, Vidushi Chandrabhan Gupta1, Amey Abhijit Ambike1, Keval Tushar Dedhia1, Shreeya Kuldeepsing Raul1
1 MBBS Student, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
2 Department of Psychiatry, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| Date of Submission | 09-Jan-2022 |
| Date of Decision | 31-Jan-2022 |
| Date of Acceptance | 21-Feb-2022 |
| Date of Web Publication | 30-Jan-2023 |
Correspondence Address:
Mr. Prashant Harish Saraf
Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/aip.aip_1_22
Background: Media and technology have become an integral part of today's life. Internet addiction, video gaming, binge-watching, social media use, and hence the overall screen time is rising. There are physical, psychological, and social adverse consequences of screen overuse. Objective: The objective is to assess the knowledge and attitudes of the study participants and to present solutions for screen addiction. Subjects and Methods: A structured questionnaire was developed content validity ratio (CVR >0.65). It was sent via email to more than 500 participants and also on more than 70 WhatsApp groups. It was an online cross-sectional study where 800 participants were recruited using convenience and snowball sampling. Microsoft Excel 2019 and SPSS version 26 were used to obtain and analyze data. P value was determined by using the Chi-square test. Results: Knowledge of screen use guidelines and health concerns was highest in doctors followed by teachers and least in parents (P 0.001). 95% of doctors believed any kind of screen overuse should be classified as an addiction. For preventing screen addiction, the role of parents was voted to be most important (49% participants) and for overcoming screen addiction, the role of the person himself was voted to be most important (48% participants). Conclusion: The level of knowledge in our study population regarding screen use guidelines was moderate to low. The attitude of parents for tackling their child's screen use was found to be appropriate. The multi-stakeholder approach should be considered for tackling screen addiction.
Keywords: Children, education, parental guidance, screen addiction
How to cite this article:
Rao SR, Saraf PH, Adarkar SA, Inamdar GS, Mhatre PP, Gupta VC, Ambike AA, Dedhia KT, Raul SK. Knowledge and attitudes of parents, teachers, and doctors regarding screen overuse and its addiction in children, adolescents, and young adults: A survey focusing towards possible solutions. Ann Indian Psychiatry 2022;6:332-8 |
How to cite this URL:
Rao SR, Saraf PH, Adarkar SA, Inamdar GS, Mhatre PP, Gupta VC, Ambike AA, Dedhia KT, Raul SK. Knowledge and attitudes of parents, teachers, and doctors regarding screen overuse and its addiction in children, adolescents, and young adults: A survey focusing towards possible solutions. Ann Indian Psychiatry [serial online] 2022 [cited 2023 Mar 26];6:332-8. Available from: https://www.anip.co.in/text.asp?2022/6/4/332/368776 |
| Introduction | |  |
Since the past decade, media and technology have intersected with our lives to influence us drastically. The devices have become technologically superior and easy to use, making them an indispensable part and leading to an increase in our dependence on them for various aspects of our lives.[1]
A meta-analysis on the global prevalence of internet addiction has estimated average rates to be around 6%.[2] In India, studies have shown the prevalence of internet addiction to be 1.3% in the general population.[3] Higher rates of 11.8% in high school students,[4] and 8% in college populations[5] have been reported. It has been found that there was a greater prevalence of internet addiction among dental students as compared to medical students.[6] Inconsistencies across studies in the measurement of internet addiction can account for this variation.
Internet and Gaming addiction have also been found to be associated with an increased risk of obesity, cardiometabolic disease,[7] moderate or severe depression level,[8] less healthy dietary patterns,[9] dry eye disease symptoms,[10] altered posture and respiratory functions,[11] text anxiety[12] and nomophobia.[13] Along with these prevalence studies, it is important to identify stakeholders and study their knowledge and attitudes regarding screen addiction.
It is the responsibility of multiple stakeholders to promote balance and healthy screen usage. Children being a vulnerable group need the support of multiple stakeholders such as teachers, parents, content developers to develop healthy digital habits.[1] Hence, it was essential to assess their level of knowledge and get their perceptions to plan effective strategies to tackle this growing concern.
Aims and objectives
To assess the knowledge and attitudes of parents, teachers, and doctors regarding screen overuse and its addiction in children, adolescents and young adults.
- To find the difference in the knowledge and attitudes of parents, teachers, and doctors
- To present solutions to the problematic screen use and addiction by analyzing views and suggestions of the stakeholders.
| Subjects and Methods | | |
We conducted a cross-sectional, online questionnaire-based study in which the link of the online questionnaire was sent to 70 WhatsApp groups comprising parents, teachers, and doctors all over India.
The form was open for any of the three stakeholders (parents, teachers, and doctors). Students were not included in the study population. The link was also sent to 500 individuals personally through either WhatsApp or Email. A mixture of convenience and snowball sampling was followed. Individuals having regular access to electronic screen devices, teachers of government and private schools and colleges which included primary, secondary or higher secondary schools and professional degree colleges and doctors from all possible fields and branches were included in the study.
Ethical considerations
The study commenced after being approved by Institutional Ethics Committee (EC/OA-135/2019).
Informed consent was obtained from the participants.
Study tools
The questionnaires were developed to aid the comprehensive interpretation of the thoughts and views of the participants of the survey. The questionnaires were available in English, Hindi, and Marathi. A focused group discussion among parents and teachers was conducted, and medical professionals were subjected to unstructured interviews to gather information regarding the perceived needs and views on electronic screen addiction. A structured questionnaire was drafted after analyzing their responses and also by referring to the available literature. The questionnaires included multiple-choice questions, the options of which were carefully selected after analyzing all possibilities such that the participants could find their answers to the questions from the given options. It also included Yes/No type questions. Open-ended questions were also included to consider their novel ideas.
The questionnaire was validated by six Professors of various departments like Psychiatry, Community Medicine, Paediatrics, and Physiology. The Professors rated each question on a three-point Likert scale. Each question was given a score from one-three. Thus, the content validity ratio of the questionnaire used was calculated at 0.95. Reliability analysis was not done for the questionnaire.
Statistical analysis
Responses were obtained and analyzed using Microsoft Excel 2019 and SPSS version 26 (IBM Corp., Armonk, N.Y., USA). Chi-square test was used to derive association and find the difference in the proportion of doctors, teachers and parents concerning the knowledge and attitudes.
| Results | | |
Responses were obtained from a total of 800 participants of whom 57% were females and 43% were males. The majority of the responses were obtained from the state of Maharashtra (68%) and Gujarat (10%) and the remaining 22% were obtained equally from the rest of the states. Though 546 of the participants identified themselves as parents, we have considered 344 (43%) of the participants as "Parent only" as the rest have been included either as doctors, 352 (44%) or teachers, 104 (13%). In terms of the level of education, 57% and 28% were postgraduates and graduates respectively while the remaining 15% had a level of education up to higher secondary.
Knowledge
Although 98% of the participants believed that they were aware of the detrimental effects of screen overuse, the proportion of participants knowing about various physical and mental health concerns was comparatively low as depicted in [Table 1]. The proportion of participants knowing each of the health concerns was highest among the doctors, followed by teachers and least among the parents. This was statistically significant (P 0.001). The proportion of participants knowing excessive gaming being classified as a disorder and that the American Academy of Paediatrics (AAP) has formulated guidelines for parents about children's screen time was 59% and 53%, respectively. This was also significantly different among the three groups. | Table 1: The proportion of participants knowing detrimental effects of screen overuse and addiction
Click here to view |
Attitude towards benefits of screen use
Ninety-three percentage (746) participants felt that media can expand children's knowledge. However, only 76% (605) participants felt that children needed to be exposed to all of the gadgets mentioned to be ready for the world. 90% (722) participants felt that knowledge of technology is a vital skill that prepares students for the workforce at a young age. However, only 53% (421) participants agreed that a child is considered behind if they do not know how to handle a smartphone. These questions were adapted from the study of Ernest et al.[14]
Perceptions regarding the change in behavior
Ninety-five percent of doctors believe that any kind of screen overuse irrespective of being online or offline, should be classified as an addiction and the term shouldn't only be restricted to the context of gaming and internet use. The participants perceived the following changes in the behavior of children about problematic screen use: Becoming more lethargic and living a sedentary life (63%), preferring to stay alone (55%), losing interest in face-to-face interactions and preferring online platforms (61%), being more aggressive and ill-mannered (54%), losing interest in studies and compromising on their academics (43%), difficulty in facing real-life problems leading to stress and anxiety (59%). 76% of participants believed easy availability and access to the internet and smartphones was the main cause of screen overuse which was followed by availability of fascinating content and games (64%), peer pressure and social influence (49%), lenient parents (38%), and availability of a lot of free time (20%). The proportion of participants agreeing to each of the perceptions was highest among the doctors, followed by teachers and least among the parents. This difference was statistically significant (P 0.001).
Perceptions regarding possible solutions
The most important role in preventing screen addiction was believed to be that of the parents (49%) while in overcoming, it was of the person himself (48%). There was a significant difference in this perception among the three groups (P 0.001). Of the solutions proposed in [Table 2], the most voted solutions were to implement screen usage guidelines at home by parents and to educate students regarding media literacy and digital well-being at the schools. The proportion of participants agreeing to each of the solutions was highest among the doctors, followed by teachers, and least among the parents. This was statistically significant (P 0.001). In addition, 74% of participants felt the need to open more digital-deaddiction centers. | Table 2: Solutions to prevent screen overuse and counter screen addiction
Click here to view |
For controlling screen use of one's child, 70% of participants engaged in guiding their children about the advantages and disadvantages of screen devices, 20% were strict about their child's excessive screen usage and only 10% had realized their child's expertise in technology and left its use up to him/her.
| Discussion | | |
This is one of the few studies in which the knowledge and attitudes of all the three identified stakeholders (doctors, parents, and teachers) regarding screen overuse and its addiction in children and young adults have been assessed and compared together in a single study. These stakeholders themselves are not addicted to screen but may interact with screen addicts. The proportion (<50% in all the variables) of parents knowing the health concern was significantly less as compared to Doctors and Teachers. However, awareness regarding long-term consequences like early-onset diabetes and hypertension was poor in all three groups.
Participants have the attitude that knowledge of media and technology is helpful but it is not obligatory for children. Participants' belief that children have lost interest in face-to-face interactions and prefer online platforms was following several other studies which primarily showed that adolescents addicted to screen devices enjoyed much less social support and were not very attached to family members and peers.[15]
In-person communication and physical interactions have been associated with social wellness. However, with an increasing tendency to indulge in virtual interactions, adolescents are rapidly moving away from such offline forms of communication, thus jeopardizing valuable social support.[15]
In our current study, 59% of respondents felt that children have developed maladaptive tendencies, that is, they are much more accustomed to the virtual world. Therefore, on being faced with difficulties of the real world they become stressed and anxious. Moreover, adolescents often use avoidance strategies to overcome tension and anxiety that they experience as a result of boredom in certain social situations.[16]
Ninety-four percent (751) participants felt that children and adolescents are particularly vulnerable to negative media influences. Along similar lines, 76% (605) participants felt that the use of technology and screen devices by infants and young children must be carefully monitored.
Hence, there is a need for a multistakeholder approach [Flowchart 1] to tackle this growing public health problem.
Role of parents
The role of parents was voted as most important and also implementing screen use guidelines by them at home was chosen to be the most effective solution.
Parental guidance involves parents putting into practice certain behaviors that aim to reinforce their child's performance and potential.[17]
An emphasis was laid on three varieties of parental guidance in a study by Wu et al.[17]
- Informative parental guidance: Parents advise children on how to evaluate the content and intervene if the content is found to be inappropriate
- Restrictive guidance: Parents restrict media usage by placing time constraints or may prohibit children from viewing certain content
- Relational guidance: Parents and children collaborate while using screen devices. This is not a didactic approach in which parents deliver instructions to children. Instead, an environment of support is created wherein both, children, as well as parents, share ideas to use screen devices more healthily.
Seventy percent of our study participants said that they engaged in guiding their children about the advantages and disadvantages of screen use which is the informative type of parental guidance. However, this figure may be an overestimate as parental guidance is often seen very differently by parents as compared to children. A child's perspective may be more credible as a parent might want to portray himself/herself positively and may hence manipulate responses to appear so.[17]
With this being said, it has been also found that the restrictive parenting approach is significantly associated with internet addiction with odds of 1.9 as compared to the other two kinds of parental guidance.[17] Exercising restrictive parental guidance to "discipline" adolescents may not yield desirable results. Adolescents, for want of autonomy, resort to a refusal to comply as a coping strategy in the face of stress and coercion.[17]
Instead, maintaining a steady level of communication with adolescents and indulging in informative or relational parenting strategies might lead to more successful outcomes as it creates a conducive atmosphere for dialogue. This will go a long way in the prevention of internet addiction among adolescents.[17]
With the above being said, the abysmally low awareness amongst the Indian parents about the AAP guidelines and the psychological manifestations of problematic screen use also stands as a major barrier. Parents must actively look for problems and negative effects that may stem from their child's media use. In case they find that their child's use of technology is detrimental to his/her mental or physical health, performance at school or relationships with family or peers, they must address the issue themselves or seek help from a health care provider or another professional equipped enough to do so.[1]
Role of teachers
Education of school students about the productive usage of electronic devices and the harms associated with screen overuse was chosen as the most effective solution. One such intervention was done by Bonnaire et al.[18] They conducted an in-person session which aimed at:
- Increasing awareness about how much time is spent engaged in a screen-based activity and the substantial rise in the number of screen devices in each student's day-to-day life
- Enhancing introspection about one's most important priorities that may include academic, extra-curricular, or other personal goals
- Emphasizing the detrimental consequences of screen overuse on physical and mental health and interpersonal relationships
- Establishing ways of achieving self-control to prevent screen overuse, while underlining the need to gain insight into one's screen dependence.
These students were followed up for 5 months postintervention and there was a significant decrease in the incidence of the Internet or Gaming addiction in the intervention group as compared to the control during this follow-up period.
A long-term solution could be to integrate media literacy and digital hygiene in the routine curriculum similar to how the "Digital Citizenship Curriculum" developed by Common Sense Media has done. It is a comprehensive curriculum that has been divided into a module for each class starting right from nursery to class 10th, thus supplementing the child's growth in a digitally evolving world.
Teachers must be trained not only to teach media literacy and digital hygiene but also to routinely screen students for signs and symptoms of screen addiction. Schools may act as a source to increase awareness amongst the parents.[18]
Role of medical professionals
The main role played by the medical professional would be to identify and treat those who are already addicted. As per the current evidence, Cognitive Behavior Therapy has proven to be most effective in treating gaming and internet addicts. However, lack of agreed-upon classification and diagnostic criteria is likely to act as a hurdle in effectively screening the cases.[19]
There is a need to combine gaming, social media addiction, binge-watching, or any other kind of excessive screen use that shows signs of behavioral addiction into a broad umbrella of screen addiction since 95% of doctors have agreed for the same.
Forty-eight percent of participants said that "the person himself" plays the most effective role in overcoming screen addiction.
This is in agreement with the "Health Belief Model," where "the individual's perception of a disease and likelihood of adoption of positive attitude and practices depend on four important parameters, i.e., perceived seriousness of a disease, perceived susceptibility of a disease, perceived benefits of positive attitude and practice and lastly perceived barriers that might restrain an individual to make positive changes."[20]
Hence psychoeducation is an important modality of treatment as it would aid the individual in becoming more aware of their symptoms and hence find the motivation to make a positive change in combination with other treatment options.
About 50% of doctors agreed that during outpatient department (OPD) visits, medical practitioners should enquire about Problematic Screen Use and associated signs of depression, stress and loneliness so that more screen addicts or potential addicts can be recognized and treated accordingly. A similar recommendation was given by Ak et al., who found that almost half (44%) of the patients visiting psychiatry OPD for other mental health disorders, reported severely dependent levels of internet addiction.[21]
Role of policymakers and digital content creators
Entertainment and social media apps are meant to be extremely engaging. Endless scrolling or streaming can lead to a state of "flow" in which the user finds himself/herself deeply engrossed in the screen-based activity.[22]
The auto-play feature produces a steady stream of videos and other engaging content hence making it difficult for users to stop watching it.[22]
Telecom Ministry and Digital service providers need to come up with initiatives such as the "Gamer guard" in Thailand, the "Fatigue system" policy in China and the National Addictions Management Service in Singapore, that control the nature and accessibility of content in the form of age and time limits and lay down rules for advertisements, thereby preventing the content from being addictive. There must also be awareness programs to educate parents as well as children and adolescents. The HRD ministry should consider mandatory training of educational institute staff. In the light of infrastructural restraints, a horizontal inclusion of screen addiction under the Drug de-addiction program of India will help manage cases at existing centres. As supported by 73% of doctors there should be an increment in the number of de-addiction centres and a few centres of excellence to facilitate gauging this national public health concern by incorporating in the National Family Health Survey or National Mental health survey of India.
Limitations
The study was conducted online and the questionnaire was self-answered by the participants thus there are high chances of personal biases of the respondents due to misinterpretation of questions and subsequent misrepresentation of information.
Confounding factors have not been accounted for. The socioeconomic status of parents, teachers, and doctors has not been determined. Hence, socioeconomic status and type of responses cannot be associated.
An attempt has been made to gather data from teachers of various school settings by circulating the forms for filing the questionnaire to more than 10 primary schools, 15 secondary and higher secondary schools and 10 colleges. However, the school settings have not been determined separately for each participant. Hence, the school settings of teachers and their responses cannot be associated.
Since a majority of the participants were from Maharashtra and Gujarat, the results should be considered representative for these states and not for the whole of India.
| Conclusion | | |
There is a disproportionate level of knowledge amongst doctors, teachers and parents of whom parents are the least aware. The majority of the study population has an appropriate attitude regarding media use and say that they practice informative parental guidance. Still, screen addiction is rising which reflects poor application of the knowledge and inconsistency in practice.
Any strategies to tackle the adversity of problematic screen use requires the combined efforts of multiple disciplines; parents, peers, educators, medical professionals, content developers, policymakers and the individual, all need to collaborate on this issue. At the same time, the stakeholders need to be sensitized to the various health problems that stem from excessive screen time. To successfully reach measures to curb its prevalence, the views and perceptions of the various stakeholders involved need to be considered to create a healthier "on-screen" environment for the community.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]
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