Effekten av Screen to Move-programmet hos förskolebarn

Originally planned as 6 weekly sessions; before the intervention started, the content was consolidated into 5 weekly sessions at the request of school administrators and parents. All topics planned for the 6 sessions were delivered in the 5 sessions; no content was removed. The Screen-to-Move Program (STEP) is a nurse-led program based on Social Cognitive Theory. Children received one 30-40 minute classroom session per week for 5 weeks, including stories, pictures, video demonstrations, interactive education and active play, with goal cards, achievement stickers and reinforcement. Parents received 5 concurrent online interactive sessions (about 45 minutes, each repeated 3 times) and weekly information notes. Children's screen time, step count and sleep duration, and parents' knowledge, attitudes, self-efficacy, screen use during child activities, screen time, physical activity and sleep were assessed at baseline, post-intervention and 3-month follow-up.

A nurse-led program based on Social Cognitive Theory, delivered in 5 sessions, 1 session per week for children and parents. The program was introduced to children and parents as the "Screen-to-Move Program (STEP)".

Screen use time, daily physical activity time, sleep time, parents' knowledge, behavior, attitude and self-efficacy about children's screen use time will be evaluated simultaneously from the control group with the intervention group. After the 3rd month follow-up test, the STEP will be applied to the children and parents in the control group.

Children's screen usage time will be evaluated with questions. "How long (…hours…..minutes) on average did your child use any device with an electronic screen, such as a smartphone, tablet, video game, or watch television, movies, video games in a day?". Daily screen usage time will be evaluated in minutes. A maximum of 60 minutes of screen time is recommended for pre-school children (World Health Organization, 2019).

Children's physical activity levels; Item 1: "How long is your child active on average in a day? (e.g. walking slowly, making the bed etc.)" and Item 2:"How long does your child do physical activity in a day, on average, until he is out of breath?" (walking fast, cycling, running, playing ball games, swimming, dancing, etc.) will be evaluated based on parent self-report. The total daily (Item1 + Item2) physical activity time will be evaluated in minutes. A minimum of 180 minutes of physical activity is recommended for pre-school children (World Health Organization, 2019).

Pre-school children's daily step count will be measured with the OMRON HJ-109-E pedometer. In our study, the number of steps for children aged 3-5 will be evaluated as 11,500 steps, which is stated to correspond to the 180 minutes physical activity target recommended by the World Health Organization for children aged 3-5 (De Craemer et al., 2015; World Health Organization, 2019).

The information form was created by researchers in line with the literature (World Health Organization, 2019). The form contains information about the PA, screen usage time and sleep duration of the children of parents who have children between the ages of 2-5 and consists of 14 questions. For each item, the correct option is scored as 1, and the incorrect and I don't know option is scored as 0. The total score obtained by collecting the items varies between 0-14 points. A high score indicates a high level of knowledge.

Parents' attitudes towards their children's screen time were evaluated with an eight-item questionnaire developed by Zimmerman et al. in 2007. The questionnaire is in a five-point Likert type, ranging from strongly agree (1) to strongly disagree (5). High scores on the survey reflect more positive attitudes. The questionnaire has been used in many studies before and has a high reliability with the cronbach alpha value of .84 (Carson & Janssen, 2012; Mansor et al., 2021; Raj et al., 2022).

Self-efficacy will be measured separately to reduce screen time and increase physical activity. Parents' self-efficacy in reducing their children's screen time: "How confident are you that you can say no to your child's request to participate in screen time (TV/computer/tablet/video games)?" It will be assessed on a 5-point scale ranging from 'not at all sure' to 'very sure' (Carson & Janssen, 2012). The parent's self-efficacy in influencing the child's physical activity reflects the parent's level of confidence in situations related to the child's physical activity. The questionnaire developed in 2010 has a single factor structure and high reliability (α= 0.88). The eight-question survey (For example: How confident are you that your child will do physical activity even if you do not have much time) is a five-point Likert type ranging from I do not trust myself (1) to I am very confident (5). High scores on the questionnaire reflect higher self-efficacy (Smith et al., 2010).

Parent-reported nighttime sleep duration of the child, calculated separately for weekdays and weekends from reported bedtime and wake-up time (hours/day).

Percentage of children meeting each guideline individually and all three combined, based on the WHO guidelines for children under 5: physical activity (≥11,500 steps/day by pedometer), screen time (≤60 minutes/day, parent-reported) and sleep duration (10-13 hours/night, parent-reported).

Assessed with the Parental Screen Use During Child Activities Scale (PSU-CAS; 8 items, 5-point Likert). Total score ranges from 8 to 40; higher scores indicate more frequent parental screen use during child activities.

Parent self-reported average daily physical activity time on weekdays and weekends (minutes/day).

Parent self-reported average daily non-work screen time (phone, tablet, computer, TV) on weekdays and weekends (minutes/day).

Parent self-reported nighttime sleep duration, calculated from reported bedtime and wake-up time (hours/day).