Screen Use by Children in a Pediatric Waiting Room and the Effect of an Environmental Intervention (PANDA)

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.