BACKGROUND: Excessive screen time is associated with adverse physical and mental well-being for children. Interventions to reduce screen time in different settings have been studied extensively, with mixed findings. We systematically reviewed evidence that evaluated the effects of screen time reduction interventions conducted in school settings on screen usage, physical, and mental health of school children.
METHODS: PubMed, Cochrane, PsycInfo, and Education Resources Information Centre (ERIC) (from inception till 12 September 2024) were searched for relevant randomised and cluster-randomised trials. We assessed risk of bias using the Cochrane risk of bias 2 tool, performed Bayesian random-effects meta-analysis, and rated certainty of evidence using GRADE.
RESULTS: Thirty-nine studies (95,033 participants), published between 1999 and 2024, were included. High risk of bias and great heterogeneity contributed to low-certainty evidence for most outcomes. School-based interventions modestly reduced screen time (SMD: -0.10, 95% CrI: -0.14, -0.06, 27 studies, n = 19,751, I<sup>2</sup>: 85%) and increased physical activity (SMD: 0.10, 95% CrI: 0.02, 0.19, 21 studies, n = 14,944, I<sup>2</sup>: 88%). No clear difference was observed in BMI (MD: -0.15, 95% CrI: -0.39, 0.03, 13 studies, n = 4683, I<sup>2</sup>: 51%), although the subgroup of studies evaluating comprehensive lifestyle interventions appeared to show a slight BMI reduction, while studies evaluating screen-time focused interventions showed no difference.
CONCLUSIONS: School-based interventions modestly reduce screen time and increase physical activity, but their effects on BMI are inconclusive. Variations in local school systems and cultural practices might have contributed to heterogeneity in study findings and should be considered in policy decisions. Future studies should strengthen the cluster-randomization process and include academic performance as an outcome.
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