A Qualitative Study Examining Household Context and Parental Perspectives on Preschoolers' Digital Media Use Guidelines

A Qualitative Study Examining Household Context and Parental Perspectives on Preschoolers' Digital Media Use Guidelines | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Qualitative Study Examining Household Context and Parental Perspectives on Preschoolers' Digital Media Use Guidelines Anh Ly, Gina Dimitropoulos, Julianna Watt, Emma Cullen, Brae Anne McArthur, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6657587/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Jan, 2026 Read the published version in BMC Public Health → Version 1 posted 12 You are reading this latest preprint version Abstract Background Evidence suggests that the uptake of pediatric guidelines for screen use is generally low, which highlights an urgent need to better understand the familial factors shaping children’s digital media use. This study aimed to explore parents’ perspectives regarding digital media use guidelines, including the factors that influence adherence to recommendations. Methods Semi-structured interviews with 28 parents of young children were analyzed using thematic analysis. Purposive and snowball sampling were employed to recruit parents through notices posted at grocery stores, libraries, preschools, and a university database. Results Three overarching themes emerged: 1) influences and variations on digital media use in families; 2) views regarding guidelines; and 3) recommendations for disseminating and improving uptake of guidelines. Sub-themes included parental attitudes, family context, child characteristics, lack of information, parenting stress, and knowledge dissemination strategies. Conclusions Parental views regarding guidelines are shaped by personal attitudes, family context, child characteristics, availability of information, and societal influences. Recommendations include highlighting the developmental impacts on children, the effects of different types of screen activities, and strategies for limiting digital media use. Dissemination of information should use a multi-faceted approach that involves different sectors such as health and education, providing follow-up assessments, and building supportive environments. early childhood digital media use digital media use guidelines parental perspectives digital devices qualitative research semi-structured interviews Figures Figure 1 Introduction Children are one of the fastest growing users of digital media, including content transmitted over tablets, television, smartphones, computers, and gaming systems (Radesky & Christakis, 2016; Rideout, 2021). Before the COVID-19 pandemic, children under the age of 5 were on screens for an average of ~25% of their waking hours, which amounts to approximately 2-4 hours per day (Galland et al., 2012; Madigan et al., 2019). As a result of the COVID-19 pandemic, which led to school and daycare closures, as well as work from home orders, many parents turned to screens as a means of preoccupying children. A meta-analysis of changes in digital media use suggested a 50% increase in duration of use during the COVID-19 pandemic compared to before the pandemic (Madigan et al., 2022). Given the tendency for digital media use habits to form quickly, these increases were sustained over time (Plamondon et al., 2023). This predicted trend is concerning, as excessive digital media use in young children is associated with an array of developmental consequences (e.g., delayed language, cognition, behavioural problems), which are related to rapid brain development and sensitivity to environmental exposures during this stage of life (Christakis et al., 2004; Cliff et al., 2017; Eirich et al., 2022; Fitzpatrick et al., 2024; Hutton et al., 2020; Madigan et al., 2019; McArthur, Browne, et al., 2021; Radesky & Christakis, 2016; Radesky et al., 2014; Zimmerman & Christakis, 2005). Although research evidence is still emerging on how the context or content of digital media use (e.g., co-viewing with caregivers or watching educational material) may differentially impact children’s development, existing research shows that the developmental health of preschool-aged children is affected by prolonged exposure to “screen time”, i.e., duration of use (Christakis, 2009; Madigan et al., 2020; Rasmussen et al., 2016). For instance, Madigan et al. (2019) demonstrated that heightened digital media use at 24 and 36 months of age was associated with delays in achieving developmental milestones at 36 and 54 months, respectively; however, the obverse association was not found. Earlier research that focused on children’s television viewing showed that children exposed to elevated amounts of television viewing were more at risk for poorer academic skill development (Pagani et al., 2013; Pagani et al., 2010; Wright et al., 2001), lower levels of physical activity (Pagani et al., 2010; Ross et al., 2013), poorer sleep habits (Magee et al., 2014; Marinelli et al., 2014), and adverse dietary outcomes (Ford et al., 2012). Theoretically, it has been proposed that when young children are engaged in digital media use, it can displace or divert their attention from learning skills that contribute to children’s developmental success (Christakis, 2009). Specifically, the displacement hypothesis suggests that excessive digital media use comes at an opportunity cost – reducing the time available for other activities that may be more developmentally beneficial, such as language, play-based learning, literacy, physical activity, and sleep (McArthur et al., 2021). Qualitative Research on Digital Media Use in Young Children and Families Qualitative studies on digital media use in young children from age 0-5 have predominantly focused on parental perceptions of and strategies to manage children’s digital media use, including related views regarding physical activity (Bentley et al., 2016; Carson et al., 2014; Golden et al., 2020; He et al., 2005; Hesketh et al., 2012; Hinkley & McCann, 2018; Jago et al., 2016). Bentley et al. (2016) noted that the majority of prior studies on digital media use were conducted before the availability of mobile devices such as smart phones or tablets. Thus, qualitative studies to date have tended to focus on children’s exposure to television viewing. Their summary of the literature on parental views on children’s television viewing (Carson et al., 2014; De Decker et al., 2012; He et al., 2005; Hesketh et al., 2012; Knowles et al., 2015) suggests that parents perceive the benefits of television viewing (e.g., educational content, tool for children’s emotional regulation and behavioural management, aid for childcare to allow parents to do household chores) to outweigh the potential adverse health outcomes. These findings are important to consider as access to newer technologies, such as mobile devices, has increased rapidly to make digital media use more pervasive in households and in people’s daily lives. He et al. (2005) early study of parental perceptions of screen-viewing behaviours among preschoolers revealed that parents were more concerned about the content of what was being viewed by their children rather than the amount of television use. They also found in their study that parents expressed little concern about the linkages between television use, physical activity, and the risk for obesity. Carson et al. (2014) conducted one of the first studies to examine parents’ perspectives on newer technologies such as tablets and smartphones. Their findings suggest that parents view the benefits of mobile devices (e.g., useful tool for distraction and educational purposes) in a similar way that parents previously viewed the benefits of television viewing. This evolving research on children’s digital media use demonstrates that researchers need to pay attention to the varied contexts in which children interact with screens, which includes the type of media or devices they are exposed to and what kind of content they are viewing and with whom. Similarly, Bentley et al. (2016) conducted interviews with mothers to explore maternal views on children’s use of mobile devices and found that they were used on an ad hoc basis, rather than habitually, as a portable television that served multi-functional purposes such as entertainment and education. Lastly, Hinkley and McCann (2018) study of parental perceptions of the risks and benefits of digital media use and active play during early childhood showed that there were mixed perceptions of digital media use with parents highlighting both the educational benefits as well as the habit-forming and health detriments of digital media use. The common conclusion of these qualitative studies is that more research is needed to understand children’s digital media use behaviours, the impact of digital media use on children’s development, and how public health interventions can increase parents’ awareness about the effects of digital media use. This current study attempts to address this gap in the literature by examining the family context of children’s digital media use and parental views on digital media use guidelines. Digital Media Use Guidelines Half of Canadian parents report they are concerned about their children’s digital media use, demonstrating that it is a pressing issue for caregivers (Angus Reid Institute, 2019). However, a paradox exists regarding parental concern over children’s digital media use and the lack of uptake of children’s screen guidelines, with reports showing that children are likely to use digital media at a rate well above the recommended digital media use guidelines (Madigan et al., 2019; McArthur et al., 2022). Canadian as well as international guidelines generally converge in their recommendation of no digital media use in children under the age of 2 and less than one hour of digital media use per day for children between the ages of 2 and 5 (American Academy of Child & Adolescent Psychiatry, 2024; National Health Service, 2024; NSW Government, 2024; Ponti, 2023). The guidelines also specify that parents should co-view with their children when possible, and that programing should be educational in nature. A meta-analysis of 95 international samples found that only 24.7% and 35.6% of children less than 2 and between 2-5, respectively, are meeting digital media use guidelines (McArthur et al., 2022). The Current Study Given that only a small minority of families with young children adhere to the digital media use recommendations outlined by pediatric societies (McArthur et al., 2022), there is a pressing need to capture parents’ perceptions of these guidelines. This includes the barriers and facilitators – both within families and at the systemic level – that influence their ability to meet digital media use recommendations. To explore parents’ perceptions of digital media use guidelines, we opted to conduct qualitative interviews to capture parents’ views on their children’s digital media use and contextual information about their perceptions of the recommended guidelines. The pervasiveness of digital media in the lives of young children, coupled with the increasing accessibility and consumption of screen-based technologies in households, underscores the importance of examining the factors that shape children’s digital media use. Parents’ perceptions of digital media use guidelines are particularly critical in this context. A better understanding of these views can equip health practitioners to develop effective digital health promotion strategies for young children and families. Raising awareness about the developmental implications of elevated digital media use in young children, as well as the importance of adhering to digital media use guidelines, is especially vital for this age group. Research indicates that digital media use habits during the preschool period tend to persist over time and become increasingly resistant to change (McArthur et al., 2020; Trinh et al., 2020). By addressing these factors, interventions can better support families in fostering healthy digital media practices for young children. Methods To explore parents’ views regarding digital media use guidelines and their perceptions of what interferes with or supports their application of the guidelines within their family environment, semi-structured interviews with 28 parents of young children aged 5 or younger were conducted online via Zoom or over the telephone over a 12-month period starting in June 2023. The study was approved by the Research Ethics Board at the University of Calgary (Study ID: REB22-1793). A Research Associate (AL) and Research Coordinator (EC), both of whom have extensive experience in qualitative research, conducted the interviews. A Research Assistant (JW) assisted with the participant recruitment. Recruitment and sampling The inclusion criteria included being a parent of a child that is 5 years old or younger, being conversationally fluent in English, residing in Calgary, Alberta or surrounding rural areas, and the ability to provide informed consent. Recruitment notices were posted at local grocery stores, community libraries, and preschools throughout a large urban center in Western Canada. To increase diversity in the sample, we sent out targeted invitations to parents through an existing database of participants who had previously taken part in another child development study and who had consented to being contacted about other research studies. We purposefully invited fathers, individuals from ethnic minority backgrounds, single parents, people with low socioeconomic status, and those residing in rural localities to participate in the study. This recruitment effort yielded additional participants from rural areas of the province as well as those from ethnic minority backgrounds. Lastly, snowball sampling was used to recruit 5 participants who were referred to the study by others who had participated in the interviews. Interviews were conducted online via Zoom and scheduled to last approximately 30–40 minutes. Accommodations were made for those who preferred to do the interview over the telephone. Participants were sent an electronic copy of the consent form and a brief demographic questionnaire (supplementary file 1) to complete before the interview. While a concerted effort was made to recruit both mothers and fathers, only one participant was a father, which suggests that perhaps different recruitment venues were needed to reach fathers. Participants received a $ 25 electronic gift card in appreciation for their time. Data collection A total of 28 interviews were conducted with parents (23 via Zoom, 5 over the telephone). The last 5 interviews were conducted 6 months after the first batch because we made a concerted effort to increase the sample diversity through an additional recruitment attempt. Interviews lasted between 15 and 50 minutes, with an average duration of 27 minutes. Six participants resided in rural areas, while the rest lived in the city (see Table 1 for sample characteristics). Preliminary data analysis commenced following the first batch of 23 interviews and prior to the last 5 interviews being conducted. Hence, emerging themes from earlier data collection could be used to guide later interviews and to see if new data were emerging from additional participants or if data saturation had been reached. For consistency across the interviews and to ensure that all critical research questions were addressed, a semi-structured interview guide was used. The interview guide included questions to explore the context of children’s digital media use (e.g., amount of time, type of device, nature of digital media use), parental attitudes and concerns around digital media use, awareness of digital media use guidelines or views regarding them, barriers and facilitators to following guidelines, and recommendations to improve the uptake of digital media use guidelines among families (see Table 2 for sample interview questions). Data analysis Interviews were audio-recorded, transcribed verbatim by a professional transcription service, and transcripts were anonymized prior to data analysis. AL and EC took supplemental notes during and after the interviews to describe any non-verbal interactions or additional contextual information to inform the data analysis (e.g., frequent interruptions during the interview, participant level of engagement, reasons why an interview was shorter or longer than expected, predominant theme arising from each individual interview, participants expressing distress or seeking information after the interview was done). Utilizing a qualitative description approach (Bradshaw et al., 2017 ), which aims to gain subjective perspectives to describe the experience of those directly impacted by the area of focus, this project sought perspectives directly from parents of young children to understand their considerations of digital media use guidelines, without researchers imposing their own perspectives. Verbatim quotes were utilized to support researchers’ interpretations (Bradshaw et al., 2017 ). The data were analyzed inductively using thematic analysis to interpret and extract patterns in data about parents’ knowledge of screen guidelines and barriers or facilitators in the household environment that influenced their children’s digital media use (Braun & Clarke, 2006 ; Guest et al., 2011 ; Maguire, 2017 ). This entailed a three-step process: 1) preliminary data analysis and development of a coding frame; 2) secondary analysis and consolidation of codes; and 3) data interpretation and summary of overarching themes. Numerous steps were taken to better ensure the trustworthiness of the data analysis process. Firstly, all preliminary analysis was conducted independently by the coders to ensure there was no undue influence over coding. Next, both coders kept diligent notes of their coding reflections and memos of the decision-making process behind their analysis; this helped to ensure that all themes emerged from the data, were unique and supported the aims of the research. Finally, regular meetings were held to discuss the individual coding process and to uncover points of dissent; the coders were able to work through any points of contention through discussion and consensus building. In the first step of preliminary data analysis, AL and JW read the interview transcripts (the transcripts were divided in half and shared between the two) independently to identify potential codes that could be applied to the data. AL and JW then discussed the proposed codes until there was a consensus over a coding frame. The broad categories for the coding frame included: child digital media use, family context, parental views and behaviours, guidelines, barriers and concerns. Specific codes under these categories were then discussed and agreed upon before AL and JW independently coded the transcripts (see Table 3 for coding schema). Regular briefing meetings were held to discuss any discrepancies in coding or issues that arose that might require revision of the coding frame. NVivo (version 12.0) was used to conduct electronic coding of the data and to allow for easy retrieval of data for subsequent analysis. For example, queries by code could be conducted using NVivo to allow for easy data retrieval or to revise coding decisions if necessary. In the secondary analysis stage, AL reviewed all the data that was compiled according to different codes to ensure consistency within the codes or to identify patterns across the codes. This stage of analysis resulted in the consolidation of some codes to minimize redundancy and to ensure that while codes may be related to each other that they stood independently on their own as salient data points. AL and JW further discussed the results of the secondary analysis until there was a consensus on the final coding frame. In the final stage of data interpretation, codes were analyzed by AL and summarized to provide descriptions of the context in which they were discussed in the interviews. Emerging themes were identified across the data. The larger project team, including the Principal Investigator (SM) and Co-Investigator (GD) met to discuss the results of the emerging themes and implications of the data for what it could tell us about the needs and desires of parents regarding digital media use guidelines for young children. Our interpretation of the data focused on elucidating the household context that shapes children’s digital media use and actions that could be taken to improve the uptake of digital media use guidelines based on parents’ feedback. Supportive quotes used in this paper have been anonymized but a unique participant ID accompanies the quote. Since the sample is demographically homogenous, we have not indicated whether quotes are from participants with certain geographic (e.g., rural, urban) or socioeconomic (low, medium or high SES) backgrounds. Results Results are presented below according to the three overarching themes that emerged from the data: 1) influences and variations on family digital media use; 2) views regarding guidelines including barriers and facilitators to uptake; and 3) recommendations for disseminating and improving uptake of guidelines (see Fig. 1 ). Each of the overarching themes contains sub-themes which illustrate clusters of salient topics or viewpoints that participants discussed or shared. Table 4 provides verbatim quotes from the interviews to illustrate the predominant themes and sub-themes that emerged. Theme 1: Influences and Variations on Household Digital Media Use Parental Attitudes Parental attitudes toward digital media use were influenced by parents’ educational or professional background and their own childhood history of family practices around screen use (mainly television watching). There were varying views among parents on the negative and positive impacts of digital media use according to their level of concern, access to information about the impacts of digital media use on children’s development, and their perceived ability to manage their child’s digital media use. Several of the participants had a teaching background, ranging from elementary school to high school. These participants spoke about how they saw the effects of digital media on children and adolescents that they taught. They had concerns about how technology was affecting youth’s social skills, attention span, sleep, anxiety levels, and overall mental health. Their exposure to older children as teachers has shaped their views on the negative effects of technology and their increased vigilance regarding their own children’s digital media use. Digital media use was sometimes described as being a positive influence on children. For example, a few participants mentioned how it can help with language development by either enhancing a child’s vocabulary or helping them to learn a different language. It was also perceived to help with the development of interests, such as drawing. Parents also described some screen content as being educational, such as nature shows where young children can learn more about wildlife. Several parents gave examples of how digital media use could increase family bonding such as having regular family movie nights or connecting with relatives abroad over FaceTime. Watching movies together as a family was seen as family bonding time rather than viewing it as a form of parental supervision or parent-directed co-viewing. The use of FaceTime was seen as an important tool to allow family members to stay connected and for children to develop a relationship with extended family members who live abroad. This type of digital media use was viewed as being a positive social activity and some caregivers highlighted the interactional aspect of this type of screen activity as opposed to other screen activities that are more passive. Family Context When describing their family context, the subject of sibling influence, daily routines such as chores, and work-at-home arrangements were highlighted by parents as factors that influenced their children’s digital media use. Older siblings play an important role in influencing younger siblings’ exposure to digital media use. Younger children are often exposed to digital media use at an earlier age if they have an older sibling who is using screens. On one hand, some caregivers learned from their first child’s digital media use patterns and have changed their approach with the second child by introducing more restrictions on digital media use. On the other hand, several caregivers described being stricter around digital media use with their first child and then subsequently being more relaxed with their second child since they have less time to monitor the younger child’s digital media use. Some parents described how challenging it can be to balance digital media use between their children of different ages, especially if the family is sharing a common television and the younger child will always be exposed to what the older child is doing or watching. Daily routines including chores or childcare needs of younger children in the household play a role in shaping parents’ ability to manage their children’s digital media use. Some parents described how caregiving responsibilities for their younger child meant that they relied on screens more for their older child to keep them occupied and distracted. Screens were also seen as a helpful tool when parents are preparing meals or cleaning the house because it gave their child something to do while they attended to household chores. Lastly, working from home contributed to parents’ reliance on screens to keep their child engaged while they got their work done. Parents who worked from home found it particularly difficult to balance work, parenting, and limiting their child’s digital media use. Child Characteristics Parents described individual child characteristics such as preferences, temperament, personality, or developmental needs as playing an important role in shaping digital media use behaviours and expectations. Some parents described how their child seemed to have a limited interest in screens, while others described how their child appeared to rely on digital media and have tantrums when asked to stop using it. For parents who described their child’s interest in screens as being limited, they felt that this was often related to the child’s personality, age and attention span, whether the child was used to engaging in other activities, or if their previous exposure to digital media use was limited. On the other hand, for parents with children who expressed more interest in digital media use, they remarked on the increasing resistance to digital media use limits as their child got older. Children’s preferences for certain shows or games also played a role in their desire for more digital media use. For example, some children want to play certain games on the phone or get excited about a video call with family, while others showed self-interest in shows that promote learning about things like nature, animals, and science. Additionally, children’s routines played an important role in their expectations for digital media use. For example, some children were used to television routines like weekend cartoons, regular show days set aside by parents, or mealtime tablet use when dining out in order to avoid disturbing other customers. A child’s developmental needs also plays a role in shaping their digital media use. One parent of a child with autism spectrum disorder described how it was difficult to get their child to focus on other activities, so as a result the child spent 5–7 hours per day on screens (playing games on the phone, watching television or videos on the computer). Another parent of a child with behavioural challenges expressed concern over their child’s increasing insistence on spending at least 1–2 hours at a time continuously watching YouTube videos. Lastly, another parent described their child as being neurologically divergent and talked about the challenges of setting digital media use limits with the child as they would have tantrums. Theme 2: Parental Perceptions Regarding Guidelines Utility of Guidelines Parents felt that digital media use guidelines were useful to help parents monitor their children’s digital media use behaviour, but they see them as being flexible depending on their personal views or family practices and needs. The guidelines were viewed as being useful as both a prevention or intervention strategy. The guidelines could help to prevent further problems with digital media use at a later age. Additionally, the guidelines themselves might serve as an intervention for families where there is already problematic digital media use and if families were not aware of the recommended amounts of digital media use for young children. Some people felt that one of the benefits of the guidelines is that it raises awareness about the topic for parents who might not have been aware of it. Guidelines also serve as a reminder for parents to monitor their child’s digital media use, and they can prompt parents to do more of their own research on the topic. Lack of and Gaps in Information Several participants indicated that they were not aware of the digital media use guidelines for young children. A few parents stated that they vaguely recalled hearing about or coming across the guidelines previously but that they could not remember exactly what the guidelines recommended. Some parents commented on how the guidelines seemed vague, were too abstract to follow, or they felt disconnected from them. For example, some felt that the guidelines were not very clear because they did not specify the context of digital media use (e.g., type of screen activity, content, co-viewing). Also, parents felt that digital media use may not always be consistent over a given period, so it is difficult to estimate their child’s amount of exposure to screens. Other stated that they could not relate to them until they started to develop their own opinions about digital media use, suggesting that the uptake of guidelines had to be personally driven rather than externally influenced. Many parents expressed interest in wanting to know more about the impacts of digital media use on children’s development or strategies for how to manage it. For instance, they wanted to learn about good methods for teaching children about what is appropriate digital media use or the reasons behind limiting digital media use. They also wanted to know more about the basic science behind how screens affect brain development. They were curious about how digital media use differentially affects children of different ages or how children who are neurodivergent or have special learning needs may be impacted differently. Lastly, they wanted to have a better understanding of how to differentiate the impacts of different types of screen activities in order to identify which ones are more healthy or harmful. Parenting Stress Parenting stress was a predominant issue that was identified as a barrier to following digital media use guidelines or turning to screens as an aid in childcare. Parents described an array of factors that contributed to parenting stress including caring for multiple children, household chores, lack of social support, sick periods, single parenting, managing child behaviour, general work demands, lack of daycare, lack of access to children’s programs, and lack of knowledge on how to engage children in other activities. These stressors contribute to parental decisions to rely on screens to distract their children. It was clear from parents’ responses that screens were viewed sometimes as a tool that helped parents cope with the daily demands of parenting. For example, lack of social support could be a reason that parents sometimes turned to screens to entertain their children while they attended to other tasks or simply needed a break. Some people described how having relatives in town who could help with childcare provided reprieve for them, so they did not have to rely on screens. Similarly, lack of daycare options or access to children’s programs contributed to increased digital media use because parents were unable to find help with the childcare they needed so that they could get work and other tasks done. Children’s behaviour greatly influenced parents’ decision to allow children access to screens. When parents faced challenging behaviour in their children (e.g., tantrums, whining, excessive energy, arguing with other children), it was easier to resort to screens to get children to calm down. One parent mentioned how digital media use during travel, like long plane rides, helped to distract their child and manage their behaviour so they would not disturb other passengers. Psychosocial and Societal Factors Several psychosocial and societal factors were identified by parents as being barriers to following digital media use guideline recommendations. For example, parents discussed how peer pressure, stigma, shame, and the sensitive nature of the topic of children’s digital media use made it difficult to openly discuss the topic with others or to find support. Some parents mentioned how children can feel pressured to play online games in order to connect with friends, or how they hear about apps or programs from other children and want to explore them as well. One parent described how they were afraid that cutting off their child from certain devices or games might affect their child’s ability to connect with peers and develop peer relationships. A few participants described how parents themselves can also experience social pressure from other parents who are letting their children watch certain shows or programs. They talked about how shows are generally advertised to a certain demographic and there is an unstated expectation that all families will become familiar with it because it is part of a cultural trend. Feelings of shame and guilt came up a few times, as participants described instances where parents may not want to disclose how much digital media use their child is exposed to for fear of being judged by others, especially by health providers who are doing an assessment and trying to tell them what is best for their child. Parents sometimes feel judged by other parents as well, especially if they feel that their screen practices are not as strict as others. Lastly, parents identified some societal factors that influence children’s exposure to digital media, including society’s growing dependency on technology, the increasing incorporation of digital technology into the educational system, and socioeconomic challenges that some families may face. Several participants remarked on the pervasiveness of digital devices such as smartphones which has contributed to increased exposure to digital media use for both children and adults. Some people pointed out how screens are increasingly needed to stay in contact with friends and family and how jobs nowadays require knowledge of technology use, so children should learn how to use it. Also, because screens are being increasingly incorporated into the school curriculum, parents feel that children will inevitably be introduced to screens in school despite their best efforts to limit digital media use at home. Regarding how socioeconomic disadvantages might affect children’s digital media use, parents talked about how families with low income might not be able to afford to buy books or put children in activities. Also, families with low income might be prioritizing other things, like trying to put food on the table, rather than worrying about digital media use limits. Theme 3: Recommendations for Uptake of Guidelines Parents provided several recommendations on how to bolster the uptake of children’s digital media use guidelines, including ways to improve the content of the guidelines so that they are informative and relevant to parents, knowledge dissemination strategies to enhance parents’ awareness about children’s digital media use, implementing routine health check-ups and follow-up assessments, and building supportive environments for parents to discuss concerns and ideas. Table 5 outlines the key areas and specific recommendations shared by parents. Content Development Parents recommended that screen guidelines should highlight information on the research evidence of the impacts of digital media use on children’s health, including their physical development, brain development, behavioural outcomes, sleep, or attention span. They felt that this science-informed approach would more effectively capture parents’ attention so that they have a clearer understanding of why the guidelines are being recommended and what they can do to ensure their child’s healthy development. Parents also recommended that the guidelines contain accompanying information on strategies for limiting digital media use in young children. In this way, the guidelines can be more of a toolkit that offers helpful resources rather than simply outlining abstract targets that parents should follow. Additionally, several parents indicated that they would like to know more about the effects of different types of screen activities. They felt that the current guidelines do not differentiate the different uses of screens, which they believe is important to consider because perhaps some forms of digital media use are more detrimental than others. Lastly, one parent suggested that information about digital media use among children with specific development concerns (e.g., autism) would be helpful. Knowledge Dissemination Strategies Most parents felt that a multi-faceted approach was required to raise awareness about digital media use guidelines for children. This involves disseminating information about digital media use through different sectors, including the health care system, education system, and various social services and community agencies. Parents emphasized that it was important to deliver information in creative and engaging ways and to reduce stigma associated with digital media use. Parents suggested that information could be disseminated through community centres, family resource networks, at child wellness check-ups with a family physician or immunization clinics, or at information sessions or classes offered at libraries or through provincial health services such as birthing and baby classes. Parents suggested that the provision of print material, such as pamphlets, would be helpful so that parents can have some resources that they can take with them and view on their own time. It was also suggested that information sheets could perhaps contain QR codes that provide links to additional resources. Most participants agreed that it is beneficial to carry out awareness raising campaigns regarding children’s digital media use, especially when children are young and in their early years of school. These campaigns could be delivered through social media such as Facebook pages targeted to parent groups or early childhood educators. One participant suggested that information pamphlets could be handed out to parents at daycares. A few participants suggested that targeting families with children in kindergarten (e.g., at kindergarten orientation sessions) or grade 1 could help to reinforce the message about limiting digital media use as children transition into school as their exposure to technology may increase. Follow-up Assessments & Building Supportive Environments Some parents talked about the importance of having follow-up assessments or reminders about digital media use because as children grow up their needs and screen behaviours might change. A few parents highlighted the importance of having access to supportive resources, such as parent or community support groups, to encourage open discussion, share experiences or ideas, or to help them manage their children’s digital media use. It was also suggested that access to affordable after-school programming could help parents to reduce children’s digital media use because it would keep children occupied or reduce parental stress during the day from having to balance several activities and responsibilities. Discussion This current study aimed to explore parents’ perceptions of young children’s digital media use via semi-structured interviews, which were analyzed inductively using thematic analysis. Given that only a small minority of parents with young children adhere to screen use guidelines (McArthur et al., 2022 ), it is critical to understand parents’ views on digital media, to in turn inform digital media health promotion strategies. We found that parents’ attitudes towards digital media use are shaped by a variety of factors, including their personal experience, professional background, and access to information about the impacts of digital media use on children’s behaviour and development. These attitudes do not appear to be static, rather they have evolved in response to changing family dynamics (e.g., birth of a new child), as well as external pressures (e.g., household chores, working from home), and contextual factors (e.g., number of children in the home). Moreover, consistent with other parenting behaviours and practices (Garcia et al., 2020 ; Madigan et al., 2019 ), we found that parents’ perspectives on digital media were often shaped by their own childhood experiences around television use. Understanding the Attitudinal and Familial Context of Digital Media Use Parents’ attitudes toward the potential risks and benefits of digital media use appear to be shaped by their contextual experiences of children’s developmental expectations. For example, teachers in the current study often expressed concerns about the negative consequences of digital media on their students’ academic and learning skills. These concerns are well-supported by research, where several meta-analyses report small-to-moderate associations between the quantity of digital media use and various child outcomes, including poorer language skills (Madigan et al., 2020 ), academic achievement (Adelantado-Renau et al., 2019 ), and socio-emotional problems (Eirich et al., 2022 ). The acute observations of developmental consequences for these participants appear to have shaped their views on their own children’s digital media use. Specifically, in being more aware of the risks of excessive digital media use on child development through their classroom observations over time, they may have reported increased vigilance in managing their own children’s media consumption. While some parents viewed digital media with some skepticism, others were more optimistic by highlighting its potential benefits under certain contexts and for specific developmental skills. For example, digital media was seen as a tool to engage in family interactions around digital media, such as movie nights or FaceTime with family members, or to engage children in learning a new skill, such as drawing, music, or science. Some of these activities tend to be more active and engaging versus passive (e.g., streaming television) forms of digital media use, which in turn may be a mechanism that fosters more perceived closeness among family members when viewing digital media together. Several parents also described the benefits of educational content, such as nature documentaries and reading apps and how it may provide enrichment opportunities for children’s language, cognition, and academic success. In line with this perception, research suggests that there is some support for language learning via educational programming (Madigan et al., 2020 ); however, these benefits are not comparable to receiving high doses of human-to-human caregiver sensitivity in device-free interactions (Hirsh-Pasek et al., 2025 ; Madigan et al., 2019 ). Dyadic and verbally-loaded “serve and return” interactions have been shown to foster children’s communication and language acquisition, and solidify word learning (Madigan et al., 2020 ). Although sibling influence on digital media exposure has received little research, it emerged as a key theme for parents, highlighting the difficulties of managing digital media use across children of different ages. This is undoubtedly a complex task for parents, as siblings often co-exist in shared family spaces where digital media is readily accessible. Specifically, parents mentioned how an older sibling’s screen use played a significant role in shaping the younger sibling’s digital media habits. Some parents reported that, due to practical constraints, having an older child in the household required them to apply more relaxed digital media use rules. Accordingly, younger siblings were introduced to digital media at earlier ages compared to their older sibling. However, not all parents shared this experience. Other parents reported that they implemented stricter limits for their younger children because they felt they had learned from their experiences with their older children, and therefore adjusted their approach accordingly. The emergence of this theme, coupled with the lack of research on sibling influence in digital media use, suggests that this is an important area for future research. Moreover, it underscores the need to consider multi-child households when developing digital media guidelines, with targeted recommendations for managing the device use of siblings at varying ages. Raising Awareness About Guidelines and Addressing Barriers The current qualitative study reveals that many parents were either unaware of the guidelines or found them too vague and abstract to follow with their children. Parents who shared these views noted how the guidelines were unclear because they did not specify the context of digital media use, such as type of screen activity, nature of the content, or co-viewing practices that should be followed. This lack of context-specific information results in overly generalized and unclear recommendations, which in turn makes it difficult for parents to take actions to alter their children’s digital media behaviours. Thus, improving guideline adherence requires actionable, clear, and detailed recommendations that take into account various contexts of digital media use. While there is research that shows that only a small minority of parents with young children adhere to digital media guidelines (McArthur et al., 2022 ), we are unaware of any studies that have examined parents’ knowledge of or perceptions of digital media guidelines. This current study contributes to this gap in the literature and provides insight into how parents feel that there is a lack of context-specific information about digital media use guidelines, which in turn contributes to their difficulty in implementing them effectively. Parenting stress emerged as a significant barrier to following digital media use guidelines. Caregiving responsibilities (especially in multi-child households), household chores, lack of social support, work demands or arrangements, and lack of access to daycare or children’s programs are factors that play a role in parents’ reliance on screens in varying amounts throughout the day to occupy their children. In this way, digital media devices are sometimes used in households as a parenting aide to help with the daily demands of parenting. The predominant theme of parenting stress and digital media use underscores the need to develop resources for parents that can offer strategies for reducing parenting stress and providing supports. Offering parents strategies that will help them to balance parenting responsibilities while also monitoring their children’s digital media use will enable parents to rely less on digital media devices as a parenting aide. This seems particularly relevant for children who spend more time in home-based care, as this has consistently been shown to be associated with higher levels of screen use in young children compared to daycare-based settings (Madigan et al., 2019 ; McArthur et al., 2020 ). Several psychosocial and societal factors were identified by parents as barriers to following digital media use guideline recommendations. Peer pressure, stigma, shame, and the sensitive nature of the topic of children’s digital media use reportedly made it difficult to openly discuss the topic with others or seek support. Parental feelings of shame and guilt in the context of interactions with health care providers appear especially to be a barrier in screening for digital media use during child health assessments. Parents, for example, may not want to disclose the actual extent of their child’s digital media use for fear of being judged, and thus may not receive the proper corresponding information that could be useful to them regarding digital media use guidelines. Hence, these feelings of shame and guilt that parents may harbour make it difficult for health providers to conduct assessments and advise on what is best for their child. Additionally, parents sometimes felt judged by other parents, especially if their digital media practices were perceived as less strict. This combination of peer pressure and fear of judgment can create significant barriers to openly address and manage digital media use among families. Thus, public awareness raising campaigns about children’s digital media use and the creation of supportive environments, such as parenting groups to discuss the topic, could help reduce stigma associated with the topic. There was a general feeling among parents that the pervasiveness of technologies in society and in children’s lives is inevitable, which contributes to the challenge of limiting children’s digital media use. With the growing dependency on technology in homes and schools, some parents felt it was more advantageous to help their children adapt to these technological shifts in society rather than limiting their interaction with digital devices. In this way, increased digital media use was seen as a natural and integral part of daily life that was important for children to learn how to use technology effectively. This perspective highlights the need for guidelines to be realistic and adaptable to the evolving digital landscape, providing parents with practical strategies to manage digital media use in a way that aligns with modern societal norms. Improving the Uptake of Guidelines Parents provided several recommendations to improve the uptake of digital media use guidelines. They emphasized that the guidelines should highlight the research evidence to clearly show the impacts of digital media use on children’s development. This science-informed approach would not only ensure that the guidelines are reliable, but it would also more effectively capture parents’ attention by highlighting the developmental outcomes of elevated digital media use. Other recommendations included focusing on developing guidelines that clearly outline the differential outcomes of digital media use for different age groups, considerations for children with special needs, and the effects of different types of digital media activities. Parents also suggested that guidelines should include practical strategies that they can use to limit their children’s digital media use. Together, these recommendations suggest that there are several gaps in existing digital media use guidelines that can be addressed to help parents better understand the guidelines and ultimately adhere to them. These gaps include the need to provide more research evidence, enhance the content of the guidelines by considering different contexts of digital media use and developmental needs, and provide practical strategies that will enable parents to adhere to guideline recommendations. In terms of knowledge dissemination strategies about the guidelines, most parents felt that a multi-faceted approach was required to raise awareness about digital media use guidelines. To reinforce the delivery of information to a broad audience through multiple channels, the involvement of different sectors, including health, education, social services, and community agencies was seen as critical for a coordinated effort to raise awareness about the topic. Parents also highlighted the need for information campaigns and materials to use creative and engaging methods such as social media forums, print materials with QR codes, and information sessions at community centers and schools. Moreover, parents stated that it was better to start these information campaigns when children are in their early years of school. While these suggestions were self-generated by parents in this study, they also align with the gold standards for successful health promotion campaigns (The Health Communication Unit, 2007 ). Lastly, some parents talked about the importance of having follow-up assessments at routine health check-ups for their children where they can be reminded about digital media use because children’s developmental needs and digital media behaviours change as they age. This recommendation speaks to the importance of having health providers routinely bring up the topic of digital media use in young children with parents so that it remains current and parents can reassess their children’s digital media behaviours as they grow and make adjustments accordingly. Moreover, implementing follow-up assessments can help ensure that parents receive ongoing support and guidance tailored to their child's developmental stage. Strengths and limitations The interviews were conducted with a largely homogenous sample of highly educated parents from mostly in-tact two-parent households living in an urban setting. While an effort was made to recruit both mothers and fathers to compare differences in parental views on digital media use, all but one participant were mothers. There was some diversity in the sample in terms of ethnicity (60.7% Caucasian); however, we lacked viewpoints from single parents, male caregivers, those from socioeconomically disadvantaged backgrounds, more individuals from ethnic minority backgrounds, people living in rural and remote locations, and more parents with children with developmental challenges. There may have also been some participant self-selection bias as a result of posting recruitment notices at community libraries, as many of the participants recruited through this venue tended to come from a teaching background and possessed preexisting strong views about digital media use behaviour in children. Given that digital media use behaviours among children may be a sensitive topic for some parents who might feel judged for their parenting practices, parents may have provided socially desirable responses and minimized the extent to which their children are exposed to screens. This may have also obscured the actual extent to which parents are concerned about their children’s digital media use. The interviewers did their best to reinforce the importance of hearing a variety of perspectives in a non-judgmental and non-stigmatizing way by using neutral and open-ended questions. The sample size for this study was adequate for a qualitative study involving semi-structured interviews. We monitored for data saturation and given the recruitment challenges we faced in recruiting a more diverse sample where additional findings could have emerged, we felt that we reached data saturation with the particular sample that we had. However, the results of this study may not be generalizable to the wider population of parents with young children across Canada or in other geographical locations where other contextual factors may play a role in shaping children’s digital media use. The average length of the interviews (27 min) was somewhat short where longer, more in-depth, interviews may have yielded additional information about parental attitudes toward children’s digital media use. We made every effort to engage parents in discussion for 30–45 minutes, but a few parents were busy with childcare and were not able to participate in the interview for more than 20 minutes. As with most qualitative research that relies on interview data rather than direct observations, there is the possibility that participant accounts may differ from actual practices. Qualitative research findings are also based on the research analysts’ data interpretation rather than on objective measures of behaviours. Our research team includes individuals who have extensive experience in qualitative research and we followed procedures to ensure the trustworthiness of the data analysis process, which included double coding the data and having several consensus meetings with the research team to discuss the findings. Ultimately, the strength of qualitative interviews is that they allow participants to reflect on their views, provide contextual information, make connections with other ideas that emerge during the conversation, and ultimately yield rich and nuanced data about participants’ perspectives on a given topic. Conclusion Findings from this study suggest that there are a variety of factors that may influence the uptake of digital media use guidelines for young children. These factors include parents’ personal attitudes toward digital media use, household context, child characteristics, availability of information about digital media use, and societal influences. Exploring parental views on digital media use guidelines can provide insight into how to develop guideline content (i.e., informational content) and ways to enhance awareness about children’s screen use (i.e., digital media health promotion strategies). To bolster the uptake of digital media use guidelines, parents recommended that content should highlight the developmental impacts on children, the effects of different types of screen activities, and concrete strategies for limiting digital media use. Recommendations for dissemination of information included using a multi-faceted approach that involves different sectors such as health, education, and community centres, and providing follow-up discussions with health providers as children’s digital media habits evolve throughout their development. Declarations Competing interests The authors declare that they have no competing interests. Ethics approval and consent to participate This study adhered to the Declaration of Helsinki Ethical Principles for Medical Research Involving Human Participants (April 2025). Ethical approval was granted for this study by the Research Ethics Board at the University of Calgary (Study ID: REB22-1793). All participants taking part in this study provided informed consent. Consent for the publication of data was provided by participants. Funding This study was funded by the Social Sciences and Humanities Research Council (SSHRC). Author Contribution AL conducted the interviews, led the data analysis, and drafted the paper. EC conducted a set of interviews. JW assisted with participant recruitment, coding the transcripts, and preliminary thematic analysis. GD and SM assisted with the thematic analysis and data interpretation. BM provided writing and editing for the manuscript. All authors were involved in the design of the study, provided critical revisions to the manuscript, read, and approved the final manuscript. Acknowledgement The authors would like to give thanks to the caregivers who participated in the interviews. We would also like to thank Ana Virginia Figueras (Research Coordinator) for providing feedback on the thematic analysis, and Haneen Salama (Research Assistant) for help with formatting the manuscript. 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Tables Table 1 Participant Characteristics ( N = 28) Number Percent Parent Gender Female 27 96.4 Male 1 3.6 Parent Age (mean = 36.3) 20–29 years 4 14.3 30–39 years 17 60.7 40 + years 7 25.0 Residence Urban 21 75 Rural/remote 6 21.4 Unspecified 1 3.6 Parent Education Highschool 1 3.6 Trade school 4 14.3 Partial university 2 7.1 University degree 10 35.7 Graduate level 10 35.7 Unspecified 1 3.6 Racial Origin Caucasian 17 60.7 Asian/South Asian 7 25 Indigenous 1 3.6 Mixed race 1 3.6 Unspecified 2 7.1 Employment Full-time 12 42.9 Part-time 4 14.3 On-leave 2 7.1 Unemployed 8 28.6 Unspecified 2 7.1 Number of children in household One 11 39.3 Two 13 46.4 Three 3 10.7 Four 1 3.6 Target Child Age ( N = 38) 0–1 13 34.2 2 11 28.9 3 4 10.5 4 4 10.5 5 6 15.8 Target Child Gender Female 23 60.5 Male 15 39.5 Table 2 Sample Interview Guide Questions Questions 1. For some context on your child(ren)’s digital media use, could you describe the following: Average amount of time per day they spend on a screen? What type of device are they using (TV, computer, smartphone, tablet, video games, etc.)? The nature of the digital media use (educational content, social media, supervised/unsupervised? 2. Do you set limits on digital media use in your household? If so, are these limits followed? Is there resistance from the child(ren) with regards to these limits? 3. Do you think your child(ren)’s digital media use is problematic? If so, what are your concerns? 4. Are you aware of the national guidelines for children’s digital media use? If so, how were you made aware of them? 5. Are you following these guidelines or have you tried to follow them? 6. What do you think are some barriers for yourself or other families in general for following the digital media use guidelines? 7. What recommendations do you have for how we could improve the uptake of children’s digital media use guidelines among families? Table 3 Coding Schema Category Codes 1. Child Digital media use Type of digital media use Frequency of digital media use Parental monitoring Child attitude or behaviour 2. Family Context Sibling influence Household rules Parental education Co-parenting 3. Parental Views and Behaviours Parental digital media use Views on technology types Fears or concerns Positive effects of screen-time Personal attitudes or motivations Family time 4. Guidelines Views regarding guidelines Understanding and knowledge Acquiring or seeking information Health provider roles Recommendations 5. Barriers Parenting stress Technology and society Peer pressure Feeling judged SES challenges Lack of information Mental health COVID-19 Table 4 Supportive Quotes from Interviews Theme 1: Influences and Variations on Household Digital media use Sub-Theme Supportive Quote Parental Attitudes “Digital media use has been something of interest to us. I’m a teacher as well, so I see the effects of screens on – I teach junior high, so, I see how it affects my students’ sleep, and their social lives and their anxiety levels, and all kinds of mental health concerns. And so, when I had my own kids, it was something that I was interested in, and I wanted to do things a certain way.” (P08) “But moving to Miss Rachel on YouTube, we pick it. My son is 14 months, and his vocabulary is so large already. And it’s because he watches her songs, he can sing them. He does the actions to such a – I just feel like it’s a good thing. If you’re going to watch something, then you’re watching something good, right?” (P19) “[I]f you’re FaceTiming family, then you don’t technically need to say that that’s digital media use, because that’s connecting with family. Or if you’re looking at family pictures on a screen, then that’s not actual digital media use.” (P06) Household Context “But we started [firstborn] with digital media use at the age of six, I would say, and her little sister started about age three, very slowly. I think when you have one versus two kids, it sort of shifts and changes and life can get busy … I think we do it quite differently as parents for them.” (P22) “And then she’s the only child in my house. That’s one more problem, because if she has a sibling or someone else playing with her, then she would not ask watching more TVs. But she’s the only one at home, and then she gets bored often, even if she’s playing herself for a bit.” (P09) “We’re busy, I think is one of the biggest issues. So, my wife and I work quite a bit, and even when we’re focused on our daughter, it can be quite challenging to have her not staring at a screen all the time. But we don’t have the luxury of being able to focus on her. So, it’s an easy babysitter, in a way.” (P16) Child Characteristics “Honestly, I don’t need to cut her off though, because she just doesn’t have the attention span.” (P14) “Because once she gets started, it’s hard to get her to stop … she will often play games when she gets home from school, and we don’t want that to be pushed much past 2 hours, but it’s challenging to just take it away. She often throws a fit if that happens.” (P16) “I tried to put her focusing on something like drawing, painting or something like that … She doesn’t really like it. So, I started to put her on the screen, like YouTube on my laptop. And then she’s so, so into YouTube program, anything like Cocomelon those stuff. So, once I put her on the YouTube, she just watching that constantly, up to one or 2 hours straight.” (P09) Theme 2: Parental Perceptions Regarding Guidelines Sub-Theme Supportive Quote Utility of Guidelines “… because the younger you deal with these things, any health problem or societal problem, the younger the kids are, the better.” (P04) “Even for moms in my play-groups and stuff, a lot of them I see that they use the digital media use and I feel like, yes, maybe if a medical professional, I feel like it should be a topic that is talked about, which yes, it definitely isn’t.” (P17) “[T]his information is beneficial for somebody who has it out of control but they don’t know it’s out of control, you know, because they’re just so used to the background noise. Or they’re constantly on the tablet or they’re constantly scrolling on the phone, you know, while their child is playing next to them.” (P11) Lack of and Gaps in Information “I wasn’t really aware of them [screen guidelines] until I think you mentioned it in the study description in detail.” (P16) “My doctor never brought it up. We’ve been to the clinic so many times, no one’s talked about it. I go at least once a month to weigh him and measure him, and there’s no brochure, nothing.” (P01) “I guess going forward as she gets more independent on how to limit digital media use, what are good methods, or how can I teach her about what’s appropriate and whatnot.” (P15) “Like what type of digital media use is I guess negative, and what is maybe still maybe not great but now is like maybe slightly more beneficial?” (P13) Parenting Stress “When my six-year-old was a toddler and [younger child] was born, screens were used more often. And I do think that was reflecting on just being busy with a baby and feeling tired, and using screens was an easy distraction for the toddler.” (P06) “… if the kids are having a temper tantrum or they’re having one of those days where they just can’t seem to keep it together and regulate, and they’re having meltdowns over every little thing. Sometimes it’s tempting for me, and I know for some other people, they just give them a phone or turn on the TV.” (P18) “I have to work. I don’t know what else to do with them. And I’m trying to get them into daycare full-time. So, that would eliminate a significant amount of their digital media use a week, those two extra days.” (P19) Psychosocial and Societal Factors “The thing is that they’re offering tablets in school too, so, even when he goes to school, if we have a rule of no electronics, he still has access to it in other places.” (P01) “There’s all these shows being created for that demographic that parents, I think, feel pressured to show these shows to their kids … And there’s this social pressure to expose your kids to all this stuff sooner.” (P08) “So if we cut off the use of electronic device[s], some of my friends say that it would make them difficult to make friends at school. So, that’s one of the … reasons why I would let my kids play games when they get older, because I do worry it would affect how they make friends at school, because it’s one of a very popular things in their social circle.” (P03) “So when I was given the guidelines, I would always flub my answers because it made me feel embarrassed that [child’s name], my six-year-old now, was over the guideline.” (P06) Theme 3: Recommendations for Uptake of Guidelines Sub-Theme Supportive Quote Content Development “I think giving people the guidelines is really important. But I think explaining why is more [important] when the guidelines are given.” (P12) “Probably just stating that there is [a] correlation between developmental delays and digital media use use, and, I don’t know, maybe some research behind that or something.” (P17) “Yes, I think, like, managing transitions to other activities, if there are tips for that. And then also, just like I said, figuring out way to present her with screens, like screen activities that are appropriate for her age.” (P16) “I think it would be useful to have more resources on what types of activities are good … more access to different things that you can do with your kid instead of just defaulting to putting, turning on a show …” (P15) Knowledge Dissemination Strategies “So I think it’s a multifaceted approach. There needs to be those guidelines. It’s awesome if the public health nurse and family doc mentions it. Those kindergarten, grade 1 teachers and principals. Everybody kind of has to work together so you’re getting it from all sides.” (P04) “Public health, when kids get immunizations, that might be another place, like places that families are going regularly, family doctors, maybe when they do their medical checks each year.” (P08) “The Family Resource Networks, I think that they would be absolutely incredible to get on board with this. They see so many parents. They see a variety of parents too. They’re not just seeing the usual players … But you’re reaching parents that really need to be reached with the FRN, because they do take referrals from schools, they take referrals from all over the place.” (P12) Follow-up Assessments & Building Supportive Environments “So, they were talking about no more than an hour a day or something like that. At that point, it was much easier to kind of manage that. But we haven’t heard anything about that since, that was like three years ago.” (P16) “I feel I would appreciate if optometrists also followed through with checking in on your digital media use.” (P06) “I think parents are more likely to listen to other parents or, you know, sort of hear the perspectives of another parent’s experience.” (P22) “So just like a support system wherein they are able to get like, you know – a venue to be able to share and learn from each other.” (P02) Table 5 Recommendations for Uptake of Guidelines Key Areas Specific Recommendations Content Development • Provide evidence-based information on the impacts of digital media use on children’s development including physical development, cognitive and behavioural outcomes, sleep, attention span, or socioemotional outcomes • Offer strategies for limiting digital media use • Explain the effects of different types of screen activities • Discuss the impacts of digital media use on children at different ages • Provide information about digital media use among children with specific developmental concerns (e.g., autism) Knowledge Dissemination Strategies • Use a multi-faceted approach that includes different sectors such as the education, health, and social services sectors (e.g., schools, daycares, public health clinics, primary care, prenatal classes, community centres, family resource networks, library information sessions) • Deliver information in creative and engaging ways to reduce stigma associated with digital media use • Offer print material (e.g., pamphlets, brochures) that can be taken home and that provides links to additional resources • Develop and implement public health campaigns to raise awareness among parents about the effects of digital media use (e.g. use social media platforms) Follow-up Assessments • Ensure that digital media use assessments are part of routine pediatric visits and that follow-up assessments are conducted • Health providers should provide information on the developmental needs and changes of children as they age with regards to digital media use Building Supportive Environments • Develop community programs that provide a supportive environment for parents to discuss concerns and ideas about digital media use (e.g., peer support programs) • Advocate for affordable after-school programming that can provide support to parents to reduce children’s digital media use Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Jan, 2026 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 08 Jul, 2025 Reviews received at journal 26 Jun, 2025 Reviews received at journal 12 Jun, 2025 Reviewers agreed at journal 29 May, 2025 Reviews received at journal 28 May, 2025 Reviewers agreed at journal 28 May, 2025 Reviewers agreed at journal 28 May, 2025 Reviewers invited by journal 27 May, 2025 Editor assigned by journal 20 May, 2025 Editor invited by journal 20 May, 2025 Submission checks completed at journal 19 May, 2025 First submitted to journal 19 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Before the COVID-19 pandemic,\u0026nbsp;children under the age of 5 were on screens for an average of ~25% of their waking hours, which amounts to approximately 2-4 hours per day (Galland et al., 2012; Madigan et al., 2019). As a result of the\u0026nbsp;COVID-19 pandemic, which led to school and daycare closures, as well as work from home orders, many parents turned to screens as a means of preoccupying children. A meta-analysis of changes in digital media use suggested a 50% increase in duration of use during the COVID-19 pandemic compared to before the pandemic\u0026nbsp;(Madigan et al., 2022). Given the tendency for digital media use habits to form quickly, these increases were sustained over time (Plamondon et al., 2023). This predicted trend is concerning, as excessive\u0026nbsp;digital media use in young children is associated with an array of developmental consequences (e.g., delayed language, cognition, behavioural problems), which are related to rapid brain development and sensitivity to environmental exposures during this stage of life\u0026nbsp;(Christakis et al., 2004; Cliff et al., 2017; Eirich et al., 2022; Fitzpatrick et al., 2024; Hutton et al., 2020; Madigan et al., 2019; McArthur, Browne, et al., 2021; Radesky \u0026amp; Christakis, 2016; Radesky et al., 2014; Zimmerman \u0026amp; Christakis, 2005).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough research evidence is still emerging on how the context or content of digital media use (e.g., co-viewing with caregivers or watching educational material) may differentially impact children’s development, existing research shows that the developmental health of preschool-aged children is affected by prolonged exposure to “screen time”, i.e., duration of use (Christakis, 2009; Madigan et al., 2020; Rasmussen et al., 2016). For instance, Madigan et al. (2019)\u0026nbsp;demonstrated that heightened digital media use at 24 and 36 months of age was associated with delays in achieving developmental milestones at 36 and 54 months, respectively; however, the obverse association was not found. Earlier research that focused on children’s television viewing showed that children exposed to elevated amounts of television viewing were more at risk for poorer academic skill development\u0026nbsp;(Pagani et al., 2013; Pagani et al., 2010; Wright et al., 2001), lower levels of physical activity\u0026nbsp;(Pagani et al., 2010; Ross et al., 2013), poorer sleep habits\u0026nbsp;(Magee et al., 2014; Marinelli et al., 2014), and adverse dietary outcomes\u0026nbsp;(Ford et al., 2012).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTheoretically, it has been proposed that when young children are engaged in digital media use, it can displace or divert their attention from learning skills that contribute to children’s developmental success (Christakis, 2009). Specifically, the \u003cem\u003edisplacement hypothesis\u0026nbsp;\u003c/em\u003esuggests that excessive digital media use comes at an opportunity cost – reducing the time available for other activities that may be more developmentally beneficial, such as language, play-based learning, literacy, physical activity, and sleep (McArthur et al., 2021).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative Research on Digital Media Use in Young Children and Families\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQualitative studies on digital media use in young children from age 0-5 have predominantly focused on parental perceptions of and strategies to manage children’s digital media use, including related views regarding physical activity (Bentley et al., 2016; Carson et al., 2014; Golden et al., 2020; He et al., 2005; Hesketh et al., 2012; Hinkley \u0026amp; McCann, 2018; Jago et al., 2016). Bentley et al. (2016) noted that the majority of prior studies on digital media use were conducted before the availability of mobile devices such as smart phones or tablets. Thus, qualitative studies to date have tended to focus on children’s exposure to television viewing. Their summary of the literature on parental views on children’s television viewing (Carson et al., 2014; De Decker et al., 2012; He et al., 2005; Hesketh et al., 2012; Knowles et al., 2015) suggests that parents perceive the benefits of television viewing (e.g., educational content, tool for children’s emotional regulation and behavioural management, aid for childcare to allow parents to do household chores) to outweigh the potential adverse health outcomes. These findings are important to consider as access to newer technologies, such as mobile devices, has increased rapidly to make digital media use more pervasive in households and in people’s daily lives.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; He et al. (2005) early study of parental perceptions of screen-viewing behaviours among preschoolers revealed that parents were more concerned about the content of what was being viewed by their children rather than the amount of television use. They also found in their study that parents expressed little concern about the linkages between television use, physical activity, and the risk for obesity. Carson et al. (2014) conducted one of the first studies to examine parents’ perspectives on newer technologies such as tablets and smartphones. Their findings suggest that parents view the benefits of mobile devices (e.g., useful tool for distraction and educational purposes) in a similar way that parents previously viewed the benefits of television viewing. This evolving research on children’s digital media use demonstrates that researchers need to pay attention to the varied contexts in which children interact with screens, which includes the type of media or devices they are exposed to and what kind of content they are viewing and with whom. Similarly, Bentley et al. (2016) conducted interviews with mothers to explore maternal views on children’s use of mobile devices and found that they were used on an ad hoc basis, rather than habitually, as a portable television that served multi-functional purposes such as entertainment and education. Lastly, Hinkley and McCann (2018) study of parental perceptions of the risks and benefits of digital media use and active play during early childhood showed that there were mixed perceptions of digital media use with parents highlighting both the educational benefits as well as the habit-forming and health detriments of digital media use.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe common conclusion of these qualitative studies is that more research is needed to understand children’s digital media use behaviours, the impact of digital media use on children’s development, and how public health interventions can increase parents’ awareness about the effects of digital media use. This current study attempts to address this gap in the literature by examining the family context of children’s digital media use and parental views on digital media use guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDigital Media Use Guidelines\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHalf of Canadian parents report they are concerned about their children’s digital media use, demonstrating that it is a pressing issue for caregivers (Angus Reid Institute, 2019).\u0026nbsp;However, a paradox exists regarding parental concern over children’s digital media use and the lack of uptake of children’s screen guidelines, with reports showing that children are likely to use digital media at a rate well above the recommended digital media use guidelines\u0026nbsp;(Madigan et al., 2019; McArthur et al., 2022). Canadian as well as international guidelines generally converge in their recommendation of no digital media use in children under the age of 2 and less than one hour of digital media use per day for children between the ages of 2 and 5\u0026nbsp;(American Academy of Child \u0026amp; Adolescent Psychiatry, 2024; National Health Service, 2024; NSW Government, 2024; Ponti, 2023). The guidelines also specify that parents should co-view with their children when possible, and that programing should be educational in nature. A meta-analysis of 95 international samples found that only 24.7% and 35.6% of children less than 2 and between 2-5, respectively, are meeting digital media use guidelines\u0026nbsp;(McArthur et al., 2022).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Current Study\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGiven that only a small minority of families with young children adhere to the digital media use recommendations outlined by pediatric societies (McArthur et al., 2022), there is a pressing need to capture parents’ perceptions of these guidelines. This includes the barriers and facilitators – both within families and at the systemic level – that influence their ability to meet digital media use recommendations. To explore parents’ perceptions of digital media use guidelines, we opted to conduct qualitative interviews to capture parents’\u0026nbsp;views on their children’s digital media use and contextual information about their perceptions of the recommended guidelines.\u003c/p\u003e\n\u003cp\u003eThe pervasiveness of digital media in the lives of young children, coupled with the increasing accessibility and consumption of screen-based technologies in households, underscores the importance of examining the factors that shape children’s digital media use. Parents’ perceptions of digital media use guidelines are particularly critical in this context. A better understanding of these views can equip health practitioners to develop effective digital health promotion strategies for young children and families.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRaising awareness about the developmental implications of elevated digital media use in young children, as well as the importance of adhering to digital media use guidelines, is especially vital for this age group. Research indicates that digital media use habits during the preschool period tend to persist over time and become increasingly resistant to change (McArthur et al., 2020; Trinh et al., 2020). By addressing these factors, interventions can better support families in fostering healthy digital media practices for young children.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e To explore parents\u0026rsquo; views regarding digital media use guidelines and their perceptions of what interferes with or supports their application of the guidelines within their family environment, semi-structured interviews with 28 parents of young children aged 5 or younger were conducted online via Zoom or over the telephone over a 12-month period starting in June 2023. The study was approved by the Research Ethics Board at the University of Calgary (Study ID: REB22-1793). A Research Associate (AL) and Research Coordinator (EC), both of whom have extensive experience in qualitative research, conducted the interviews. A Research Assistant (JW) assisted with the participant recruitment.\u003c/p\u003e\n\u003ch3\u003eRecruitment and sampling\u003c/h3\u003e\n\u003cp\u003eThe inclusion criteria included being a parent of a child that is 5 years old or younger, being conversationally fluent in English, residing in Calgary, Alberta or surrounding rural areas, and the ability to provide informed consent. Recruitment notices were posted at local grocery stores, community libraries, and preschools throughout a large urban center in Western Canada. To increase diversity in the sample, we sent out targeted invitations to parents through an existing database of participants who had previously taken part in another child development study and who had consented to being contacted about other research studies. We purposefully invited fathers, individuals from ethnic minority backgrounds, single parents, people with low socioeconomic status, and those residing in rural localities to participate in the study. This recruitment effort yielded additional participants from rural areas of the province as well as those from ethnic minority backgrounds. Lastly, snowball sampling was used to recruit 5 participants who were referred to the study by others who had participated in the interviews.\u003c/p\u003e \u003cp\u003e Interviews were conducted online via Zoom and scheduled to last approximately 30\u0026ndash;40 minutes. Accommodations were made for those who preferred to do the interview over the telephone. Participants were sent an electronic copy of the consent form and a brief demographic questionnaire (supplementary file 1) to complete before the interview. While a concerted effort was made to recruit both mothers and fathers, only one participant was a father, which suggests that perhaps different recruitment venues were needed to reach fathers. Participants received a \u003cspan\u003e$\u003c/span\u003e25 electronic gift card in appreciation for their time.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eA total of 28 interviews were conducted with parents (23 via Zoom, 5 over the telephone). The last 5 interviews were conducted 6 months after the first batch because we made a concerted effort to increase the sample diversity through an additional recruitment attempt. Interviews lasted between 15 and 50 minutes, with an average duration of 27 minutes. Six participants resided in rural areas, while the rest lived in the city (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for sample characteristics). Preliminary data analysis commenced following the first batch of 23 interviews and prior to the last 5 interviews being conducted. Hence, emerging themes from earlier data collection could be used to guide later interviews and to see if new data were emerging from additional participants or if data saturation had been reached. For consistency across the interviews and to ensure that all critical research questions were addressed, a semi-structured interview guide was used. The interview guide included questions to explore the context of children\u0026rsquo;s digital media use (e.g., amount of time, type of device, nature of digital media use), parental attitudes and concerns around digital media use, awareness of digital media use guidelines or views regarding them, barriers and facilitators to following guidelines, and recommendations to improve the uptake of digital media use guidelines among families (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for sample interview questions).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eInterviews were audio-recorded, transcribed verbatim by a professional transcription service, and transcripts were anonymized prior to data analysis. AL and EC took supplemental notes during and after the interviews to describe any non-verbal interactions or additional contextual information to inform the data analysis (e.g., frequent interruptions during the interview, participant level of engagement, reasons why an interview was shorter or longer than expected, predominant theme arising from each individual interview, participants expressing distress or seeking information after the interview was done). Utilizing a qualitative description approach (Bradshaw et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), which aims to gain subjective perspectives to describe the experience of those directly impacted by the area of focus, this project sought perspectives directly from parents of young children to understand their considerations of digital media use guidelines, without researchers imposing their own perspectives. Verbatim quotes were utilized to support researchers\u0026rsquo; interpretations (Bradshaw et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe data were analyzed inductively using thematic analysis to interpret and extract patterns in data about parents\u0026rsquo; knowledge of screen guidelines and barriers or facilitators in the household environment that influenced their children\u0026rsquo;s digital media use (Braun \u0026amp; Clarke, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Guest et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Maguire, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). This entailed a three-step process: 1) preliminary data analysis and development of a coding frame; 2) secondary analysis and consolidation of codes; and 3) data interpretation and summary of overarching themes. Numerous steps were taken to better ensure the trustworthiness of the data analysis process. Firstly, all preliminary analysis was conducted independently by the coders to ensure there was no undue influence over coding. Next, both coders kept diligent notes of their coding reflections and memos of the decision-making process behind their analysis; this helped to ensure that all themes emerged from the data, were unique and supported the aims of the research. Finally, regular meetings were held to discuss the individual coding process and to uncover points of dissent; the coders were able to work through any points of contention through discussion and consensus building.\u003c/p\u003e \u003cp\u003eIn the first step of preliminary data analysis, AL and JW read the interview transcripts (the transcripts were divided in half and shared between the two) independently to identify potential codes that could be applied to the data. AL and JW then discussed the proposed codes until there was a consensus over a coding frame. The broad categories for the coding frame included: child digital media use, family context, parental views and behaviours, guidelines, barriers and concerns. Specific codes under these categories were then discussed and agreed upon before AL and JW independently coded the transcripts (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for coding schema). Regular briefing meetings were held to discuss any discrepancies in coding or issues that arose that might require revision of the coding frame. NVivo (version 12.0) was used to conduct electronic coding of the data and to allow for easy retrieval of data for subsequent analysis. For example, queries by code could be conducted using NVivo to allow for easy data retrieval or to revise coding decisions if necessary.\u003c/p\u003e \u003cp\u003eIn the secondary analysis stage, AL reviewed all the data that was compiled according to different codes to ensure consistency within the codes or to identify patterns across the codes. This stage of analysis resulted in the consolidation of some codes to minimize redundancy and to ensure that while codes may be related to each other that they stood independently on their own as salient data points. AL and JW further discussed the results of the secondary analysis until there was a consensus on the final coding frame.\u003c/p\u003e \u003cp\u003eIn the final stage of data interpretation, codes were analyzed by AL and summarized to provide descriptions of the context in which they were discussed in the interviews. Emerging themes were identified across the data. The larger project team, including the Principal Investigator (SM) and Co-Investigator (GD) met to discuss the results of the emerging themes and implications of the data for what it could tell us about the needs and desires of parents regarding digital media use guidelines for young children. Our interpretation of the data focused on elucidating the household context that shapes children\u0026rsquo;s digital media use and actions that could be taken to improve the uptake of digital media use guidelines based on parents\u0026rsquo; feedback. Supportive quotes used in this paper have been anonymized but a unique participant ID accompanies the quote. Since the sample is demographically homogenous, we have not indicated whether quotes are from participants with certain geographic (e.g., rural, urban) or socioeconomic (low, medium or high SES) backgrounds.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e Results are presented below according to the three overarching themes that emerged from the data: 1) influences and variations on family digital media use; 2) views regarding guidelines including barriers and facilitators to uptake; and 3) recommendations for disseminating and improving uptake of guidelines (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Each of the overarching themes contains sub-themes which illustrate clusters of salient topics or viewpoints that participants discussed or shared. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e provides verbatim quotes from the interviews to illustrate the predominant themes and sub-themes that emerged.\u003c/p\u003e\n\u003ch3\u003eTheme 1: Influences and Variations on Household Digital Media Use\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eParental Attitudes\u003c/h2\u003e \u003cp\u003eParental attitudes toward digital media use were influenced by parents\u0026rsquo; educational or professional background and their own childhood history of family practices around screen use (mainly television watching). There were varying views among parents on the negative and positive impacts of digital media use according to their level of concern, access to information about the impacts of digital media use on children\u0026rsquo;s development, and their perceived ability to manage their child\u0026rsquo;s digital media use. Several of the participants had a teaching background, ranging from elementary school to high school. These participants spoke about how they saw the effects of digital media on children and adolescents that they taught. They had concerns about how technology was affecting youth\u0026rsquo;s social skills, attention span, sleep, anxiety levels, and overall mental health. Their exposure to older children as teachers has shaped their views on the negative effects of technology and their increased vigilance regarding their own children\u0026rsquo;s digital media use.\u003c/p\u003e \u003cp\u003eDigital media use was sometimes described as being a positive influence on children. For example, a few participants mentioned how it can help with language development by either enhancing a child\u0026rsquo;s vocabulary or helping them to learn a different language. It was also perceived to help with the development of interests, such as drawing. Parents also described some screen content as being educational, such as nature shows where young children can learn more about wildlife. Several parents gave examples of how digital media use could increase family bonding such as having regular family movie nights or connecting with relatives abroad over FaceTime. Watching movies together as a family was seen as family bonding time rather than viewing it as a form of parental supervision or parent-directed co-viewing. The use of FaceTime was seen as an important tool to allow family members to stay connected and for children to develop a relationship with extended family members who live abroad. This type of digital media use was viewed as being a positive social activity and some caregivers highlighted the interactional aspect of this type of screen activity as opposed to other screen activities that are more passive.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFamily Context\u003c/h2\u003e \u003cp\u003e When describing their family context, the subject of sibling influence, daily routines such as chores, and work-at-home arrangements were highlighted by parents as factors that influenced their children\u0026rsquo;s digital media use. Older siblings play an important role in influencing younger siblings\u0026rsquo; exposure to digital media use. Younger children are often exposed to digital media use at an earlier age if they have an older sibling who is using screens. On one hand, some caregivers learned from their first child\u0026rsquo;s digital media use patterns and have changed their approach with the second child by introducing more restrictions on digital media use. On the other hand, several caregivers described being stricter around digital media use with their first child and then subsequently being more relaxed with their second child since they have less time to monitor the younger child\u0026rsquo;s digital media use. Some parents described how challenging it can be to balance digital media use between their children of different ages, especially if the family is sharing a common television and the younger child will always be exposed to what the older child is doing or watching.\u003c/p\u003e \u003cp\u003eDaily routines including chores or childcare needs of younger children in the household play a role in shaping parents\u0026rsquo; ability to manage their children\u0026rsquo;s digital media use. Some parents described how caregiving responsibilities for their younger child meant that they relied on screens more for their older child to keep them occupied and distracted. Screens were also seen as a helpful tool when parents are preparing meals or cleaning the house because it gave their child something to do while they attended to household chores. Lastly, working from home contributed to parents\u0026rsquo; reliance on screens to keep their child engaged while they got their work done. Parents who worked from home found it particularly difficult to balance work, parenting, and limiting their child\u0026rsquo;s digital media use.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eChild Characteristics\u003c/h2\u003e \u003cp\u003eParents described individual child characteristics such as preferences, temperament, personality, or developmental needs as playing an important role in shaping digital media use behaviours and expectations. Some parents described how their child seemed to have a limited interest in screens, while others described how their child appeared to rely on digital media and have tantrums when asked to stop using it. For parents who described their child\u0026rsquo;s interest in screens as being limited, they felt that this was often related to the child\u0026rsquo;s personality, age and attention span, whether the child was used to engaging in other activities, or if their previous exposure to digital media use was limited.\u003c/p\u003e \u003cp\u003e On the other hand, for parents with children who expressed more interest in digital media use, they remarked on the increasing resistance to digital media use limits as their child got older. Children\u0026rsquo;s preferences for certain shows or games also played a role in their desire for more digital media use. For example, some children want to play certain games on the phone or get excited about a video call with family, while others showed self-interest in shows that promote learning about things like nature, animals, and science. Additionally, children\u0026rsquo;s routines played an important role in their expectations for digital media use. For example, some children were used to television routines like weekend cartoons, regular show days set aside by parents, or mealtime tablet use when dining out in order to avoid disturbing other customers.\u003c/p\u003e \u003cp\u003eA child\u0026rsquo;s developmental needs also plays a role in shaping their digital media use. One parent of a child with autism spectrum disorder described how it was difficult to get their child to focus on other activities, so as a result the child spent 5\u0026ndash;7 hours per day on screens (playing games on the phone, watching television or videos on the computer). Another parent of a child with behavioural challenges expressed concern over their child\u0026rsquo;s increasing insistence on spending at least 1\u0026ndash;2 hours at a time continuously watching YouTube videos. Lastly, another parent described their child as being neurologically divergent and talked about the challenges of setting digital media use limits with the child as they would have tantrums.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Parental Perceptions Regarding Guidelines\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eUtility of Guidelines\u003c/h2\u003e \u003cp\u003e Parents felt that digital media use guidelines were useful to help parents monitor their children\u0026rsquo;s digital media use behaviour, but they see them as being flexible depending on their personal views or family practices and needs. The guidelines were viewed as being useful as both a prevention or intervention strategy. The guidelines could help to prevent further problems with digital media use at a later age. Additionally, the guidelines themselves might serve as an intervention for families where there is already problematic digital media use and if families were not aware of the recommended amounts of digital media use for young children. Some people felt that one of the benefits of the guidelines is that it raises awareness about the topic for parents who might not have been aware of it. Guidelines also serve as a reminder for parents to monitor their child\u0026rsquo;s digital media use, and they can prompt parents to do more of their own research on the topic.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLack of and Gaps in Information\u003c/h2\u003e \u003cp\u003e Several participants indicated that they were not aware of the digital media use guidelines for young children. A few parents stated that they vaguely recalled hearing about or coming across the guidelines previously but that they could not remember exactly what the guidelines recommended. Some parents commented on how the guidelines seemed vague, were too abstract to follow, or they felt disconnected from them. For example, some felt that the guidelines were not very clear because they did not specify the context of digital media use (e.g., type of screen activity, content, co-viewing). Also, parents felt that digital media use may not always be consistent over a given period, so it is difficult to estimate their child\u0026rsquo;s amount of exposure to screens. Other stated that they could not relate to them until they started to develop their own opinions about digital media use, suggesting that the uptake of guidelines had to be personally driven rather than externally influenced.\u003c/p\u003e \u003cp\u003e Many parents expressed interest in wanting to know more about the impacts of digital media use on children\u0026rsquo;s development or strategies for how to manage it. For instance, they wanted to learn about good methods for teaching children about what is appropriate digital media use or the reasons behind limiting digital media use. They also wanted to know more about the basic science behind how screens affect brain development. They were curious about how digital media use differentially affects children of different ages or how children who are neurodivergent or have special learning needs may be impacted differently. Lastly, they wanted to have a better understanding of how to differentiate the impacts of different types of screen activities in order to identify which ones are more healthy or harmful.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eParenting Stress\u003c/h2\u003e \u003cp\u003e Parenting stress was a predominant issue that was identified as a barrier to following digital media use guidelines or turning to screens as an aid in childcare. Parents described an array of factors that contributed to parenting stress including caring for multiple children, household chores, lack of social support, sick periods, single parenting, managing child behaviour, general work demands, lack of daycare, lack of access to children\u0026rsquo;s programs, and lack of knowledge on how to engage children in other activities. These stressors contribute to parental decisions to rely on screens to distract their children. It was clear from parents\u0026rsquo; responses that screens were viewed sometimes as a tool that helped parents cope with the daily demands of parenting. For example, lack of social support could be a reason that parents sometimes turned to screens to entertain their children while they attended to other tasks or simply needed a break. Some people described how having relatives in town who could help with childcare provided reprieve for them, so they did not have to rely on screens. Similarly, lack of daycare options or access to children\u0026rsquo;s programs contributed to increased digital media use because parents were unable to find help with the childcare they needed so that they could get work and other tasks done.\u003c/p\u003e \u003cp\u003eChildren\u0026rsquo;s behaviour greatly influenced parents\u0026rsquo; decision to allow children access to screens. When parents faced challenging behaviour in their children (e.g., tantrums, whining, excessive energy, arguing with other children), it was easier to resort to screens to get children to calm down. One parent mentioned how digital media use during travel, like long plane rides, helped to distract their child and manage their behaviour so they would not disturb other passengers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePsychosocial and Societal Factors\u003c/h2\u003e \u003cp\u003e Several psychosocial and societal factors were identified by parents as being barriers to following digital media use guideline recommendations. For example, parents discussed how peer pressure, stigma, shame, and the sensitive nature of the topic of children\u0026rsquo;s digital media use made it difficult to openly discuss the topic with others or to find support. Some parents mentioned how children can feel pressured to play online games in order to connect with friends, or how they hear about apps or programs from other children and want to explore them as well. One parent described how they were afraid that cutting off their child from certain devices or games might affect their child\u0026rsquo;s ability to connect with peers and develop peer relationships. A few participants described how parents themselves can also experience social pressure from other parents who are letting their children watch certain shows or programs. They talked about how shows are generally advertised to a certain demographic and there is an unstated expectation that all families will become familiar with it because it is part of a cultural trend.\u003c/p\u003e \u003cp\u003e Feelings of shame and guilt came up a few times, as participants described instances where parents may not want to disclose how much digital media use their child is exposed to for fear of being judged by others, especially by health providers who are doing an assessment and trying to tell them what is best for their child. Parents sometimes feel judged by other parents as well, especially if they feel that their screen practices are not as strict as others.\u003c/p\u003e \u003cp\u003eLastly, parents identified some societal factors that influence children\u0026rsquo;s exposure to digital media, including society\u0026rsquo;s growing dependency on technology, the increasing incorporation of digital technology into the educational system, and socioeconomic challenges that some families may face. Several participants remarked on the pervasiveness of digital devices such as smartphones which has contributed to increased exposure to digital media use for both children and adults. Some people pointed out how screens are increasingly needed to stay in contact with friends and family and how jobs nowadays require knowledge of technology use, so children should learn how to use it. Also, because screens are being increasingly incorporated into the school curriculum, parents feel that children will inevitably be introduced to screens in school despite their best efforts to limit digital media use at home. Regarding how socioeconomic disadvantages might affect children\u0026rsquo;s digital media use, parents talked about how families with low income might not be able to afford to buy books or put children in activities. Also, families with low income might be prioritizing other things, like trying to put food on the table, rather than worrying about digital media use limits.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Recommendations for Uptake of Guidelines\u003c/h2\u003e \u003cp\u003e Parents provided several recommendations on how to bolster the uptake of children\u0026rsquo;s digital media use guidelines, including ways to improve the content of the guidelines so that they are informative and relevant to parents, knowledge dissemination strategies to enhance parents\u0026rsquo; awareness about children\u0026rsquo;s digital media use, implementing routine health check-ups and follow-up assessments, and building supportive environments for parents to discuss concerns and ideas. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e outlines the key areas and specific recommendations shared by parents.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eContent Development\u003c/h2\u003e \u003cp\u003e Parents recommended that screen guidelines should highlight information on the research evidence of the impacts of digital media use on children\u0026rsquo;s health, including their physical development, brain development, behavioural outcomes, sleep, or attention span. They felt that this science-informed approach would more effectively capture parents\u0026rsquo; attention so that they have a clearer understanding of why the guidelines are being recommended and what they can do to ensure their child\u0026rsquo;s healthy development.\u003c/p\u003e \u003cp\u003e Parents also recommended that the guidelines contain accompanying information on strategies for limiting digital media use in young children. In this way, the guidelines can be more of a toolkit that offers helpful resources rather than simply outlining abstract targets that parents should follow. Additionally, several parents indicated that they would like to know more about the effects of different types of screen activities. They felt that the current guidelines do not differentiate the different uses of screens, which they believe is important to consider because perhaps some forms of digital media use are more detrimental than others. Lastly, one parent suggested that information about digital media use among children with specific development concerns (e.g., autism) would be helpful.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge Dissemination Strategies\u003c/h2\u003e \u003cp\u003e Most parents felt that a multi-faceted approach was required to raise awareness about digital media use guidelines for children. This involves disseminating information about digital media use through different sectors, including the health care system, education system, and various social services and community agencies. Parents emphasized that it was important to deliver information in creative and engaging ways and to reduce stigma associated with digital media use. Parents suggested that information could be disseminated through community centres, family resource networks, at child wellness check-ups with a family physician or immunization clinics, or at information sessions or classes offered at libraries or through provincial health services such as birthing and baby classes. Parents suggested that the provision of print material, such as pamphlets, would be helpful so that parents can have some resources that they can take with them and view on their own time. It was also suggested that information sheets could perhaps contain QR codes that provide links to additional resources.\u003c/p\u003e \u003cp\u003eMost participants agreed that it is beneficial to carry out awareness raising campaigns regarding children\u0026rsquo;s digital media use, especially when children are young and in their early years of school. These campaigns could be delivered through social media such as Facebook pages targeted to parent groups or early childhood educators. One participant suggested that information pamphlets could be handed out to parents at daycares. A few participants suggested that targeting families with children in kindergarten (e.g., at kindergarten orientation sessions) or grade 1 could help to reinforce the message about limiting digital media use as children transition into school as their exposure to technology may increase.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eFollow-up Assessments \u0026amp; Building Supportive Environments\u003c/h2\u003e \u003cp\u003eSome parents talked about the importance of having follow-up assessments or reminders about digital media use because as children grow up their needs and screen behaviours might change. A few parents highlighted the importance of having access to supportive resources, such as parent or community support groups, to encourage open discussion, share experiences or ideas, or to help them manage their children\u0026rsquo;s digital media use. It was also suggested that access to affordable after-school programming could help parents to reduce children\u0026rsquo;s digital media use because it would keep children occupied or reduce parental stress during the day from having to balance several activities and responsibilities.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis current study aimed to explore parents\u0026rsquo; perceptions of young children\u0026rsquo;s digital media use via semi-structured interviews, which were analyzed inductively using thematic analysis. Given that only a small minority of parents with young children adhere to screen use guidelines (McArthur et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), it is critical to understand parents\u0026rsquo; views on digital media, to in turn inform digital media health promotion strategies. We found that parents\u0026rsquo; attitudes towards digital media use are shaped by a variety of factors, including their personal experience, professional background, and access to information about the impacts of digital media use on children\u0026rsquo;s behaviour and development. These attitudes do not appear to be static, rather they have evolved in response to changing family dynamics (e.g., birth of a new child), as well as external pressures (e.g., household chores, working from home), and contextual factors (e.g., number of children in the home). Moreover, consistent with other parenting behaviours and practices (Garcia et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Madigan et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), we found that parents\u0026rsquo; perspectives on digital media were often shaped by their own childhood experiences around television use.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eUnderstanding the Attitudinal and Familial Context of Digital Media Use\u003c/h2\u003e \u003cp\u003eParents\u0026rsquo; attitudes toward the potential risks and benefits of digital media use appear to be shaped by their contextual experiences of children\u0026rsquo;s developmental expectations. For example, teachers in the current study often expressed concerns about the negative consequences of digital media on their students\u0026rsquo; academic and learning skills. These concerns are well-supported by research, where several meta-analyses report small-to-moderate associations between the \u003cem\u003equantity\u003c/em\u003e of digital media use and various child outcomes, including poorer language skills (Madigan et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), academic achievement (Adelantado-Renau et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), and socio-emotional problems (Eirich et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The acute observations of developmental consequences for these participants appear to have shaped their views on their own children\u0026rsquo;s digital media use. Specifically, in being more aware of the risks of excessive digital media use on child development through their classroom observations over time, they may have reported increased vigilance in managing their own children\u0026rsquo;s media consumption.\u003c/p\u003e \u003cp\u003eWhile some parents viewed digital media with some skepticism, others were more optimistic by highlighting its potential benefits under certain contexts and for specific developmental skills. For example, digital media was seen as a tool to engage in family interactions around digital media, such as movie nights or FaceTime with family members, or to engage children in learning a new skill, such as drawing, music, or science. Some of these activities tend to be more \u003cem\u003eactive\u003c/em\u003e and engaging versus \u003cem\u003epassive\u003c/em\u003e (e.g., streaming television) forms of digital media use, which in turn may be a mechanism that fosters more perceived closeness among family members when viewing digital media together. Several parents also described the benefits of educational content, such as nature documentaries and reading apps and how it may provide enrichment opportunities for children\u0026rsquo;s language, cognition, and academic success. In line with this perception, research suggests that there is some support for language learning via educational programming (Madigan et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e); however, these benefits are not comparable to receiving high doses of human-to-human caregiver sensitivity in device-free interactions (Hirsh-Pasek et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Madigan et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Dyadic and verbally-loaded \u0026ldquo;serve and return\u0026rdquo; interactions have been shown to foster children\u0026rsquo;s communication and language acquisition, and solidify word learning (Madigan et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Although sibling influence on digital media exposure has received little research, it emerged as a key theme for parents, highlighting the difficulties of managing digital media use across children of different ages. This is undoubtedly a complex task for parents, as siblings often co-exist in shared family spaces where digital media is readily accessible. Specifically, parents mentioned how an older sibling\u0026rsquo;s screen use played a significant role in shaping the younger sibling\u0026rsquo;s digital media habits. Some parents reported that, due to practical constraints, having an older child in the household required them to apply more relaxed digital media use rules. Accordingly, younger siblings were introduced to digital media at earlier ages compared to their older sibling. However, not all parents shared this experience. Other parents reported that they implemented stricter limits for their younger children because they felt they had learned from their experiences with their older children, and therefore adjusted their approach accordingly. The emergence of this theme, coupled with the lack of research on sibling influence in digital media use, suggests that this is an important area for future research. Moreover, it underscores the need to consider multi-child households when developing digital media guidelines, with targeted recommendations for managing the device use of siblings at varying ages.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eRaising Awareness About Guidelines and Addressing Barriers\u003c/h2\u003e \u003cp\u003e The current qualitative study reveals that many parents were either unaware of the guidelines or found them too vague and abstract to follow with their children. Parents who shared these views noted how the guidelines were unclear because they did not specify the \u003cem\u003econtext\u003c/em\u003e of digital media use, such as type of screen activity, nature of the content, or co-viewing practices that should be followed. This lack of context-specific information results in overly generalized and unclear recommendations, which in turn makes it difficult for parents to take actions to alter their children\u0026rsquo;s digital media behaviours. Thus, improving guideline adherence requires actionable, clear, and detailed recommendations that take into account various contexts of digital media use. While there is research that shows that only a small minority of parents with young children adhere to digital media guidelines (McArthur et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), we are unaware of any studies that have examined parents\u0026rsquo; knowledge of or perceptions of digital media guidelines. This current study contributes to this gap in the literature and provides insight into how parents feel that there is a lack of context-specific information about digital media use guidelines, which in turn contributes to their difficulty in implementing them effectively.\u003c/p\u003e \u003cp\u003e Parenting stress emerged as a significant barrier to following digital media use guidelines. Caregiving responsibilities (especially in multi-child households), household chores, lack of social support, work demands or arrangements, and lack of access to daycare or children\u0026rsquo;s programs are factors that play a role in parents\u0026rsquo; reliance on screens in varying amounts throughout the day to occupy their children. In this way, digital media devices are sometimes used in households as a parenting aide to help with the daily demands of parenting. The predominant theme of parenting stress and digital media use underscores the need to develop resources for parents that can offer strategies for reducing parenting stress and providing supports. Offering parents strategies that will help them to balance parenting responsibilities while also monitoring their children\u0026rsquo;s digital media use will enable parents to rely less on digital media devices as a parenting aide. This seems particularly relevant for children who spend more time in home-based care, as this has consistently been shown to be associated with higher levels of screen use in young children compared to daycare-based settings (Madigan et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; McArthur et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Several psychosocial and societal factors were identified by parents as barriers to following digital media use guideline recommendations. Peer pressure, stigma, shame, and the sensitive nature of the topic of children\u0026rsquo;s digital media use reportedly made it difficult to openly discuss the topic with others or seek support. Parental feelings of shame and guilt in the context of interactions with health care providers appear especially to be a barrier in screening for digital media use during child health assessments. Parents, for example, may not want to disclose the actual extent of their child\u0026rsquo;s digital media use for fear of being judged, and thus may not receive the proper corresponding information that could be useful to them regarding digital media use guidelines. Hence, these feelings of shame and guilt that parents may harbour make it difficult for health providers to conduct assessments and advise on what is best for their child.\u003c/p\u003e \u003cp\u003e Additionally, parents sometimes felt judged by other parents, especially if their digital media practices were perceived as less strict. This combination of peer pressure and fear of judgment can create significant barriers to openly address and manage digital media use among families. Thus, public awareness raising campaigns about children\u0026rsquo;s digital media use and the creation of supportive environments, such as parenting groups to discuss the topic, could help reduce stigma associated with the topic.\u003c/p\u003e \u003cp\u003e There was a general feeling among parents that the pervasiveness of technologies in society and in children\u0026rsquo;s lives is inevitable, which contributes to the challenge of limiting children\u0026rsquo;s digital media use. With the growing dependency on technology in homes and schools, some parents felt it was more advantageous to help their children adapt to these technological shifts in society rather than limiting their interaction with digital devices. In this way, increased digital media use was seen as a natural and integral part of daily life that was important for children to learn how to use technology effectively. This perspective highlights the need for guidelines to be realistic and adaptable to the evolving digital landscape, providing parents with practical strategies to manage digital media use in a way that aligns with modern societal norms.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eImproving the Uptake of Guidelines\u003c/h2\u003e \u003cp\u003e Parents provided several recommendations to improve the uptake of digital media use guidelines. They emphasized that the guidelines should highlight the research evidence to clearly show the impacts of digital media use on children\u0026rsquo;s development. This science-informed approach would not only ensure that the guidelines are reliable, but it would also more effectively capture parents\u0026rsquo; attention by highlighting the developmental outcomes of elevated digital media use. Other recommendations included focusing on developing guidelines that clearly outline the differential outcomes of digital media use for different age groups, considerations for children with special needs, and the effects of different types of digital media activities. Parents also suggested that guidelines should include practical strategies that they can use to limit their children\u0026rsquo;s digital media use. Together, these recommendations suggest that there are several gaps in existing digital media use guidelines that can be addressed to help parents better understand the guidelines and ultimately adhere to them. These gaps include the need to provide more research evidence, enhance the content of the guidelines by considering different contexts of digital media use and developmental needs, and provide practical strategies that will enable parents to adhere to guideline recommendations.\u003c/p\u003e \u003cp\u003e In terms of knowledge dissemination strategies about the guidelines, most parents felt that a multi-faceted approach was required to raise awareness about digital media use guidelines. To reinforce the delivery of information to a broad audience through multiple channels, the involvement of different sectors, including health, education, social services, and community agencies was seen as critical for a coordinated effort to raise awareness about the topic. Parents also highlighted the need for information campaigns and materials to use creative and engaging methods such as social media forums, print materials with QR codes, and information sessions at community centers and schools. Moreover, parents stated that it was better to start these information campaigns when children are in their early years of school. While these suggestions were self-generated by parents in this study, they also align with the gold standards for successful health promotion campaigns (The Health Communication Unit, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLastly, some parents talked about the importance of having follow-up assessments at routine health check-ups for their children where they can be reminded about digital media use because children\u0026rsquo;s developmental needs and digital media behaviours change as they age. This recommendation speaks to the importance of having health providers routinely bring up the topic of digital media use in young children with parents so that it remains current and parents can reassess their children\u0026rsquo;s digital media behaviours as they grow and make adjustments accordingly. Moreover, implementing follow-up assessments can help ensure that parents receive ongoing support and guidance tailored to their child's developmental stage.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThe interviews were conducted with a largely homogenous sample of highly educated parents from mostly in-tact two-parent households living in an urban setting. While an effort was made to recruit both mothers and fathers to compare differences in parental views on digital media use, all but one participant were mothers. There was some diversity in the sample in terms of ethnicity (60.7% Caucasian); however, we lacked viewpoints from single parents, male caregivers, those from socioeconomically disadvantaged backgrounds, more individuals from ethnic minority backgrounds, people living in rural and remote locations, and more parents with children with developmental challenges.\u003c/p\u003e \u003cp\u003eThere may have also been some participant self-selection bias as a result of posting recruitment notices at community libraries, as many of the participants recruited through this venue tended to come from a teaching background and possessed preexisting strong views about digital media use behaviour in children. Given that digital media use behaviours among children may be a sensitive topic for some parents who might feel judged for their parenting practices, parents may have provided socially desirable responses and minimized the extent to which their children are exposed to screens. This may have also obscured the actual extent to which parents are concerned about their children\u0026rsquo;s digital media use. The interviewers did their best to reinforce the importance of hearing a variety of perspectives in a non-judgmental and non-stigmatizing way by using neutral and open-ended questions.\u003c/p\u003e \u003cp\u003eThe sample size for this study was adequate for a qualitative study involving semi-structured interviews. We monitored for data saturation and given the recruitment challenges we faced in recruiting a more diverse sample where additional findings could have emerged, we felt that we reached data saturation with the particular sample that we had. However, the results of this study may not be generalizable to the wider population of parents with young children across Canada or in other geographical locations where other contextual factors may play a role in shaping children\u0026rsquo;s digital media use. The average length of the interviews (27 min) was somewhat short where longer, more in-depth, interviews may have yielded additional information about parental attitudes toward children\u0026rsquo;s digital media use. We made every effort to engage parents in discussion for 30\u0026ndash;45 minutes, but a few parents were busy with childcare and were not able to participate in the interview for more than 20 minutes.\u003c/p\u003e \u003cp\u003eAs with most qualitative research that relies on interview data rather than direct observations, there is the possibility that participant accounts may differ from actual practices. Qualitative research findings are also based on the research analysts\u0026rsquo; data interpretation rather than on objective measures of behaviours. Our research team includes individuals who have extensive experience in qualitative research and we followed procedures to ensure the trustworthiness of the data analysis process, which included double coding the data and having several consensus meetings with the research team to discuss the findings. Ultimately, the strength of qualitative interviews is that they allow participants to reflect on their views, provide contextual information, make connections with other ideas that emerge during the conversation, and ultimately yield rich and nuanced data about participants\u0026rsquo; perspectives on a given topic.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e Findings from this study suggest that there are a variety of factors that may influence the uptake of digital media use guidelines for young children. These factors include parents\u0026rsquo; personal attitudes toward digital media use, household context, child characteristics, availability of information about digital media use, and societal influences. Exploring parental views on digital media use guidelines can provide insight into how to develop guideline content (i.e., informational content) and ways to enhance awareness about children\u0026rsquo;s screen use (i.e., digital media health promotion strategies). To bolster the uptake of digital media use guidelines, parents recommended that content should highlight the developmental impacts on children, the effects of different types of screen activities, and concrete strategies for limiting digital media use. Recommendations for dissemination of information included using a multi-faceted approach that involves different sectors such as health, education, and community centres, and providing follow-up discussions with health providers as children\u0026rsquo;s digital media habits evolve throughout their development.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e This study adhered to the Declaration of Helsinki Ethical Principles for Medical Research Involving Human Participants (April 2025). Ethical approval was granted for this study by the Research Ethics Board at the University of Calgary (Study ID: REB22-1793). All participants taking part in this study provided informed consent. Consent for the publication of data was provided by participants.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was funded by the Social Sciences and Humanities Research Council (SSHRC).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAL conducted the interviews, led the data analysis, and drafted the paper. EC conducted a set of interviews. JW assisted with participant recruitment, coding the transcripts, and preliminary thematic analysis. GD and SM assisted with the thematic analysis and data interpretation. BM provided writing and editing for the manuscript. All authors were involved in the design of the study, provided critical revisions to the manuscript, read, and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to give thanks to the caregivers who participated in the interviews. We would also like to thank Ana Virginia Figueras (Research Coordinator) for providing feedback on the thematic analysis, and Haneen Salama (Research Assistant) for help with formatting the manuscript.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe dataset supporting the conclusions of this article cannot be shared publicly due to information contained within the interviews that could be linked to participants. For information about or requests to access the data for this study, please contact Dr. Sheri Madigan at [email protected].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdelantado-Renau M, Moliner-Urdiales D, Cavero-Redondo I, Beltran-Valls MR, Mart\u0026iacute;nez-Vizca\u0026iacute;no V, \u0026Aacute;lvarez-Bueno C. Association Between Screen Media Use and Academic Performance Among Children and Adolescents: A Systematic Review and Meta-analysis. 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Child Dev. 2001;72(5):1347\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/https://doi.org/10.1111/1467-8624.t01-1-00352\u003c/span\u003e\u003cspan address=\"10.1111/1467-8624.t01-1-00352\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZimmerman FJ, Christakis DA. Children\u0026rsquo;s Television Viewing and Cognitive Outcomes: A Longitudinal Analysis of National Data. Arch Pediatr Adolesc Med. 2005;159(7):619\u0026ndash;25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/archpedi.159.7.619\u003c/span\u003e\u003cspan address=\"10.1001/archpedi.159.7.619\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":" \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eParticipant Characteristics\u003c/b\u003e (\u003cem\u003eN\u0026thinsp;=\u003c/em\u003e\u0026thinsp;28)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParent Gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParent Age (mean\u0026thinsp;=\u0026thinsp;36.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;29 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural/remote\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnspecified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParent Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighschool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrade school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartial university\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduate level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnspecified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRacial Origin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaucasian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian/South Asian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndigenous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed race\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnspecified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFull-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePart-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn-leave\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnspecified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of children in household\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTarget Child Age (\u003cem\u003eN\u0026thinsp;=\u003c/em\u003e\u0026thinsp;38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTarget Child Gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSample Interview Guide Questions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. For some context on your child(ren)\u0026rsquo;s digital media use, could you describe the following: Average amount of time per day they spend on a screen? What type of device are they using (TV, computer, smartphone, tablet, video games, etc.)? The nature of the digital media use (educational content, social media, supervised/unsupervised?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Do you set limits on digital media use in your household? If so, are these limits followed? Is there resistance from the child(ren) with regards to these limits?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Do you think your child(ren)\u0026rsquo;s digital media use is problematic? If so, what are your concerns?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Are you aware of the national guidelines for children\u0026rsquo;s digital media use? If so, how were you made aware of them?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Are you following these guidelines or have you tried to follow them?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. What do you think are some barriers for yourself or other families in general for following the digital media use guidelines?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. What recommendations do you have for how we could improve the uptake of children\u0026rsquo;s digital media use guidelines among families?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCoding Schema\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCodes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Child Digital media use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType of digital media use\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency of digital media use\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParental monitoring\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChild attitude or behaviour\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Family Context\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSibling influence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousehold rules\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParental education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCo-parenting\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Parental Views and Behaviours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParental digital media use\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eViews on technology types\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFears or concerns\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive effects of screen-time\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePersonal attitudes or motivations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily time\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Guidelines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eViews regarding guidelines\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderstanding and knowledge\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcquiring or seeking information\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth provider roles\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRecommendations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Barriers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParenting stress\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTechnology and society\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeer pressure\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFeeling judged\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSES challenges\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLack of information\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMental health\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOVID-19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSupportive Quotes from Interviews\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTheme 1: Influences and Variations on Household Digital media use\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSub-Theme\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eSupportive Quote\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParental Attitudes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;Digital media use has been something of interest to us. I\u0026rsquo;m a teacher as well, so I see the effects of screens on \u0026ndash; I teach junior high, so, I see how it affects my students\u0026rsquo; sleep, and their social lives and their anxiety levels, and all kinds of mental health concerns. And so, when I had my own kids, it was something that I was interested in, and I wanted to do things a certain way.\u0026rdquo; (P08)\u003c/p\u003e \u003cp\u003e\u0026ldquo;But moving to Miss Rachel on YouTube, we pick it. My son is 14 months, and his vocabulary is so large already. And it\u0026rsquo;s because he watches her songs, he can sing them. He does the actions to such a \u0026ndash; I just feel like it\u0026rsquo;s a good thing. If you\u0026rsquo;re going to watch something, then you\u0026rsquo;re watching something good, right?\u0026rdquo; (P19)\u003c/p\u003e \u003cp\u003e\u0026ldquo;[I]f you\u0026rsquo;re FaceTiming family, then you don\u0026rsquo;t technically need to say that that\u0026rsquo;s digital media use, because that\u0026rsquo;s connecting with family. Or if you\u0026rsquo;re looking at family pictures on a screen, then that\u0026rsquo;s not actual digital media use.\u0026rdquo; (P06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold Context\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;But we started [firstborn] with digital media use at the age of six, I would say, and her little sister started about age three, very slowly. I think when you have one versus two kids, it sort of shifts and changes and life can get busy \u0026hellip; I think we do it quite differently as parents for them.\u0026rdquo; (P22)\u003c/p\u003e \u003cp\u003e\u0026ldquo;And then she\u0026rsquo;s the only child in my house. That\u0026rsquo;s one more problem, because if she has a sibling or someone else playing with her, then she would not ask watching more TVs. But she\u0026rsquo;s the only one at home, and then she gets bored often, even if she\u0026rsquo;s playing herself for a bit.\u0026rdquo; (P09)\u003c/p\u003e \u003cp\u003e\u0026ldquo;We\u0026rsquo;re busy, I think is one of the biggest issues. So, my wife and I work quite a bit, and even when we\u0026rsquo;re focused on our daughter, it can be quite challenging to have her not staring at a screen all the time. But we don\u0026rsquo;t have the luxury of being able to focus on her. So, it\u0026rsquo;s an easy babysitter, in a way.\u0026rdquo; (P16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild Characteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;Honestly, I don\u0026rsquo;t need to cut her off though, because she just doesn\u0026rsquo;t have the attention span.\u0026rdquo; (P14)\u003c/p\u003e \u003cp\u003e\u0026ldquo;Because once she gets started, it\u0026rsquo;s hard to get her to stop \u0026hellip; she will often play games when she gets home from school, and we don\u0026rsquo;t want that to be pushed much past 2 hours, but it\u0026rsquo;s challenging to just take it away. She often throws a fit if that happens.\u0026rdquo; (P16)\u003c/p\u003e \u003cp\u003e\u0026ldquo;I tried to put her focusing on something like drawing, painting or something like that \u0026hellip; She doesn\u0026rsquo;t really like it. So, I started to put her on the screen, like YouTube on my laptop. And then she\u0026rsquo;s so, so into YouTube program, anything like Cocomelon those stuff. So, once I put her on the YouTube, she just watching that constantly, up to one or 2 hours straight.\u0026rdquo; (P09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTheme 2: Parental Perceptions Regarding Guidelines\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSub-Theme\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eSupportive Quote\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUtility of Guidelines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;\u0026hellip; because the younger you deal with these things, any health problem or societal problem, the younger the kids are, the better.\u0026rdquo; (P04)\u003c/p\u003e \u003cp\u003e\u0026ldquo;Even for moms in my play-groups and stuff, a lot of them I see that they use the digital media use and I feel like, yes, maybe if a medical professional, I feel like it should be a topic that is talked about, which yes, it definitely isn\u0026rsquo;t.\u0026rdquo; (P17)\u003c/p\u003e \u003cp\u003e\u0026ldquo;[T]his information is beneficial for somebody who has it out of control but they don\u0026rsquo;t know it\u0026rsquo;s out of control, you know, because they\u0026rsquo;re just so used to the background noise. Or they\u0026rsquo;re constantly on the tablet or they\u0026rsquo;re constantly scrolling on the phone, you know, while their child is playing next to them.\u0026rdquo; (P11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of and Gaps in Information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I wasn\u0026rsquo;t really aware of them [screen guidelines] until I think you mentioned it in the study description in detail.\u0026rdquo; (P16)\u003c/p\u003e \u003cp\u003e\u0026ldquo;My doctor never brought it up. We\u0026rsquo;ve been to the clinic so many times, no one\u0026rsquo;s talked about it. I go at least once a month to weigh him and measure him, and there\u0026rsquo;s no brochure, nothing.\u0026rdquo; (P01)\u003c/p\u003e \u003cp\u003e\u0026ldquo;I guess going forward as she gets more independent on how to limit digital media use, what are good methods, or how can I teach her about what\u0026rsquo;s appropriate and whatnot.\u0026rdquo; (P15)\u003c/p\u003e \u003cp\u003e\u0026ldquo;Like what type of digital media use is I guess negative, and what is maybe still maybe not great but now is like maybe slightly more beneficial?\u0026rdquo; (P13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParenting Stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;When my six-year-old was a toddler and [younger child] was born, screens were used more often. And I do think that was reflecting on just being busy with a baby and feeling tired, and using screens was an easy distraction for the toddler.\u0026rdquo; (P06)\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u0026hellip; if the kids are having a temper tantrum or they\u0026rsquo;re having one of those days where they just can\u0026rsquo;t seem to keep it together and regulate, and they\u0026rsquo;re having meltdowns over every little thing. Sometimes it\u0026rsquo;s tempting for me, and I know for some other people, they just give them a phone or turn on the TV.\u0026rdquo; (P18)\u003c/p\u003e \u003cp\u003e\u0026ldquo;I have to work. I don\u0026rsquo;t know what else to do with them. And I\u0026rsquo;m trying to get them into daycare full-time. So, that would eliminate a significant amount of their digital media use a week, those two extra days.\u0026rdquo; (P19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychosocial and Societal Factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;The thing is that they\u0026rsquo;re offering tablets in school too, so, even when he goes to school, if we have a rule of no electronics, he still has access to it in other places.\u0026rdquo; (P01)\u003c/p\u003e \u003cp\u003e\u0026ldquo;There\u0026rsquo;s all these shows being created for that demographic that parents, I think, feel pressured to show these shows to their kids \u0026hellip; And there\u0026rsquo;s this social pressure to expose your kids to all this stuff sooner.\u0026rdquo; (P08)\u003c/p\u003e \u003cp\u003e\u0026ldquo;So if we cut off the use of electronic device[s], some of my friends say that it would make them difficult to make friends at school. So, that\u0026rsquo;s one of the \u0026hellip; reasons why I would let my kids play games when they get older, because I do worry it would affect how they make friends at school, because it\u0026rsquo;s one of a very popular things in their social circle.\u0026rdquo; (P03)\u003c/p\u003e \u003cp\u003e\u0026ldquo;So when I was given the guidelines, I would always flub my answers because it made me feel embarrassed that [child\u0026rsquo;s name], my six-year-old now, was over the guideline.\u0026rdquo; (P06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTheme 3: Recommendations for Uptake of Guidelines\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSub-Theme\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eSupportive Quote\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContent Development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I think giving people the guidelines is really important. But I think explaining why is more [important] when the guidelines are given.\u0026rdquo; (P12)\u003c/p\u003e \u003cp\u003e\u0026ldquo;Probably just stating that there is [a] correlation between developmental delays and digital media use use, and, I don\u0026rsquo;t know, maybe some research behind that or something.\u0026rdquo; (P17)\u003c/p\u003e \u003cp\u003e\u0026ldquo;Yes, I think, like, managing transitions to other activities, if there are tips for that. And then also, just like I said, figuring out way to present her with screens, like screen activities that are appropriate for her age.\u0026rdquo; (P16)\u003c/p\u003e \u003cp\u003e\u0026ldquo;I think it would be useful to have more resources on what types of activities are good \u0026hellip; more access to different things that you can do with your kid instead of just defaulting to putting, turning on a show \u0026hellip;\u0026rdquo; (P15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge Dissemination Strategies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;So I think it\u0026rsquo;s a multifaceted approach. There needs to be those guidelines. It\u0026rsquo;s awesome if the public health nurse and family doc mentions it. Those kindergarten, grade 1 teachers and principals. Everybody kind of has to work together so you\u0026rsquo;re getting it from all sides.\u0026rdquo; (P04)\u003c/p\u003e \u003cp\u003e\u0026ldquo;Public health, when kids get immunizations, that might be another place, like places that families are going regularly, family doctors, maybe when they do their medical checks each year.\u0026rdquo; (P08)\u003c/p\u003e \u003cp\u003e\u0026ldquo;The Family Resource Networks, I think that they would be absolutely incredible to get on board with this. They see so many parents. They see a variety of parents too. They\u0026rsquo;re not just seeing the usual players \u0026hellip; But you\u0026rsquo;re reaching parents that really need to be reached with the FRN, because they do take referrals from schools, they take referrals from all over the place.\u0026rdquo; (P12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up Assessments \u0026amp; Building Supportive Environments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;So, they were talking about no more than an hour a day or something like that. At that point, it was much easier to kind of manage that. But we haven\u0026rsquo;t heard anything about that since, that was like three years ago.\u0026rdquo; (P16)\u003c/p\u003e \u003cp\u003e\u0026ldquo;I feel I would appreciate if optometrists also followed through with checking in on your digital media use.\u0026rdquo; (P06)\u003c/p\u003e \u003cp\u003e\u0026ldquo;I think parents are more likely to listen to other parents or, you know, sort of hear the perspectives of another parent\u0026rsquo;s experience.\u0026rdquo; (P22)\u003c/p\u003e \u003cp\u003e\u0026ldquo;So just like a support system wherein they are able to get like, you know \u0026ndash; a venue to be able to share and learn from each other.\u0026rdquo; (P02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRecommendations for Uptake of Guidelines\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKey Areas\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecific Recommendations\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContent Development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Provide evidence-based information on the impacts of digital media use on children\u0026rsquo;s development including physical development, cognitive and behavioural outcomes, sleep, attention span, or socioemotional outcomes\u003c/p\u003e \u003cp\u003e\u0026bull; Offer strategies for limiting digital media use\u003c/p\u003e \u003cp\u003e\u0026bull; Explain the effects of different types of screen activities\u003c/p\u003e \u003cp\u003e\u0026bull; Discuss the impacts of digital media use on children at different ages\u003c/p\u003e \u003cp\u003e\u0026bull; Provide information about digital media use among children with specific developmental concerns (e.g., autism)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge Dissemination Strategies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Use a multi-faceted approach that includes different sectors such as the education, health, and social services sectors (e.g., schools, daycares, public health clinics, primary care, prenatal classes, community centres, family resource networks, library information sessions)\u003c/p\u003e \u003cp\u003e\u0026bull; Deliver information in creative and engaging ways to reduce stigma associated with digital media use\u003c/p\u003e \u003cp\u003e\u0026bull; Offer print material (e.g., pamphlets, brochures) that can be taken home and that provides links to additional resources\u003c/p\u003e \u003cp\u003e\u0026bull; Develop and implement public health campaigns to raise awareness among parents about the effects of digital media use (e.g. use social media platforms)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up Assessments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Ensure that digital media use assessments are part of routine pediatric visits and that follow-up assessments are conducted\u003c/p\u003e \u003cp\u003e\u0026bull; Health providers should provide information on the developmental needs and changes of children as they age with regards to digital media use\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBuilding Supportive Environments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Develop community programs that provide a supportive environment for parents to discuss concerns and ideas about digital media use (e.g., peer support programs)\u003c/p\u003e \u003cp\u003e\u0026bull; Advocate for affordable after-school programming that can provide support to parents to reduce children\u0026rsquo;s digital media use\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"early childhood, digital media use, digital media use guidelines, parental perspectives, digital devices, qualitative research, semi-structured interviews","lastPublishedDoi":"10.21203/rs.3.rs-6657587/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6657587/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e Evidence suggests that the uptake of pediatric guidelines for screen use is generally low, which highlights an urgent need to better understand the familial factors shaping children\u0026rsquo;s digital media use. This study aimed to explore parents\u0026rsquo; perspectives regarding digital media use guidelines, including the factors that influence adherence to recommendations.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e Semi-structured interviews with 28 parents of young children were analyzed using thematic analysis. Purposive and snowball sampling were employed to recruit parents through notices posted at grocery stores, libraries, preschools, and a university database.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e Three overarching themes emerged: 1) influences and variations on digital media use in families; 2) views regarding guidelines; and 3) recommendations for disseminating and improving uptake of guidelines. Sub-themes included parental attitudes, family context, child characteristics, lack of information, parenting stress, and knowledge dissemination strategies.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003e Parental views regarding guidelines are shaped by personal attitudes, family context, child characteristics, availability of information, and societal influences. Recommendations include highlighting the developmental impacts on children, the effects of different types of screen activities, and strategies for limiting digital media use. Dissemination of information should use a multi-faceted approach that involves different sectors such as health and education, providing follow-up assessments, and building supportive environments.\u003c/p\u003e","manuscriptTitle":"A Qualitative Study Examining Household Context and Parental Perspectives on Preschoolers' Digital Media Use Guidelines","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-30 06:21:39","doi":"10.21203/rs.3.rs-6657587/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-08T08:23:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-26T21:51:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-12T16:53:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139947739509435130807312755091787578610","date":"2025-05-29T16:42:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-28T21:38:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"218150763374454632214271979854355549929","date":"2025-05-28T20:12:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"209000266915664198429199903101899370726","date":"2025-05-28T14:58:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-28T03:10:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-20T08:28:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-20T08:03:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-19T21:06:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-05-19T21:05:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5fdd636c-0d81-45de-b56a-5ca5a5a85385","owner":[],"postedDate":"May 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T17:04:47+00:00","versionOfRecord":{"articleIdentity":"rs-6657587","link":"https://doi.org/10.1186/s12889-026-26248-0","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2026-01-17 16:29:00","publishedOnDateReadable":"January 17th, 2026"},"versionCreatedAt":"2025-05-30 06:21:39","video":"","vorDoi":"10.1186/s12889-026-26248-0","vorDoiUrl":"https://doi.org/10.1186/s12889-026-26248-0","workflowStages":[]},"version":"v1","identity":"rs-6657587","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6657587","identity":"rs-6657587","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}