From Persuasive Design to Persuasive Change in Young Children’s Digital Media Use

The American Academy of Pediatrics (AAP) guidelines for young children’s media use recommended 1 hour or less of daily screen media.1 A meta-analysis synthesizing 95 samples (90 000 young children) showed that only 25% of children less than 2 years old and 34% of those aged 2–5 years met the recommendation.2 The gap between AAP guidance and families’ practical realities indicates that simply sharing guidelines is insufficient and more nuanced, complex strategies are needed. This gap also reflects how devices are digitally engineered to capture and sustain attention, which can offer short-term relief or convenience in parenting. Most digital technologies are designed using theories of behavioral change, and pediatric providers could harness these same persuasive strategies to promote caregiver agency in managing their children’s media use.One widely used model in digital product design (eg, Instagram and Netflix) is the Fogg behavioral model for persuasive design.3 This model posits that to create behavior change, a person must be (1) motivated, (2) able to perform the behavior, and (3) triggered to perform that behavior. Design characteristics that harness cognitive-behavioral reward systems4 help to motivate. Such characteristics could range from appealing visual features of tablets (eg, catchy songs or colorful animation) to tokens in apps that reinforce behavior. Next, design characteristics support children’s ability to engage with technology in many ways, from autoplay requiring no active behavior beyond attention to specific features that simplify tasks (eg, tap here to see reaction). Such seamless design in mobile devices, apps (eg, easy unlocking and recognizable icons), and programming (eg, autoplay of next show/video) facilitate children’s ability to engage with media. Finally, devices and apps are designed with triggers that provoke behaviors, such as sending notifications to play after periods of idle time.4Fogg’s theory of behavior change can also persuade caregivers to choose more media for their young child. For instance, digital designs that readily capture children’s attention may encourage caregivers to use devices in situations in which children might need to stay quiet, calm, or seated. The portability of mobile devices provides ease of access, and the touch and autoplay features offer little friction to initiate or sustain use. Lastly, children’s previous device experiences could also trigger use by leading them to ask for digital play.This same behavior change theory could be applied during pediatric care visits. First, providers could discuss caregiver-child motivation for digital media use. For instance, media might be used at mealtimes to help kids stay seated. Discussing with caregivers how mealtimes provide important opportunities for development, such as linguistic interactions, family connection, and nutritious food consumption, could introduce more motivating reasons not to use media.By discussing the underlying motivation, providers can create opportunities to brainstorm replacement behaviors to support success with mealtimes, such as quick dinner games (eg, “point to things that are red”) or cultivation of self-regulatory skills (eg, “let’s beat last night’s sitting time”). Providers can also recognize the trade-offs in choices without black and white restrictions. Some nights, a device at mealtimes might enable a caregiving break, but one every night might replace opportunities for relational connection and language development.These conversations can set the stage for realistic, co-created media plans. Fogg’s second component includes increasing one’s ability by simplifying tasks or behaviors. Often, families want to adopt healthy media habits but have competing demands that make adherence to media guidelines challenging. Helping families to identify small and easy changes could help them achieve early success that can grow over time. Providers can also increase caregiver capacity and ability by leaning on what they know about a family’s psychosocial history. For instance, if families take public transportation and use devices to keep children from disrupting others, providers could introduce public transit games (eg, “I spy something round”). Additionally, many families experience conflict when trying to disengage their child from devices. Working with families about how to enact media rules, including transitions, may make implementation of those practices easier.Ample research demonstrates that individuals are more likely to adhere to recommendations when they understand the reasoning behind them, which may help caregivers to apply recommendations in their day-to-day lives. Providers’ efforts to support children’s healthier media use must focus on building caregiver capacity while also respecting the diversity of family needs. This is supported by self-determination theory, which posits that motivation to follow rules occurs when people feel a sense of autonomy (choice and agency) and competence (belief they can successfully do the behavior).5 By asking about families’ media ecosystem and explaining the reasons why screen use guidelines exist, providers help foster caregivers’ understanding and efficacy. For instance, during pediatric visits, providers can talk with caregivers about their children’s emotion regulation skills and explain that routinely giving devices to soothe upset children may hinder the development of those abilities and, over time, increase children’s fussiness or reliance on devices.6,7 By grounding guidance in developmentally relevant explanations, providers can move beyond rule-following and toward better understanding of how to support the child’s development, both on and offline.Fogg’s final component, effective prompts for target behaviors, is critical. Providers have the privilege of continuity with families and can help support incremental change over time. When digital media are identified as concerns, effective prompts from providers can include check-ins, conversations about how previous discussions regarding media went, and goal-setting (see Table 1). Additionally, rather than portraying all screens as harmful or focusing solely on restriction, providers can help caregivers reflect on when and how screen use fits into healthy routines. The digital ecosystem is deeply embedded into the rhythms of daily life. Thus, it is important to take a neutral problem-solving approach and understand how digital media might support family functioning or offer opportunities for learning (eg, educational programing) and family time (eg, movie night).Although time restrictions offer a useful starting point, they often fall short of addressing the key components of behavioral change for families’ use of media. To support caregivers’ sense of competency, providers’ guidance should be grounded in an understanding of the broader family ecology, acknowledging the ways in which screens both can support family functioning and may pose developmental challenges. For example, for families in crowded households (as is common for low-income families in high-cost cities), screens might provide privacy and functioning for the family unit.2 Digital media can also have protective functions, such as displacing potentially harmful environmental exposures. By acknowledging these complexities, providers can partner with families to weigh the benefits and risks of digital media use within their unique circumstances.When caregivers and providers discuss motivations, triggers, and ease of use to co-create goals, families can feel more autonomy and efficacy around their decisions. The new pediatric media guidelines8 include more than reviewing screentime limits. Providers should use this guidance to help caregivers build their capacity to parent effectively in a digitally saturated world. Given that providers experience systemic constraints on time with families, triaging concerns may be needed. Targeting specific areas of media use per visit might support incremental change and can help families successfully establish healthy digital habits and in turn promote children’s wellbeing across several domains of development. Such efforts will support bridging gaps between persuasive designs promoting children’s use to persuasive change for families to make the best decisions about their families’ daily digital media habits.