Digital well-being in children and youth: Protocol for a comprehensive systematic review of reviews on interventions of problematic digital technology use

Jing Shi; Jerome Jie Ming Tan; Hwee En Ong; Dahlia Aljuboori; Saud Alomairah; Michelle Colder Carras; Johannes Thrul

doi:10.12688/f1000research.149317.1

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Study Protocol

Digital well-being in children and youth: Protocol for a comprehensive systematic review of reviews on interventions of problematic digital technology use

[version 1; peer review: 1 approved with reservations]

Jing Shi ¹, Jerome Jie Ming Tan¹, Hwee En Ong¹, [...] Dahlia Aljuboori², Saud Alomairah², Michelle Colder Carras², Johannes Thrul^2-4

Jing Shi ¹, Jerome Jie Ming Tan¹, [...] Hwee En Ong¹, Dahlia Aljuboori², Saud Alomairah², Michelle Colder Carras², Johannes Thrul^2-4

PUBLISHED 08 Jul 2024

Author details Author details

¹ Health and Social Science, Singapore Institute of Technology, Singapore, Singapore
² Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
³ Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, USA
⁴ Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia

Jing Shi
Roles: Conceptualization, Methodology, Project Administration, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Jerome Jie Ming Tan
Roles: Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Hwee En Ong
Roles: Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Dahlia Aljuboori
Roles: Methodology, Writing – Review & Editing

Saud Alomairah
Roles: Methodology, Writing – Review & Editing

Michelle Colder Carras
Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing

Johannes Thrul
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Gambling and Gaming Addiction collection.

Abstract

Background

Digital technologies proliferate in many people’s lives around the world with over 65% of these technology users being online. Children and youth are among the most prominent adopters of digital technologies in forms such as video gaming, social media, and online shopping. Problematic use of digital technologies can lead to poorer school/work performance, neglect of self-care skills, and comorbidities with other mental health issues. However, when used non-problematically, digital technology can also contribute to improving health and well-being. With the abundance of literature published, many reviews have sought to collate literature on treatment and interventions for children and youth with varying results. Thus, our proposed systematic review aims to synthesize current systematic reviews and meta-analyses on interventions and treatment of problematic digital technology use in children and youth (up to 25 years old).

Methods

As part of a three-paper series, a systematic search was completed in PsycINFO, Web of Science, and PubMed databases. Grey literature databases of the World Health Organization (IRIS database) and ClinicalTrials.gov were also searched. Furthermore, hand-searching of reference lists was also conducted. Title and abstract screening, followed by full-text screening, were completed by at least two independent reviewers. For this review, the extractions and the quality of selected reviews will be assessed using AMSTAR 2.0 by two authors independently and reviewed by two additional authors.

Results

Results will be presented in narrative and tabular form. The results of this study are expected to offer insights into the populations of children and youth studied, treatments/interventions provided, outcomes, results, limitations, and conclusions of literature from the past five years. Feasibility and generalizability of the reviews will also be discussed.

Conclusions

Methodological strengths and weaknesses of reviewed studies will point to gaps in knowledge and can be used to inform future areas of policy and research.

Keywords

digital wellbeing, internet, video games, social media, children, youth, intervention, treatment

Corresponding author: Jing Shi

Competing interests: No competing interests were disclosed.

Grant information: This research was supported by a grant from Aramco Services Company, a subsidiary of Saudi Aramco. The funders had no role in conducting the review or reporting the results.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2024 Shi J et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Shi J, Tan JJM, Ong HE et al. Digital well-being in children and youth: Protocol for a comprehensive systematic review of reviews on interventions of problematic digital technology use [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:774 (https://doi.org/10.12688/f1000research.149317.1) First published: 08 Jul 2024, 13:774 (https://doi.org/10.12688/f1000research.149317.1) Latest published: 08 Jul 2024, 13:774 (https://doi.org/10.12688/f1000research.149317.1)

Introduction

Digital technologies are a part of most people’s lives around the globe and around 65% of these technology users are connected to the Internet (Petrosyan, 2023). Digital technology is used as an umbrella term that involves the use of electronic devices (Dienlin & Johannes, 2020). Activities through digital technologies include Internet use, watching television, and the use of embedded apps within devices (Stiglic & Viner, 2019; Twenge & Campbell, 2018). Children and youth are using digital technologies that involve activities like video gaming, social connection apps, and online shopping (Adachi & Willoughby, 2017; Ibrahim et al., 2023; Richards & Caldwell, 2015; Shi et al., 2019). Other activities that historically did not involve digital technology have changed to digital form in recent years. Examples of these activities are reading on an e-reader (such as a Kobo or Kindle) or creating digital art. Newer forms of media involving digital technologies are listening to podcasts, engaging in AR/VR activities, participating in interactive shows from home, watching/interacting with live streamers, using AI (Partarakis & Zabulis, 2024), and blockchain activities.

In an increasingly digitized world where people spend a significant portion of their time using smartphones, computers, and other digital devices, the concept of digital well-being has become a critical consideration. Digital well-being is having a balanced and healthy relationship with technology (Vanden Abeele and Nguyen, 2022). It is also a measure of the impact that digital technologies have on what it means to live a “good” life (Burr & Floridi, 2020). Thus, digital well-being is a subjective individual experience that aims to strike a balance between the benefits and drawbacks that digital technologies offer.

This systematic review aims to synthesize existing literature reviews on any interventions and treatments for children and youth who use digital technologies problematically compared to any group on digital well-being outcomes. Thus, the objectives are to:

1. Undertake a systematic search of the available systematic reviews and meta-analyses on clinical interventions and treatments of problematic digital technology use in children and youth.
2. Synthesize the published reviews on clinical studies to inform clinical interventions and treatments.
3. Evaluate the quality of the published reviews in terms of strengths, weaknesses, inconsistencies, and gaps in the evidence to inform future practice and research.

Study status

This study is part of a three-paper series of systematic and rapid reviews on digital well-being. The first review of this series on the prevention of problematic digital technology use is under peer review at the time of writing this protocol. A third review of empirical clinical studies will commence later. Thus, the methods of searching and screening articles that have already been completed will be outlined below. The methods used for extracting and evaluating the articles for this study will also be described in the sections below.

Methods

This protocol was designed in accordance with the PRISMA-P statement for preferred reporting items for systematic reviews and meta-analyses protocol (Moher et al., 2015; Shamseer et al., 2015).

Eligibility criteria

We aimed to find, assess, and synthesize all systematic reviews and reviews published containing clinical treatments or interventions for children and youth who use digital technologies. Articles were included if they were interventions for problematic use of digital technologies to improve well-being in children or youth. We excluded studies if they were prevention interventions as we have our first paper on prevention that is currently under peer review. The full list of inclusion and exclusion criteria for the selected studies are outlined in the sections below.

Inclusion criteria:

• All languages (translation software will be used when the research team is unable to translate the text)
• Systematic reviews and meta-analysis
• Clinical treatment or intervention programs
• Literature published in the last 5 years
• Children, adolescents, and young adults (on average, up to 25 years old)
All interventions for problematic use of any form of digital technologies. Examples of such digital technologies include social media use, video gaming, Internet use (for productivity, leisure or information seeking), e-readers, and passive digital media consumption.

Exclusion criteria:

• Conference publications, commentaries, case reports, and thesis dissertations
• Digital gambling, loot boxes, betting, and all gambling interventions
• Digital adult content pornography use
• Average age of sample greater than 25 years and/or all participants are over 25 years old
• Articles that focused on prevention interventions and/or prevention programs
• Studies that are not interventions on digital well-being such as therapeutic uses of digital technologies (unless the aim was to improve digital well-being)

Search strategy

The databases used for this review include:

1. PsycINFO (Database of Psychological Literature)
2. Web of Science
3. PubMed
4. Grey literature databases
- a. World Health Organization (IRIS database) and
- b. ClinicalTrials.gov

Hand-searching of reference lists of the selected review articles was also completed. In the event where a full-text was not accessible, we emailed the authors of the paper to request permission to access the full-text. The search terms in Box 1: Search Terms were used with Boolean operators. MeSH headings were used when appropriate. The search was started on March 3, 2023 and we anticipated to complete this review by the end of July 2024.

Box 1. Search terms.

(adolescents or teenagers or young adults or teen or youth or children)

AND

(Internet addiction disorder OR problematic online shopping OR impulsive online shopping OR excessive online shopping OR compulsive buying OR buying disorder OR Social media use disorder OR Problematic social media use OR Problematic social networking site use OR Social networking site addiction OR Social media addiction Social networking site dependence OR Pathological social networking site use OR Pathological social media use OR Compulsive social networking site use OR Compulsive social media use OR Excessive social networking site use OR Excessive social media use OR Problematic social networking site use OR Social networking site addiction OR Social media addiction OR Social networking site dependence OR Pathological social networking site use OR Pathological social media use OR Compulsive social networking site use OR Compulsive social media use OR Excessive social networking site use OR Excessive social media use OR screen time OR Gaming disorder OR Gaming addiction OR Heavy gaming OR Internet OR gaming disorder OR Addictive gaming OR addictive-problematic gaming OR internet gaming disorder OR addictive gaming OR problematic online shopping OR impulsive online shopping OR sedentary behavior OR excessive online shopping OR compulsive buying OR buying disorder OR Social media use disorder OR Problematic social media use OR Problematic social networking site use OR Social networking site addiction OR Social media addiction OR Social networking site dependence OR Pathological social networking site use OR Pathological social media use OR Compulsive social networking site use OR Compulsive social media use OR Excessive social networking site use OR Excessive social media use OR Internet addiction disorder OR Problematic social networking site use OR Social networking site addiction OR Social media addiction OR Social networking site dependence OR Pathological social networking site use OR Pathological social media use OR Compulsive social networking site use OR Compulsive social media use OR Excessive social networking site use OR Excessive social media use OR screen time OR Gaming disorder OR Gaming addiction OR Heavy gaming Internet OR gaming disorder OR Addictive gaming OR Impulsivity OR Behavioural addiction OR Behavioral addiction OR Pathological use)

AND

(Social media OR facebook OR tik-tok OR twitter OR Instagram OR tumblr OR Social Medium OR video game OR Computer Game OR facebook OR tumblr OR TikTok OR Pinterest OR youtube OR myspace OR wechat OR whatsapp OR reddit OR social network OR SNS OR 4chan OR online forum OR blog OR image sharing OR video-based OR image-based OR weibo OR social network OR social media OR social networking OR Gaming OR serious games OR educational games OR videogames OR therapeutic games OR active video games OR exergames OR dance games OR musical games OR gamification OR affective embodies pedagogical agent OR avatar OR prosocial video games OR collaborative games OR social online games OR brain training games OR commercial games OR exercise therapy OR biofeedback video games OR games as a distraction OR neuro-exercise game OR digital game program OR action video games OR media use OR advergames OR predatory monetization OR purchasing systems OR long-term cost of activity OR gamer-cognitions OR violant games OR violant media OR video game playing OR intensive video games OR spatial games OR virtual reality OR vr OR augmented reality OR ar OR mixed reality OR metaverse OR game development OR within-game creation OR Minecraft OR mine-craft OR modified commercial games OR online shopping)

AND

(wellbeing OR well-being OR well being OR digital balance OR digital detox OR digital wellbeing OR health technology OR screen time OR Interventions OR psychological interventions OR behavior modification OR addictive behaviors OR reality therapy OR Maladaptive cognitions OR cognitive-behavioral therapy OR craving behavioral intervention OR media regulations OR parenting style OR health behavior OR health behavior change OR digital balance OR Therapy OR Policy OR media regulations OR parenting style OR parenting interventions OR national interventions OR national preventions OR Intervention OR Treatment OR Therapy OR Therapeutics Program OR Programmes OR Behavioral modification)

Study selection and screening

All search results were imported to Covidence, a systematic review reference management software. Duplicates were removed automatically; additional duplicates were identified and manually screened out. Screening by title and abstract was conducted by a minimum of two authors independently. Following the screening of titles and abstracts, full texts were obtained for the remaining articles. Two authors reviewed the full texts against the inclusion criteria. The hand searching of reference lists were also completed by two members of the research team, independently. Additionally, to ensure accuracy, a third author reviewed at least 10% of all screened articles at each phase. Discrepancies at all three phases of screening and selection were discussed and resolved by consensus. Finally, searching, screening, and studies selected will be reported in a flow chart using the PRISMA Flow Diagram (Page et al., 2021).

Data extraction

A standardised Microsoft Excel form will facilitate data extraction of the final selected studies. Two authors will extract all the studies while two additional authors will review the extractions to ensure accuracy. Should there be any uncertainties between the four authors, they will first discuss amongst themselves and then report the discussions to the first author. Authors of the review articles will be contacted in the case of any ambiguity.

Data to be extracted from the articles will include author, publication year, type of review, participants, digital technology/diagnoses, setting, aim of study, databases searched, date of last search update, number of included studies, treatment/interventions included, digital well-being outcomes assessed, results, author’s reported limitations, author’s conclusions, author’s future directions, and all criteria from the AMSTAR 2.0 checklist. A sample of the extraction table with headings and brief descriptions can be found in Table 1: Data Extraction.

Table 1. Data extraction.

Authors	Publication year	Type of review	Participants (N, Age range, M, male %, ethnicity)	Digital technology/Diagnosis	Aim of study	Databases searched; Date of last search update	Number of included studies	Location of Corresponding author	Treatment/intervention; Target Setting	Digital well-being outcomes assessed	Results	Author’s Reported Limitations	Author’s Conclusions	Author’s Future directions	AMSTAR 2.0 Score

Outcomes and prioritization

Our primary objective is to identify and categorize the types of treatments and interventions for children and youth who experience problematic digital use from literature reviews. Our secondary objective is to evaluate the evidence presented in literature reviews on this topic published within the past five years. We will identify potential strengths, limitations, inconsistencies, and gaps in the evidence.

Data synthesis

Our findings will be summarized into narrative form and extracted into a table. The narrative text will provide an explanation of our primary and secondary findings. Any overlaps of primary studies in the systematic reviews will be considered when drawing conclusions. Due to a mix of quantitative and narrative literature reviews that will be included in this systematic review, no meta-analysis is planned. However, we will discuss the applicability/feasibility and generalizability of the reviews on this population.

The strength of the body of evidence will be assessed by considering the following: 1) AMSTAR 2.0 assessments; 2) providing a clear research question with searches that capture the construct; 3) acknowledgment of review and methodological limitations.

Quality and risk of bias assessment

The quality and risk of bias of the reviews will be assessed using the AMSTAR 2.0 checklist (Shea et al., 2017) by at least two authors independently for each review paper. An additional two authors will review assessments to ensure accuracy. Should there be any uncertainties between the four authors, it will be handled similarly to article extractions where they will first discuss amongst themselves and then report the discussions to the first author. Completed AMSTAR 2.0 checklists will be uploaded to our OSF website and a table of results will be presented in the final report.

Future amendments and dissemination

Should the protocol be amended, the date of each amendment will be provided with a description of the changes and the rationale for the changes on our OSF website. Dissemination of the systematic review results will be in the form of a peer-reviewed publication and/or a conference presentation.

Conclusions

Consolidation of the literature on clinical interventions and treatments for children and youth who use digital technologies is needed. This study’s rigorous design along with risk-of-bias assessments of existing review literature is poised to provide valuable insights into the treatments and interventions for children and youths’ digital well-being. We hope that these insights will contribute significantly to advancements in the understanding of this field.

Ethical considerations

Not applicable as this study is a systematic review of published literature and does not involve human/animal subjects.

Data availability

Underlying data

No data are associated with this article.

Reporting guidelines

Open Science Framework: PRISMA-P checklist for this article can be found at: https://osf.io/dg2ce/

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0)

Acknowledgements

We express our gratitude to Fatima Karkoub and Fasika Molla Abreha for their assistance during the initial stage of the larger project.

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VERSION 1 PUBLISHED 08 Jul 2024