[version 1; peer review: 1 approved with reservations]
No competing interests were disclosed.
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).
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
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.
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.
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 (
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 (
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:
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. Synthesize the published reviews on clinical studies to inform clinical interventions and treatments. Evaluate the quality of the published reviews in terms of strengths, weaknesses, inconsistencies, and gaps in the evidence to inform future practice and research.
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.
This protocol was designed in accordance with the PRISMA-P statement for preferred reporting items for systematic reviews and meta-analyses protocol (
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)
The databases used for this review include:
PsycINFO (Database of Psychological Literature) Web of Science PubMed Grey literature databases World Health Organization (IRIS database) and
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
(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)
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 (
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
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N=number of participants; M=mean age (standard deviation).
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.
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.
The quality and risk of bias of the reviews will be assessed using the AMSTAR 2.0 checklist (
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.
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.
Not applicable as this study is a systematic review of published literature and does not involve human/animal subjects.
No data are associated with this article.
Open Science Framework: PRISMA-P checklist for this article can be found at:
Data are available under the terms of the
We express our gratitude to Fatima Karkoub and Fasika Molla Abreha for their assistance during the initial stage of the larger project.
Thank you for inviting me to review. I think this is my first protocol review; the publication format has not been very common in the fields related to my expertise. As I see it, the protocol format falls between preregistrations and Stage 1 RRs: it aims to describe the plan in more detail than preregistrations do (hence peer review), but not to the extent of RRs where sentence and word level detail is fixed in advance. Due to my regular involvement with editing and reviewing RRs, the below feedback may request “too much detail” in the present context, in which case the authors can naturally state that and ignore my point.
In general, the protocol is solid and will yield valuable results for related fields. Numerous reviews are being published continuously, and synthesizing that (meta) information is crucial for progress. I leave comments in a chronological order of their appearance in the manuscript.
You’re planning to include all languages and use LLMs to interpret the studies. In general it’s ok, but I’m curious how this is taken into consideration in the selected databases, screening, and search terms (and of course, study limitations). The translation software and its use could also be registered. Regardless, I’d encourage this to be further reflected on, especially considering the risks in presenting conclusions about cultures/languages of which a team may not have full expertise. The objectives of the study are presented at the end of the protocol. As a structural issue, I would prefer to have explicit RQs before the methods (and inclusion/exclusion criteria). This is because, as a reader, I find myself asking why certain criteria have and have not been selected. For example, why only search the last 5 years? Why exclude gambling and porn? This could be explained by presenting carefully crafted RQs preceding the criteria. The inclusion plan involves systematic reviews and meta analyses. Later on, however, on page 8 it is noted that narrative reviews will also be included. Narrative reviews (by most definitions) are not systematic, albeit there might be some hybrids. Defining ‘systematic’ (also for the coding process in the study) would be useful. Why conference proceedings are excluded? In my experience, many relevant reviews are published in HCI proceedings (HCI proceedings are among the most prestigious publication venues in that field). I don’t fully understand the last criterion; what kind of digital therapeutic intervention would not address wellbeing? All therapeutic interventions seem to have some wellbeing aspect. Will there be no backward and forward reference search? Especially if all languages are included, this might be a way to discover otherwise difficult to find reviews. EDIT: later in the protocol, there is a sentence saying that hand searching of reference lists were done; if this refers to back-forward search, please move the information to the search section. Will coder-specific ratings and disagreements be reported in a supplement? Location of corresponding author will be extracted. I would prefer extracting wider team composition of authors and, if possible, looking at the regional/language differences in their included studies to shed light on the important cultural aspect. I would also be interested in the COIs, funders, and positionalities of authors in the reviews. This might be worth coding. I also notice that the protocol itself has no COIs; because the synthesis will be reported in narrative form, which allows a lot of rhetoric freedom, it might be worth adding positionality statements, if relevant ones exist -- some might say reviews like this shouldn’t have statements but I’ve made a case of there potentially being benefits [1]. The synthesis and its reporting refer to primarily and secondary findings; primary being the types of treatments and the secondary being the assessment of evidence. It is not fully clear how the categorization of primary findings will occur. What method will be used for clustering? The secondary goal of assessment of evidence includes three listed elements. Again, I might be asking for too much detail, but considering that the epistemology of the review is somewhat on the positivist side, it would be important (in the final paper at least) to explain how each of the three listed elements are evaluated both respectively and in synthesis. I know this is a lot to ask; we recently tried to explain such process in detail and ended up with a rather complex plan [2]. Although I would not expect such detail here, the above planning taught me how much freedom there is in any synthesis process and we as researchers have a lot of power in it.
Because I've never reviewed a protocol before, I had a chat with my colleague Marcel (we work in the same project daily) about the manuscript and he, as an expert of systematic metas/reviews, got so curious that he offered to write a co-review. Hopefully you find his additional feedback helpful. (A lot of it overlaps with what I wrote above, but we decided not to edit our reviews for transparency, as we wrote them independently.)
1) It appears that the Introduction is currently quite broad in scope. In my opinion, it would be more appropriate to focus the Introduction on defining and clarifying the main construct of this review, which is the problematic use of digital technologies. I was struggling to find its definition. The keywords used in the search string partially gave me a little hint.
The Inclusion criteria list some examples, such as Internet use (for productivity, leisure, or information seeking) and e-readers, but e-readers, for instance, are not included in the search string. Based on the keywords used in the search strings, it seems that 'problematic digital technology use' is limited to internet addiction, online shopping, social media addiction, and gaming addiction. May I inquire why constructs such as smartphone addiction, streaming addiction, excessive online dating app use, crypto trading addiction, excessive use of virtual reality environments, excessive use of fitness tracking or health apps, excessive use of smart home devices or IoT were not included? Similarly, could you explain why Digital adult content pornography use was excluded?
2) It would be beneficial to specify more clearly what types of interventions this review covers. Interventions focused on what construct? Later in the text, it's mentioned that these are 'interventions for problematic use of digital technologies to improve well-being'. What did the authors mean by the term 'well-being'? (this construct is extremely vague and broad). Does it also relate to other related constructs?
1) The eligibility section mentions 'all systematic reviews and reviews', but the inclusion criteria only list systematic reviews. Are the authors including all types of reviews or only systematic ones?
2) The authors state that they want to include all languages. How do they intend to achieve this if their keywords are only in English?
3) I'd appreciate an explanation for the inclusion of only 'Literature published in the last 5 years.' What is the rationale behind this decision?
4) Have the authors considered expanding the search in Grey literature databases to include preprints and Google Scholar?
5) The authors state that 'Additionally, to ensure accuracy, a third author reviewed at least 10% of all screened articles at each phase.' However, I couldn't find any mention of the level of agreement between reviewers. What measures are in place in case of low agreement? How will accuracy be ensured?
6) Data extraction: The extracted data should be explained in detail. Many descriptions are unclear about what should be coded and how, for example the code: 'setting'. It would be beneficial if the coding sheet had already undergone a pilot coding phase, and individual codes, their explanations, and instructions had been tested. [VMK note: as an example of preregistered coding, the materials of the synthesis that I mentioned earlier (2) can be found here:
7) How will the authors 'identify and categorize the types of treatments and interventions'? Will this be based on some existing classifications or done inductively?
8) I find the text lacking an explanation of what exactly the authors mean by 'inconsistencies and gaps in the evidence.' How do they intend to identify these? Similarly, it wasn't clear to me how the 'acknowledgment of review and methodological limitations' will contribute to the assessment of the strength of the body of evidence. Do the authors aim to merely check for the presence/absence of limitations, or do they intend to evaluate the nature of the reported limitations as well? What about cases where original review authors don't mention any limitations, but the review objectively contains several? Do the authors plan to analyze the limitations of each included review?
9) The authors mention that they will synthesize both meta-analyses and reviews. How do they plan to combine their results, given their qualitatively different nature? What is their plan or procedure for doing this?
Is the study design appropriate for the research question?
Partly
Is the rationale for, and objectives of, the study clearly described?
Partly
Are sufficient details of the methods provided to allow replication by others?
Partly
Are the datasets clearly presented in a useable and accessible format?
Not applicable
Reviewer Expertise:
Related to the present article: gaming disorder, technology use, meta-science.
We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above.