Centering Children's Health in Technology Design: Understanding Online Behaviors and Perspectives of Children and Parents in a Digital World

Abstract

Child health challenges are on the rise, exacerbated by a decline in preventive care, a global pandemic, and heightened use of digital technology for varied aspects of life, all of which were catalyzed by the COVID-19 pandemic.

This dissertation explores the intricate relationship between children's health and digital technology use, with a focus on screen time in middle childhood (ages 7-12). Using a multi-method approach, this dissertation investigates the perspectives of children and their parents on the health implications of screen time.

Three multi-method studies form the basis for this dissertation. The first, a longitudinal survey study followed by interviews with parents of children with behavioral needs, examines the impact of technology on children and their receipt of care due to the COVID-19 pandemic. This work identified the impacts of digital behavioral health services on children's health and receipt of care, as well as parental care burden. This prompted an in-depth investigation into children's and parents' perspectives of the impacts of digital technology use on children's health, more broadly. Using a dyadic interview study with children and their parents/grandparents, the next study elicited empirical findings on children's nuanced views of the implications of screen time on child health and their strategies for navigating their concerns. Building on these insights, the final study used child design workshops and parent focus groups to understand their perspectives on dark design patterns in digital media, seeking to inform the development of healthier, more beneficial digital environments for children.

This dissertation contributes a comprehensive examination of children's and parents' perspectives on children's digital technology use, from telehealth to entertainment. Findings illuminate the nuanced influences of children’s screen time on their health. Children and parents identified positive health implications, such as social and emotional health benefits using digital technology. However, findings also show the negative implications of excessive screen time, inappropriate content exposure, and challenges regarding the delivery of special education services online. Notably, children's and parents' insights suggest that manipulative design patterns in digital media undermine children's autonomy and overburden parents, calling for a redesign that affords autonomy support and potentially lightens caregivers' loads.

In conclusion, this work highlights the urgent need for revision to health practice, technology policy, and digital technology design, ensuring that digital technology better meets children's developmental needs and promotes their health. It recommends a nuanced approach to technology design that provides autonomy support and design interventions like nudges and controls. The insights from this dissertation inform future human-computer interaction research, behavioral health services, pediatric screen time recommendations, and inclusive technology design.