The findings indicated that all parents have television at their home and watching television was the most commonly used sedentary screen-based activity among the children with smartphones being the second regardless of whether they are attending the nursery and/or daycare service or not. This finding supported earlier research conducted in Korea, whereby television and smartphones are the most popular devices among the children sample . This shows that despite the growing technological advancement whereby devices with screens become more sophisticated and accessible, television remained an important medium in the family time since its introduction in the 1950s  which could potentially explain the reported finding. Children's sedentary television viewing can be an outcome of co-viewing with their parents due to its perceived benefits as an educational medium and early learning . However, the finding obtained showed that 50% of children are exposed to an interactive form of screen time content compared to educational (21.6%) and passive (19.7%), this shows that the concept of giving screen time is leaning more towards recreational basis rather than learning. In Brunei, it has become a culture seen in parents’ ways of parenting to give screen time to their children as a source of entertainment or distraction tool, which was on par with the finding in our study whereby 40.7% of parents practiced the idea of giving screen-based devices to keep their children temporarily occupied when they are busy or when the children get fussy or moody. Parent’s screen time behavior can be a potential causal factor contributing to the children’s television viewing as 69% of the parents reported that they are aware that their use of screen-based devices influenced their children sedentary screen time behavior which supported earlier research stating that children learned the behavior of their parents’ use of screen-based devices as an indicative sign that encourages them to maximally fulfill their screen time as means of personal interest just like their parents . However, we are unable to confirm this assumption as information on the nature of parents’ screen time behavior is not available. Hence, this finding should be served as a baseline to further expand current findings targeting the association between parent’s screen time and children’s level of screen time, thus, contributing to existing literature.
Secondly, our findings reported that 70.6% of children aged < 2 years old spent more time watching television (between < 30 minutes to > 2 hours) during nursery and/or daycare day as well as during non-nursery and/or daycare day and on public holiday of 82.3% and 88.2% respectively. Our study also reported that 47% of children aged < 2 years old spent more time on a smartphone of < 1 hour during non-nursery and/or daycare day compared to nursery and/or daycare day of only 23.6%. Also, 18.8%, 43.8% and 62.6% of children aged 3 to 4 years old are found to engage in television viewing of > 1 hour during nursery and/or daycare day, non-nursery and/or daycare day and public holiday respectively. To compare these findings with the recommended guidelines for time spent on screen as according to WHO stating that children aged 2 to 4 years should have < 1 hour of screen time/day while limiting screen time to not recommended for infants below two years of age, it can be concluded that the most children in our study have exceeded the advised screen time recommendation . This finding is consistent with other researches whereby 60.8% of children of 1.5 years old had screen time < 2 hours daily, with about 40% of it had > 2 hours spent on screen time/day . Additionally, 96.1% of 259 infants samples were exposed as early as the age of 6 months with a mean total screen time of 152.7 minutes/day. Furthermore, a study conducted in Thailand found that 68% of the 200 pre-school children had screen time spent > 1 hour/day whilst 28% of them had screen time spent > 2 hours/day . The parents’ level of knowledge on screen may help to understand these findings. Despite the majority of parents significantly aware of the responsibility in controlling their children’s screen time and its appropriateness (p = 0.035) and believe that children’s use of screen time interferes with their family quality time (p = 0.030) which further constitutes their practice on taking over their screen-based devices when they play or have social activities (p = 0.008) shows that they are aware of the importance of limiting their children’s screen time, however, the reported low rate on the level of knowledge (< 50%) on screen time remains concerning given the association of screen time with other medical, emotional and behavioral risks it imposes and may explain the greater prevalence of excess screen time reported in findings. For children not attending the nursery and/or daycare service, there is a significant association observed between the age of children (aged < 2 years and 3 to 4 years) and their total screen time spent on a tablet device (p = 0.037) and very strong association on smartphones (p = < 0.001). This shows that children as young as < 2 years old have access to smartphones and tablet devices which in line with our finding whereby all the parents reported having smartphones. This is consistent with other earlier study conducted in Philadelphia, whereby out of the sample of families having children < 4 years old being investigated, 83% owned a tablet device, 77% owned a smartphone and almost all of the children (96.6%) had used these devices even before turning 1 year old . This clearly indicates that touch devices use is getting more prevalent among the children in Brunei.
Interestingly, our findings observed notable increments in children total screen time of both aged groups during nursery and/or daycare day/weekdays, non-nursery and/or daycare day/weekends and on public holiday and we postulated that every additional hour of free time is associated with an increase in screen time spent on screen-based devices. This is congruent with other research stating that pre-school children spent more time on weekends on average of less than 1 hour whereas children on weekends spent an average of more than 78 minutes . A study conducted by Korea also reported that 39% of the children sample involved in sedentary behavior of watching television almost on daily basis and it is during weekends that the children watched television of > 1 hour .
Lastly, a statistically significant association is observed between parents’ socioeconomic status (income < 2000) and their knowledge on screen time-associated sleep problems (p = 0.033), emotional, mental and behavioral problems (p = 0.038) and screen time addiction (p = 0.042). This association is noteworthy as it may reflect that the lower the household income, increases the children sedentary screen time. This assumption is consistent with the earliest researches done which reported that excessive screen time is more prevalent among low-income children rather than high-income children [24,25,26]. Additionally, parents of 2 children were found to have statistically significant knowledge on emotional, mental and behavioral risks of screen time (p = 0.014) and to the best of the author’s knowledge, this area of association has not been studied previously. Moreover, a significant association between parent’s income between 1000 to 3000 (p = 0.009), having at least 2 children (p = 0.037) with an attitude of parents giving screen time to their children to keep them temporarily occupied in time of busy hour were noted in the finding. This could reflect the idea of increasing workload and increase responsibility in childcare significantly contributes to increasing time spent on screen. However, the association between socioeconomic status, having siblings and total sedentary screen time is not well characterized as there are studies identified that they found no significant and/or unclear association [27,28]. Therefore, further investigation is warranted to explore the role of socioeconomic status and the presence of siblings on children’s sedentary screen time to help in future interventions.
Implications For Future Practice
The prevalence of excessive screen time has become a concerning problem worldwide and findings suggest that majority of the children aged < 4 years old in Brunei also exceeds the minimum requirement of screen time which requires immediate attention. The incidence of poor screen time knowledge among parents also calls for intervention strategies. These findings should serve as a baseline to provide ground discussion for collaboration between professional health care practitioners and possibly coordinated school health committees to liaise in promoting healthy screen time behavior at every healthcare facilities and at school that accommodates service to children and/or the parents in guiding and education the importance of practicing screen time behavior in moderation. Evidence of health risks impact of screen time faced by the children in Brunei is lacking, thus, more prospective studies in the future, are warranted to bring substantial benefits to the community in providing evidence for health education and consultations necessary to support the child’s overall health and well-being. Moreover, whether parent’s media use, the influence of socioeconomic factors and the presence of siblings have a significant relationship with a child’s sedentary screen time should be investigated.