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Table 1 Screen-time Weight-loss Intervention Targeting Children at Home (SWITCH) trial intervention components

From: Screen-time Weight-loss Intervention Targeting Children at Home (SWITCH): A randomized controlled trial study protocol

Strategy Explanation of strategy to caregiver Tips provided to caregiver Examples Theoretical basis
Praise Praise involves using words and actions to tell your child that you liked what he or she did. Praising your child's behavior will not only make them feel good, it will also make them want to repeat that behavior. Tips for using praise: Observe your child to catch them being good.
Give the praise immediately or as soon as possible after the desired behavior. Praising before the behavior, or too long after, will not be effective.
Be specific about what you praise. Tell your child exactly what they have done that you like.
Be consistent with your praise. What is good behavior today should be good behavior tomorrow.
"I am so proud of you for finding other things to do than watch TV. Great!"
"I am very pleased that you stuck to your budget and only watched TV for 30 minutes today."
Behavioral Economics Theory - modification of reinforcing value
Positive reinforcement Positive reinforcement involves giving a reward to your child once a desired behavior has been performed. A reward can be as simple as praise, or as involved as a family outing. After your child is given the reward, he or she will want to do the good behavior again. Be consistent with reinforcement. Always give the reward you have promised.
Do not give the reinforcer if your child has not earned it. A reinforcer only strengthens behaviors if it is earned.
You didn't play any video games today. I told you that if you did this we would play catch. Let's go!" Behavioral Economics Theory - modification of reinforcing value
Environmental control You can change the home environment to reduce the number of cues that prompt screen time. You can also make changes that increase the number of cues or opportunities to do other alternative activities. Try to break the habit of your child coming home from school and watching TV or using the computer.
You could have a rule that states when you child gets home they can have a snack, but then must do something other than watch TV for half an hour.
Remove TV or video games from your child's bedroom.
Put video games in hard to reach places.
Hang a sign over the TV during times your child plans not to watch.
Have toys easily available, or an area set up where your child has everything they need to do homework.
Behavioral Economics Theory - modification of access
Budgeting and self-monitoring Research assistant connects the Time Machine to the two devices most commonly used by the child. Research assistant explains to the caregiver how these devices can be used to budget the amount of time the child spends on each device. Cut down your child's use gradually.
For the first week, start by decreasing their time on the TV or computer by 10% compared to their usual amount. Reduce this by 10% per week.
Agree on a budget by discussing with your child. Help them plan their screen-time for the week to ensure they don't go over the budget. This will help them to "buy-in" to the idea of having a budget and may help them stick to it.
Post the budget in a visible place, like on the fridge.
  Behavioral Economics Theory - modification of access
Positive role modeling You can help your child meet their goals for reducing screen-time by supporting their efforts with your own and other family members' behaviour. Many families use the TV for background noise even though they aren't really paying attention to it. If you want your child to stick to their screen-time budget, you can help by turning off the TV when you are not watching it. Just as modeling is a powerful way to teach your child good behaviour it can also create or encourage poor habits. Modeling poor behaviours in front of your child may result in him or her repeating those same behaviours.
Involve the whole family. It will be hard for your child to stay away from the TV if the rest of the family is watching it.
The old saying, "Do as I say, not as I do," will not work. Your child will not understand why it is okay for you to watch TV while he or she cannot.
Eat together as a family without the TV on You turn off the TV in the evening and read a book/magazine instead.
Older siblings play with your child together rather than playing video games.
Social Cognitive Theory - modeling
Alternative activities Research assistant provides caregiver with an activity pack and explains that this can be used to provide alternatives to sedentary activities.
They can also be used as rewards outlined in the positive reinforcement strategy.
Emphasize to caregivers that less screen-time means more time for doing homework.
Contents of activity pack: Activity cards, Tennis ball
Elastics, Yo-yo, Colored pencils, Chalk, Playing cards, Checkers, 2 m rope with loops at end, Stickers
SWITCH magnet
Te Reo octopus game (Māori)
After the activity pack has been given to the family, the research assistant teaches the caregiver and child a couple of games using items from the activity pack. Behavioral Economics Theory - modification of access