{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:44:04Z","timestamp":1785545044603,"version":"3.56.0"},"reference-count":58,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Res Protoc"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Children\u2019s leisure time has changed in recent decades\u2014with more time spent on screen media and less time face-to-face with peers\u2014potentially affecting their physical and mental well-being.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This protocol outlines a cluster randomized controlled trial evaluating the Screen-Free Time With Friends intervention, which aims to promote face-to-face peer interaction and reduce recreational screen media use among children aged 9\u201011 years.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The study is conducted as a cluster randomized controlled trial involving 9-11-year-old children and their parents from 18 schools in Denmark. Schools are randomized (1:1) to either a control or an intervention group. The intervention includes five core components: (1) curricular activities, (2) two family meetings, (3) a brief parent exercise, (4) a development program for after-school clubs, and (5) two community workshops. It is designed to allow local adaptation while maintaining fidelity to the core components. Primary and key secondary outcomes, including face-to-face peer interaction across leisure domains and solitary screen time, are assessed at baseline, 6\u201010 months, and 13\u201015 months follow-up. Additional exploratory outcomes (e.g., leisure activities, social relations, and well-being) are measured at baseline and follow-up. Time spent in face-to-face interactions with peers was assessed using a short SMS-based questionnaire sent to registered parents. The instrument has not been formally validated but was tested in a feasibility study. A comprehensive process evaluation explores implementation, context, and mechanisms of change.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The project was funded in July 2020. Schools were recruited from July 2023 to January 2024, while children and parents were recruited from November 2023 to April 2024. At baseline, 685 children were enrolled at the participating schools, with 343 (50%) having at least one parent enrolled in the questionnaire. The primary outcome is therefore assessed among a subset of participants, which may affect the effective sample size. Baseline data were collected from December 2023 to June 2024, and follow-up data from March to August 2025. As of March 2026, data analysis has not yet commenced, and no study results are currently available. Findings are expected to be published by the end of 2026.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Regardless of the findings, this study will generate important knowledge about the intervention\u2019s potential effectiveness, complemented by insights into its implementation, context, and mechanisms of change. These insights can assist municipalities, schools, after-school clubs, community stakeholders, and parents in shaping everyday environments that foster children\u2019s face-to-face interaction and encourage balanced screen use. The findings may inform policy decisions, guide the development of new national and local initiatives, and inspire future research into feasible, real-world interventions that support meaningful and enriching leisure experiences for children.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/84831","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T11:50:06Z","timestamp":1774957806000},"page":"e84831-e84831","source":"Crossref","is-referenced-by-count":0,"title":["Screen-Free Time With Friends to Promote Face-to-Face Peer Interaction and Reduce Recreational Screen Use Among Children Aged 9-11 Years: Protocol for a Cluster Randomized Controlled Trial"],"prefix":"10.2196","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6477-2325","authenticated-orcid":false,"given":"Sara Kruse","family":"Lange","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3953-3387","authenticated-orcid":false,"given":"Sarah Overgaard","family":"S\u00f8rensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2452-1535","authenticated-orcid":false,"given":"Teresa Victoria","family":"H\u00f8y","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3918-6645","authenticated-orcid":false,"given":"Kristian Traberg","family":"Larsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6777-2257","authenticated-orcid":false,"given":"Anders Bl\u00e6del Gottlieb","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3394-0176","authenticated-orcid":false,"given":"Russell","family":"Jago","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5666-9614","authenticated-orcid":false,"given":"Peter Lund","family":"Kristensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1584-679X","authenticated-orcid":false,"given":"Anders","family":"Gr\u00f8ntved","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6736-3725","authenticated-orcid":false,"given":"Mette","family":"Toftager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6781-2263","authenticated-orcid":false,"given":"Anne K\u00e6r","family":"Gejl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"R1","unstructured":"Rideout V Peebles A Mann S Robb MB . The Common Sense census: media use by tweens and teens, 2021. Common Sense; 2022. URL: https:\/\/www.commonsensemedia.org\/sites\/default\/files\/research\/report\/8-18-census-integrated-report-final-web_0.pdf [Accessed 14-05-2026]"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-023191","article-title":"Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews","volume":"9","author":"Stiglic","journal-title":"BMJ Open"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2018.01.015","article-title":"Adverse physiological and psychological effects of screen time on children and adolescents: literature review and case study","volume":"164","author":"Lissak","journal-title":"Environ Res"},{"issue":"7","key":"R4","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.19881","article-title":"Screen media use and mental health of children and adolescents: a secondary analysis of a randomized clinical trial","volume":"7","author":"Schmidt-Persson","journal-title":"JAMA Netw Open"},{"issue":"8","key":"R5","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1001\/jamapediatrics.2022.1519","article-title":"Effects of limiting recreational screen media use on physical activity and sleep in families with children","volume":"176","author":"Pedersen","journal-title":"JAMA Pediatr"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2014.07.007","article-title":"Screen time and sleep among school-aged children and adolescents: a systematic literature review","volume":"21","author":"Hale","journal-title":"Sleep Med Rev"},{"issue":"6","key":"R7","doi-asserted-by":"publisher","first-page":"1892","DOI":"10.1177\/0265407519836170","article-title":"Less in-person social interaction with peers among U.S. adolescents in the 21st century and links to loneliness","volume":"36","author":"Twenge","journal-title":"J Soc Pers Relat"},{"issue":"4","key":"R8","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1111\/j.1083-6101.2007.00368.x","article-title":"Online communication and adolescent well-being: testing the stimulation versus the displacement hypothesis","volume":"12","author":"Valkenburg","journal-title":"J Comput Mediat Commun"},{"key":"R9","unstructured":"Ottosen MH Andreaen AG Dahl KM Lausten M Rayce SB Tagmose BB . B\u00f8rn og unge i Danmark: velf\u00e6rd og trivsel 2022. VIVE \u2013 Det Nationale Forsknings- og Analysecenter for Velf\u00e6rd; Dec 19, 2022. URL: https:\/\/www.vive.dk\/da\/udgivelser\/boern-og-unge-i-danmark-velfaerd-og-trivsel-2022-0xgg53xk\/ [Accessed 14-05-2026]"},{"key":"R10","unstructured":"Madsen KR Rom\u00e1n JEI Damsgaard MT et al. Skoleb\u00f8rnsunders\u00f8gelsen 2022: Helbred, trivsel og sundhedsadf\u00e6rd blandt skoleelever i 5., 7., og 9. klasse i Danmark. Statens Institut for Folkesundhed, University of Southern Denmark; 2023. ISBN: 978-87-7899-622-0"},{"issue":"421-9","key":"R11","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.neubiorev.2018.09.024","article-title":"Healthy play, better coping: the importance of play for the development of children in health and disease","volume":"95","author":"Nijhof","journal-title":"Neurosci Biobehav Rev"},{"key":"R12","doi-asserted-by":"crossref","unstructured":"Rubin KH Bukowski WM Parker JG . Peer interactions, relationships, and groups. In: Handbook of Child Psychology. John Wiley & Sons; 2007. [doi: 10.1002\/9780470147658]","DOI":"10.1002\/9780470147658.chpsy0310"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2020.101116","article-title":"Screen-time during the after-school period: a contextual perspective","volume":"19","author":"Haycraft","journal-title":"Prev Med Rep"},{"issue":"7","key":"R14","doi-asserted-by":"publisher","first-page":"e23","DOI":"10.2105\/AJPH.2013.301366","article-title":"Influence of friends on children\u2019s physical activity: a review","volume":"103","author":"Maturo","journal-title":"Am J Public Health"},{"issue":"2","key":"R15","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1249\/MSS.0b013e3181edefaa","article-title":"Better with a buddy: influence of best friends on children\u2019s physical activity","volume":"43","author":"Jago","journal-title":"Med Sci Sports Exerc"},{"key":"R16","unstructured":"Kristensen PL Br\u00f8nd JC Toftager M et al. Fysisk aktivitetsadf\u00e6rd i skole, b\u00f8rnehave og fritid blandt 3- til 17-\u00e5rige b\u00f8rn og unge i Danmark: En kortl\u00e6gning baseret p\u00e5 accelerometerm\u00e5linger blandt 7,550 deltagere fra fem befolkningsunders\u00f8gelser. Institut for Idr\u00e6t og Biomekanik, University of Southern Denmark; 2024. ISBN: 97887-975610-1-0"},{"issue":"1","key":"R17","doi-asserted-by":"publisher","DOI":"10.1186\/s40814-024-01462-y","article-title":"Study protocol for the Screen-Free Time With Friends feasibility trial","volume":"10","author":"S\u00f8rensen","journal-title":"Pilot Feasibility Stud"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.1007\/s10389-025-02534-w","article-title":"Insights from the evaluation of the Screen-Free Time With Friends feasibility trial","author":"Slater","journal-title":"J Public Health (Berl)"},{"issue":"2","key":"R19","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1177\/1536867x1801800204","article-title":"cvcrand and cptest: commands for efficient design and analysis of cluster randomized trials using constrained randomization and permutation tests","volume":"18","author":"Gallis","journal-title":"Stata J"},{"key":"R20","unstructured":"Education statistics [in Danish: Uddannelsesstatistik]. B\u00f8rne- og Undervisningsministeriet. 2023. URL: https:\/\/uddannelsesstatistik.dk\/Pages\/main.aspx [Accessed 14-05-2026]"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance","volume":"374","author":"Skivington","journal-title":"BMJ"},{"issue":"1","key":"R22","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1186\/s12889-017-4695-8","article-title":"Development of a framework for the co-production and prototyping of public health interventions","volume":"17","author":"Hawkins","journal-title":"BMC Public Health"},{"issue":"8","key":"R23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0284765","article-title":"Application of group model building in implementation research: a systematic review of the public health and healthcare literature","volume":"18","author":"Estrada-Magbanua","journal-title":"PLoS One"},{"issue":"2","key":"R24","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1037\/0033-2909.98.2.310","article-title":"Stress, social support, and the buffering hypothesis","volume":"98","author":"Cohen","journal-title":"Psychol Bull"},{"key":"R25","unstructured":"Social media and youth mental health: the U.S. Surgeon General\u2019s Advisory. Office of the Surgeon General, US Department of Health and Human Services. URL: https:\/\/www.hhs.gov\/surgeongeneral\/reports-and-publications\/youth-mental-health\/social-media\/index.html [Accessed 14-05-2026]"},{"key":"R26","unstructured":"Et dansk svar p\u00e5 en vestlig udfordring. Trivselskommissionen; Feb 2025. URL: https:\/\/uvm.dk\/media\/vxwpfnxc\/250224-trivselskommissionens-afrapportering.pdf [Accessed 14-05-2026]"},{"key":"R27","unstructured":"Revans R . ABC of Action Learning. Gower Publishing; 2011. ISBN: 9781409427049"},{"issue":"4","key":"R28","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1002\/(SICI)1099-1727(199924)15:4<379::AID-SDR179>3.0.CO;2-E","article-title":"Group model-building: tackling messy problems","volume":"15","author":"Vennix","journal-title":"Syst Dyn Rev"},{"issue":"3","key":"R29","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1111\/1468-0009.12339","article-title":"Systems thinking as a framework for analyzing commercial determinants of health","volume":"96","author":"Knai","journal-title":"Milbank Q"},{"issue":"10","key":"R30","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17103457","article-title":"Community group model building as a method for engaging participants and mobilising action in public health","volume":"17","author":"Gerritsen","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1038\/s41746-020-0230-x","article-title":"Tools and analytic techniques to synthesise community knowledge in CBPR using computer-mediated participatory system modelling","volume":"3","author":"Hayward","journal-title":"NPJ Digit Med"},{"key":"R32","unstructured":"AX3: 3-axis logging accelerometer. Axivity Ltd. URL: https:\/\/axivity.com\/product\/ax3 [Accessed 14-05-2026]"},{"issue":"4","key":"R33","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1123\/jmpb.2022-0024","article-title":"Integrity and performance of four tape solutions for mounting accelerometry devices: Lolland-Falster health study","volume":"5","author":"Petersen","journal-title":"J Meas Phys Behav"},{"issue":"7","key":"R34","doi-asserted-by":"publisher","DOI":"10.3390\/children7070072","article-title":"Simple method for the objective activity type assessment with preschoolers, children and adolescents","volume":"7","author":"Br\u00f8nd","journal-title":"Children (Basel)"},{"key":"R35","unstructured":"AX3 GUI. GitHub, Inc. URL: https:\/\/github.com\/digitalinteraction\/openmovement\/wiki\/AX3-GUI [Accessed 14-05-2026]"},{"key":"R36","unstructured":"Patient-centric clinical trial and health research software platform. Avicenna Research. URL: https:\/\/avicennaresearch.com\/ [Accessed 14-05-2026]"},{"issue":"1","key":"R37","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1186\/s12889-020-08810-6","article-title":"The development of a questionnaire to assess leisure time screen-based media use and its proximal correlates in children (SCREENS-Q)","volume":"20","author":"Klakk","journal-title":"BMC Public Health"},{"issue":"1","key":"R38","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1037\/ppm0000163","article-title":"Development and validation of the Problematic Media Use Measure: a parent report measure of screen media \u201caddiction\u201d in children","volume":"8","author":"Domoff","journal-title":"Psychol Pop Media Cult"},{"issue":"3","key":"R39","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1007\/s10567-010-0071-2","article-title":"Psychometric properties of the parent and teacher versions of the Strengths and Difficulties Questionnaire for 4- to 12-year-olds: a review","volume":"13","author":"Stone","journal-title":"Clin Child Fam Psychol Rev"},{"issue":"2","key":"R40","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0032025","article-title":"Psychometric properties of the Danish Strengths and Difficulties Questionnaire: the SDQ assessed for more than 70,000 raters in four different cohorts","volume":"7","author":"Niclasen","journal-title":"PLoS ONE"},{"key":"R41","unstructured":"Cantril H . The Pattern of Human Concerns. Rutgers University Press; 1965."},{"issue":"2","key":"R42","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1187\/cbe.13-08-0162","article-title":"Understanding classrooms through social network analysis: a primer for social network analysis in education research","volume":"13","author":"Grunspan","journal-title":"CBE Life Sci Educ"},{"issue":"12","key":"R43","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0083558","article-title":"The smartphone addiction scale: development and validation of a short version for adolescents","volume":"8","author":"Kwon","journal-title":"PLoS One"},{"key":"R44","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h1258","article-title":"Process evaluation of complex interventions: Medical Research Council guidance","volume":"350","author":"Moore","journal-title":"BMJ"},{"issue":"1","key":"R45","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-018-6144-8","article-title":"Protocol for evaluating the impact of a national school policy on physical activity levels in Danish children and adolescents: the PHASAR study - a natural experiment","volume":"18","author":"Pedersen","journal-title":"BMC Public Health"},{"issue":"1","key":"R46","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1093\/ije\/dyx169","article-title":"Cluster randomized trials with a small number of clusters: which analyses should be used?","volume":"47","author":"Leyrat","journal-title":"Int J Epidemiol"},{"issue":"2","key":"R47","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1038\/s41390-025-03866-9","article-title":"Leisure activities of adolescents\u2014associations with demographic characteristics, well-being and parental leisure engagement","volume":"98","author":"Wanka","journal-title":"Pediatr Res"},{"issue":"3","key":"R48","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1002\/wps.21224","article-title":"Social connection as a critical factor for mental and physical health: evidence, trends, challenges, and future implications","volume":"23","author":"Holt-Lunstad","journal-title":"World Psychiatry"},{"key":"R49","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-081477","article-title":"SPIRIT 2025 statement: updated guideline for protocols of randomised trials","volume":"389","author":"Chan","journal-title":"BMJ"},{"issue":"4","key":"R50","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1037\/hea0000172","article-title":"Reducing youth screen time: qualitative metasynthesis of findings on barriers and facilitators","volume":"34","author":"Minges","journal-title":"Health Psychol"},{"issue":"3","key":"R51","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/j.physbeh.2012.03.022","article-title":"Influence of peers and friends on children\u2019s and adolescents\u2019 eating and activity behaviors","volume":"106","author":"Salvy","journal-title":"Physiol Behav"},{"issue":"1","key":"R52","doi-asserted-by":"publisher","first-page":"1492","DOI":"10.1186\/s12889-020-09581-w","article-title":"Home-based screen time behaviors amongst youth and their parents: familial typologies and their modifiable correlates","volume":"20","author":"Arundell","journal-title":"BMC Public Health"},{"issue":"1","key":"R53","doi-asserted-by":"publisher","DOI":"10.1186\/1479-5868-10-99","article-title":"A place for play? The influence of the home physical environment on children\u2019s physical activity and sedentary behaviour","volume":"10","author":"Maitland","journal-title":"Int J Behav Nutr Phys Act"},{"issue":"3","key":"R54","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.rpped.2016.01.001","article-title":"School environment, sedentary behavior and physical activity in preschool children","volume":"34","author":"Barbosa","journal-title":"Rev Paul Pediatr"},{"issue":"3","key":"R55","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1007\/s12160-011-9260-6","article-title":"Is the neighbourhood environment associated with sedentary behaviour outside of school hours among children?","volume":"41","author":"Veitch","journal-title":"Ann Behav Med"},{"key":"R56","doi-asserted-by":"publisher","DOI":"10.1016\/j.ufug.2023.128081","article-title":"Urban environment and green spaces as factors influencing sedentary behaviour in school-aged children","volume":"88","author":"Squillacioti","journal-title":"Urban For Urban Green"},{"key":"R57","unstructured":"B\u00f8rn og unge i fritids- og klubtilbud: analyse af kommunernes fritids- og klubtilbud. Kommunernes Landsforening KL; Jan 2020. URL: https:\/\/www.kl.dk\/media\/fo1jd2rk\/kortlaegning-final-januar-2020.pdf [Accessed 14-05-2026]"},{"key":"R58","unstructured":"B\u00f8rns og unges brug af fritids- og klubtilbud. Danmarks Evalueringsinstitut EVA; Feb 2018. URL: https:\/\/eva.dk\/udgivelser\/2018\/feb\/boerns-og-unges-brug-af-fritids-og-klubtilbud [Accessed 14-05-2026]"}],"container-title":["JMIR Research Protocols"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e84831","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:25:55Z","timestamp":1785536755000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e84831"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,5]]},"references-count":58,"URL":"https:\/\/doi.org\/10.2196\/84831","relation":{},"ISSN":["1929-0748"],"issn-type":[{"value":"1929-0748","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,5]]},"article-number":"v15i1e84831"}}