Mothers’ Perception Regarding Effect of Internet Usage on Health Status of their Children

Background: Internet is easily accessible for children. Excess screen time exposure can cause negative impact on physical, social, emotional, and psychological wellbeing of children. The study was aimed to assess mothers' perception regarding the effect of internet usage on health status of their children. Design: A descriptive research design was utilized Subject: Purposive sampling of 150 mothers and their preschool age children were included in the study Setting: the study was conducted at Hemayt El Osra Nursery School, Childhood Care and Development Center, Jannati Nursery and El Shaima Nursery. Tools : two tools were utilized Tool I: Internet usage questionnaire. Tool II: mothers' attitude regarding internet usage on health status of their children. Results: More than two quarters (76%) of studied mothers had moderate level of knowledge about internet usage and 64% of them had negative attitudes toward internet usage. Conclusion: it could be concluded that more than three quarters of the studied mothers had moderate level of knowledge about internet usage on health status of their children, while two thirds of them had negative attitudes toward internet usage on health status of their children. There was positive significant correlation between mothers’ education and their total knowledge score. Additionally, there was no statistically significant correlation between total mothers’ knowledge and their total attitude scores. Recommendations: Educational instructions must be designed for mothers to raise awareness about the detrimental impacts of internet usage on their children's health.


Introduction
A healthy society consists of healthy families and children; therefore, healthy children are not only important for families and for society but also very important for the well-being of the entire nation.Today, healthy children are the parents, leaders, workers, and decision-makers of the future.A healthy child is one who does not show any illnesses but shows body growth, cognitive development, and physiological maturity.The first few years of a child's life are critically important, as they are the basis for the rest of their future life.(Gronhoj & Gram,2020).
A preschool child is one who is able to establish relationships outside the circle of the family and is prepared for nursery and the world outside the home.The preschool child is affected mostly by external factors, and there is a good likelihood that the child will continue developing new attitudes, behaviors, and practices.The preschool period includes the age ranges from 3 years old to the end of the child's fifth years.Preschool period is the time when a child interacts, learns from, and communicates with the immediate and extended family as well as the care providers in the nursery schools.(Bekir,2020).Due to the ease of use and affordability of these gadgets, preschoolers are interacting with them more and more when it comes to portable and mobile technology, such as smartphones and tablets.Young children are accustomed to using touch screens from an early age, even though they do not own smartphones or tablets of their own.Instead, they can use their parents' devices.(Zigh et al., 2020).While most children can use these devices with ease, mobile technologies are much more.Since most children can use the devices with ease, mobile technologies are far more entertaining and highly motivating than traditional teaching methods.(Matzavela & Alepis, 2021).The influence of technology on the lives of people is only growing.Young children in preschool are increasingly becoming a vital part of this reality.Although preschoolers can pick up reading and language skills through play or entertainment with welldesigned programs or interactive media, they still need adult supervision and connection.(Choi, Kirkorian & Pempek, 2021) However, children who spend too much time in front of screens suffer from it.Reduced sleep duration, the possibility of having poor social skills, bad habits and obesity, unsuitable behavioral features, and exposure to inappropriate information were the majority of these impacts.(Beyens & Nathanson, 2019).Digital screen exposure may be harmful to children's physical health, cognitive abilities, and psychosocial development, even while high-quality screen activities meet some educational and enjoyment demands.As a result, it is important to control young children's screen usage by balancing the hazards and benefits.Nature of the study did not cause any harm or pain to the entire sample.c.
Privacy and confidentiality were taken into account when collecting data.d.
Mothers were reassured that their participation is voluntary and that they can withdraw from the study at any time, and their consent to participate was obtained.

Content validity had been confirmed by a jury of five expertises in Pediatric
Nursing before conducting the study.4. A pilot study was carried out on 10% of mothers to test the feasibility and clarity of tools according to that necessary modification was done.The pilot study was excluded from the study.5. Cronbach's alpha for knowledge score was 0.780 (high reliability).Cronbach's alpha for attitude score was 0.740 (good reliability) 6.The researcher met all mothers and their children to assess children who met the inclusion criteria.The researcher first met mothers in the waiting room to establish their trust and cooperation by outlining the study's aim. 7. The aim of the study was explained to the mothers.8.A written consent was taken from mothers.9. Meeting with mothers was held in the afternoon period in the time period from 1pm to 2 pm after finishing the nursery activities.
10.Total number of mothers interview was conducted individually and sequentially from each setting (25 mothers from Hemayt El Osra Nursery School, 25 mothers from Childhood Care and Development center, 50 mothers from Jannati Nursery and 50 mothers from El Shaima Nursery with total number of 150 mothers.11.The researcher met mothers in the previously mentioned settings 3 days per week.12.The data was collected within 6 months.13.Some questionnaires were filled by mothers themselves in the presence of the researcher after replaying all quires, while others were filled by the researcher through question / answer technique.

Results
Table (1): portrays percentage distribution of studied mothers regarding their sociodemographic characteristics.It was revealed that more than two thirds of the mothers (68%), their age ranged from 20-29 years old and about one quarter of them (27.3%) were from 30-39 years old, while the least percent (4.7%) were from 40-49 years old with Mean ±SD= 28.63+4.38.Concerning marital status, it was clear that the majority of mothers (92.7%) were married and 4.0% of them were divorced while, minorities of them (3.3%) were widow.Regarding their residence, about two thirds of them (62.0%) were living in urban area, while about 38% of them were living in rural areas.As regards job, about three quarters of mothers (74.7%) were working, whereas one quarter of them (25.3%)weren't working.As regards mothers' education, about two thirds of them (65.3%) had university education and one third of them (30.7%) had secondary education.Regarding their family type, about two thirds of them (61.4%) were having nuclear family and one third of them (33.3%) were having extended family.As regards family size, about one quarter of them (27.3%) had 4 members and 24.6% of them had less than 3 members with Mean ±SD (5.17+2.46).As regards child's sex, about more than half of the children (53.3%) were males, whereas 46.7% of them were females.The table also revealed that about two thirds of them (61.3%) were the first child in the family while one third of them (30.7%) were the second child in family.Table (3): describes mothers' knowledge about internet.Regarding meaning of internet, more than half of the mothers (59.3%) had correct incomplete answers.Concerning uses of internet, more than half of them (56.0%) had correct incomplete answers.The table points that 58% of mothers reported correct incomplete answers in relation to advantages of internet while half of them (50%) had correct incomplete answers regarding disadvantages of internet As regards the suitable age for using internet, there was more than half of mothers (56%) had correct answers, and for suitable duration of using internet, more than half of mothers (58.7%) had correct answers.The table also revealed that the majority of mothers (92.7 %) had correct incomplete answers related to physical effects of internet.The table also clarifies that, three quarters of mothers (75.3%) had correct incomplete answers related to social effects of internet.In addition, the majority of mothers (82%) had correct incomplete answers regards psychological effects of internet.The table also clarifies that, more than three quarters of them (76%) had also correct incomplete answers regarding effect of internet on attention.Concerning the effect of internet on daily activities, it was observed that the majority of mothers (92.7%) had correct incomplete answers , while two third of them (65.3%) had correct incomplete answers about positive effects of internet on child's health Finally, as regards negative effects of internet on child's health, more than three quarters of mothers (76%) reported correct incomplete answer.Table (4): describes total mothers' knowledge scores about internet usage.It was observed that slightly more than three quarters of mothers (76%) had moderate level of knowledge while 14.7% of them had mild level of knowledge and 9.3% had high level of knowledge with Mean ±SD = 15.63+2.95.Table (5): reveals total mothers' attitude scores toward internet usage.It was found that about two thirds of studied mothers (64%) had negative attitude, whereas more than one third of them (36 %) had positive attitude toward internet usage on health status of their children with Mean ±SD= 13.99+2.77.Table ( 6): explains correlation between total mothers' knowledge and their total attitude scores.It was clear that, there was no significant correlation between total mothers' knowledge and their total attitude score, where r =0.317 and p =0.094.Table ( 7): illustrates correlation between total mothers' knowledge score, their age, level of education, family size and their children age and birth order.It was clear that, there was positive significant correlation between mothers' education and their total knowledge where r =0.295 and p =<0.001.On the other hand, there was negative significant, correlation between family size and mothers' total knowledge p =0.01

Discussion
Children are integrating digital technology more and more into their daily lives, and this is having an increasing impact on their social, emotional, and cognitive development.Technology offers many opportunities for children to play, explore, and learn.Nowadays, most children have access to a variety of modern equipment at home, including TVs, computers, and smartphones.According to certain research, preschool-aged children watch more television or use their smartphones and tablets than they do computers.(Moon, Mathews, Oden & Carlin, 2019).Concerning mothers' total knowledge scores about internet; the current study showed that more than three quarters of mothers had moderate level of knowledge regarding the effect of internet usage on children's health status.From the researcher point of view, this might be due to high educational level as two thirds of them had university education, in addition to their work and urban residence where about three quarters of mothers were working, and two thirds of them were living in urban area, all such factors facilitate their acquisition of knowledge.This result was matched with Özyurt, Dinsever, Çalişkan & Evgin, (2018) who revealed that more than half of their participants had average total knowledge score regarding effects of digital technological device use in preschool children.Also, this finding was in agreement with Nassar & Mohammed, (2021) who showed that the average total knowledge score of more than three quarters of mothers' in their study about technology addiction in preschoolers.
Concerning total mothers' attitude scores toward internet, the present study showed that about two thirds of the studied mothers had negative attitude toward internet usage on health status of their children.From the researcher point of view, these mothers had moderate level of knowledge and more than two thirds of them were highly educated so they can easily acquire knowledge about the internet and its negative impact on their children's health.At the same time, they can easily discover any changes occur to their children because of usage mobiles or internet, all of this will in turn change their attitudes and become keener on their children to protect them from its hazards so they had a negative attitude toward usage internet.This result was in harmony with Nassar & Mohammed, (2021) & Shin & Li (2017) who revealed that less than three quarters of studied mothers in their studies had a negative attitude regarding internet and technology addiction.The current study illustrated that there was no significant correlation between total mothers' knowledge and their total attitude score.This finding may be due to mothers may have knowledge about internet and its correct use for their children but, they may be unable to set a correct and safe regimen for their use.On the same line, Gür & Türel, (2022) stated that there was no significant relation was found between perception of mothers and attitude about internet and digital technology using in children.This finding disagreed with Papadakis, Zaranis & Kalogiannakis, (2019), who stated that a positive relation was found between parents' awareness and their total attitude related to internet use.Vol.33.No. 2 (Suppl 1) ,May 2024 1 .
Another study by Akgün, (2023) was contradicted with the current study findings that showed that there was a positive correlation between mother's total knowledge score and their total attitudes score toward children's use of technology.In the same context, a study performed by Tewenge (2019), was contravene with the current study findings that showed that there was a positive correlation between total knowledge score, total practices score and total attitudes score of their study participants.The current study observed that there was positive significant correlation between mothers' education and their total knowledge and there was also negative significant correlation between family size and their total knowledge.This may be explained that increasing level of education, the level of knowledge of mothers will be increased because they can read and search about the topic on the contrast to others who had low level of education.Additionally, the size of the family and the number of children in it has a big role.As found in this study results that more than one quarter of mothers had 4 members therefor with the smaller number of children, the mother has time to learn, understand, and take care of her children.This result was in line with the findings reported by Goncalves, Byrne, Viana & Trost, (2019) who found that there was a significant correlation between level of education and total level of knowledge among the studied subjects.This was inconsistent with Waziry (2019) who reported that there was no significant relation found between mothers' knowledge and their level of education.
This study revealed no statistically significant relationship between mothers' attitudes and their age, level of education and child's age, child's birth order.This result was congruent with Alkalash et al., (2023) who reported that there was no correlation found between child's age, birth order and mothers' attitude.Zhou, Zhu, Sun, & Huang (2022) also stated that there was no significant association found between parents' educational level, child characteristics and attitude of the participant.
In conclusion, young children's daily activities, behavior, and development are greatly influenced by media exposure, with preschoolers being one of the main target audiences.We have shown that preschoolers who spend a lot of time online are more likely to experience externalizing issues, even if they have never experienced problems with externalizing before.Parents' knowledge and attitudes on screen time exposure for their children under six years old were influenced by various factors, including gender, marital status, education, occupation, a child's use of a mobile phone, and kindergarten attendance.These factors underscore the significance of education and environmental impacts in this regard.

Conclusion
Based on the results of the present study, it can be concluded that: More than three quarters of the studied mothers had moderate level of knowledge about internet usage, while two thirds of them had negative attitudes toward internet usage on health status of their children.There was positive significant correlation between mothers' education and their total knowledge score.Additionally, there was no a

Likert scale was used to assess mothers' attitude regarding
internet use, scale with three continuums (Agree, Neutral and Disagree).It consisted of 10 statements to which the mothers were asked to respond.