The Effect of Traditional Children's Games on Internet Use Stress Level of Primary School Students

This randomized controlled trial was conducted to evaluate the effectiveness of a nurse-led traditional children's games program on reducing internet use and perceived stress among middle school students in Türkiye.

Excessive internet use among children has become an important public health concern because of its association with psychological stress, physical inactivity, sleep problems, and psychosocial difficulties. Traditional children's games are culturally relevant, physically active, group-based activities that may provide a healthy alternative to excessive screen time while promoting children's physical, emotional, and social well-being.

The study employed a pre-test/post-test, parallel-group randomized controlled design. Eligible students who used the internet for more than two hours per day were randomly assigned to either an intervention group or a control group. Randomization was performed using a computer-generated random allocation sequence created through Randomizer.org by an independent statistical expert.

The intervention consisted of an eight-week traditional children's games program implemented by a nurse researcher as an extracurricular school-based activity. Students in the intervention group participated in 60-minute sessions three times per week under researcher supervision. The games were selected from the Traditional Children's Games Festival Games Guide published by the Turkish Ministry of National Education and the Ministry of Youth and Sports. Activities included structured, age-appropriate group games such as Duck, Duck, Goose, Hide and Seek, Handkerchief Grab, Dodgeball, and Jump Rope, emphasizing physical activity, teamwork, communication, attention, and self-regulation.

Participants in the control group continued their routine school curriculum, including regular physical education classes, without receiving any additional intervention.

Primary study outcomes were weekly internet use duration and perceived stress levels. Weekly internet use duration was obtained from parental reports using a descriptive characteristics questionnaire, whereas perceived stress was assessed using the Turkish version of the Perceived Stress Scale for Children (8-11 years). Measurements were performed before the intervention and within one week after completion of the eight-week program.

The primary objective was to determine whether participation in traditional children's games reduced weekly internet use and perceived stress compared with usual school activities. The study also aimed to provide evidence supporting the role of school nurses in implementing culturally appropriate, school-based health promotion interventions designed to encourage healthy technology use and improve children's psychosocial well-being.

Inclusion criteria

• Students enrolled in the 5th or 6th grade.
• Aged 10-12 years.
• Daily internet use of more than 2 hours.
• Written informed consent obtained from a parent or legal guardian.
• Child assent obtained before participation.

Exclusion criteria

• Having a physical, orthopedic, or mental illness or disability that could interfere with participation in the intervention.
• Regular participation in organized sports activities or sporting events.