**4. Discussion**

This naturalistic study explored mobile device use by parent/caregivers of children aged 0–5 years in four playgrounds in metropolitan Perth, Western Australia. The study found that parent texting/scrolling, telephone calls and camera use were a common occurrence in the playground setting (70% of observation participants) but occupied a small part of their time at the playground. This finding is consistent with other research in Australia and the US [4,27], however, the paradox between convenience and distraction was a salient theme of the study which has also been found in other research [7,24,32,33]. Of interest, parents and carers suggested that the practicality of having a mobile phone close-by was reassuring in the event of an emergency, thus creating a tension between having the mobile phone close by or not at all. Child-injury prevention agencies and playground designers should explore broad strategies to promote the importance of supervision to prevent child injury, reduction in MDU in social settings and the promotion of parent–child play. Going forward, policies and programmes must embrace the social determinants of health that play a vital role in the development years.

It has been suggested that the longer the time spent on a mobile device, increases the negative impact on supervision, and decreases interaction with the child [24]. This finding was supported by our observations, for as the time on the mobile device increased, the supervision and caregiver–child play decreased, being replaced by no parent/carer supervision, and independent play by the child. Furthermore, when parents were on the mobile device for a full minute, the potential for injury increased, compared with those parent/carers not using their mobile device. The injury potential increased when the supervision was interrupted by scrolling and increased again when on a telephone call. There is recent evidence suggesting children's safety needs are compromised when parents use their mobile phones [34], and smartphone ownership by parents' may help explain the increase in young children presenting at ED with injuries [23,26]. Interviewees acknowledged the potential for interrupted supervision, especially if there was an opportunity to multi-task (e.g., telephone calls or check work emails). However, worthy of exploration is the notion that a parent/carer may take the child to the playground more frequently because they can use their smartphone to multi-task, e.g., access e-mails, and in turn the child may ge<sup>t</sup> injured more, not because the caregiver is distracted but simply because the child goes to the playground more [23]. Our findings support a recent review where parents reported the need for uninterrupted supervision of children in and around playgrounds, roads and waterways where there is the potential for childhood injury [25]. Further research to fully understand the level of device distraction, multi-tasking and childhood safety to provide guidelines for parents' use is a research priority.

This study found that the tasks (telephone call, scroll/type or camera) undertaken on the mobile device influenced supervision and the opportunity for the social interplay between parents and their children. Participants reported that scrolling/texting resulted in a break from visual supervision, however, using the camera function not only maintained supervision but was often associated with play interaction between parents and their child. Of interest, parent/caregivers did not connect camera use with being distracted, and this finding is consistent with another recent Australian study that found parents value mobile devices as a way to capture memorable moments [4]. Noteworthy, the longer the time spent on taking or making a telephone call was found to be most closely associated with no supervision and minimal play between the parent and the child. Parental behaviours have a critical role as a social determinant of child development. For example, positive reinforcement while on play equipment, displays of warmth and a ffection result in fewer child behaviour problems and positive peer relations that, in turn, enhance a child's health [12]. An investment in early child development as a determinant of health will translate to learning skills and increased well-being across the life course.

Using a social determinants lens, early childhood development opportunities are a ffected by various social and environmental factors, including relationships with parents and caregivers [12]. The playground, specifically controlled, gated playground environments purpose-built for those under 6 years of age, provide co-benefits for the child and parent/carer. There is an opportunity for children's involvement in independent, active and risky play [34–36]; and a time for parents to 'take a break' from constant supervision acknowledging that some minor injuries are an inevitable aspect of early childhood [37]. As such, factors including a child's age, physical ability and the playground design have the potential to influence the level and type of supervision, and the benefit of parents using their mobile device whilst at the playground. Furthermore, recent literature supporting risky play, i.e., a play that is thrilling and exciting but includes the possibility of physical injury, has been positively associated with physical and social health in children [36]. However, despite the di ffering designs of the four playgrounds in this study, ranging from a large gated setting with multiple play areas to a small single ungated play area, similar patterns of MDU and supervision were observed. Further exploration of the mitigation of potential risks of MDU and the interplay of the benefits might be an area worthy of future research.

Social acceptability and parent role-modelling were identified as influences of parent MDU. Quick calls, text messages and work were deemed more acceptable than using the device for social media or entertainment. Observations of other adults MDU in the playground were reported to influence interviewee's attitudes to their own MDU and how this relates to 'good parenting' but also the importance of role-modelling non-intentional use [27] to their children and to other adults in the playground setting. These perspectives contrast to prior work where caregivers were less critical of others and reserved judgement about the appropriateness of others' MDU [27]. These findings may highlight a changing social climate that is becoming more critical of parent/caregiver MDU and may indicate a need for realistic population-wide strategies to raise awareness of the risks associated with the distraction caused by mobile phones.

Most interviewees indicated that they had experienced success in limiting their own MDU and offered a range of strategies to help minimise use when caring for children. These strategies included abstinence, achieved by leaving the device in a bag, at home or in the car, choosing a phone function mode such as a silent or camera, and synchronising MDU during times when they perceived children required less interaction or supervision. In addition, a less often mentioned but observed strategy was caregiver proximal supervision i.e., following the child around the playground and keeping close whilst using a mobile device. This behaviour enabled the caregiver to maintain 'Constant supervision' whilst engaging in MDU [20]; however, it did not support caregiver–child interaction and exploit the time for parents and children to interact in a play setting.
