An Exposure-Based Video Game (Dr. Zoo) to Reduce Needle Phobia in Children Aged 3 to 6 Years: Development and Mixed Methods Pilot Study

BackgroundNeedle phobia, which affects 19% of children aged 4 to 6 years, prevents many children from receiving necessary or preventive medical treatments. Digital interventions have been made to target needle phobia but currently rely on distraction rather than evidence-base...

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Main Authors: Pat Healy, Celine Lu, Jennifer S Silk, Oliver Lindhiem, Reagan Harper, Abhishek Viswanathan, Dmitriy Babichenko
Format: Article
Language:English
Published: JMIR Publications 2023-10-01
Series:JMIR Serious Games
Online Access:https://games.jmir.org/2023/1/e42025
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author Pat Healy
Celine Lu
Jennifer S Silk
Oliver Lindhiem
Reagan Harper
Abhishek Viswanathan
Dmitriy Babichenko
author_facet Pat Healy
Celine Lu
Jennifer S Silk
Oliver Lindhiem
Reagan Harper
Abhishek Viswanathan
Dmitriy Babichenko
author_sort Pat Healy
collection DOAJ
description BackgroundNeedle phobia, which affects 19% of children aged 4 to 6 years, prevents many children from receiving necessary or preventive medical treatments. Digital interventions have been made to target needle phobia but currently rely on distraction rather than evidence-based exposure. ObjectiveWe designed and evaluated a serious exposure-based mobile game called Dr. Zoo to reduce the fear of needles in children aged 3 to 6 years, where players administered shots to cartoon animals. MethodsWe conducted a mixed methods study with 30 parents (mean age 35.87, SD 4.39 years) and their 36 children (mean age 4.44, SD 1.11 years) who played the game for 5 days leading to a scheduled appointment that included an injection (eg, influenza vaccination). After the study, parents completed exit surveys and participated in semistructured interviews to evaluate ease of use, acceptability, and preliminary effectiveness of the game and to provide insights on their experience with the game to inform future developments. Interview transcripts were analyzed by 3 independent coders following an open coding process and subsequently coded and discussed to reach consensus. ResultsParents rated their child’s difficulty in completing the game as very low on average (scale 1-5; mean 1.76, SD 0.82) and were highly likely to recommend Dr. Zoo to other parents (scale 1-5; mean 4.41, SD 0.87), suggesting Dr. Zoo’s strong ease of use and high acceptability. In the exit survey, parents rated their child’s fear as significantly lower after participating in the study (scale 1-5; mean 3.09, SD 1.17) compared with that before participating (scale 1-5; mean 4.37, SD 0.81; z score=−4.638; P<.001). Furthermore, 74% (26/35) of the parents reported that the game had a positive impact on their child’s fear or perception of needles (only 2 parents reported a negative impact). Qualitative analysis of the interview transcripts revealed potentially important features of the game in this positive impact, such as the game’s interactive design, as observed in 69% (24/35) of our participants. ConclusionsThe results suggest that an evidence-based serious mobile game can be an easy-to-use, acceptable, and potentially effective intervention for changing young children’s fear and perceptions of needles. Leveraging digital interventions may be a potential solution to needle anxiety as a public health concern.
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spelling doaj.art-508817a52a3142a69fd3b577d67d8f1d2023-10-16T14:01:53ZengJMIR PublicationsJMIR Serious Games2291-92792023-10-0111e4202510.2196/42025An Exposure-Based Video Game (Dr. Zoo) to Reduce Needle Phobia in Children Aged 3 to 6 Years: Development and Mixed Methods Pilot StudyPat Healyhttps://orcid.org/0000-0002-8167-2671Celine Luhttps://orcid.org/0000-0002-7018-6627Jennifer S Silkhttps://orcid.org/0000-0002-8638-4337Oliver Lindhiemhttps://orcid.org/0000-0002-1012-9102Reagan Harperhttps://orcid.org/0009-0007-6585-9536Abhishek Viswanathanhttps://orcid.org/0000-0002-0845-0140Dmitriy Babichenkohttps://orcid.org/0000-0003-1187-6684 BackgroundNeedle phobia, which affects 19% of children aged 4 to 6 years, prevents many children from receiving necessary or preventive medical treatments. Digital interventions have been made to target needle phobia but currently rely on distraction rather than evidence-based exposure. ObjectiveWe designed and evaluated a serious exposure-based mobile game called Dr. Zoo to reduce the fear of needles in children aged 3 to 6 years, where players administered shots to cartoon animals. MethodsWe conducted a mixed methods study with 30 parents (mean age 35.87, SD 4.39 years) and their 36 children (mean age 4.44, SD 1.11 years) who played the game for 5 days leading to a scheduled appointment that included an injection (eg, influenza vaccination). After the study, parents completed exit surveys and participated in semistructured interviews to evaluate ease of use, acceptability, and preliminary effectiveness of the game and to provide insights on their experience with the game to inform future developments. Interview transcripts were analyzed by 3 independent coders following an open coding process and subsequently coded and discussed to reach consensus. ResultsParents rated their child’s difficulty in completing the game as very low on average (scale 1-5; mean 1.76, SD 0.82) and were highly likely to recommend Dr. Zoo to other parents (scale 1-5; mean 4.41, SD 0.87), suggesting Dr. Zoo’s strong ease of use and high acceptability. In the exit survey, parents rated their child’s fear as significantly lower after participating in the study (scale 1-5; mean 3.09, SD 1.17) compared with that before participating (scale 1-5; mean 4.37, SD 0.81; z score=−4.638; P<.001). Furthermore, 74% (26/35) of the parents reported that the game had a positive impact on their child’s fear or perception of needles (only 2 parents reported a negative impact). Qualitative analysis of the interview transcripts revealed potentially important features of the game in this positive impact, such as the game’s interactive design, as observed in 69% (24/35) of our participants. ConclusionsThe results suggest that an evidence-based serious mobile game can be an easy-to-use, acceptable, and potentially effective intervention for changing young children’s fear and perceptions of needles. Leveraging digital interventions may be a potential solution to needle anxiety as a public health concern.https://games.jmir.org/2023/1/e42025
spellingShingle Pat Healy
Celine Lu
Jennifer S Silk
Oliver Lindhiem
Reagan Harper
Abhishek Viswanathan
Dmitriy Babichenko
An Exposure-Based Video Game (Dr. Zoo) to Reduce Needle Phobia in Children Aged 3 to 6 Years: Development and Mixed Methods Pilot Study
JMIR Serious Games
title An Exposure-Based Video Game (Dr. Zoo) to Reduce Needle Phobia in Children Aged 3 to 6 Years: Development and Mixed Methods Pilot Study
title_full An Exposure-Based Video Game (Dr. Zoo) to Reduce Needle Phobia in Children Aged 3 to 6 Years: Development and Mixed Methods Pilot Study
title_fullStr An Exposure-Based Video Game (Dr. Zoo) to Reduce Needle Phobia in Children Aged 3 to 6 Years: Development and Mixed Methods Pilot Study
title_full_unstemmed An Exposure-Based Video Game (Dr. Zoo) to Reduce Needle Phobia in Children Aged 3 to 6 Years: Development and Mixed Methods Pilot Study
title_short An Exposure-Based Video Game (Dr. Zoo) to Reduce Needle Phobia in Children Aged 3 to 6 Years: Development and Mixed Methods Pilot Study
title_sort exposure based video game dr zoo to reduce needle phobia in children aged 3 to 6 years development and mixed methods pilot study
url https://games.jmir.org/2023/1/e42025
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