Healy Pat, Lu Celine, Silk Jennifer S, Lindhiem Oliver, Harper Reagan, Viswanathan Abhishek, Babichenko Dmitriy
University of Pittsburgh, School of Computing and Information, Pittsburgh, PA, United States.
University of Washington, Department of Psychology, Seattle, WA, United States.
JMIR Serious Games. 2023 Oct 16;11:e42025. doi: 10.2196/42025.
Needle 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.
We 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.
We 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.
Parents 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.
The 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.
恐针症影响着19%的4至6岁儿童，致使许多儿童无法接受必要的或预防性的医疗治疗。已经有针对恐针症的数字干预措施，但目前这些措施依赖于分散注意力，而非基于证据的暴露疗法。
我们设计并评估了一款名为《动物医生动物园》的基于暴露疗法的严肃手机游戏，以减轻3至6岁儿童对打针的恐惧，游戏中玩家要给卡通动物打针。
我们对30位家长（平均年龄35.87岁，标准差4.39岁）及其36名孩子（平均年龄4.44岁，标准差1.11岁）进行了一项混合方法研究，这些孩子玩了5天这款游戏，然后迎来一次包括打针（如流感疫苗接种）的预约就诊。研究结束后，家长完成了退出调查并参与了半结构化访谈，以评估游戏的易用性、可接受性和初步有效性，并分享他们对游戏体验的见解，为未来的发展提供参考。3名独立编码员按照开放编码流程对访谈记录进行分析，随后进行编码和讨论以达成共识。
家长对孩子完成游戏的难度评价平均很低（1至5分制；平均1.76分，标准差0.82分），并且极有可能向其他家长推荐《动物医生动物园》（1至5分制；平均4.41分，标准差0.87分），这表明该游戏易用性强且可接受度高。在退出调查中，家长表示孩子参与研究后的恐惧程度（1至5分制；平均3.09分，标准差1.17分）明显低于参与研究前（1至5分制；平均4.37分，标准差0.81分；z值=-4.638；P<0.001）。此外，74%（26/35）的家长报告称该游戏对孩子对打针的恐惧或认知产生了积极影响（只有2位家长报告有负面影响）。对访谈记录的定性分析揭示了游戏在产生这种积极影响方面可能具有的重要特征，比如游戏的互动设计，69%（24/35）的参与者提到了这一点。
结果表明，一款基于证据的严肃手机游戏可能是一种易于使用、可接受且可能有效的干预措施，可改变幼儿对打针的恐惧和认知。利用数字干预措施可能是解决作为公共卫生问题的打针焦虑的一个潜在办法。
