JMIR Publications

ABSTRACT

Background:

Needle phobia, which affects 19% of young children, prevents many children from receiving necessary or preventative medical treatments. Digital interventions have been made to target needle phobia, but currently rely on distraction rather than evidence-based exposures.

Objective:

We designed and evaluated a serious exposure-based mobile game called Dr. Zoo to reduce fear of needles in children 3-6 years of age, where players administered shots to cartoon animals.

Methods:

We conducted a mixed-methods study with 30 parent/guardians (M[age]=35.87, SD= 4.39) and their 36 children (M[age]=4.44, SD=1.11) who played the game for 5 days leading up to a scheduled appointment that included an injection (e.g., flu shot). After the study, parents completed exit surveys and participated in semi-structured interviews to evaluate efficacy, usability, and acceptability of the game. Interview transcripts were analyzed by three independent coders following an open coding process and subsequently coded and discussed to reach consensus.

Results:

In the exit survey, parents rated their child’s fear as significantly lower after participating in the study (scale 1 to 5, M=3.09, SD=1.17) compared to before participating (scale 1 to 5, M=4.37, SD=.81) and most parents (74.3%) reported that the game had a positive impact on their child’s fear and perception of needles Qualitative analysis of interview transcripts revealed potentially important features of the game in facilitating this positive impact, such as the game’s tendency to encourage players to roleplay as a caregiver, as observed in 42.9% of our participants. Additionally, parents rated their child’s difficulty in completing the game as very low on average (scale 1 to 5, M=1.76, SD=.82) and were highly likely to recommend Dr. Zoo to other parents (scale 1 to 5, M=4.41, SD=.87), suggesting Dr. Zoo’s strong ease of use and high acceptability.

Conclusions:

The results suggest that an evidence-based serious mobile game can be an acceptable and potentially efficacious 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.