JMIR Publications

ABSTRACT

Background:

Anxiety disorders are among the most common mental health conditions in childhood but most children with anxiety disorders do not access evidence-based interventions. The delivery of therapeutic interventions via digital technologies has been proposed to significantly increase timely access to evidence-based treatment. Lumi Nova is a digital therapeutic intervention designed to deliver evidence-based anxiety treatment for 7-12-year-olds through a mobile application incorporating immersive gaming technology.

Objective:

We aimed to evaluate the real-world impact of providing access to Lumi Nova through NHS-funded mental health services.

Methods:

We analysed anonymised data routinely captured through the implementation of Lumi Nova. Children eligible for inclusion were invited to use Lumi Nova during an 18-month period ending December 2022, were aged 7-12 years, living in the UK and had the opportunity to use the intervention for at least one week. Engagement indices included whether the game key was activated, number of unique sessions, time spent engaging, and number of ‘challenges’ (exposures) completed. Clinical outcomes were assessed using the Goal Based Outcomes (GBOs) measure and Child Outcome Rating Scale (CORS). Demographic data were analysed to assess the health equality implications of Lumi Nova.

Results:

Of 1029 eligible families invited to use Lumi Nova, 644 (62.6%) activated their game key, of whom 58.1% completed at least one in-game graded exposure challenge. The median number of unique sessions was six and the median time spent engaging with the intervention was 42 minutes (IQR 15-79). Due to substantial attrition in the dataset, paired GBO data was available for 224 cases and paired CORS data for 123 cases. For the subset of young people with paired outcomes, there were statistically significant small to medium improvements in GBO scores (t=5.78, df=223, P<.001, d=0.37, CI 0.25-0.52) and CORS scores (t=5.10, df=122, P<.001, d=0.46, CI 0.27-0.65) between the first and last datapoints. Around 2 in 5 young people's scores reflected a change that would be considered reliable. Analysis of demographic characteristics tentatively suggested that children from ethnic minority backgrounds and those living in the most deprived neighbourhoods may be less likely to access Lumi Nova. We found preliminary evidence that males, those from more affluent areas and children with a disability may be less likely to engage with the intervention. However, the level of missing data and small number of children belonging to some demographic groups limited meaningful statistical comparisons.

Conclusions:

This study provides initial evidence that Lumi Nova is associated with significantly improved outcomes for 7–12-year-olds seeking treatment for anxiety in real-world settings. However, substantial attrition limited the analysis that could be conducted and confidence in the conclusions drawn. Future research should consider how engagement with the intervention can be maximised and sustained, particularly in children from less advantaged groups. Clinical Trial: N/A