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

Abstract

Background: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: anxiety; children; cognitive behavioral therapy; exposure therapy; mobile phone; needle phobia; serious games.

Figure 1

The character-select screen of Dr. Zoo. This is the screen where players choose which animal they will help next.

Figure 2

The end of the Dominic the dragon chapter.

Figure 3

The player must play fetch with Max the dog in the second chapter.

Figure 4

In the Penny the penguin chapter, the player must tap the screen to place the orange fish on the ground, which Penny will follow.

Figure 5

In the Sami the orca chapter, the player must search through the small ocean environment to tap on trash objects.

Figure 6

Characters in Dr. Zoo receiving an injection administered by the player.

Figure 7

A celebration sequence that occurs after the player has administered an injection.

Figure 8

A flowchart depicting the timeline of assessments in the study. FSSC-R: Fear Survey Schedule for Children–Revised.