Design and User Experience of VirNE Application: Deep Breathing Exercise in a Virtual Natural Environment to Reduce Treatment Anxiety in Pediatrics

Abstract

Treatment anxiety is a serious problem among child patients. A few studies have addressed this issue with virtual reality solutions, with promising results; however, the applications used have generally been designed for entertainment instead of this purpose. This article studies the potential of using deep breathing exercises in a virtual natural environment to address this issue, with a focus on design approach and user experience. It presents the VirNE-Virtual Natural Environments relaxation application, which is based on known stress-reduction methods, and a feasibility study conducted with it in a local hospital. The study had a within-subjects design, and it included 21 eight to twelve-year-old child patients, who used the application during an intravenous cannulation procedure related to their treatment. The study found good user acceptance and user experience both among the child patients and pediatricians, with the perceived usefulness of the method being higher among the patients with increased levels of anxiety or needle phobia. In addition, a clear stress-reducing effect was found. This offers proof-of-concept for the multidisciplinary design approach based on existing scientific knowledge regarding the desired effect for pediatric virtual reality applications for this use context.

Keywords: analgesia; anxiety; child; deep breathing; nature; stress; user experience; virtual natural environments; virtual reality.

Figure 1

VirNE avatar characters used in the research: The Fox (left) and the Bot (right). The third option was to use the application without a visual representation of the exercise guidance dialog.

Figure 2

The breathing balloon animation and the Fox character in a VirNE exercise, along with an explanatory breathing animation diagram.

Figure 3

The five VirNE natural environments used in this research: (A) Sunset by a lake shore in the Pirkanmaa region; (B) Ocean shore in the Kymenlaakso region; (C) Dry coniferous forest in the Kymenlaakso region; (D) Path in a deciduous forest in the South Karelia region; (E) Coniferous forest in the South Karelia region.

Figure 4

The (left) screenshot shows the main menu on the computer screen, which is used to set up the exercise according to the research protocol and patient selections. The (right) screenshot presents the computer view during the exercise. The progress bar in the bottom right of the picture is not visible in the HMD view.

Figure 5

Research scenario. The child patient receiving the treatment is lying on a bed in a half-sitting posture, wearing a Polar H10 chest strap (Polar Electro Oy, Kempele, Finland), and is using a Meta Quest 2 HMD to experience the VR intervention during the cannulation procedure.

Figure 6

VirNE avatar character and virtual natural environment selections grouped by gender. Environment A is Sunset by a lake shore, B is Ocean shore, C is Dry coniferous forest, D is Path in a deciduous forest, and E is Coniferous forest.

Figure 7

SCARED questionnaire results with histograms and a line presenting normal distribution. The histogram charts represent the sum of participants per total score. All three graphs indicate a non-normal distribution of data.

Figure 8

Customized user experience results. The histogram charts represent the sum of participants per each value regarding the question, where a value of six indicates participants “completely agree” with the statement and a value of zero indicates participants “completely disagree”, along with a line presenting normal distribution. All graphs indicate a non-normal distribution of data.