A new study investigated the effects of a mobile game called “Dr. Zoo” in reducing the fear of injection needles in children between 3 and 6 years of age. The findings revealed that children who played “Dr. Zoo” – a game where they give shots to cartoon animals – for five days before a medical appointment involving an injection, showed a significant reduction in their fear. The study was published in JMIR Serious Games.
Fear of needles, known as needle phobia or trypanophobia, is a common and understandable issue in many children. Studies indicate that approximately 19% of children between 4 and 6 years of age have fear of needles and injections. The fear of needles arises in anticipation of pain and discomfort associated with injections. Children may develop this fear from previous negative experiences, witnessing others’ reactions, or simply from a lack of understanding about the purpose and importance of vaccinations or medical procedures.
If needle phobia remains unaddressed, it can persist into adulthood. Adults with this fear may avoid vaccinations and routine medical procedures such as blood tests, pain relief measures, or blood donations. In some cases, this fear can lead adults to delay or forgo critical medical treatments, posing serious risks to their health.
Traditional approaches to this problem were based on combinations of child-friendly techniques for administering shots, distractions, positive reinforcement, and offering choices. Recent studies have shown that virtual reality games that distract patients during the injection process could also be effective. For adults, cognitive behavioral therapies are generally highly effective in treating needle phobias.
Study author Pat Healy and his colleagues wanted to examine whether a video game in which a child aged between 3 and 6 years administers injections might change children’s perception of injection needles and reduce their fear. They also wanted to evaluate the ease of use and acceptability of such a game based on feedback from parents.
The researchers developed a 3D adventure game for mobile devices, named “Dr. Zoo.” Created using Unity for Android and iOS platforms, the game features a series of chapters where the player encounters an animal, engages in a minigame to resolve an issue the animal faces, and concludes by giving the animal an injection. The version used in the study comprised four chapters.
The study involved 36 children aged 3 to 6 years and 30 parents, including six parents with two children participating. The children, who all had upcoming medical appointments involving needles, had previously exhibited needle anxiety during similar medical treatments (as reported in the Fear Survey Schedule for Children-Revised).
About two weeks before their scheduled medical appointments involving needles, researchers instructed parents on how to download “Dr. Zoo” onto their mobile devices. They were advised to have their children complete all four chapters of the game daily for at least five consecutive days before the medical appointment.
After each day’s gameplay, parents evaluated their child’s fear level using the Children’s Fear Scale. The researchers also sent SMS reminders to parents, encouraging them to have their children play the game and complete the survey. Following the medical appointments, the researchers conducted exit interviews with parents, lasting between 10 and 30 minutes, to gather their views on the game’s impact and suggestions for its future development.
The results indicated that parents perceived a significant reduction in their children’s fear of needles during needle-related activities after participating in the study, compared to their recollections of past experiences. They also noted a decrease in their children’s distress during needle-involved activities. However, there was no difference in the initial and final fear scale ratings.
Qualitative findings showed that 26 out of 35 children experienced reduced needle fear or physical reactions at the time of their medical appointments. The extent of this reduction varied, with some parents reporting a significant improvement in their children’s fear of needles after playing “Dr. Zoo,” although some children still exhibited fear during the actual injection.
“Overall, Dr. Zoo demonstrated strong acceptability, ease of use, and potential preliminary effectiveness in this pilot feasibility study. Parent participants provided insightful feedback on the facilitators of and barriers to use, which will be helpful in the future development of the game,” the study authors concluded.
This study highlights the potential of using video games to reduce needle fear in children. However, it’s important to note that this was not an experimental study, and the assessments of changes in children’s fear were reported by parents post-study without comparison to previous measurements. Moreover, parents were fully aware of the study’s aims and the researchers’ expectations. Thus, a study with more rigorous measurement procedures and better control of confounding factors might yield different results.
The paper “An Exposure-Based Video Game (Dr. Zoo) to Reduce Needle Phobia in Children Aged 3 to 6 Years: Development and Mixed Methods Pilot Study” was authored by Pat Healy, Celine Lu, Jennifer S Silk, Oliver Lindhiem, Reagan Harper, Abhishek Viswanathan, and Dmitriy Babichenko.
