The Acceptability and Impact of the Xploro Digital Therapeutic Platform to Inform and Prepare Children for Planned Procedures in a Hospital: Before and After Evaluation Study

Abstract

Background There is increasing interest in finding novel approaches to improve the preparation of children for hospital procedures such as surgery, x-rays, and blood tests. Well-prepared and informed children have better outcomes (less procedural anxiety and higher satisfaction). A digital therapeutic (DTx) platform (Xploro) was developed with children to provide health information through gamification, serious games, a chatbot, and an augmented reality avatar. Objective This before and after evaluation study aims to assess the acceptability of the Xploro DTx and examine its impact on children and their parent’s procedural knowledge, procedural anxiety, and reported experiences when attending a hospital for a planned procedure. Methods We used a mixed methods design with quantitative measures and qualitative data collected sequentially from a group of children who received standard hospital information (before group) and a group of children who received the DTx intervention (after group). Participants were children aged between 8 and 14 years and their parents who attended a hospital for a planned clinical procedure at a children’s hospital in North West England. Children and their parents completed self-report measures (perceived knowledge, procedural anxiety, procedural satisfaction, and procedural involvement) at baseline, preprocedure, and postprocedure. Results A total of 80 children (n=40 standard care group and n=40 intervention group) and their parents participated in the study; the children were aged between 8 and 14 years (average 10.4, SD 2.27 years) and were attending a hospital for a range of procedures. The children in the intervention group reported significantly lower levels of procedural anxiety before the procedure than those in the standard group (two-tailed t63.64=2.740; P=.008). The children in the intervention group also felt more involved in their procedure than those in the standard group (t75=−2.238; P=.03). The children in the intervention group also reported significantly higher levels of perceived procedural knowledge preprocedure (t59.98=−4.892; P=.001) than those in the standard group. As for parents, those with access to the Xploro intervention reported significantly lower levels of procedural anxiety preprocedure than those who did not (t68.51=1.985; P=.05). During the semistructured write and tell interviews, children stated that they enjoyed using the intervention, it was fun and easy to use, and they felt that it had positively influenced their experiences of coming to the hospital for a procedure. Conclusions This study has shown that the DTx platform, Xploro, has a positive impact on children attending a hospital for a procedure by reducing levels of procedural anxiety. The children and parents in the intervention group described Xploro as improving their experiences and being easy and fun to use.

‘We should have been told what would happen’: Children’s and parents’ procedural knowledge levels and information-seeking behaviours when coming to hospital for a planned procedure

“…The qualitative data aimed to help provide some explanatory understanding of the quantitative data and as such was an embedded element to the study design (Creswell et al, 2003). The data presented were collected from a group of children who received standard hospital information provision as part of a larger cohort study which was focussed on the evaluation of a gamification and augmented reality health app (Xploro, 2020; https://xploro.health/) for children attending hospital (Bray et al, 2020). Fieldwork was carried out over a 4-month period in 2018.…”

Interventions and methods to prepare, educate or familiarise children and young people for radiological procedures: a scoping review

“…A medical play session led by the child with a mock toy MRI scanner with figures and dolls. Practice of coping techniques such as keeping still, guided imagery, audio music, and movie with MRI goggles Nurse developed CCLS supported MRI quality on a 5 point likert scale Hospital charges Procedural time Image Quality Hospital Cost Procedural Time The PFC/NA intervention group was found to have statistically significant lower and shorter procedure times and 96.8% of the MRI images were of acceptable or better quality than those of the SC/A and CCLS/A groups McGlashan et al (2017) [ 4 ] UK To examine whether the animated educational video provides an internet-based tool for MRI preparation Prospective cohort study 6.5 to 11.5 years 9 children with A-T (neurodisability with movement disorders) and 12 undergoing a clinical research MRI scan An internet-based educational 3 min animated video The animation used was an updated version from the Szeszak et al (2016) study Self-directed Participants were sent an internet link to the animation prior to the MRI scan appointment Locally developed questionnaire with closed responses (Likert and yes/no) and some qualitative responses Children Frequency of watching video and perceptions of the video Pre-scan perceptions (worry, expectations) Post-scan perceptions (whether the animation helped them undergo the scan, whether it helped them feel less nervous) Parents Pre-scan questionnaire on whether the animation was viewed, perceived positively by their child, helped prepare their child for the scan Understanding of MRI scan Likeability of the animation Usefulness of the animation in preparing the child for the MRI The children rated that they liked the animation and had a good pre-scan understanding of the MRI. The impact the animation had on preparing the children for the MRI was rated good The results indicated the animation had a larger impact on younger children.…”

Medical Device Development for Children and Young People—Reviewing the Challenges and Opportunities

“…Other new ultrasound scan techniques include ultrafast Doppler to deliver high spatiotemporal resolution of flow, three-and four-dimensional technique to generate accurate spatiotemporal representation of anatomy, and high-frequency imaging to delineate anatomic structures at a resolution down to 30 µm [78]. More recently, there has been a focus on using technology to prepare children for diagnostic imaging such as MRI and CT scanning using augmented and virtual reality to familiarize children with the clinical setting and the investigative process [79,80]. Fundamental to the use of medical devices and technology to prepare children for imaging techniques is the involvement of CYP to ensure the approach is developmentally appropriate and acceptable for the intended age group.…”