185 - Playing the CARD (Comfort, Ask, Relax, Distract) Internet Game to Cope with Needle Fear and Pain: Results from User Testing

Poster Number: 185
Publication Number: 185.317

Anna Taddio, University of Toronto, Toronto, ON, Canada; Anthony Ilersich, University of Waterloo, Toronto, ON, Canada; Lucie M. Bucci, Immunize Canada/Canadian Public Health Association, Ottawa, ON, Canada; C Meghan McMurtry, University of Guelph, Guelph, ON, Canada; Moshe Ipp, Hospital for Sick Children, Toronto, ON, Canada; Shenthuraan Tharmarajah, University of Toronto Leslie Dan Faculty of Pharmacy, Scarborough, ON, Canada; Victoria A. Gudzak, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Noni MacDonald, Dalhousie University Faculty of Medicine, Halifax, NS, Canada

Background: Two-thirds of children are afraid of needles. The CARD (Comfort, Ask, Relax, Distract) system is a framework for teaching children about how to cope with needles proven to reduce fear and pain. In prior projects, we created videos and pamphlets to support education of children and families about CARD. In the present study, we developed an internet game targeted to children aged 6-12 years to diversify learning formats and improve accessibility. Game characters educate children about the coping strategy letter categories (C-A-R-D) using a didactic approach at the beginning of the game. Opportunities for practice and reinforcement of learning occur via integration of minigame activities (e.g., deep breathing). Additional activities are included in the arcade (e.g., stories, word search).

Objective: To evaluate acceptability of the CARD game in children and parents as a tool for learning and practicing coping strategies for upcoming needle procedures.

Design/Methods: User testing was carried out with a convenience sample of parent-child dyads recruited from an outpatient pediatric clinic (Toronto, Canada). Children play-tested the game on an external device (e.g., cell phone) with a parent present. Gameplay was virtually monitored by researchers. Children and parents provided feedback using an interviewer-administered survey containing closed-ended and open-ended questions.

Results: Fifteen child-parent dyads participated. Children’s ages ranged from 6-12 years; 8 were female. Before playing, 14 (93%) reported being afraid of needles to varying levels (a little, medium amount, or a lot). After playing, 9 of 14 (64%) were less afraid; the remainder reported the same level of fear. Children reported understanding the game and recalled coping strategies. Parents liked the simplicity and variety of distraction activities. Some parents were concerned about the amount of reading required and suitability of some minigames for all children in the target age range. Feedback was incorporated in the game, including adding voice-overs to didactic components. Parents primarily recommended learning about the game at their doctor’s office.Conclusion(s): This study demonstrated acceptability of the CARD game in children and parents. Future studies are planned to evaluate feasibility and effectiveness when integrated into upcoming needle procedure appointments like COVID-19 vaccinations.