Developing the Therapeutic Video Game with MDA Framework to Decrease Anxiety for Pre-school Children with Acute Lymphoblastic Leukemia: Mix-method Approaches (Preprint)

Abstract

Preschoolers with acute lymphoblastic leukemia (ALL) received the long-term treatment plan with TPOC protocol. The frequent invasive therapies cause them with severe anxiety and also increase the care cost of their health team. Previous studies had showed that therapeutic video games (TVG) could decrease anxiety of sick children. But a dearth of TVG was designed specific for the preschoolers with ALL in Taiwan.

The purpose of this study was to develop the TVG with the popular adopted mechanic-dynamic-aesthetic (MDA) framework for game design and investigate the effect on the therapeutic anxiety reduction for preschoolers with ALL.

This study conducted mix-method approaches with three phases: 1) to develop TVG with MDA framework, 2) to test the reliability of TVG with three certified children art therapists and 3) to evaluate the therapeutic anxiety reduction after using TVG for six weeks with two-group stratified randomized controlled trial in one medical center in northern Taiwan. Eligible preschoolers with ALL were divided into experimental group and control group with ration of 1:1. Both group subjects received the same usual care and only experimental group used TVG. The children anxiety response was reported with facial ranking scale (FRS) by their family caregiver. Description analysis, Fisher's Exact test, Pearson's chi-squared test, Mann-Whitney U test were used as the data statistic.

The TVG included six rules as mechanic to support the dynamics with the four main features (character, nursery, tasks and market) and facilitating players with eight emotional responses of the aesthetic. The results of reliability test showed the TVG was usefulness and trusted for preschoolers with ALL (Cronbach α level=0.98). A total of 15 participants were enrolled and randomly allocated to the experimental (n=7) or the control (n=8) groups. The average of TVG login was 37.5 times (min. was 14 times; max. was 62 times) in experimental group. The demographic data showed homogeneity between two groups in age (range from 3 to 5 years), sex (boy), risk classification (standard risk), and treatment status (continuation therapy). The FRS was 6.82 (6.16 vs. 7.45, P= .036) in average which significantly decreased in experimental group versus the control group during six weeks.

This research provides some evidence for using a therapeutic video game to decrease their anxiety for ALL preschoolers in Taiwan. The TVG could be used to support clinical professionals before execute invasive therapy.

NCT04199637