How Digital Media Affects Kids' Healthcare Experiences and Outcomes

Children experience anxiety before medical procedures, which have negative effects. Educating them about what to expect can help reduce this anxiety. In this study, the investigators aim to prepare children for procedures using 2D and 360 video with audio, including virtual reality (VR). Children and adolescents aged 5-18 and adults aged 19-23 will be randomized to receive either 2D video with audio-, 360 video with audio-, or 360 video with audio in VR-based preparation materials. Participants will complete patient-reported outcomes and experience surveys before and after their preparation through a secure mobile app, accessible through their smartphone. The investigators hypothesize that VR video-based education will reduce anxiety and improve patient experience compared to when patients learn about their procedure through a 2D video with audio and a 360 video with audio without VR. The investigators further hypothesize that the media fidelity, in terms of level of immersiveness, will have an effect on associated outcomes.

In this study the investigators plan to recruit 500 participants between the ages of 5 to 23. Participants will be randomized into one of 3 preparation groups (e.g., 2D video w/ audio, 360 video w/ audio w/o VR, or 360 video w/ in VR). Participants in the 2D video-preparation group will watch and hear descriptions about the hospital environment, equipment, staff, and / or their scheduled upcoming procedure. Participants in the 360 video with audio-based preparation group will also see and hear descriptions of the hospital environment, equipment, staff, and / or their scheduled upcoming procedure. However, unlike the 2D video-based group, 360 video group will have the ability to swipe on their phone and see 360 views of the environment (i.e., the procedure room). Participants in the 360 video with audio in VR-based preparation group will see and hear videos of the hospital environment, equipment, staff, and /or their scheduled upcoming procedure in VR. Participants randomly assigned to this group will have the ability to move their head around using a cardboard VR headset and see 360 views of the hospital environment. Each participant will have their media tailored to their specific procedure. For example, participants that are undergoing a cast removal will be given different media (i.e., cast removal specific material) compared to someone who is scheduled to receive a magnetic resonance imaging scan. Participants will use their preparation materials at least once, approximately 1 week prior to their scheduled procedure.

Participants (i.e., patients) will take a series of short surveys before and after experiencing their preparation material. Surveys will include self-report anxiety and pain measures. After the procedure, the investigators plan to follow-up with the participants at 3 separate occasions. During follow-up assessments the investigators will ask participants about their anxiety as well as pain. The patient's caregivers will also complete baseline state and trait anxiety measures in addition to a satisfaction survey, but all other surveys / measures will be completed by the patient (i.e., child).

Interested participants will first complete an online screening survey to ensure their eligibility on Qualtrics. Upon successful screening, the user will be allowed to proceed to the consent and assent agreement page on Qualtrics. After consent and assent, participants will complete baseline survey data (demographics, trait anxiety) on Qualtrics. After baseline survey data, the study team will email the user to a link to where participants will be asked to download and register (password, and e-mail address) to access the app. In this way, data collected in the app will be de-identified but linked to the consent form data that is collected on Qualtrics via a randomly generated number that will be recorded by the app. All intervention media (2D video with audio, 360 video with audio w/o VR, and 360 video with audio in VR) will be accessed through the secure app (in compliance with local and provincial/national data collection/residency policies). This app will need to be downloaded. Upon successful registration, the research team will provide them with a unique code. The code will allow participants to enter into the app and the appropriate room where their material is located. Because Qualtrics is embedded within the app, participants will complete surveys within the app but through Qualtrics.

To access the media (2D video with audio, 360 video with audio on smartphone, or 360 video with audio viewed in VR) participants will explore a gamified version of the BC Children's Hospital. Participants will create an avatar and set a procedure date before leaving the home room (i.e., a bedroom). After setting a procedure date, participants will be able to access the lobby of the hospital and their procedure room (provided that it is within 7 days of their scheduled procedure). The gamified hospital environment is modeled after BC Children's Hospital and included non-playable characters, a learning kiosk, and a computer to finish surveys.

For those randomized to receive the 360 video-based preparation, participants will receive standard-of-care specific to the division/clinic that scheduled their procedure, with audio-based descriptions of their upcoming procedure, as well as videos. Videos will contain a voice-over tour and procedural experience, specific to the participant's procedure, including an orientation to the hospital environment, equipment, and sometimes each procedural step specific to their procedure. Thus, there will be multiple 360 video-based exposure and education videos, each one specific to the procedure the participant is scheduled to have. Participants randomized to the 360 video with audio WITHOUT VR, will watch the videos on their phone without the use of a VR headset. They will be able to swipe on their phone and move the video around to fully experience the hospital environment. Participants randomized to the immersive arm of the study (e.g., VR), will be able to view video in virtual reality with the use of a VR-viewer / headset that utilizes their existing mobile phone. The VR headset will be provided to participants at the time of recruitment or sent to them through mail.

Participants in the 2D video with audio-based group will receive standard-of-care specific to the division/clinic that scheduled their procedure plus 2D video with audio-based preparation. 2D video with audio-based preparation will include and spoken descriptions of the hospital environment, the staff, equipment, and / or each procedural step specific to their procedure. Therefore, persons that are in the 2D video with audio-based preparation group will receive the same information as the 360 video groups, however, all exposure / education will be in a 2D video format (image stills played in a video) that is specific to the procedure the participant is scheduled to have. Therefore, there will be multiple 2D video with audio-based exposure scenarios, each one specific to the procedure the participant is scheduled to have.

All participants will use a standalone mobile app to access their preparation media. It should be noted that all participants will have the opportunity to access a VR tutorial as a part of their participation in this study. Participants that are not randomized to the immersive video arm will not be able to access content specific to their procedure, but instead will be able to experience a VR environment briefly within the gamified version of the hospital. All participants will be able to do this.