I previously worked part-time as a secretary for a pediatrics office, Sears Pediatrics. Since it is a single doctor practice, we had to make most of our own systems and services. My target for this project was to improve the patient experience. Currently, Dr. Sears struggles a lot with vaccine appointments for children in the 3-6 age range, due to vaccine fears.

According to Dr. Sears and my observations, many parents currently use their phones to try to distract their children during vaccinations. There is already technology being used as an informal solution, so I wanted to introduce more specialized aids that better serve the nuances of the vaccination process. Several effective technological solutions are on the market currently, but they seem to be used primarily in large hospitals, and utilize virtual reality consoles that would be too difficult, expensive, and time- consuming for a less tech-savvy pediatrician to set up (Li 2011).
How might we...
  • Reduce patient anxiety during and before vaccination appointments, to lessen the possibility of children developing lasting needle phobias?

  • Develop a specialized solution that would be accessible to smaller pediatric offices, and not just hospitals with more employees and larger budgets?​

Why is addressing vaccine anxiety important?
According to study done by A. Taddio, in a sample of 1024 children and 883 parents, two-thirds of children and one-quarter of adults reported a fear of needles (2012). This needle fear caused immunization non-compliance and healthcare avoidance in about one twelfth of both adults and children (Taddio 2012).

Inspiration
What are our stakeholder needs?

Interview with Dr. Sears:
  • 3-6 age group is the most difficult to administer vaccines for
  • “Easy” vaccines: currently 5 minutes
  • “Difficult” vaccines: can take up to 30 minutes before giving up and trying another day: this messes up the appointment schedule quite a bit.
  • The most difficult part is convincing children to lie down for leg administration.
  • She can spend up to 3 minutes setting up a distraction method
  • Parental participation and sufficient distraction work best for having vaccination go smoothly
  • Not technologically savvy
Interview with 6-year old patient:
  • Didn’t know what vaccines were for
  • Favorite game is i-Spy
  • Doesn’t play games on parents’ phones
  • Likes the prize at the end of shots
  • Doesn’t like getting vaccinations on leg
Observation of vaccine administration
  • Parents were active participants
  • Child protested the most when set to lie down for the vaccine
  • Child seemed least upset when distracted by iPhone
  • No limb movement allowed
  • iPhone was not visible during the vaccine administration
Additional research findings
  • Customized pre-treatment simulations were effective in hospitals for reducing preoperative anxiety (Liguori 2016)
    • Were created by and for the specific hospital, however
  • Digital distraction methods are more effective in reducing pain perception than non-digital methods (Li 2011, Windich-Biermeier 2007) 
    • VR is typically inaccessible to smaller pediatricians

Ideation
Co-design with youth

I did a co-design session with 2 patients who were sisters, so they influenced each other's ideas quite a bit.

Prompt: “How could you help a friend who is sad or scared far away?”
Make something or someone that could comfort them in your place.

I used the "bags of stuff" design method and supplied a lot of items for the kids to design with, which is often used for younger age groups. This was a young age group (3-6) so this worked well as a non-writing based technique, and stickers were the most effective storytelling tools.

Character designs

In my current design iteration, I am using the the folowing characters to demonstrate my prototype. Animals provide fewer struggles with customization than human characters—children like to see their appearances reflected in characters, and character customization on the patients’ end would take time from their appointment. 
The duck is my favorite of all of them!"
​-Young patient
The dad is handsome!”
​-Dr.Sears
She laughed at the duck doctor because he would be a “quack” (pun) ​

Design 1
Reducing pre-operative anxiety

My first product design was a pre-treatment simulation. I conceptualized designs for a platform for doctors to quickly make customized simulations of vaccines fit to their practice. This would be a website / mobile app for parents with their young children, and doctors.

In its basic state, it would educate on why vaccines are helpful in an age-friendly way, and help children feel less nervous about the process. Further expansions would accommodate more types of practices, like for a child visiting the hospital for the first time and getting an MRI, or going to the dentist for braces. 
Features
  • Interactive digital children’s book format
  • Mobile app or browser access
  • Further expansions would accommodate other types of treatments and practices, like an MRI
    ​
Design criteria
  • Quick setup by doctor
  • Visual friendliness of a children’s book
  • Easily accessible to parents
  • Effective, age-appropriate education on why vaccines are helpful
  • Reduce nervousness about the treatment

Part 1: Introducing doctor and space

  • Introduction of Dr. Deedee
  • Picture & introduction of actual doctor
  • A few fun facts about doctor to humanize them
  • Pictures of practice, waiting room, etc.

Part 2: Vaccination process and education

Possible pages:
  • ​”I heard you were going to get a shot soon, (patient name)! Mac here is also about to get a shot too. Shots can hurt a little, but they make us strong against feeling sick!”
  • “Hi, I’m Mac! I’m going to get a shot today! Shots used to make me scared, but now I know that they can protect me from scarier sicknesses. Let me show you.”
  • Different simulations depending on arm or leg administration selected in questionnaire

Treatment, Multiple pages for full process:
  • Taking temperature
  • Cleaning area
  • Visualization of what the vaccine does:
    • "Helps the body beat up bad guys"
    • "Like getting a superpower"
    • "It only took a second! It was over faster than I thought. I stayed calm and still, so it was easy!"
  • Mac: "We say thank you to Dr. Deedee! Mama and I are going to get lunch."
  • Dr. Deedee comes back: "Mac did a great job, I’m sure you can too, (Patient name)! We’ll see you at (office name) soon!"

Feedback from Dr. Sears

  • Meets all design criteria.
  • Would be very marketable to hospitals if other treatments were added!
  • Doctors would have no time for customization beyond the initial questionnaire, most likely.

Limitations

  • I am not a children’s book writer
  • Multiple treatment options will take a long time to make art for and animate; 3D assets can lessen this
  • Customization can’t be fully voice acted

Design 2
Reducing during-operation anxiety

My second product design would be a simple distraction app that a pediatrician or parent could set up on a phone or tablet. All activities are designed to be hands and motion-free to allow the pediatrician to administer the vaccine. This is where I used inspiration from my design session with children. 

​Design criteria
  • Accessible to small practices
  • Visually appealing
  • Quick setup
  • Requires little to no bodily movement
  • Self-explanatory with little to no instructions
  • Will incentivize children to lie on their backs, and must be visible Must not get in the way of treatment
  • Fun and effectively distracting to reduce pain perception
 Activity 1: hands-free game (I-Spy)
  • Mentioned as favorite game by 6-year old interviewee
  • Often played in waiting room
  • Most effective in projection format so parents can see
  • Invites parental participation
Activity 2: calming activity
  • We used to have a fish tank in the waiting room that patients now ask about frequently; this would be a way to bring it back
  • Calming music that can be muted
  • Animated fish
  • Mac the dog swims across the screen in new outfits

Activity 3: Song
  • ​Wheels on the bus often sung in waiting room
  • Encourages participation from all stakeholders
  • Animated video

Physical Format Options

Feedback from Dr. Sears
  • Activities would all be effective distraction methods and met the design criteria
  • Wall swivel mount format would be much better
  • Could keep iPad there at all times
  • Secure to wall out of child reach when not in use
  • Projector too much to set up during appointment; could get knocked down
Limitations
  • i-Spy not as effective on iPad as it is on projected ceiling
  • Swivel mount not obvious solution for other doctors who do leg administration
Works cited
Li, A., Montaño, Z., Chen, V. J., & Gold, J. I. (2011). Virtual reality and pain management: current trends and future directions. Pain management, 1(2), 147-157.
Liguori, S., Stacchini, M., Ciofi, D., Olivini, N., Bisogni, S., & Festini, F. (2016). Effectiveness of an app for reducing preoperative anxiety in children: a randomized clinical
trial. JAMA pediatrics, 170(8), e160533-e160533.
Taddio, A., Ipp, M., Thivakaran, S., Jamal, A., Parikh, C., Smart, S., ... & Katz, J. (2012). Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine, 30(32), 4807-4812.
Windich-Biermeier, A., Sjoberg, I., Dale, J. C., Eshelman, D., & Guzzetta, C. E. (2007). Effects of distraction on pain, fear, and distress during venous port access and venipuncture in children and adolescents with cancer. Journal of Pediatric Oncology Nursing, 24(1), 8-19.
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