How families prepare their children for tooth extraction under general anaesthesia: Family and clinical predictors of non-compliance with a ‘serious game’

Objective: To explore family and clinical factors for usage of an online serious game designed to prepare children with ECC for dental treatment under general anaesthesia. Design: Observational study. Secondary data of 60 children, aged 5-to-7, randomised to the intervention group in a phase-III randomised controlled trial [NIHR Portfolio 10006, ISRCTN: 18265148] testing the efficacy of the serious game http://www.scottga.org (available online). Usage was captured automatically, with each click, in real time. The total number of replays and total number of missing slides per game-run performed by the child, were recorded and used to monitor usage. Compliance outcomes were: total time running the game and number of completely missed slides. Results: 57/60 played the game. Median age of parent/carer was 32. For 74% of the families, fathers resided at home and for 65% the parent/carer had A-levels-to-university education. At recruitment, 70% of the children were reported as anxious/highly-fearful and 37% as “significantly psychologically disturbed”. Conclusions: Factors for non-compliance were absence of a father at home (P = 0.01) and higher child-anxiety (P = 0.01) and, to a lesser extent, a low parent/carer education level (P = 0.09). Interactive cartoons featuring dental assessment, oral health messages and modelling featured in the more popular slides.</p

On-line preparatory information for children and their families undergoing dental extractions under general anesthesia:A phase III randomized controlled trial

BackgroundFamily‐centered interactive on‐line games are increasingly popular in healthcare, but their effectiveness for preoperative preparation needs further research. www.scottga.orgis the new on‐line version of a proven nonweb‐based game for children and parents/caregivers.AimsThe aim of this study was to evaluate if www.scottga.org improved children's anxiety and families' satisfaction compared with controls.MethodsIn this phase III double‐blind randomized controlled trial, children/parents/caregivers received (i) www.scottga.org, (ii) standard care, or (iii) a placebo hand‐washing game. The intervention and placebo games were available online for home usage and provided again on the ward before surgery. All children were accompanied by parent/caregivers at induction and observed and scored using validated measures. Stratified randomization and generalized linear models were used. An intention‐to‐treat approach was adopted.ResultsOverall, 52/176 children had baseline “psychological disturbance.” Children's anxiety increased preinduction, but there were no differences between groups (Facial Image Scale: video‐standard OR = 1.08, P = .82, 95% CI [0.56, 2.1]; video‐placebo OR = 0.9, P = .77 95% CI [0.46, 1.8]). There were no differences in induction behavior (visual analog scale: video mean = 3.5; standard care mean = 3.5; placebo mean = 3.7: video‐standard OR = 2.0, P = .42, 95% CI [−0.6, 1.3]; video‐placebo OR = 1.53, P = .65, 95% CI [−0.8, 1.1]) or induction anxiety (modified Yale Preoperative Anxiety Scale: video‐standard OR 1.02, P = .97, 95% CI [0.61, 2.6]; video‐placebo OR 1.38, P = .49, 95% CI [0.87, 3.81]). Families favored the intervention regarding the “child handling the visit better” (Treatment Evaluation Inventory: video‐standard OR = 12; 95% CI 4.7‐32; P &lt; .001; video‐placebo OR = 8.2; 95% CI 3‐22; P &lt; .001) and “improving the child's ability to cope” (Treatment Evaluation Inventory: video‐standard OR = 21; 95% CI 8‐56; P &lt; .001 and video‐placebo OR = 13; 95% CI 5‐34; P &lt; .001).ConclusionFamilies believed that a video‐game preparation helped their child's perioperative anxiety, but there were no objective measures of behavioral improvement associated with this intervention.</p