GLOWING STARS: improving the NHS hospital experience of children (aged 4–11) having an MRI scan using a digital app with augmented reality/avatar, and gamification

Purpose
Children undergoing Magnetic Resonance Imaging (MRI) often experience anticipatory anxiety, which can lead to distress, rescheduled scans or sedation. This study evaluated the acceptability and impact of Xploro, a digital interactive app designed to improve children's understanding of MRI procedures and reduce anxiety.

Design/methodology/approach
The GLOWING STARS study used a before-and-after design. Children aged 4–11 attending diagnostic MRI scans in secondary care paediatric NHS Trusts accessed Xploro one-to-one on the day of their appointment. Children and parents/caregivers completed paper proformas assessing perceived knowledge and emotional responses before and after using the app. Qualitative data were analysed thematically, and quantitative data summarised descriptively.

Findings
The study indicated that Xploro was highly acceptable and effective in enhancing procedural understanding, improving preparation and increasing emotional security before MRI scans, especially for children aged 7 to 11. This study is the first to involve children aged 4–6 years using the Xploro digital interactive intervention for MRI preparation, and the first to deliver Xploro on-site at the ANONYMISED hospital NHS Trust. This study provides valuable evidence guiding recommendations for the development of digital interventions for children under 7 years old (∼3–6).

Research limitations/implications
Due to the very small sample size of the data, caution should be taken when interpreting results about app-based strategies alongside relational support. Further research with a larger sample and with more balanced representation across diagnostic categories is needed to clarify the child-digital technology relationship and explore the role of adult facilitation in digital health app engagement among children (7–11 years old). Although the subgroup sizes were too small to draw reliable conclusions about children with physical disabilities and neurodevelopmental conditions, the qualitative data from the 4 children with conditions suggest a potential disparity in the perceived effectiveness of the app for children with physical disabilities and neurodiverse developmental needs.

Originality/value
This study is the first to involve children aged 4–6 years using the Xploro digital interactive intervention for MRI preparation, and the first to deliver Xploro on-site at the ANONYMISED hospital NHS Trust. This study provides valuable evidence guiding recommendations for the development of digital interventions for children under 7 years old (∼3–6).