TY - JOUR
AU - Donnelly, Ryan F
AB - Abstract Objectives To explore children's views on microneedle use for this population, particularly as an alternative approach to blood sampling, in monitoring applications, and so, examine the acceptability of this approach to children. Methods Focus groups were conducted with children (aged 10–14 years) in a range of schools across Northern Ireland. Convenience sampling was employed, i.e. children involved in a university-directed community-outreach project (Pharmacists in Schools) were recruited. Key findings A total of 86 children participated in 13 focus groups across seven schools in Northern Ireland. A widespread disapproval for blood sampling was evident, with pain, blood and traditional needle visualisation particularly unpopular aspects. In general, microneedles had greater visual acceptability and caused less fear. A patch-based design enabled minimal patient awareness of the monitoring procedure, with personalised designs, e.g. cartoon themes, favoured. Children's concerns included possible allergy and potential inaccuracies with this novel approach; however, many had confidence in the judgement of healthcare professionals if deeming this technique appropriate. They considered paediatric patient education critical for acceptance of this new approach and called for an alternative name, without any reference to ‘needles’. Conclusions The findings presented here support the development of blood-free, minimally invasive techniques and provide an initial indication of microneedle acceptability in children, particularly for monitoring purposes. A proactive response to these unique insights should enable microneedle array design to better meet the needs of this end-user group. Further work in this area is recommended to ascertain the perspectives of a purposive sample of children with chronic conditions who require regular monitoring. children, microneedle, minimally invasive, monitoring, perception Introduction Microneedle arrays (MNs) consist of a base plate with up to 20 000 tiny projections per cm2 which penetrate the skin in the absence of pain or bleeding.[1–5] This ability to evade the skin's outermost layer, the stratum corneum, is responsible for the extensive exploration of MN to facilitate transdermal drug and vaccine delivery.[6–9] More recently, the potential for minimally invasive blood or interstitial fluid (ISF) extraction has also been recognised.[10–14] Work in this area has highlighted numerous applications including glucose,[11,14,15] lactate,[15,16] and drug monitoring,[17] as well as designs enabling protein biomarker recognition.[1] Approaches have included the use of hollow MN for fluid collection,[10,18,19] pretreatment with solid arrays and subsequent fluid capture,[11,20] as well as more integrated designs negating the need for formal fluid extraction for analysis.[1,21] While the use of both blood and ISF has been documented, the latter fluid may be particularly advantageous when blood sampling is difficult or volumes are limited, e.g. neonates.[22] Donnelly et al.[23] have recently described hydrogel-forming MNs that swell to facilitate drug delivery by absorbing ISF into the polymeric matrix following skin penetration. Current work by this group aims to exploit this ISF absorption for monitoring purposes. While considerable progression has been made for other applications, such as the Dermaroller (Germany) for cosmetic purposes, an optimal MN design and approach to MN-mediated monitoring is still evolving. The success of any technique will depend on its acceptance among potential end-users. Birchall et al. have explored public and healthcare professional (HCP) perspectives on MN.[24] One finding noted from this work was the potential for MN use in children. Minimally invasive MN application as an alternative to hypodermic needle use may be expected to be more favourable to children given the unpopularity of the latter,[25–28] but also potentially facilitate closer monitoring. Suitability recommendations, however, currently originate from adults, with children's views uncharted, despite their acknowledged rights for such involvement.[30,31] Without this, MNs potentially risk rejection by children emulating the fears and disapproval associated with the conventional technique. In the present study, children's views on MNs and their use as an alternative approach to blood sampling are explored for the first time, providing a valuable insight into their anticipated acceptance. Methods This was a qualitative study involving focus groups with schoolchildren aged 10–14 years, conducted in a range of schools in Northern Ireland between April 2011 and June 2011. The qualitative design was chosen to facilitate viewpoint and idea exploration on this new and complex concept.[32,33] Focus groups were specifically selected given their appropriateness for children[34] and the lack of previous research on this topic.[35] The protocol was approved by the Research Ethics Committee, School of Pharmacy, Queen's University Belfast (Reference No. 011PMY2011). Participants Study sites were selected pragmatically, utilising links already in place with local schools through their participation in a Queen's University Belfast lead programme (Pharmacists in Schools) involving the delivery of scientific workshops.[36] These made no reference to monitoring or MN technology. Sampling was inclusive for all participants of the program within a defined age range (10–14 years). Participants were randomly selected, using a random integer generator,[37] to form optimal group sizes of six to eight participants.[32,35,38–41] Informed consent and assent was respectively gained from parent/guardian(s) and children (using separate information packs) recognising the importance of the child's involvement in the decision process.[42] Participant's characteristic data were also collected at this stage. School post codes were recorded and a score for each generated using the Northern Ireland Multiple Deprivation Measure (NIMDM) 2010. These scores were then used to provide some indication of the socioeconomic environments participants were familiar with. Data collection Focus groups were structured into three main phases: introductory questioning, MN introduction and main discussion. A short slide show ( Appendix 1) was used as a basis for phase 2, an approach adopted in previous work collecting children's views,[43] and included MN visualisation, Figure 1. Figure 1 Open in new tabDownload slide Microneedle array contained within a sealed Perspex container for viewing. The trained facilitator had no prior established relationship with participants, but all sessions were carried out in the familiar classroom setting and circular seating employed to encourage a relaxed environment.[44] A full explanation of the study and its purpose was provided at the outset, supporting voluntary participation.[45] Discussions were then audio-recorded using a digital voice recorder (Model: WS-321M, Olympus, Tokyo, Japan). A topic guide with a semi-structured design was used during all focus groups, Figure 2, and constructed to enable complexity progression, beginning with less complex topics.[41,44] An open-questioning style and general probes enabled further clarity or viewpoint expansion.[46] With little prior work in the area, guide construction was based upon the combined use of pilot focus group experience (conducted with colleagues) and prior literature, with only one paper of close relevance.[24] The guide was progressively adapted on reflectance of ongoing analysis.[47] Session duration was 45–60 min, considering the age range concerned.[48] Figure 2 Open in new tabDownload slide Outline of main topics for discussion contained within the topic guide. Data analysis All audio-recordings were transcribed verbatim, transferred to NVIVO 9 (QSR International Pty Ltd, Doncaster, Australia) and analysed by thematic analysis, with constant comparison employed throughout. An iterative approach to data analysis was followed using components of grounded theory: iterative theme construction, constant comparison, topic guide modification and data saturation.[47,49–51]Due to the study design, theoretical sampling was unachievable and, thus, grounded theory could not be adopted in its entirety. Data analysis and collection progressed simultaneously, permitting ongoing topic guide refinement. Analytical validation was performed by two separate investigators, whose work was not directly related to MN research. Data collection continued until ‘data saturation’, i.e. a stage when no new themes were emerging.[49] While criticisms exist regarding this approach, clear recommendations for a better method for determining focus group sample size are lacking.[51] Each participant was given a unique identifier code outlining their gender, age and focus group number, allowing distinction of those sharing attributes. A unique ID code of ‘F14G2_2’ should thus be read as ‘the second female in focus group 2 with an age of 14 years. Results Thirteen focus groups involve 86 children (aged 10–14 years) of both genders, Table 1. In terms of medical background, 26% (n = 22) of participants declared a diagnosed medical condition and 20% (n = 17) received regular prescribed medication. Focus groups were conducted in seven schools located in Northern Ireland, Table 2, and included both the primary and post-primary sectors. In one school (B), the teacher remained present. Table 1 Summary of participants' characteristics Focus group . Age range (years) . Male (n) . Female (n) . MC (n) . Rx (n) . Paediatric (n) . Neonatal (n) . 1 14 1 5 4 2 2 1 2 13–14 3 3 3 3 0 0 3 10–11 4 3 1 1 3 1 4 11 3 4 0 0 2 0 5 10–11 4 3 1 1 6 2 6 10–11 0 7 0 0 4 0 7 11 1 5 0 0 1 1 8 10–11 2 6 3 3 2 0 9 12–14 2 5 1 1 1 0 10 11 2 5 1 1 3 1 11 11–12 0 6 2 1 2 0 12 12 0 6 4 3 1 1 13 12 0 6 2 1 2 0 Focus group . Age range (years) . Male (n) . Female (n) . MC (n) . Rx (n) . Paediatric (n) . Neonatal (n) . 1 14 1 5 4 2 2 1 2 13–14 3 3 3 3 0 0 3 10–11 4 3 1 1 3 1 4 11 3 4 0 0 2 0 5 10–11 4 3 1 1 6 2 6 10–11 0 7 0 0 4 0 7 11 1 5 0 0 1 1 8 10–11 2 6 3 3 2 0 9 12–14 2 5 1 1 1 0 10 11 2 5 1 1 3 1 11 11–12 0 6 2 1 2 0 12 12 0 6 4 3 1 1 13 12 0 6 2 1 2 0 MC, diagnosed medical condition; Neonatal, neonatal hospital experience (self/sibling); Paediatric, paediatric hospital experience (self/sibling); Rx, prescribed regular medications. Open in new tab Table 1 Summary of participants' characteristics Focus group . Age range (years) . Male (n) . Female (n) . MC (n) . Rx (n) . Paediatric (n) . Neonatal (n) . 1 14 1 5 4 2 2 1 2 13–14 3 3 3 3 0 0 3 10–11 4 3 1 1 3 1 4 11 3 4 0 0 2 0 5 10–11 4 3 1 1 6 2 6 10–11 0 7 0 0 4 0 7 11 1 5 0 0 1 1 8 10–11 2 6 3 3 2 0 9 12–14 2 5 1 1 1 0 10 11 2 5 1 1 3 1 11 11–12 0 6 2 1 2 0 12 12 0 6 4 3 1 1 13 12 0 6 2 1 2 0 Focus group . Age range (years) . Male (n) . Female (n) . MC (n) . Rx (n) . Paediatric (n) . Neonatal (n) . 1 14 1 5 4 2 2 1 2 13–14 3 3 3 3 0 0 3 10–11 4 3 1 1 3 1 4 11 3 4 0 0 2 0 5 10–11 4 3 1 1 6 2 6 10–11 0 7 0 0 4 0 7 11 1 5 0 0 1 1 8 10–11 2 6 3 3 2 0 9 12–14 2 5 1 1 1 0 10 11 2 5 1 1 3 1 11 11–12 0 6 2 1 2 0 12 12 0 6 4 3 1 1 13 12 0 6 2 1 2 0 MC, diagnosed medical condition; Neonatal, neonatal hospital experience (self/sibling); Paediatric, paediatric hospital experience (self/sibling); Rx, prescribed regular medications. Open in new tab Table 2 Summary of school characteristics School . No. FG conducted . FG . Gender classification . Sector . A 2 1,2 Mixed Post-primary B 4 3, 4, 5, 6 Mixed Primary C 1 7 Mixed Primary D 1 8 Mixed Primary E 1 9 Mixed Post-primary F 1 10 Mixed Primary G 3 11, 12, 13 Female Post-primary School . No. FG conducted . FG . Gender classification . Sector . A 2 1,2 Mixed Post-primary B 4 3, 4, 5, 6 Mixed Primary C 1 7 Mixed Primary D 1 8 Mixed Primary E 1 9 Mixed Post-primary F 1 10 Mixed Primary G 3 11, 12, 13 Female Post-primary FG, focus group; Primary, school with an age range of children between 4 and 11 years; Post-primary, school with an age range of children between 11 and 18 years. Open in new tab Table 2 Summary of school characteristics School . No. FG conducted . FG . Gender classification . Sector . A 2 1,2 Mixed Post-primary B 4 3, 4, 5, 6 Mixed Primary C 1 7 Mixed Primary D 1 8 Mixed Primary E 1 9 Mixed Post-primary F 1 10 Mixed Primary G 3 11, 12, 13 Female Post-primary School . No. FG conducted . FG . Gender classification . Sector . A 2 1,2 Mixed Post-primary B 4 3, 4, 5, 6 Mixed Primary C 1 7 Mixed Primary D 1 8 Mixed Primary E 1 9 Mixed Post-primary F 1 10 Mixed Primary G 3 11, 12, 13 Female Post-primary FG, focus group; Primary, school with an age range of children between 4 and 11 years; Post-primary, school with an age range of children between 11 and 18 years. Open in new tab Three core themes were identified and defined as technique practicalities, technique acceptance and end-user suitability. A fourth outlier theme was also identified as ‘Drug/vaccine delivery’ in which potential use of MN in a delivery application was also identified by participants. Core theme 1: technique practicalities Children associated MN-mediated monitoring with simplicity, contrasting this with the skill requirements of blood sampling and likened MN to sticking plasters, e.g. Band-Aid, thus viewing self-application possible. They perceived greater freedom for a MN-based approach and anticipated reduced aftercare. It doesn't look that hard to put on, it just looks like a plaster. F11G10_1 You maybe wouldn't have to be so specific with it … it's only going to go in so far and it won't cause any serious bleeding … F13G9_1 … you wouldn't have to keep your arm out … F11G10_3 … you don't have to stop with it, so you can just put it on and carry on. M14G1_1 … even an ordinary person could apply it to themselves. M12G9_1 While the sticking-plaster association largely heightened this perceived ease of use, such connections also triggered concerns regarding allergy and pain on removal. Allergies were a particular concern in relation to newborns given their unknown allergy status. Eh, as long as … like regular plasters, they don't hurt when you rip them off, I'm fine with them. M11G5_4 … if a baby was only born … they don't know if it's gonna have an allergic reaction … F11G6_3 Most presumed an elongated time frame for MN-mediated monitoring and, expecting some level of unsupervised patient use, some felt patient interference was possible. … would it not be longer to get all the little bits of fluid out of all the wee needles. F12G12_6 … just rip it off if they didn't like it … F12G12_3 Core theme 2: technique acceptance Acceptance was closely linked to fear, with fears for blood and needles prevalent. The reduced pain, and subsequently fear, offered by MN represented widespread motives for approval. … it's (MN device) better because it's painless. F14G1_1 … people who are scared of needles would like it better because it doesn't hurt them. F11G4_4 MN had increased visual acceptance, in comparison to conventional needles, primarily as a consequence of their size. Size also promoted an impression of safety, while standard needles required greater skill during use. … the size of the needle. It makes people scared. M12G9_1 … they (MN) look safer. F12G13_4 … they can put it (hypodermic needle) in wrong, like the needle might not be in the spot. F14G1_4 The reduced visibility of the monitoring process, particularly of blood, was predominantly welcomed; however, some feared such subtlety could provoke efficacy concerns. They're not that noticeable and they're not bothering you. F11G6_3 … you wouldn't get as scared cus you don't see the actual blood come out. F12G11_2 People might not think it's working cus they don't see the blood actually coming out … M13G2_1 Children also discussed adaption of MN patch design to increase end-user appeal. If it had the wee designs on it, like cartoons or something, wee kids would want it on. F11G3_2 … make them personalized. F12G12_4 Other optimal features included indicator incorporation, the use of an applicator and being waterproof, non-allergenic and biodegradable. … it could go different colours, so like, red means it's not ready, and then it could change to green. … F11G7_1 … have something that sticks it on, like instead of a person doing it. F14G2_3 Lack of experience with MN-based monitoring was deemed a threat to acceptance and perceived reliability. Such concerns were expected to diminish with time. … it's new so it might not be as reliable … M13G2_2 … you probably would be quite nervous when you first got them, but after you first got them you'd … probably … be fine at getting them any other time. F12G13_2 Children considered patient education crucial for acceptance, believing that ignorance provoked fear. In comparison, parental understanding was of minimal importance to participants, however, and only considered in relation to MN use in babies. … what the microneedle patches were, I'd be really afraid and, em, probably like hide and not want to go, but cus I do know then I'm not, I wouldn't be afraid … F11G4_1 … they would want to learn a wee bit more about it before eh they put it on their baby. … F12G13_5 The smaller volumes associated with a MN-based approach raised some doubts regarding accuracy; however, others viewed this attribute advantageous for use in infants. … a little bit concerned as well because it's not taking as much … would you get as good results. M13G2_2 … they only take littler amounts … that would be better (for children). F11G4_1 Perceived reliability of MN-derived results was also influenced by the trust held by participants for the HCP and impacted on by previous healthcare experiences. For others, the manufacturer's desire for success and to sustain a reputation ensured device performance. … the same doctor for like most of their life, they're obviously gonna trust that person and what comes back … F11G6_3 … the people that made it (MN device), don't want to be, like, losing anything from it, ya know, cus people won't trust them next time … F11G7_4 The name of the device was a particular stumbling block for children. ‘Needle terminology’ provided little differentiation from the conventional approach and an alternative description was considered vital. All but one of the suggested alternative names omitted the term ‘needle’, Figure 3. Because they are called microneedles people might still be scared of them … they still think of needles. F14G1_5 For some children, their feelings regarding blood sampling using conventional needles went far beyond a dislike or lack of acceptance, echoing classical signs of phobia and associated activation of the autonomic nervous system including sweating, nausea and avoidance behaviour. I like kind of break out in sweat and get all warm. F11G6_2 … you can get dizzy and you feel a bit sick. F12G11_5 I'm always meant to get the flu jab … I tell her (Mother) I'm not getting it so she doesn't make me. … F12G12_2 In contrast, the employment of MN as an alternative was anticipated to potentially reduce this response. … you'd think needle ‘ah I don't want to do that’ then when you hear you've got a microneedle you'd think ‘oh, that's alright I'll go’. F13G9_2 For most children, the preference for a MN-based approach seemed obvious. … the microneedle would be better, and I'd prefer using that. M11G5_1 Figure 3 Open in new tabDownload slide Children's alternative name suggestions for microneedles (number of cases). Core theme 3: end-user suitability Age Many children felt MNs were suitable for all ages and assumed a unanimous preference, basing this largely on the reduction in pain and elimination of needles offered by this latter approach. Just everyone … I don't think anyone likes getting needles. M14G1_1 I think all people should use it … it wouldn't hurt as much. F10G8_2 A few, however, were concerned regarding MN application in babies. … with the babies their skin is quite fragile, so it could hurt the skin, even if you can't feel it, you could damage it. F12G11_4 The elderly were also considered particularly suitable recipients to avoid the trauma of conventional needles. Many, however, suspected that this generation may be unreceptive to new techniques because of unfamiliarity. … their (the elderly) body can't heal as quickly as younger peoples can. F12G12_2 … elderly are normally very defiant and they would, em even though if it's better, they would still. … they normally just stick to their guns. M11G8_1 Health status Those ‘low in blood’, needing regular monitoring and with phobias, were deemed most suited to a MN approach. Potentially unsuitable users, however, included those with sensitive skin, eczema, allergies or diseases affecting fluid. It would also be good for people who might be low in blood, and the microneedle wouldn't really take any out. F11G3_2 For people who go and get blood taken regularly … M11G3_3 Just people who have skin conditions … they couldn't take it because it would be sore. M11G4_3 Patient choice Some also debated the importance of patient choice for technique selection, but generally deemed a MN-based approach preferable. All children should have a choice. F12G12_5 … most children would probably choose the microneedles, because they could just put it on like a plaster and just forget about it and it's just less painful for them. F12G12_5 Only one child (with experience as a paediatric patient) viewed technique choice a doctor's role. Parental input was not considered by any group. I think the doctor should probably decide. F12G13_2 Outlier theme: drug and vaccine delivery Some children recognised the potential for MN-mediated drug and vaccine delivery, despite no prior information regarding this being provided. Maybe they could turn it into an injection like that, instead of taking it out. Maybe getting something that can put it in. M12G9_1 Discussion This work indicates an improved acceptance of MN-based monitoring in comparison to traditional blood sampling among participating children, building on findings by Birchall et al. which outline children as suitable MN candidates from adult perspectives,[24] albeit from a drug delivery focus. The pain and unacceptable appearance associated with traditional blood sampling lead to fear and disapproval. Contrastingly, a MN-mediated monitoring approach was appealing to all those involved, despite differences in their age, gender, medical background or school. This study provides us with the first initial indication of the views of children on MNs and confirms their preference MN-mediated monitoring above traditional blood sampling. The findings thus hold significant implications for future paediatric care by enabling the development of a child-approved approach to monitoring. Furthermore, this work provides a valuable insight for MN researchers seeking a patient acceptable design, therefore facilitating a smoother transition from lab bench into the clinical arena. Children (aged 10–14 years) of both genders attending various schools in Northern Ireland were included in the study. Schools were located in areas with a range of NIMDM scores, encompassing both the most and least deprived areas of Northern Ireland. The recruitment strategy introduced limitations since only children attending schools linked to the Pharmacists in Schools programme were eligible to take part. However, according to the NIMDM scores, this approach did enable fast access to a wide range of suitable participants from schools based in a range of social settings, based on the NIMDM scores. Although participants were predominantly female (74%), no gender differences were detected in the views held for the topics discussed. Furthermore, while it is acknowledged that the results obtained in this study may not be fully transferable to children with chronic conditions requiring regular monitoring, a substantial proportion of the participants in this work did have diagnosed medical conditions (25.6%) and were receiving regular medications (19.8%), thus indicating a reasonable level of healthcare experience within this sample. It is also acknowledged that the views of younger children were not gathered and it is possible that these could show differences. Providing information to the participants was not ideal, but this was considered unavoidable given the new topic under investigation. Furthermore, the need for this was supported by confirming the unfamiliarity of participants for this topic. Aware of the possible introduction of bias, information relayed was of a factual nature only and the MN visualisation was incorporated to greater facilitate the independent generation of ideas and opinions. Care was also taken to ensure this information was understood by simplifying explanations for this sample group and providing adequate time for clarification. Steps taken to further minimise bias included the use of the topic guide during discussions and the independent checking of transcripts was carried out by two separate investigators who did not work directly in the area of MN development. The identified unpopularity of blood sampling, reinforced by the unpopularity for ‘needle’ terminology, is not unexpected given that needle fears reportedly exist in 10% of the population,[52] and indeed, work exploring factors influencing adolescent blood donation found fear of needles a barrier to donation in almost a third of participants.[53] Undertones of pathological phobia were also evident among the present participants in their descriptions of nausea, sweating and avoidance behaviour. The main origins of this fear were related to expected pain and needle size, echoing similar findings of work by Nir et al.[54] The mere use of ‘needle’ in naming this alternative technique must therefore be recognised as an important barrier to acceptance. Clearly, those striving for MN end-user acceptance should seek a name with greater approval. Visual aspects often underpinned children's perceptions, outlining the importance of appearance during technique development. Children desired the removal of medical imagery, as exemplified by the sticking-plaster image and suggestions for personalised patch designs. Such preferences parallel that of public participants in previous exploratory research, who also preferred patch or plaster-type designs.[24] Interestingly, children's recommendations for an indicator and applicator were design issues discussed only by professionals in previous work.[24] It must be recognised that alternative blood extraction methods or traditional samplings with local anaesthesia still involve salient visual barriers, e.g. blood and needles, and thus inadequately address children's needs. The employment of a blood-free, minimally invasive technique seems, therefore, a superior approach in light of the findings. Education of the end-user was considered imperative, with knowledge deemed a weapon against fear. Education has also been found important in reducing apprehension regarding influenza vaccination,[54] in addition to needle-phobia management.[27,52] Adequate instruction of paediatric patients on techniques used on them should thus be imperative not only for MN use but also across healthcare scenarios. Children gave minimal consideration to parental involvement, with regard to both knowledge requirements and technique choice. Other studies, however, claim parents to have a significant influence on children's attitudes in a healthcare context.[55,56] Bhat-Schelbert et al. found that teenagers viewed parents influential to decision-making for influenza vaccination.[55] Furthermore, work regarding blood donations found over one-fourth of adolescents claimed parents influential on their choice.[53] In the present study, it is possible that participating children may have concealed their desires for parental input for reasons of social desirability as a consequence of the focus group setting.[44] HCP and previous healthcare experiences were found highly influential on participants' attitudes toward employed techniques. Similar associations have been noted for adolescent attitudes to vaccination.[55] This latter point highlights the importance of the HCP–patient relationship and implies that HCP opinions and behaviour could significantly impact on technique acceptance among paediatric patients. This research has important implications that arise for practice and research. Firstly, the work will aid the development of MN systems, which take the opinions of children into account. Those within the MN field should, however, note the widespread disapproval for the name ‘microneedle’. Those seeking the children's approval of MN-based technologies should seek an alternative name, which does not evoke associations with the traditional needle. Furthermore, this work suggests that the use of local anaesthetics and the use of minimally invasive techniques for blood extraction are insufficient to eliminate fear and gain approval in children, given the importance of appearance alongside pain minimisation. The work also identified a desire for greater involvement among children in healthcare decision-making, and improved understanding by patient education was viewed as a way to reduce anxiety. Clearly, this latter finding is relevant to all those involved in the health care of children. Conclusion Overall, this article indicates strong support for minimally invasive techniques with the unpopularity of traditional methods clearly prevalent. While judgements were made in the absence of actual MN application experience, good MN acceptance is expected among this group given the positivity of participants following visualisation. We report children's self-identified recognition of MN-based drug/vaccine delivery, indicating possible support for this application. The findings hold important implications for MN development, as proactively responding to children's preferences could enhance progression toward successful clinical use. We challenge those in the field to search for an alternative name to remove the ‘needle’ stigma. Adequately addressing children's preferences and concerns in health care could ultimately facilitate improved paediatric patient experiences. Since appearance was crucial to attitudes in these children, due attention should be given to appearance of all devices to be used on children. Furthermore, with this work highlighting children's desire for involvement, together with the recognised importance of patient involvement in modern health care,[57,58] the case is made to include children in decision-making on their care. Work is underway to ascertain views of paediatricians, given the identified importance of HCP to acceptance. Further work is also recommended to specifically examine views of children undergoing regular monitoring. Declarations Conflict of interest The Author(s) declare(s) that they have no conflicts of interest to disclose. Funding This work was partially funded by EPSRC grant EP/H021647/1. Authors' contributions KM assisted with study design, conducted the focus groups, carried out data analysis and drafted the initial manuscript. RFD conceived the idea, assisted with study design, supervised the project and critically appraised drafts of the manuscript. JCM assisted with study design, participated in project supervision and critically appraised drafts of the manuscript. All Authors state that they had complete access to the study data that support the publication. Acknowledgements We recognise the important contribution of all university staff involved in the Pharmacists in Schools project for facilitating the focus groups during their scheduled visits. Furthermore, we also wish to acknowledge the important contribution made by Helen McPhilips and Luc Belaid in assisting with communications with schools and by independently verifying transcripts for their consistency with the analytical findings. References Bhargav A , et al. Surface modifications of microprojection arrays for improved biomarker capture in the skin of live mice . ACS Appl Mater Interfaces 2012 ; 4 : 2483 – 2489 . 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Google Scholar PubMed OpenURL Placeholder Text WorldCat Appendix 1 The goal of the slide show during phase 2 was to introduce children to MN technology and their potential use for monitoring applications. Slides were colourful[43,59] and included diagrams to aid understanding. The verbal explanations accompanying each slide were tailored to the anticipated intellectual and developmental abilities of the different groups participating.[34] Slide No. . Title . Content . 1 Microneedle patches for monitoring – 2 This talk will explain: What microneedles are What monitoring is and why it is important How monitoring is usually carried out How microneedle patches could be used instead 3 What is a microneedle patch? Patch contains tiny tips No bleeding Painless 4 Microneedles Image showing a five pence coin and an array containing 121 microneedles 5 Look at actual microneedles Time allocated for MN viewing 6 What is monitoring? Collecting substances from the body to measure how much there is. Examples: medicines, substances in disease 7 What can be collected? Illustration depicting the skin and underlying tissue and blood vessels, with the presence of medicine indicated as within blood and tissue fluid. 8 Important for children Different doses of medicines … use monitoring Premature babies need monitored every day … but very little blood 9 How is monitoring normally done? Flow chart style image showing the traditional monitoring process: using a needle and collecting blood in sample tubes 10 Monitoring with microneedles Flow chart style image showing the monitoring process using MN 11 – Video showing MN application on human skin 12 – Video showing removal of MN from human skin Slide No. . Title . Content . 1 Microneedle patches for monitoring – 2 This talk will explain: What microneedles are What monitoring is and why it is important How monitoring is usually carried out How microneedle patches could be used instead 3 What is a microneedle patch? Patch contains tiny tips No bleeding Painless 4 Microneedles Image showing a five pence coin and an array containing 121 microneedles 5 Look at actual microneedles Time allocated for MN viewing 6 What is monitoring? Collecting substances from the body to measure how much there is. Examples: medicines, substances in disease 7 What can be collected? Illustration depicting the skin and underlying tissue and blood vessels, with the presence of medicine indicated as within blood and tissue fluid. 8 Important for children Different doses of medicines … use monitoring Premature babies need monitored every day … but very little blood 9 How is monitoring normally done? Flow chart style image showing the traditional monitoring process: using a needle and collecting blood in sample tubes 10 Monitoring with microneedles Flow chart style image showing the monitoring process using MN 11 – Video showing MN application on human skin 12 – Video showing removal of MN from human skin Open in new tab Slide No. . Title . Content . 1 Microneedle patches for monitoring – 2 This talk will explain: What microneedles are What monitoring is and why it is important How monitoring is usually carried out How microneedle patches could be used instead 3 What is a microneedle patch? Patch contains tiny tips No bleeding Painless 4 Microneedles Image showing a five pence coin and an array containing 121 microneedles 5 Look at actual microneedles Time allocated for MN viewing 6 What is monitoring? Collecting substances from the body to measure how much there is. Examples: medicines, substances in disease 7 What can be collected? Illustration depicting the skin and underlying tissue and blood vessels, with the presence of medicine indicated as within blood and tissue fluid. 8 Important for children Different doses of medicines … use monitoring Premature babies need monitored every day … but very little blood 9 How is monitoring normally done? Flow chart style image showing the traditional monitoring process: using a needle and collecting blood in sample tubes 10 Monitoring with microneedles Flow chart style image showing the monitoring process using MN 11 – Video showing MN application on human skin 12 – Video showing removal of MN from human skin Slide No. . Title . Content . 1 Microneedle patches for monitoring – 2 This talk will explain: What microneedles are What monitoring is and why it is important How monitoring is usually carried out How microneedle patches could be used instead 3 What is a microneedle patch? Patch contains tiny tips No bleeding Painless 4 Microneedles Image showing a five pence coin and an array containing 121 microneedles 5 Look at actual microneedles Time allocated for MN viewing 6 What is monitoring? Collecting substances from the body to measure how much there is. Examples: medicines, substances in disease 7 What can be collected? Illustration depicting the skin and underlying tissue and blood vessels, with the presence of medicine indicated as within blood and tissue fluid. 8 Important for children Different doses of medicines … use monitoring Premature babies need monitored every day … but very little blood 9 How is monitoring normally done? Flow chart style image showing the traditional monitoring process: using a needle and collecting blood in sample tubes 10 Monitoring with microneedles Flow chart style image showing the monitoring process using MN 11 – Video showing MN application on human skin 12 – Video showing removal of MN from human skin Open in new tab © 2013 Royal Pharmaceutical Society This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © 2013 Royal Pharmaceutical Society
TI - Children&s views on microneedle use as an alternative to blood sampling for patient monitoring
JF - International Journal of Pharmacy Practice
DO - 10.1111/ijpp.12081
DA - 2014-09-01
UR - https://www.deepdyve.com/lp/oxford-university-press/children-s-views-on-microneedle-use-as-an-alternative-to-blood-FyJvSTLIl2
SP - 335
EP - 344
VL - 22
IS - 5
DP - DeepDyve
ER -