Introduction: Meeting a Critical Need with Digital Mental Health
Anxiety remains one of the most common mental health challenges facing children in the United Kingdom. In economically disadvantaged areas, barriers such as long wait times, limited access to professionals, and digital exclusion can widen gaps in care. This mixed-methods study examines Lumi Nova: Tales of Courage, a digital mental health intervention designed to help children aged 7–12 manage anxiety through psychoeducation and graded exposure, delivered as a mobile game-based experience. The aim was to assess usability, acceptability, and feasibility of implementing Lumi Nova in settings serving economically disadvantaged families, with an eye toward informing a future randomized trial.
What is Lumi Nova and why it matters for disadvantaged populations?
Lumi Nova is a Class 1, low-risk digital therapeutic developed to provide timely, evidence-informed support for anxiety in children. Its CBT-based approach centers on psychoeducation and exposure therapy, integrated into immersive gameplay to reduce stigma and increase engagement. The intervention is designed for home use, with real-time progress data shared with professionals for monitoring. This study specifically tested Lumi Nova’s deployment within two regions in the Northwest of England, targeting households in the lowest deprivation deciles and families eligible for free school meals.
Methods in Brief: A Pragmatic Mixed-Methods Design
The study combined quantitative data on recruitment, access, usage, and outcome measures with qualitative insights from children, parents, and professionals. In total, 113 children aged 7–12 were enrolled, with 98 accessing Lumi Nova and completing a range of in-game and out-of-game exposure tasks. Semistructured interviews with 11 professionals, 7 children, and 7 parents explored usability, acceptability, and potential barriers and enablers to uptake. Data collection followed CONSORT guidelines and drew on the AMUsED framework for usage and engagement in digital interventions.
Key Findings: Access, Engagement, and Early Signals
Access to Lumi Nova was high: 87% of eligible families accessed the intervention on smartphones or tablets. Usage varied, with a median of three challenges completed, and nearly half of participants engaging with more than three in-game challenges. Real-world exposure tasks were less consistently completed but showed promise for translating digital learning into real-life coping strategies.
Outcome data suggested a pattern consistent with graded exposure: pre-, post-, and future worry scores tended to decrease after challenges, with future worries often lower than pre-challenge levels. Parents reported improvements in their child’s anxiety on the Child Outcome Rating Scale (CORS), with 73% indicating some positive change. Importantly, engagement with psychoeducation and exposure content correlated with better parent-reported outcomes, highlighting the value of the therapeutic core of Lumi Nova in this population.
Usability, Acceptability, and Real-World Implications
Qualitative analyses revealed that Lumi Nova was generally usable and acceptable to children from economically disadvantaged backgrounds and their families. Many participants expressed a desire to continue beyond the eight-week access period, underscoring perceived value and acceptability. Practitioners and parents noted that Lumi Nova supports self-management and may reduce reliance on repeatedly scheduled in-person visits, offering a potential route to lighter-touch care in stretched health systems.
Several practical themes emerged: the need for multi-device access across households, caregiver involvement to sustain engagement, and alignment with school-based or educational settings to broaden reach. The research team adapted Lumi Nova during the study, incorporating user feedback into newer versions to improve accessibility, navigation, and readability. While the study did not establish clinical effectiveness, the observed engagement patterns and positive qualitative feedback support continued investigation in a larger trial with a robust design.
Limitations and Future Directions
Limitations include a relatively small, in-scope sample and a delivery model that relied on practitioner involvement. Results may not generalize to all economically disadvantaged communities, especially those with different language needs or digital literacy levels. The study emphasizes the need to identify an optimal digital dose and to explore standalone, hybrid, and practitioner-led delivery models to maximize reach and impact. Future research should prioritize diverse recruitment, longer follow-up, and rigorous clinical outcomes alongside implementation assessments.
Conclusion: A Feasible, Acceptable Step Toward Scalable Support
In a context of high demand and finite resources, Lumi Nova demonstrates feasibility and acceptability for children in economically disadvantaged areas. The intervention’s design—combining psychoeducation, graded exposure, and patient-facing progress data—appears well-suited to home-based delivery and potential integration with schools and primary care. The positive signals regarding engagement and parent-reported outcomes warrant further, more definitive evaluation to determine clinical effectiveness and optimal delivery models for digitally enabled mental health support.
