Using Animation to Self-Report Health: A Randomized Experiment with Children

  • Carla GuerrieroEmail author
  • Neus Abrines Jaume
  • Karla Diaz-Ordaz
  • Katherine Loraine Brown
  • Jo Wray
  • Joan Ashworth
  • Matt Abbiss
  • John Cairns
Original Research Article



The Child Health Utility-9D (CHU-9D) is the only generic preference-based measure specifically developed to elicit health-related quality of life directly from children aged 7–11 years. The aim of this study was to investigate whether the use of animation on a touch screen device (tablet) is a better way of collecting health status information from children aged 4–14 years compared to a traditional paper questionnaire. The specific research questions were firstly, do young children (4–7 years) find an animated questionnaire easier to understand; secondly, independent of age, is completion of an animated questionnaire easier for sick children in hospital settings; and thirdly, do children’s preferences for the different formats of the questionnaire vary by the age of the child.


Using a balanced cross-over trial, we administered different formats of the CHU-9D to 221 healthy children in a school setting and 217 children with health problems in a hospital setting. The study tested five versions of the CHU-9D questionnaire: paper text, tablet text, tablet still image, paper image and tablet animation.


Our results indicated that the majority of the children aged 4–7 years found the CHU-9D questions easy to answer independent of the format of the questionnaire administered. Amongst children aged 7–14 with health problems, the format of questionnaire influenced understanding. Children aged 7–11 years found the tablet image and animation formats easier compared to text questionnaires, while the oldest children in hospital found text-based questionnaires easier compared to image and animation.


Children in all three age groups preferred animation on a tablet to other methods of assessment. Our results highlight the potential for using an animated preference-based measure to assess the health of children as young as 4 years.



The study described in this work would have not been possible without the attention and enthusiasm of the children and without the help of their teachers. The authors are very grateful to the directors of the schools participating in the project: Queensbridge Primary School and Reepham High School and the clinical team of Great Ormond Street Hospital who helped with the recruitment in the hospital setting.

Author Contributions

JC and CG conceived the idea for the study. All authors contributed to the design and planning of the study. CG and KD-O performed the statistical analyses. CG wrote the first draft of the manuscript. All authors have revised the manuscript critically. All authors have given their final approval of the version to be published, and are responsible for the overall content.

Compliance with Ethical Standards


This work was supported by the Medical Research Council (Grant number MR/K00624X/1). The Medical Research Council played no role in the design or conduct of the study.

Conflict of interest

Guerriero, Abrines Jaume, Diaz-Ordaz, Brown, Wray, Ashworth, Abbiss and Cairns have no conflicts of interest that are directly relevant to the content of this article.

Ethics approval

The study “Childspla” received the Ethical Approval of the London School of Hygiene and Tropical Medicine Ethical Committee.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Università degli Studi di Napoli Federico IINaplesItaly
  2. 2.London School of Hygiene and Tropical MedicineLondonUK
  3. 3.Great Ormond Street Hospital for Children, NHS Foundation TrustLondonUK
  4. 4.Institute of Cardiovascular ScienceUniversity College LondonLondonUK
  5. 5.Animation, Royal College of ArtLondonUK

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