Online environmental scan and content analysis of social stories about needle procedures

Needle procedures are often difficult for autistic children. Preparatory education is an evidence-based strategy that is especially important for autistic children given they commonly struggle with unpredictability. Carol Gray developed Social Stories to walk autistic children through new/challenging situations step-by-step. Although needle-related Social Stories exist online, no research has investigated whether their content aligns with best practices for needle pain and fear management and Gray's guidelines for Social Story development.

This study aimed to characterize the content of online Social Stories about vaccination and venipuncture. Specifically, the degree to which Social Stories (a) depict evidence-based/helpful and unhelpful coping strategies, (b) follow Gray's guidelines, and (c) depict accurate procedural steps, was examined in an exploratory manner.

An online environmental scan (systematic method of collecting and synthesizing information) characterized the content of Social Stories. A Google search was conducted, including free, English-language stories. After screening, two coders conducted deductive content analysis (>80 codes) with the sample of 82 eligible Social Stories; frequency statistics and quotes were derived.

Most Social Stories focused on vaccination (89%). Social Stories commonly conveyed evidence-based strategies (e.g., 70% depicted distraction), accurate procedural information (e.g., >80% depicted step of needle insertion), and followed Gray's guidelines (e.g., 90% had meaningful titles). Several areas for improvement exist, including allowing for user customization and depicting less commonly shown evidence-based strategies like topical anesthetics.

Social Stories may have utility for supporting autistic children and their caregivers through needle procedures. Examining effectiveness/outcomes of usage is a future research avenue.