87 Development and evalutation of the Hospital Hero app 4 costs. The prototypes embodied the essential user interactions. Assumptions on user interaction and user experience were formulated a priori. The prototypes and the assumptions were tested with children and caregivers at the outpatient clinic of the Willem-Alexander Children’s Hospital in Leiden, the Netherlands, during two observation days. Children who had an appointment during the testing days were selected following purposive sampling to ensure a variation in gender, age (between 4 and 10 years old), type of visit and prior hospital experience. A letter was sent to all participants two days prior to the observation day to test the entire concept, including the process taking place at home (i.e., informing children and caregivers about the app, preparing for the visit with the app), and to provide a realistic experience. The letter included a QR code with which the participants could download the app and a form on which caregivers could indicate their interest to participate in the study. Two of the eight invited caregivers indicated that their child did not experience stress or anxiety. In total, six caregivers and eight children participated in the prototype testing day. This number was deemed sufficient to test the assumptions (21). During the prototype testing day, observations were held, followed by a short semi-structured interview with the child and caregiver. The interviews were guided by a topic list covering the a priori assumptions. Phase 2: prototype – iteration 2 Findings from the prototype testing were discussed with the development team. A list of necessary features was drafted and translated into user stories (i.e., stories describing the needed functionality from a user’s perspective) which were used to guide and prioritize the development process. A working prototype was developed, which included essential features for the app and acted as a real app (e.g., user interaction, navigation, visual designs). Due to COVID-19 measures, the prototype could not be tested at the outpatient clinic. Instead, a hospital setting was built in an external setting where a hospital visit was simulated (e.g., waiting room, consultation room). Children from the development team’s social network were invited for the simulation testing day. The aim of the test was to evaluate user-interactions with the app (e.g., can the user navigate through the app, are there functionalities the user does not understand) and basic user-experiences (e.g. does the user enjoy key activities in the app such as selecting a favourite animal, what does the user like/ dislike). Therefore, it was not necessary that the children visited the outpatient clinic and/or had any hospital experience. Two developers observed how the participants performed. An observation list was used to take notes on users’ errors/problems and users’ expressions for each task. Findings were discussed with the development team and used to identify necessary features and improvements. Phase 3: realize Improvements were made and the app’s functionalities and design were further refined based on input from the development team. This resulted in a first version (minimum viable product, MVP) of the Hospital Hero app ready to be pilot-tested and evaluated further in practice.
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