Introduction: eHealth seems promising in addressing challenges in the provision of care for Huntington’s disease (HD) across Europe. By harnessing information and communication technologies, eHealth can partially relocate care from specialized centers to the patients’ home, thereby increasing the availability and accessibility of specialty care services beyond regional borders. Previous research on eHealth (development) in HD is however limited, especially when it comes to including eHealth services specifically designed together with HD gene expansion carriers (HDGECs) and their partners to fit their needs and expectations. Methods: This article describes the qualitative human-centered design process and first evaluations of the Huntington Support App prototype: a web-app aimed to support the quality of life (QoL) of HDGECs and their partners in Europe. Prospective end-users, i.e., HDGECs, their partners, and healthcare providers (HCPs), from different countries were involved throughout the development process. Through interviews, we captured people’s experiences with the disease, quality of life (QoL), and eHealth. We translated their stories into design directions that were further co-designed and subsequently evaluated with the user groups. Results: The resulting prototype centralizes clear and reliable information on the disease, HD-related news and events, as well as direct contact possibilities with HCPs via an online walk-in hour or by scheduling an appointment. The app’s prototype was positively received and rated as (very) appealing, pleasant, easy to use and helpful by both HDGECs and partners. Discussion: By involving end-users in every step, we developed a healthcare app that meets relevant needs of individuals affected by HD and therefore may lead to high adoption and retention rates. As a result, the app provides low-threshold access to reliable information and specialized care for HD in Europe. A description of the Huntington Support App as well as implications for further development of the app’s prototype are provided.

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Despite the growing potential of artificial intelligence (AI) in improving clinical decision making, patients' perspectives on the use of AI for their care decision making are underexplored. In this paper, we investigate patients' preferences towards the autonomy of AI in assisting healthcare decision making. We conducted interviews and an online survey using an interactive narrative and speculative AI prototypes to elicit participants' preferred choices of using AI in a pregnancy care context. The analysis of the interviews and in-story responses reveals that patients' preferences for AI autonomy vary per person and context, and may change over time. This finding suggests the need for involving patients in defining and reassessing the appropriate level of AI assistance for healthcare decision making. Departing from these varied preferences for AI autonomy, we discuss implications for incorporating patient-centeredness in designing AI-powered healthcare decision making.

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In this article we describe how designers can apply storytelling to reduce health-related stigmas. Stigma is a pervasive problem for people with illnesses, such as obesity, and it can persistently hinder coping, treatment, recovery, and prevention. Reducing health-related stigma is complex because it is multi-layered and self-perpetuating, leading to intertwined vicious circles. Interactive storytelling environments can break these vicious circles by delimiting the narrative freedom of stigma actors. We theoretically explain the potential of interactive storytelling environments to reduce stigma through the following seven functions: 1) expose participants to other perspectives, 2) provide a protective frame, 3) intervene in daily conversations, 4) persuade all stigma actors, 5) exchange alternative understandings, 6) elicit understanding and support for stigma victims, and 7) support stigma victims to cope with stigmatization. We elaborate on these functions through a demonstration of an interactive storytelling environment against weight stigma. In conclusion, this article is a call on designers for health and wellbeing, scientists, and practitioners from various disciplines to be sensitive to the pervasiveness of stigma and to collaboratively create destigmatizing storytelling environments.@en

Background: Medical procedures can cause considerable stress and anxiety among children. Current interventions mainly diminish stress and anxiety during procedures, while stress and anxiety often build up at home. Moreover, interventions often focus on either distraction or preparation. eHealth can combine multiple strategies and provide a low-cost solution that can be used outside the hospital. Objective: To develop an eHealth solution to diminish preprocedural stress and anxiety, and to evaluate the app on use, usability and user experience in practice. We also aimed to gain in-depth insights in children's and caregivers' opinions and experiences to inform future improvements. Methods: This is a multi-study report on the development (Study 1) and evaluation (Study 2) of a first version of the developed app. In study 1 we adopted a participatory design approach in which children's experiences were central to the design process. We performed an experience journey session with stakeholders (n = 13) to map the child's outpatient journey, identify pains and gains, and formulate the desired experience journey. Iterative development and testing with children (n = 8) and caregivers (n = 6) resulted in a working prototype. The prototype was tested with children, resulting in a first version of the Hospital Hero app. The app was evaluated on use, user-experience and usability during an eight-week pilot study in practice (Study 2). We triangulated data from online interviews with children and caregivers (n = 21) and online questionnaires (n = 46). Results: Multiple stress and anxiety experience touchpoints were identified. The Hospital Hero app supports children in their hospital journey by facilitating preparation at home and providing distraction at the hospital. The pilot study showed that the app was evaluated positively on usability and user-experience and is considered feasible. Qualitative data showed five themes: (1) user-friendliness, (2) coherence and power of storytelling, (3) motivation and reward, (4) fit with real hospital journey, (5) procedural comfort. Discussion: Using participatory design, we developed a child-centered solution that supports children in the entire hospital journey and may diminish preprocedural stress and anxiety. Future efforts should create a more tailored journey, define an optimal engagement window and formulate implementation strategies.

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For health and environmental reasons, humanity should reduce the consumption of animal-based products, whereas vegetable consumption should be increased. We created stimuli (drawings with texts) that may be able to increase or decrease the purchasing of mushrooms, cheese, and meat. During the design process, we identified four aspect categories (sensory, health, environment, moral) and we generated positive and negative examples for all products. In Study 1 we determined the familiarity, credibility and relevance of each aspect and measured emotional responses to them. In Study 2, we investigated to what extent four aspects combined in an infographic on a poster lessened or strengthened the emotional responses, purchase intention, and tendency to adapt behavior for the three products. Regression analyses showed that the emotional responses to the posters were well predicted by the responses to the product aspects. Purchase intentions were mainly affected by negative affect, while positive and negative affect seemed equally important for people’s intention to change behavior.

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Weight-related stigma’s have an negative health effect on the stigmatized. To reduce stigma, it is essential to create awareness and discuss the underlying beliefs and consequences. The problem is that people avoid talking and thinking about it. To solve this we designed a storytelling space by means of a game (‘Ball & Stick’) for community centres in vulnerable neighbourhoods. The game consists of a gameboard and a mobile application that verbally guides the players through the storytelling space by narrated stories and discussion tasks. During the game, the players are confronted with stigmatizing situations that people with obesity encounter. The stories used in the game were created by an iterative co-creative research-through-design method that alternated between collecting, reflecting upon, and adjusting stigma related stories. Study results at community centres (N = 22 in five groups) showed that all participants reported high or medium narrative transportation, (18) had personal similar experiences (19) indicated that the game raised their awareness, for (16) the game made it easier to talk about obesity and for (12) the game changed their attitude towards people with obesity. Our game demonstrated that interactive storytelling is a powerful tool to reach and motivate people to become aware and reflect upon and discuss stigmatizing behaviour. This is likely to be generalizable to other tabooand stigma-related subjects such as differences and inequality in gender, income, culture, immigration, religion, and mental health. Follow-up research is needed to set the next step from stigma awareness and discussion towards a behavioural change. @en

Zware mensen hebben vaak te maken met vooroordelen. Hier kun je iets aan doen door erover te praten, maar dat is moeilijk. Welke taal gebruik je dan? Er is nu een spel dat hierbij helpt. Het werd bekroond tijdens het DRONGO talenfestival@en

Background: Huntington's disease (HD) is an autosomal dominant neurodegenerative disease that affects the quality of life (QoL) of HD gene expansion carriers (HDGECs) and their partners. Although HD expertise centers have been emerging across Europe, there are still some important barriers to care provision for those affected by this rare disease, including transportation costs, geographic distance of centers, and availability/accessibility of these services in general. eHealth seems promising in overcoming these barriers, yet research on eHealth in HD is limited and fails to use telehealth services specifically designed to fit the perspectives and expectations of HDGECs and their families. In the European HD-eHelp study, we aim to capture the needs and wishes of HDGECs, partners of HDGECs, and health care providers (HCPs) in order to develop a multinational eHealth platform targeting QoL of both HDGECs and partners at home. Methods: We will employ a participatory user-centered design (UCD) approach, which focusses on an in-depth understanding of the end-users' needs and their contexts. Premanifest and manifest adult HDGECs (n = 76), partners of HDGECs (n = 76), and HCPs (n = 76) will be involved as end-users in all three phases of the research and design process: (1) Exploration and mapping of the end-users' needs, experiences and wishes; (2) Development of concepts in collaboration with end-users to ensure desirability; (3) Detailing of final prototype with quick review rounds by end-users to create a positive user-experience. This study will be conducted in the Netherlands, Germany, Czech Republic, Italy, and Ireland to develop and test a multilingual platform that is suitable in different healthcare systems and cultural contexts. Discussion: Following the principles of UCD, an innovative European eHealth platform will be developed that addresses the needs and wishes of HDGECs, partners and HCPs. This allows for high-quality, tailored care to be moved partially into the participants' home, thereby circumventing some barriers in current HD care provision. By actively involving end-users in all design decisions, the platform will be tailored to the end-users' unique requirements, which can be considered pivotal in eHealth services for a disease as complex and rare as HD.

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This article describes a user-centered design experiment investigating positive and negative effects of adding game rules to brainstorms. We studied effects on brainstorm output and user experience and behavior. A coin-based gamification was developed with rules intended to improve brainstorm output in relation to quality and quantity of ideas. However, the invasiveness of a gamification can be expected to affect users both positively and negatively. To find an optimum between positive and negative effects of gamification invasiveness, we tested 5 different rule-sets with varying quantity and quality of rules. The results demonstrated that game rules stimulating competitive game behavior improved the quantity and quality of brainstorm output. Yet the invasiveness of the gamification also hindered this positive effect, due to discussions about rules and mandatory game behavior. From these results we deduced 3 types of invasiveness evoked by the rules’ qualities: a) governing rules led to negative cognitive invasiveness, b) forcing rules caused positive as well as negative behavioral invasiveness, and c) adding coins may have led to positive affective invasiveness (i.e., a playful attitude). We conclude our study with recommendations on designing and researching gamification invasiveness in real-life contexts.

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In this article, we aim to provide insights into the design and implementation of game elements for teamwork on the work floor and to study their effect. Inventing games to break monotonous jobs is a long-standing practice, yet conscious implementation of motivational elements of games at work is a recent phenomenon. Generally, gamification is used to enhance individual performance; it may be effective in enhancing teamwork as well. We developed game elements aimed at team cohesion and examined the effect of two gamified interventions (team performance feedback and personal profiles) on team cohesion in a factory. Results suggest that the interventions mainly raised attention toward the aspects of the work that were explicitly addressed. Team performance feedback led to increased task commitment and perceived team performance, while personal profiles increased nonwork-related conversations among team members. We conclude with lessons learned regarding the development and study of gamified interventions for teams on the work floor.@en

The possibilities of applying game elements for positive behavior change in non-game contexts (i.e. gamification) seem limitless, ranging from politics to treatment of mental illness. However, the number of applied gamification studies is still limited. Our research (part of CRISP G-Motiv) aimed to contribute to the knowledge about designing and applying game elements for teamwork. First, we defined four basic design components that constitute a ‘gameful’ experience (i.e. feeling as if playing a game): goals, rules, objects, and freedom. Next, we explored the application of game elements in two lab- and two field experiments. In the lab, we developed a multiplayer computer game to examine the effect of different rules on interdependent behavior and we developed a physical game with coins to investigate the effect of different rule-sets on output in group-brainstorm meetings. In the field, we implemented and investigated the effect of gamified interventions to improve the cohesion within the operating teams of a strip-galvanizing factory and at a consultancy firm, we developed and tested a game with coins to change the attitude of participants of ‘red team’ meetings. The results of these studies showed that in teamwork, game elements seem mainly valuable for raising attention and changing goal-driven behaviors and experiences. In order to design and research a gamification that positively influences teamwork it is important to consider: 1) the above-mentioned four basic design components and 2) to what extent they pervade in the emotions, attention, and behavior of team members. @en

Serious gaming is used as a means for improving organizational teamwork, yet little is known about the effect of individual game elements constituting serious games. This paper presents a game design experiment aimed at generating knowledge on designing game elements for teamwork. In previous work, we suggested that interaction- and goal-driven rules could guide interdependence and teamwork strategies. Based on this finding, for the present experiment we developed two versions of multiplayer Breakout, varying in rule-sets, designed to elicit player strategies of either dependent competition or dependent cooperation. Results showed that the two rule-sets could generate distinct reported player experiences and observable distinct player behaviors that could be further discriminated into four patterns: expected patterns of helping and ignoring, and unexpected patterns of agreeing and obstructing. Classic game theory was applied to understand the four behavior patterns and made us conclude that goal-driven rules steered players towards competition and cooperation. Interaction rules, in contrast, mainly stimulated dependent competitive behavior, e.g. obstructing each other. Since different types of rules thus led to different player behavior, discriminating in game design between interaction- and goal-driven rules seems relevant. Moreover, our research showed that game theory proved to be useful for understanding goaldriven rules.@en

Using robots to reward and stimulate children doing tasks together can be helpful in improving their social skills. Robots implemented 3 types of behavior scenarios - imitate, enhance and counteract - in a collaborative game of teaching robots perform movements shown by hand gestures. The paper presents a novel account of ASD symptoms based on the interplay of empathic concern and empathic accuracy in different personalities with and without cognitive deficits. Performance of autistic children was compared with two age groups of typically developing children - under and above the age of 7. The study confirmed the limited resource hypothesis - cognitive and motivational - bringing about the observed phenomena in situations of limited attention resources and performance under distraction. The robotic framework for educating children has shown potential for developing of various complex cognitive and social skills and has substantial developmental impact.

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