76 Chapter 3 in hospital care, research and policy. This game was developed in cocreation with adolescents through three different steps: (1) identification of the most important themes for adolescents in health care and finding out preferences for patient engagement, (2) development and evaluation of the game and (3) test the game usability in clinical practice. Methods An user-centred design, as described in the literature by Gulliksen et al., [25], was used. Key principles of an user-centred design include user-focused and active user involvement throughout the entire development process. These principles were guaranteed by actively involving all representative users, including adolescents with a chronic condition, clinicians, researchers, the Patient Alliance for Rare and Genetic Diseases (VSOP), the Dutch Childhood Cancer Organization (VKN) and a youth panel of Fonds NutsOhra (FNO). This youth panel consists of adolescents with a chronic condition, who contributed with ideas and suggestions to several projects aiming to improve social engagement in health care. All representative users were involved in all phases of the design process - from writing the project plan to the final version of the game. Other principles, such as prototyping and evaluate use in context, were applied by developing, testing, and continuously adapting the draft versions of the game. In addition, the draft versions were tested at every stage of the development process with the end-users in a real-life context. For the development and design of the game, we collaborated with design agency Studio Dam (professional attitude – www.studiodam.nl). The development of the patient engagement game was an iterative process consisting of three steps (Figure 1): 1. Identification of import themes for adolescents regarding their illness, treatment, hospital care, and influence on daily life and preferences for an engagement game. The identified themes will serve as a starting point for the development of the patient engagement game. 2. Evaluation of the draft version of the game 3. Testing usability in clinical practice
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