79 Development of a patient engagement tool; All Voices Count Step 3: Testing usability in clinical practice The third step involved usability testing of the pilot version of the game. In this field test, a pilot workshop was held with patients from the educational facility (educational support service for patients and their parents) of the Emma Children’s Hospital Amsterdam UMC. Participating patients were recruited via clinicians of the educational facility in April 2018. During the 90-min pilot workshop the game was played with the adolescents to answer a question from the educational facility: ‘What can the educational facility do (even more) for you to ensure that things go even better at school?’. Afterwards, adolescents were asked to evaluate the engagement game using traffic light colours and were asked for suggestions for improvement. The result was that insight was gained into the usability of the engagement game and a list of improvements was obtained for the game, which was used to develop a final version of the game. For all steps, participating adolescents and their parents (for adolescents <16 years) provided written informed consent and a sociodemographic questionnaire (i.e., age, gender, type of chronic disease) was completed by parents. Participants received a gift card (with an amount of 10 euro) and compensation for their travel expenses. Additionally, all focus groups, interviews and the pilot workshop were audio-recorded, transcribed verbatim, and analysed in MAXQDA [29] following the methodology for thematic analysis [30]. The focus groups, interviews, and pilot workshop were conducted by two members of the research team. These members have been trained in conducting qualitative research. Results The results are reported for every step of the development process. In total, 23 adolescents (range: 12-18 years, 57% female) participated in the cocreation of the patient engagement game, of whom nine adolescents participated in multiple steps (Table 1). 3
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