88 Chapter 3 The next step is a further distribution and implementation of All Voices Count in other children’s hospitals and rehabilitation centres in the Netherlands. Our goal is to bring All Voices Count to the attention of professionals working in different areas within the health care sector. We will therefore present All Voices Count at international conferences and to policymakers and division boards of hospitals in the Netherlands. Furthermore, we train clinicians in how to use the game and in the way in which they can use the results obtained in their daily clinical care, research or policy. To be able to deploy the game widely, we recently translated the Dutch version of All Voices Count into English. The strengths of the user-centred design used in this study were that it provided insight into the perspective of the users and that it facilitated new ideas, so that it meet the needs of the users [25,37]. Especially, the input from adolescents was very valuable to us during the development process. Adolescents thought critically about the game and came up with valuable suggestions to improve the game. All Voices Count has been tested in a real-life context, making it usable and appropriate to the cultural context, and it increases the chances of a successful implementation [25,38]. Challenges or limitations in our user-centred design were the degree of influence and control of the participants and the representativeness [17]. While adolescents were involved throughout all phases of the development process, the research team included researchers, clinicians, representatives of a youth panel and patient associations, reviewed the final version. Regarding the representativeness, we invited adolescents with different chronic conditions to participate in this study. Now, during the evaluation of the pilot version of the game, only adolescents with cancer participated, which may have limited the representativeness of our study. However, this study showed that adolescents, regardless of their chronic condition, showed the same problems and supportive factors; therefore, we do not believe that this has influenced the results. Furthermore, earlier research showed that paediatric patients willing to participate in codesign studies tend to be more self-confident, critical and assertive adolescents, which can further hinder representativeness [17,39]. Finally, we tried to include the same adolescents in several steps of the development process to give them the opportunity to be a part of the project and to hear their views on the changes that were made based on their feedback. The engagement of adolescents multiple times can have advantages such as adolescents can express their views on the changes made to the game and are well-informed, and disadvantages like adolescents can express views that are a bit more one-sided, and fewer new ideas. During the different steps of the development process, we therefore included adolescents that did not participate in earlier steps as adolescents that participated in earlier steps.
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