101 Development and evalutation of the Hospital Hero app 4 Table 3. Design recommendations by children and parents Age differentiation • Content differentiation for younger children (between 4 and 7 years old) and older children (between 7 and 12 years old) • Spoken text for younger children • Quiz or challenges for older children • More reward elements (e.g. reward tokens to ‘ purchase’ clothes for the animals’ Usability • Cue that all animals are collected and step is completed • Notification that animal can be found in another room • Interactive instruction screens • More clear instructions on how to use and navigate app for younger children • Automatic play of video’s Tailored and immersive journey • Possibility to select route or procedure • Possibility to indicate first visit or follow-up visit • Storyline stronger integrated within app and physical world Other recommendations • Distraction during blood drawing procedure • Include more smaller games • Make QR codes more appealing (e.g. integrate the animal theme) Discussion This paper described the development and evaluation of an eHealth solution to reduce pre-procedural stress and anxiety following a PD service design approach, which resulted in the Hospital Hero app. The Hospital Hero app guides children in their journey to and through the hospital. By helping children prepare in their familiar environment in a fun and appealing way through gamification, the Hospital Hero app engages and empowers children and informs them about medical procedures. Children can continue their journey at the hospital by searching and collecting animals through QR code scanning, creating an overall more positive and engaging experience. The pilot study of the Hospital Hero app in practice showed that the app is positively evaluated on usability and user-experience and is considered feasible. We adopted a PD approach, involving children, caregivers, healthcare professionals, and other stakeholders throughout the process. This approach allowed us to develop a novel intervention that is child-centred, takes into account the perspective of child, caregiver and healthcare professional and integrates state-of-the-art knowledge from all stakeholders (i.e. knowledge on procedural comfort, children, education,
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