37 Design of the persuasive game ‘Ademgenoot’ 2 Phase 2: Ideation Insights from phase 1 were translated into personas. Personas are used to better understand the needs, goals and behaviours of different user groups and create solutions that tailor to those needs (40). Personas included background information (i.e., short biography to give each persona more depth), everyday challenges with asthma self-management, asthma medication beliefs and behaviours, personal goals regarding their asthma-related health and opportunities for design. Personas were used as illustrative scenarios in ideation sessions. Multiple ideation exercises were held with user-centred designers to spark creative thinking, envision a solution, and explore various design directions. Design directions were discussed with an expert on behaviour change strategies and a persuasive game design expert (author VV), which led to a number of design and game requirements (i.e. criteria, constraints, and specifications that a product, system, or service must meet in order to fullfill its intended purpose and meet the needs of its end-users). Design and game requirements were translated into the final design concept. Phase 3 and 4: prototype and formative evaluation – iteration 1 The concept was translated to a paper-prototype (i.e., a physical representation of the design) to easily gather user feedback and make changes to the design as needed. This helped to improve the overall user experience and ensure that the final product or service is well aligned with user needs and preferences. The paperprototype consisted of the different screens that the end-users would interact with. User feedback sessions were held with people with mild asthma. We estimated the number of participants based on guidelines for user testing. Five participants generally find 80% of all usability problems in prototype testing (41). During the userfeedback sessions, participants were introduced to the concept, and a step-by-step scenario was used to let the participant walk through all the elements of the concept. Participants were asked to verbalize their thoughts and reasoning. This “think aloud” method allowed the researchers to continuously capture feedback, with participants describing their actions and immediate thoughts for each step. After the walk-through, participants were asked to rate their level of agreement with self-developed statements developed specifically for this study, regarding usability and usefulness on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree), for example, “I would find the app useful in managing my inhaler use”. The feedback sessions were audio-recorded. Recordings were transcribed and analysed using content analysis to determine usability and user preferences and identify further improvements. Insights from the feedback sessions were discussed with smart inhaler developers. Input was gathered on technical feasibility (i.e., does the concept require new technical functionalities to be developed) and commercial feasibility (i.e., does the concept add to the market value of existing smart inhalers). Healthcare professionals were asked to comment on accuracy, feasibility, and their overall opinion on the expected impact on medication adherence. Feedback was collected and used in combination with the
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