40 Chapter 2 2 knowledge regarding the distinction between the maintenance and reliever inhaler, as well as fear of potential side effects (e.g., sore throat), they associated with the use of inhaled corticosteroids (ICS). Three participants expressed a desire for more information about the difference in effect between the different inhalers. This need for more information was reinforced by the results of the online survey in which 50% of all respondents agreed or completely agreed with the statement “I would like to have more knowledge about the effect of my medication”. None of the participants were familiar with EDMs. However, when asked if insight into their inhaler use and symptoms would help them gain a better understanding of how inhaler use can help in controlling their asthma, the majority of the participants affirmed the potential benefits. They clarified that seeing trends between medication use and asthma control would help them understand how proper inhaler use can facilitate asthma control. Two participants also indicated that they also would like to have more insight in their triggers. Based on the aforementioned findings, eight behavioural change techniques were identified which were mapped onto the TTM to identify the stage in which the technique should intervene. Behaviour change techniques were: i) motivational interviewing, ii) patient education, iii) personal goal setting, and iv) commitment to support contemplation, v) feedback on inhaler usage behaviour, vi) self-monitoring of behaviour, and vii) self-monitoring of asthma control to support action; and viii) evaluation moments to support maintenance. Phase 2: ideation Five personas were created (see Appendix 2 for an example) and used to identify three design directions each focusing on a separate stage within the TTM (see Appendix 3 for the three design directions and the different ideas). A discussion meeting of the three design directions with an expert on persuasive game design and behaviour change led to the formulation of design requirements (see Table 1). Game requirements were deducted from persuasive game design theory to ensure that the persuasive game is fun, engaging and effective in promoting adherence to maintenance inhalers. These included that the game must be rewarding if the desired behaviour is carried out, visualize the effects of medication use, create an overview of medication use over time and be entertaining to engage with (see Table 1). Final concept – Ademgenoot The desired design and game requirements were translated into a serious game concept ‘Ademgenoot’. The name of the concept was based on a wordplay of the Dutch words “Ademnood” (Breathlessness) and “genoot” (Buddy). Using automatic data logging with an EDM to detect inhaler use and narrative game-elements, Ademgenoot aims to motivate people with mild asthma to adhere to their prescribed maintenance medication treatment. Ademgenoot does so by focusing on the positive effects of taking the daily maintenance medication. Moreover, the application gives the patients the opportunity to try-out the daily intake of their medication as prescribed,
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