44 Chapter 2 2 Evaluation Overview Medication Use and Asthma Control After six weeks, users are provided a report that displays their maintenance inhaler usage, reliever inhaler usage, triggers, and level of asthma control. The report serves as a tool to identify trends and assess the impact of increased adherence to their maintenance inhaler on asthma control. Phase 3 and 4: prototype and evaluation – iteration 1 Feedback on the paper prototype (see Figure 3) was obtained from four people with mild asthma who had not participated in previous activities. This number was deemed sufficient to identify major issues on usability (43,44). Overall, the participants enjoyed the games and the six-week challenge. They appreciated the ability to set a personal goal. However, two participants mentioned finding it difficult to think of one. The commitment to the challenge itself was motivating enough for them to start using Ademgenoot. One participant suggested to incorporate more daily goals, such as cycling to work without feeling out of breath, rather than linking the goal to a specific event (e.g., entering a sporting competition). Some participants preferred a weekly overview instead of updates every three days. While two participants considered the cloud character Brad to be childish, the other two felt affection for the character and found him not too childish. The paper prototype was also reviewed by two general practice nurses who commented on the clinical feasibility and provided additional clinical feedback. They expressed their enthusiasm and found the game to be feasible in practice. However, they pointed out that inhaler use may not always result in better asthma control. Therefore, it is important for healthcare professions and the serious game to manage expectations to maintain user’s motivation to continue with the challenge. Instead of “promising” improvement it is important to reflect on the effect of behaviour and asthma control together. The data collected with the app can be useful for health care professionals to evaluate inhaler usage behaviour and asthma symptoms. In addition, three patient advocates provided feedback and expressed that the game, despite its playful appearance, could appeal to a broad range of patients, including children and those over the age of 45. They appreciated the breathlessness metaphor but emphasized the importance of providing a proper explanation for the piranha/fish aspect to avoid being perceived as punishment for reliever use. A review and discussion of the prototype with smart inhaler developers showed that the Ademgenoot concept was technically feasible as EDM can be used for several reliever and maintenance inhalers. However, as some patients receive Symbicort as Symbicort Maintenance and Reliever Therapy (SMART), the commercial feasibility (i.e., complementing business strategies) may be less clearly defined.
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