83 Development and evalutation of the Hospital Hero app 4 16). Nonetheless, these interventions either have a single purpose (either preparation or distraction), are situated within the hospital, or require training of staff. Design and implementation of eHealth Despite its potential, digital health technologies are abundant in number but only sparsely implemented as standard care. Reasons for lack of uptake include issues in usability (i.e. ease of use, task performance using the app), poor integration within current healthcare workflows and habits, and issues regarding the value it brings to the user (e.g. making a task more efficient, or more pleasant) (17). To stimulate uptake and usage, apps need to fit the user’s needs and daily lives, be considered useful and user friendly. Involving children and caregivers early in the design and development is paramount in ensuring that the app is child-centred and fits children’s daily life and experience world. In addition, stakeholders need to be involved in the design process to ensure optimal uptake in practice and fit with everyday healthcare practices. Participatory service design One way to accomplish this is by applying a Participatory Design approach (PD) in combination with a service design approach. PD is a methodology that promotes the participation of users and other stakeholders in the design of technology, such as apps, by involving them in several phases during the design process (18). Service design adds by taking the experience journey as a starting point, including varying processes, experiences and people who contribute herein (19). PD can be divided into four phases: the identification of users’ needs (phase 1, discover); the generation of ideas and development of prototypes and testing (phase 2, prototype); realization (phase 3) and evaluation (phase 4). PD can be seen as an iterative process where each phase is planned by reflecting on the results of the previous phase with respect to the participants’ contributions. The iterations ultimately result in a first version of a digital health technology or service (minimum viable product; MVP) that can be evaluated in practice. Evaluation in practice is important to gain in-depth insight into actual use of the product or service, its usability, and how the productor service is used (user-experience), and to identify improvements and inform further implementation and scale-up. Study objectives The objective of this study was two-fold. First, following a PD approach, we aimed to develop an eHealth solution to reduce pre-procedural stress and anxiety among children visiting the hospital’s outpatient clinic. The second objective was to evaluate the app on use, user experience and usability in practice and to gain in-depth insight into the opinions and experiences of children and their caregivers to inform future improvements.
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