99 Development and evalutation of the Hospital Hero app 4 indicated that healthcare professionals could for example give hints and show interest in the child’s animal collection. Two caregivers also suggested adding the possibility for the child to add in how they feel before the appointment or to write down questions for the doctor, all to facilitate interaction between child and doctor. Theme 3: motivation and reward All interviewed children indicated they were motivated to engage with the app. They were attracted by the design and liked the vibrant colours and animals. Some children above ten years old found the app a bit ‘ childish’ due to the drawing style of the animals and the difficulty level of the animal searching game. They wanted more challenging games such as puzzles, riddles, assignments, or animal quiz. They could imagine it to be fun for younger children. A comparison of scores of the UEQ- hedonic scale showed that boys and younger children scored statistically higher than girls and older children, respectively, indicating that they found the app more appealing. When asked if they had collected animals, all children indicated that they had collected some or all animals. The majority of the children however did not understand that the animals indicated as silhouettes in the animal collection could only be collected during the next visit. Children felt demotivated, ‘disappointed’ and confused as they could not collect all animals. Children did like reward elements such as the virtual confetti rain, and the funny GIF when all animals were collected. They suggested to add additional reward elements such as winning clothes to dress the animal, money, tokens , points or extra assignments. “But also that if you played a game, you receive money. And with that money you can buy clothes for your animals” – Boy, 9 years old. Theme 4: fit with the real hospital journey. An important recurring theme throughout all interviews was the fit with the hospital journey. This could be seen in two different ways. First, the alignment of the true hospital journey with the journey portrayed in the app (map) should be as optimal as possible. The map used a fixed number and sequence of steps. However, not all children needed to draw blood and thus engage with the step. Some children did not mind, however, two children mentioned that this step was confusing and caused more anxiety. Second, the alignment in terms of timing is important for the overall experience. According to the participants, there should be sufficient time to search for all the animals and enough time to devote attention to playing instead of waiting. One child explained: “I did not watch the videos because I thought, I did not know how much time I had. So I just went ahead and did the fun part, seek the animals.” - Boy, 10 years old.
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