€¦ · Web viewHow ADHD Children’s Views and Experiences with Technology Can Guide the Development of a User-Centered Gamified Behavior Management App. Laszlo Pokorny

Running Head: DEVELOPMENT OF A GAMIFIED ADHD APP 1

How ADHD Children’s Views and Experiences with Technology Can Guide the Development of

a User-Centered Gamified Behavior Management App

Laszlo Pokorny

New Jersey City University

Author Note

Laszlo Pokorny, Department of Educational Technology, New Jersey City University

Correspondence concerning this article should be addressed to Laszlo Pokorny, 37 West Long

Drive, Lawrenceville, NJ 08648. Contact: [email protected]

DEVELOPMENT OF A GAMIFIED ADHD APP 2

How ADHD Children’s Views and Experiences with Technology Can Guide the Development of

a User-Centered Gamified Behavior Management App

CHAPTER 1: INTRODUCTION

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is a widespread psychiatric disorder

that affects eleven percent of American children (Barkely, 2006; Visser et al., 2014). This

prevalence rate is consistent with global epidemiological data and findings reported by Faraone

et al. (2003), Polanczyk et al. (2007, 2014), and Willcut (2012). ADHD has a higher prevalence

in boys (1 in 5 boys) verses girls (1 in 11 girls) (Visser et al., 2014).

ADHD children struggle with academics due to challenges with academic engagement

and inability to focus on rules and instructions (Teta, 2008; Brown, 2013). The impact of ADHD

on children’s lives goes beyond the classroom, which is why social problems, drug abuse,

depression, and anxiety disorders are disproportionately high among this population (Evans et

al., 2005).

Research has linked ADHD to impaired executive functions, which are commonly

referred to as the management system of the brain (Brown, 2013). The relationship between

executive function impairment and ADHD has given rise to a new understanding of the

disorder’s physiological and psychological foundations. Rewards processing is among the

components of executive functions that plays a significant role in motivation. Due to impairment

in rewards processing, children with ADHD typically lack motivation to engage in activities that

require concentration for extended periods; therefore, interventions involving continuous and

immediate rewards have been developed to help sustain motivation and engagement for longer

periods (Brown, 2013; Dovis et al., 2015).


Gamification applies game elements in educational contexts in order to create more

engaging learning experiences (Dicheva, 2015; Kapp, 2012). In the current age of smartphones

and tablets, a broad range of gamified mobile applications have been developed in the areas of

education, training, time management, health, and more. Game elements have also been

introduced to apps developed specifically for disabled persons, including those with ADHD.

Research has revealed these apps have varying degrees of effectiveness.

User-centered design (UCD) is an approach that relies on end-users to guide the design

process (Abras et al., 2014). A key component of effective development of new technologies is

understanding the user’s needs and interests. In developing mobile applications, this involves

understanding potential users’ views and experiences with technology.

Statement of the Problem

There is currently no formalized research-based framework for development of gamified

mobile applications for ADHD. A literature search revealed a lack of published research

exploring ADHD children’s technology habits, their perceptions of apps and software, and

whether their views and ideas are being used to guide app design and development. An

understanding of ADHD children’s views and experiences with technology would help guide a

user-centered approach to developing an app for this population (Abras, 2004). Due to their

unique characteristics, it would be valuable for researchers, educators, and technology

developers to know the specific needs and desires of this population to guide the app

development process.

Purpose

This qualitative study aims to shed light on how children with ADHD view and

experience apps and mobile technologies in order to guide the development of a gamified


behavior management app. The purpose of this research is to contribute new understanding in the

following three areas.

Improving lives of children with ADHD

Improving technology development

Informing policy decisions

Improving Lives of Children with ADHD

There is little research on how children and young adults with ADHD utilize the web and

mobile technologies and its value or usefulness in their everyday lives. Although ADHD-focused

programs and apps have been developed, tested, and reported upon in literature, there is a lack of

exploration and analysis of children’s views and opinions regarding these web-based and mobile

technologies. This research seeks to amend this situation by exploring how children with ADHD

relate to their condition, how they utilize mobile technology and the internet in ADHD and non-

ADHD related situations, and what new ADHD based technological innovations they think

would be useful to them, by engaging in in-depth discussion and eliciting suggestions and

feedback.

Improving Technology Development

Studies on web-based programs and mobile apps for ADHD have primarily analyzed

these technologies through the lens of a researcher, clinical practitioner, or educator. An ADHD

technology development framework that is based upon the views, opinions, and needs expressed

by ADHD children would contribute to a user-centered technology design approach for this

population. Children’s views are vital because they have a drastically different understanding

and experience with technology than parents or practitioners. Due to the proprietary nature of

commercially available technologies, there is a lack of available research regarding design and


development of ADHD-related apps. One of the aims of this study is to contribute to the creation

of a user-centered design and development framework for these technologies.

Informing Policy Decisions

Morse (2012) asserts that qualitative health research is undertaken to gain insight to the

patient’s perspective (Pulman, 2016). The current study aims to provide children with ADHD the

opportunity to share their opinions through interviews, which can be utilized to develop user-

centered technological innovations. In addition, the qualitative findings from this study could

potentially influence future policy regarding ADHD children’s needs and problems experienced

with technology.

Research Questions

This qualitative study addresses two research questions. The aim of this study is to discover

ADHD children’s views and experiences with apps and mobile technologies in order to guide the

development of a gamified behavior management app. The research seeks to answer the

following two research questions.

1. How do children with ADHD utilize technology in their lives and in relation to their

disorder?

2. How can the views and experiences of ADHD children inform the development of a user-

centered gamified behavior management app?


CHAPTER 2: LITERATURE REVIEW OUTLINE

Relevant Research

ADHD and Gamification

Retalis et al. (2014) published pilot study results on Kinems Mathloons and SpaceMotif

educational games’ impact on executive function and educational results of ADHD children.

Results show statistically significant gains in executive functions (focus and impulsive

behaviors) and learning outcomes.

Ranathunga et al. (2014) presented a summary of the design, development, and functions

of a gamified online mathematics program for children with ADHD. The paper does not indicate

any user input to the design and development process.

Wronska et al. (2015) explored the impact of an app designed to maintain ADHD

children’s attention while engaged in reading comprehension exercises. The publication provided

no indication of whether user input was utilized to guide the design process; however, the study

conducted qualitative satisfaction and usability surveys with users after the app was developed.

Tan et al. (2012) examined the impact of two gamified English language learning

computer programs (Nessy Learning Programme and Wordshark) on elementary school student

outcomes. Significant improvement in student behaviors and attention were reported.

Bruhn et al. (2017) examine twelve gamified educational apps that were shown to positively

impact motivation and engagement of special needs children. The authors introduce three

effective components (challenge, contextualization, control) that explain how apps impact

student motivation.

E-Therapy


Bul et al. (2015) assert that children with ADHD have an interesting ability to play video

games for hours even though they have difficulty with maintaining attention while engaged in

other activities. They further assert the mental health profession has capitalized on this unique

situation by designing gamified computer-based psychotherapy programs for ADHD.

Dovis et al. (2015) explain improved motivation in ADHD children during video game

play resulting from striatal dopamine release while gaming. The researcher designed and

developed Braingame Brian, a gamified executive training program for ADHD. Teacher’s

reported significant improvement in ADHD related behaviors among children who use the game.

The research did not indicate users being involved in the design and development of the app.

Bul et al. (2015) developed Plan-it Commander, a gamified computer-based program

designed to improve time organization, plan-making, and social abilities in ADHD children.

User feedback was collected and analyzed, but there was no indication whether users were

involved in the initial design of the app.

Dovis et al. (2012) looked at the motivational impact of money compared to video games.

Their findings reveal ADHD students’ motivation levels in response to gaming is comparable to

a 10-euro incentive.

Prins et al. (2011) assessed the motivational impact and training outcomes of a gamified

computer-based working memory trainer on ADHD children. Increased time-on-task and

improved training outcomes were realized by those participants who received the gamified

training.

Apps

Kumaragama et al. (2015) examined 32 mobile health apps for ADHD. The apps fell

under 10 functional categories including education, productivity, strategies, and reminder. The


study reaches the conclusion that there are inexpensive and effective life-managing apps

designed for ADHD currently available.

Schuck et al. (2016) develop a behavior management app designed to impact ADHD

children’s self-regulation. There are no gamified elements in this app. This mixed methods study

indicates that students were involved in design and development of the app; however, details

regarding how they contributed to the process are lacking. Qualitative user survey data is

analyzed to determine usability. Qualitative findings indicate a user-friendly design, and teacher

survey responses reveal the app was non-disruptive in a classroom setting.

Vogelgesang (2015) conducted a mixed methods study on the impact of a behavior

management app on students with behavioral challenges. The main objective of the research was

to examine the relationship between the use of the app and students’ academic engagement.

Qualitative data is gathered from teacher interviews, a journal, and open-ended questions on a

survey. Qualitative user feedback is not collected from student participants at any point during

the research. Teacher feedback shows consistently positive ratings on this behavior management

intervention.

Virtual Rewards

Rominus et al. (2014) conducted a mixed methods study examining the impact of

GraphoGame virtual rewards on motivation. Tokens are earned by users as they complete

reading assignments, and the players use the tokens to buy access to “reward games”. Qualitative

data from parent and user questionnaires showed improved concentration levels in response to

virtual rewards.

Denny (2013) conducted a mixed methods study examining the impact of virtual badges on

student motivation. Students’ time-on-system and total answered questions were retrieved from


the program and analyzed. A significant increase in time-on-system and total questions answered

was realized with the use of virtual badges. Qualitative data on user feedback was collected;

however, there was no discussion of whether and how the feedback will be used to improve the

program.

User-Centered Design

Abras et al. (2004) provide an overview of user-centered design, including its history,

methods for involving users in design, usability testing, participatory design, advantages and

disadvantages, and examples of user-centered design. One of the methods for involving users in

the design process is to conduct interviews to determine users’ needs and expectations, and to

provide feedback on prototypes and the final product. Participatory design has users involved

throughout the design and development of the product. Some of the advantages of user-centered

design include the development of more effective products, improved user satisfaction, products

require less redesign, more creative design solutions.

Druin (1999) created a design approach called cooperative inquiry, which enables

children to provide input during the entire technology development process. Cooperative inquiry

is grounded in the theory of participatory design. Cooperative inquiry embodies the following

three vital aspects; “1) a multidisciplinary partnership with children, 2) field research that

emphasizes understanding context, activities, and artifacts, 3) iterative low-tech and high-tech

prototyping” (Druin, 1999). The researcher includes two case summaries involving cooperative

inquiry.

Pulman (2016) uses a patient-centric approach to design an app for diabetic young adults.

The qualitative research begins with exploring participants’ lifeworld, or lived experience with

their disorder, and then examines their views and perspectives on technology. Ideas are


generated from the qualitative interviews which are then fed in to the app design and

development process. An app prototype is created, and qualitative interviews are conducted to

obtain users’ feedback on the prototype. After launching the app, new users are recruited to

provide feedback through a questionnaire and qualitative interview regarding their experiences

with the app.

Lifeworld

Hemingway (2011) argues that lifeworld-led healthcare is a way to humanize healthcare

and bring “caring” back in to a system that tends to rely on superficial quality measures and

focuses on decontextualized goals. Lifeworld is comprised of five elements; temporality,

spaciality, intersubjectivity, embodiment, and mood. Temporality is the human experience of

time. Spaciality is the human experience of our environment. Intersubjectivity is the

psychological relation between people. Embodiment is the role that the body plays in shaping the

mind. Mood reveals the meaning of our situation (Hemingway, 2011).

Summary

The reviewed literature covers several areas that are relevant to the current study.

Literature pertaining to apps helped to guide this research by revealing methods and approaches

that have, and have not, been taken to understand app usage and development by ADHD

children. Literature on gamification highlighted the potential of game elements to make an

impact on the motivational and academic outcomes of this population. The reviewed publications

on user-centered design and lifeworld contributed to how the researcher approached the current

qualitative study. The discovery of a lack of published research on a user-centered design

approach to developing technologies for children with ADHD prompted the pursuit of the

current study.


CHAPTER 3: RESEARCH METHODOLOGY

Introduction

This section provides a description of the methodology employed in this study. This

qualitative study aims to discover ADHD children’s views and experiences with apps and mobile

technologies in order to guide the development of a gamified behavior management app. The

objective of this study is to develop a mobile application for children with ADHD guided by

user-centered design principles, which emphasize direct involvement of end-users in the design

process (Abras, 2004; Pulman, 2016). User-centered design stands in contrast to traditional

software design methods that are primarily concerned with the engineers’ perspective (Abras,

2004).

The idea to investigate ADHD children’s use of mobile technology and apps was

prompted by a lack of published studies considering their views on the use of such technologies

to support their condition. Therefore, one of the goals of this research is to gain insight to how

the use of mobile technologies and apps has impacted these children’s lives. The research seeks

to explore and understand these children’s feelings about their use of technology and how they

perceive its impact on their lives. Additionally, the research seeks to explore what these children

feel about their use of technology in relation to their disorder, and whether it facilitates their

awareness and proactivity in addressing their disorder. This information is gathered through

qualitative interviewing to achieve an in-depth understanding of their daily experiences using

technology in their lives and relating to their condition. Using user-centered design principles,

this data, in addition to research participants’ input on design and usefulness of app prototypes,

will be used to guide the app development process. The research aims to provide new

understanding in the following areas.


Improving lives of children with ADHD

Improving technology development

Informing policy decisions

Research Objectives

The research objectives are as follows.

1) To investigate ADHD children’s views on their daily experiences with mobile

technologies and apps.

2) To develop an understanding of whether, and how, these children use mobile

technologies and apps in relation to their disability for:

a. Searching for information

b. Communicating their experiences

c. Managing information

d. Education and training

e. Managing symptoms, stress, and behaviors

3) To use data from phase 1 qualitative interviews to develop a prototype gamified behavior

management app.

4) To collect and analyze data from phase 2 observations and qualitative interviews

regarding user feedback on the prototype.

5) To refine, develop, and launch the most effective app based upon user suggestions and

feedback.

6) To collect and analyze phase 3 data regarding user feedback from non-Phase I & II

participants after launch.


Qualitative Approach

Qualitative research has been used to examine people’s feelings, perspectives, and

beliefs, and to discover participants’ responses to their ailments and disorders and how they

understand and view the role of their disorder in their lives (Cooper et al., 2007). Qualitative

research has been increasingly applied to disorder-related behavioral research (Pulman, 2016).

Regarding the application of this research method to healthcare, Patton (1990) asserts qualitative

research is an effective and proper means for enabling patients to communicate their thoughts

and concerns. Further, by investigating patients’ perceptions, views, motivations, and desires,

Ritholz et al. (2011) posits that qualitative research can aid clinicians in finding answers to

questions that might not be answered by quantitative methods. Although a broad array of mobile

apps has been developed specifically for ADHD, there is a lack of published qualitative research

on how children users of these technologies, and mobile apps in general, perceive and respond to

these apps. This realization provided justification to undertake this qualitative study to gather

data on the views and experiences of children with ADHD, and learn how they use apps and

mobile technologies for ADHD and non-ADHD related activities.

Generic Qualitative Inquiry Approach

This study is concerned with the practical application of what is learned from participants’

views and experiences with mobile apps and technology to design a user-centered gamified

behavior management app. Patton (2015) describes generic qualitative inquiry as an approach

that uses qualitative methods such as in-depth interviews “to answer straightforward questions

without framing the inquiry within an explicit theoretical, philosophical, epistemological, or

ontological tradition”. Patton (2015) describes a truly practical side to qualitative methods that

simply entails using skill to ask questions of participants of interest in real-life settings to solve


issues or improve systems. Merriam (1998) characterizes generic qualitative research as studies

that align with the methods of qualitative research, but instead of concentrating on culture, like

ethnography, or constructing theory, like grounded theory, they “simply seek to discover and

understand a phenomenon, a process, or the perspectives and worldviews of the people involved”

(Pulman, 2016). A goal of this study is to develop a deep understanding of the views of children

with ADHD and generate insight to their daily experiences with ADHD and how they use mobile

technologies and apps in all aspects of their lives, including in relation to their disorder.

Furthermore, the research seeks to apply this information to build a new technology utilizing

user-centered design principles to guide the design, development, and post release evaluation of

the app. The information being sought from participants requires freedom to explore the breadth

of participants’ diverse experiences, as well as the flexibility to dig deep when exploring specific

thoughts and experiences. A generic qualitative approach allows for achieving breadth of

information in exploring participants’ range of experiences, while also developing depth of

understanding specific recollections (Pulman, 2016). A consistent epistemological and

methodological standard for generic qualitative research, comprised of four key requirements,

was outlined by Caelli et al. (2003) (Pulman, 2016). They put forth the following essential

components that should be clearly articulated when using this approach.

1) Statement of Theoretical Position

2) Consistency between methodology and method

3) Clear explanation of how rigor will be maintained

4) Articulation of analytical lens (Caelli et al., 2003; Pulman, 2016)


Theoretical Position

A researcher’s experiences and views impact all aspects of their approach to research,

including their choice of research topic, perspective on the subject, investigational methods,

findings that are deemed relevant, and the conclusions that are drawn (Malterud, 2001; Pulman,

2016). The current study merges themes of ADHD behavioral interventions, gamification,

technology, and user-centered design to present an original exploration of a subject that has not

received attention in published research. The following paragraphs detail the researcher’s

reflection on his own personal, professional, and academic background, and how he arrived at

his theoretical position.

As someone personally affected by ADHD, the researcher has great sympathy and

interest in helping this population overcome their shortcomings and maximize their potential for

success in education. The researcher has read publications noting the ability of ADHD children

to engage with video games and technology for extended periods without losing attention (Bul et

al., 2015; Dovis et al., 2015). He is also aware of studies that examine the impact of gamified

technologies on ADHD therapy outcomes and academic and behavioral intervention results

(Dovis et al., 2015; Prins et al., 2011; Vogelgesang, 2015). Through these studies, his own

experiences, and observations of his students, the researcher recognizes the potential of

technology to improve the lives of those affected by ADHD.

Children with ADHD have a unique worldview, specifically regarding their behavior and

educational experiences (Dwivedi et al., 2005; Lange et al., 2010; Moon, 2010; Mueller et al.,

2012). The researcher believes this unique perspective, along with ADHD children’s views on

technology, should be taken in to consideration to guide the design of user-centered mobile

applications for this population. User-centered design is a consistent theme in this research


because the researcher’s experience in product development instilled a sense of importance in

considering the users’ needs and desires in making products. Through the researcher’s own

experience, he understands the challenge of overcoming ADHD behaviors, which are

symptomatic of executive function impairments associated with the disorder; therefore, the

ultimate objective of this research is to use lessons learned from ADHD children to develop an

app that will help these children track and manage their behaviors. The aims of the current study

are as follows.

Achieve an in-depth understanding of the perspective of children with ADHD and join

and assemble their opinions and reflections in to a comprehensive view of their daily

experiences with ADHD and how they use apps and mobile technologies related to, and

unrelated to, their disorder.

Apply this newly developed insight to guide the design and development of a user-

centered gamified behavior management app.

Consistency Between Methods and Methodology

Caelli et al. (2003) argue that description of the methods used in generic qualitative

research should be sufficiently detailed to distinguish them from methods used in other

qualitative methodologies. Methodology reflects a desire to build a specific type of knowledge

and embodies theoretical frameworks that guide the research process (Pulman, 2016). Methods

are the tools and techniques used to collect data. The following paragraphs discuss methodology

and methods used in the current study and address the issue of consistency.

Husserl was a philosopher and mathematician who expressed concern that quantitative

measures ignored aspects of human experience (Hemingway, 2011). He defines “our world as

textured, embodied and experienced by us and through us” (Husserl, 1970; Hemingway, 2011).


Husserl discussed lifeworld as “the world of lived experience” (Husserl, 1970; Pulman, 2016).

Lifeworld-led healthcare arose out of Husserl’s work and argues that when Lifeworld is ignored,

and healthcare becomes fixated on decontextualized and superficial measurements, then research

and practice become dehumanized (Hemingway, 2011). The importance of lifeworld in

humanizing the research and development of a technology meant to impact the lives of ADHD

children is what drives this research. Collecting, analyzing, and using ADHD children’s views,

opinions and lived experiences to guide the design of a technology humanizes research and

development of products for this special population.

User-centered design describes a design process in which end-users are involved in

product development. UCD entails a broad philosophical approach and utilization of diverse

methods to design products. There are many ways that users can be involved in UCD. Some

UCD processes only involve users when they assess their needs at specific times during the

design phase, whereas other UCD approaches have users intimately involved as partners

throughout the design phase (Abras, 2004). The current research aligns with UCD philosophy

and adopts UCD methods by collecting qualitative data from targeted end-users to understand

their needs and interests in order to directly inform the design of a new technology. The

participants are also involved during the development phase as they provide qualitative feedback

on the app prototypes, which facilitates refinement of the design.

Sampling

The sampling strategy targets children ages eleven to thirteen diagnosed with ADHD.

This age range is chosen because children from the current junior high school owned a personal

mobile device or tablet computer since fifth grade or age 10, which allows them at least one year

to develop a familiarity and routine with these technologies. Non-random convenience sampling


is used to select participants from the population. A purposeful, non-randomized, sampling

strategy is utilized to select participants who have knowledge and experience in the area of

interest. For collection of lifeworld data, needs and interests data, and prototype feedback,

participants are recruited from a special school that caters to children with ADHD. Candidates

are considered eligible for the study if they have an ADHD diagnosis and are within the specified

age range. Recognizing that a small number of participants from the same school could not result

in generalizable findings, the researcher intends to address this limitation by recruiting post-

launch registered app users from outside the current school to provide feedback and broader

perspective. Post-launch participants must meet the same ADHD diagnosis and age requirements

as the original participants.

Recruitment of participants starts with introduction of research to school principal, a

letter of request for permission to conduct the research at the school (See Appendix A), and

distribution of flyers and consent forms (See Appendix B) to teachers of 6th, 7th, and 8th grade

homeroom. Students are encouraged to take the flyer and consent forms home to their parents,

read it together, contact the researcher with any questions, and sign the form and mail, fax, or

email it to the researcher if they agree to participate. The information includes a statement that

participation is strictly voluntary, and participants can drop out at any time without

repercussions. Upon acceptance, the researcher contacts the participants to schedule interviews

and then makes arrangements with administration to secure a space for conducting interviews in

the school.

Post-launch participants are recruited through the app using the same information and

consent form provided in the original form in Appendix B. Upon receiving completed online

forms, interviews are scheduled via email. Post-launch participants must meet the same ADHD


diagnosis and age requirements as the original participants. Due to the risks posed by online

recruitment, the researcher follows guidelines put forth by Martinez et al. (2014) to maintain

confidentiality and reduce the risk of bias (Pulman, 2016).

Sample Size

Sample sizes are generally small in qualitative research because the focus is often on

deep exploration of information rich cases. Rather than focusing on generalizable findings,

purposeful sampling emphasizes the importance of collecting rich data and revealing the ideas

and perspectives of participants (Patton, 2015; Pulman, 2016). The current research aims to reach

a saturation point, where the sample size results in obtaining robust data with the emergence of

stable themes, and where further sampling does not reveal new information (Pulman, 2016;

Holloway, 2008). The target sample size (n=20) is comprised of five boys and five girls for

lifeworld interviews and design and development input, and five boys and five girls for post-

launch feedback.

The researcher will determine if saturation point has been reached with this sample size

upon analyzing interview responses and achieving a clear understanding of the perspectives and

experiences of ADHD children and what sort of technologies would be useful to them.

Methods

Qualitative Interviews

The researcher conducts comprehensive, 45-minute, semi-structured interviews, which

are used when the questions are known, but the answers are not (Patton, 2015). Primary

questions are asked in the same sequence in all interviews and answers to open-ended inquiries

can be probed for further information (Pulman, 2016). In-depth interviews are conducted when

information is sought on individual’s own experiences with a specific issue by recording their


stories. (Patton, 2015). Individual interviews are selected over focus groups because the age

range, maturity, and distractibility of participants might compromise the quality of results

(Pulman, 2016). In addition, children who are interviewed in a focus group setting might feel

hesitant to reveal their true feelings in front of peers. A semi-structured interview outline,

including broad questions and areas of focus, was developed (Appendix C); however, there was

room left for improvisation during the interview to address expected and unexpected responses.

The aim of each interview is a detailed examination of specific areas relevant to the participant’s

experience and its bearing on the research questions and objectives (Pulman, 2016).

Phase I: Interview Process for Lifeworld Understanding and Ideas Generation

The interview begins with the following broad question.

Can you tell me about the first smartphone or tablet that you owned?

The interview begins by discussing technology and then transitions to how technology relates to

their disorder and everyday life (Pulman, 2016). After discussing smartphones or tablets, the

discussion moves to cover all technologies that the participant interacts with, including usage of

the internet, email, Google, and social media. Then, when suitable, the researcher poses a

question regarding the interviewee’s diagnosis of ADHD, which will lead the participant to talk

about their disorder and whether they use technology related to their ADHD. The interview will

delve in to exploring varying aspects of their daily experiences with ADHD, including social

aspects, education, and family relationships, and whether they ever used technology in relation to

their disorder. As the interviewee discusses problems they experience due to their disorder, the

interviewer elicits ideas that the participant thinks could improve their life, and whether

technology could potentially help.


The interviewer will follow best practice guidelines put forth by Patton (2015) for

conducting qualitative interviews. For example, the interviewer will refrain from asking leading

questions and avoid overly complex questions by sticking to simple and clear wording (Pulman,

2016). Furthermore, the interviewer will always listen to the full response and avoid making

judgements about responses. Immediately following each interview, the researcher spends time

reflecting on the interview during transcription (Patton, 2015).

Interviews are closed out with one last question as follows.

The final question I have for you is….

After the participant’s response to this question, the interviewer summarizes the main points and

gives an opportunity for the interviewee to clarify or add to a particular area that had already

been discussed. Upon conclusion of the interview, the researcher thanks the participant and

notifies them that the finalized study will be made available to them upon request.

MethodsPre-interview – Phase I:Design qualitative interview method and write semi-structured questions. Interviews – Phase I:Conduct in-depth qualitative interviews.Generate Ideas – Phase I:Use qualitative findings to generate ideas for creating app prototype

Table 1. Methods Summary Table: Lifeworld Understanding and Ideas Generation

Phase II - User-Centered Design and Pre-Launch Feedback

Ideas for prototype app design are generated from qualitative interviews in Phase I. Upon

completion of the first app prototype, developed using ideas provided by participants in Phase I

interviews, the app is uploaded to a suitable device (e.g. iPod Touch, iPhone, Android device)

and presented to research participants for use. The app is built using Altova MobileTogether®


app development software, which is purchased and download on to the researcher’s PC. The

software supports all mobile platforms include IOS and Android.

Phase II qualitative interviews dedicate a portion of the interview to allowing participants

to share their feelings and provide meaningful feedback on the prototype. Faulkner (2000)

emphasizes the importance of unstructured interviews in usability engineering for obtaining

valuable information that the interviewer might not expect (Pulman, 2016). These interviews

allow for capture of positive and negative remarks on the prototype which are then utilized in

refinement of design and development. This is consistent with user-centered design (Abras,

2004).

Phase II - Observation of Participants Using App Prototype

In addition to interviewing participants to obtain feedback on the prototype, the research

observes the participants using the app for a short duration. The observer focuses on how the

users interact with the app, and whether they experience any problems while navigating the app.

(See Appendix E) This observational approach also aligns with user-centered design (Abras,

2004).


Anticipated

Timeframe

Methods

Months 1-3

Phase I- Conduct qualitative interviews. - Analyze and interpret qualitative data. - Generate ideas for app design.

Months4-5

Design and develop prototype app based upon ideas generated from qualitative interviews.

Months6-8

Phase II- Provide app to participants. - Conduct qualitative interviews regarding prototype feedback. - Observe participants using the prototype. - Analyze qualitative data. - Generate ideas for app revision.

Months9-10

Revise app design based upon ideas generated through feedback on the prototype, and develop a new version of the app.

Months11-13

Obtain Google and Apple approval. Launch app.

Month 19

Phase III- Design and develop post-launch questionnaire.- Design and develop semi-structured questions for qualitative interview.

Month20-23

- Collect qualitative data from post-launch questionnaires and interviews.- Analyze data and identify themes.

Table 2. Anticipated Timeline and Methods Summary Table: Phases I, II, & III

Obtaining Apple and Google Approval

Apple and Google provide specific app development and approval guidelines that must be met in

order to be listed on Apple’s App Store or Google Play. These guidelines cover a broad range of

topics including intellectual property, restricted content, privacy, security, deception,

monetization, ads, spam, and functionality. The developer ensures the app meets all the

requirements prior to submitting it for review. The review process must be completed prior to

listing the app through Apple or Google.


Phase III – Post-Launch Feedback Questionnaire

In order to collect feedback on the launched app, an online questionnaire is created using

an online survey company such as Survey Monkey. The questionnaire (See Appendix D) consists

of a combination of open-ended and closed questions. The open-ended questions are designed to

elicit reflective responses regarding the usefulness of the app to its users. Questions regarding

why they downloaded the app, how they’ve used it, and suggestions for improvement are

included in the questionnaire. Informed consent is obtained as the questionnaire is completed.

The questionnaire includes an invitation to participate in an interview with the researcher

regarding the app.

Phase III – Post-Launch Feedback Interviews

The questionnaire is used to identify potential interview participants. The participants

must meet the same requirements as the original set of post-launch participants, i.e. they must be

between ages 11-13 and diagnosed with ADHD. Consent forms are sent to participants

explaining the research, and returned to the researcher with a parent signature. Interviews are

conducted via Skype or WeChat. The focus of the interview is on clarifying questionnaire

responses and then asking similar questions to the Phase II pre-launch feedback interviews (See

Appendix B).

Maintaining Rigor

Reliability of the methodology is judged based upon the rigor of the qualitative study

(Caelli et al., 2003; Pulman, 2016). The four criteria that Pulman (2016) uses to establish the

rigor and validity of his qualitative research are credibility, transferability, dependability, and

confirmability. Credibility is maintained in the current study through triangulation of data


sources and methods. Participants in Phase I and II of the study provide qualitative data during

interviews conducted prior to- and after prototype development. Participants in Phase III of the

study provide qualitative data in a questionnaire and interviews conducted post-launch. The

qualitative data collected from these two separate groups of participants provides triangulation.

Transferability of the study findings are revealed through thorough exploration and

description of context (Lincoln and Guba, 1985; Pulman, 2016). The deep exploration of ADHD

children’s Lifeworld provides insight to how they interact with technology, their perceptions

regarding subjects that might have policy implications, and their ideas for creating an ideal

technology. Transferability is also maintained by clearly describing any assumptions and

limitations regarding the research (Pulman, 2016).

An audit trail is maintained to achieve dependability. Confirmability and trustworthiness

is maintained by keeping all raw data and original recordings for any potential auditor to be able

to confirm the study findings (Pulman, 2016).

Analytical Lens

The analytical lens refers to how the researcher approaches the data. The researcher seeks

to interpret the views and daily experiences of children with ADHD by utilizing personal

experience and understanding. Then the researcher aims to create a technology based upon this

developed understanding, thereby humanizing the design of a tool to help this population. This

entails identifying ideas and generating a technology-based solution from participants’

descriptive interview responses. Then applying user-centered design principles to guide the

development of a gamified behavior management app.

Analysis


Data analysis follows Creswell’s (2007) Data Analysis Spiral. The four loops of the Data

Analysis Spiral entail data management, familiarization with the data, describing, classifying,

and interpreting the data, and representing the data. In the describing, classifying, and

interpreting data loop (loop 3), coding and category formation takes place. In loop 4, the data is

presented in a table.

Phase I & II interview data is recorded using a digital recording device that can create

individual MP3 files. Each audio file is transcribed word-for-word in to a Microsoft Word

document. Phase III post-launch interview data is also transcribed in to a Microsoft Word

document. Phase III post-launch questionnaire data is transferred to a Microsoft Excel

spreadsheet. Digital data is securely stored on a private network drive, accessible only to the

researcher. Paper documents and transcripts are kept in a locked file cabinet.

During the reading and memoing step (loop 2), the researcher immerses in the data by

thoroughly re-reading the interview transcripts and making notes while reading. This step entails

the researcher becoming thoroughly familiarized with the data. Preliminary classification

schemes emerge and the researcher categorizes data in to groupings.

In loop 3, the interview data is coded using pre-set codes and emergent themes. Coding

will follow a descriptive to interpretive to pattern coding, which moves from summary to

meaning to explanation. The coding scheme will be refined throughout the coding process by

adding, collapsing, expanding, and revising the coding categories. If there is too much data under

a single code, then the code will be broken down in to sub-codes to improve organization of the

data. The approach to code will be to make the code fit the data. The researcher will make coding

notes of reactions and ideas that emerge. The coding process will enable the researcher to reveal

the richness and complexity of the in-depth interview responses.


Codes consist of words or short phrases that summarize the crux of the dialogue. After

first-round coding, Microsoft Word files are created based upon the codes, and the matching

coded information is cut and pasted in to the corresponding Word document. Groups of related

data with similar meaning are coded in multiple cycles. Once coded, those groups become

organized in similarly themed categories. Themes emerge from these groups. The themes are

then interpreted to answer the research questions.


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Appendix A

Letter of Request to Conduct Research at Winston Preparatory School


Appendix B

Parental Consent Form


Appendix C

Semi-Structured Interview Questions


Phase I Qualitative Interviews – Lifeworld Understanding and Generation of Ideas

1) Can you tell me about the first smartphone or tablet that you owned?

a. Probes: How important is technology for your social life? What technologies do

you use most? How much time do you spend on your technology devices per day?

What type of video games do you like?

2) When were you first diagnosed with ADHD?

a. Probes: If it’s longer than you can remember, then how long have you been aware

that you have ADHD? How often do you think about it? What does it feel like to

have ADHD?

3) Have you used any ADHD related programs or apps?

a. Probes: Are you aware that there are apps built specifically for people with

ADHD? What do you think about these apps? Do you use your favorite

technologies to help you organize?

4) What do like best and least about the technologies that you’ve used?

a. Probes: Do you have a favorite video game? What do you like about it most?

What’s you’re least favorite technology that you use regularly. Why? If you could

invent a game or technology, what would it be? Why?

Phase II & III Qualitative Interviews – Pre-Launch and Post-Launch Feedback

1) How was your experience using the app?

a. Probes: How difficult was it to use? What did you like best about it? Was there

anything you didn’t like about it?

2) What did you think about when you used the app?


a. Probes: Did you think about your behavior more or less than you normally

would? Why? What kind of rewards did you earn while you used the app, and

why did you earn then?

3) If there is anything you could change about the app, what would it be?

a. Probes: Is it something you think you would use again? Why or Why not?

4) Did this app have an impact on your behavior? If yes, in what way?

Appendix D


Phase III Post-Launch User Questionnaire

Closed Questions:

1) Are you male or female?

2) Are you 11 to 13 years old?

3) Have you been diagnosed with ADHD?

Open-ended Questions:

1) Did you experience any difficulties using this app? If yes, please explain.

2) What is your favorite feature of this app?

3) What is your least favorite feature of this app?

4) What you would like changed about this app?

5) How would you improve this app?

Appendix E


Phase II Pre-Launch Observation Sheet

Date of Observation: _______________

Location: ________________________

Observer Name: ___________________

1) How are children interacting with the app?

2) Are children experiencing any difficulties with using the app? If yes, what are they?

Documents

€¦ · Web viewHow ADHD Children’s Views and Experiences with Technology Can Guide the Development of a User-Centered Gamified Behavior Management App. Laszlo Pokorny