Hi, I'm Amy Rodger, a PhD researcher at the University of Edinburgh.

HomeExerciseBuddy

The problem

Home exercise programs are a tool deployed by physiotherapists to rehabilitate injured children, rebuilding strength and increasing mobility. One of the biggest problems physiotherapists face is a lack of adherence to these programs, resulting in longer recovery times and frustration for patients and their families.

The idea

Combining behaviour change theory, gamification, motivational theory and child-led design, this project aimed to build an app to support children through their exercise programs.

Timeline

2020-present

All artwork shown for character, badges, and shop items created by Elspeth Maxwell

Background

Assessing literature and related work, this project aims to apply techniques from the following behavioural change clusters (BCTTv1) using gamification and child-led design:

Goals and planning
Reward
Feedback and monitoring
Shaping knowledge
Social support

Methodology

Combining a participatory design process with children as design informants with consultation with a group of physiotherapy experts using the following methods:

Interviews
Persona & User journey
Design workshops
Sketching & Wireframing
Prototyping

User requirements gathering

Children

Initial consultation with children (n=12) explored rewards and characters they enjoy in apps they use. The following requirements were derived and defined design workshop content:

Rewards will include coins and badges
App will include character to support with exercise
Coins will unlock character customisation
App will consult children on 'fairness' to design rewards system

Physiotherapists

Initial consultation through semi-structured interview with physiotherapists (n=2) defined technology use within current practice, defined scope of app and necessary features to provide rehab program:

App will provide verbal encouragement to users as they exercise
App will track exercises and user goals
Each exercise will have visual and written instructions
Users can provide feedback after exercising

Sketches and Wireframes

Building from related work, established child design guidelines, and required features/functionality from above, initial sketches were developed into a wireframe for HomeExerciseBuddy

Design workshops

Design workshops were used to consult children (n=25) as informants to the design process, creating artwork and app features relating to rewards, goals, character, and motivation. Design workshops were creatively structured around children's activities at Girlguiding Brownies which reduced fatigue and created a fun, exciting, and rewarding experience for designers. Each is described as method, findings, and outcome for design.

Rewards

Method

During workshop, children provided reasons for non-adherence to the exercise program and assigned proportion of available coins according to their values.

Findings

Children valued personal responsibility and fairness, and expressed frustration when apps punished them for reasons they deemed unfair or out of their control.

Outcome

The resulting rewards system asks users why they have missed exercises and assigns a portion of missed coins according to children's values. This coin amount is always above 0 as this was particularly important to designers.

Goals

Method

Can children set reasonable and achievable goals? How do they feel when they meet or miss these goals? Workshop asked children to set goals for a physical game, before playing, and reflecting on both their performance and the process.

Findings

Children struggled to identify achievable goals, and felt frustrated when they were unable to meet them. Children did not often consider their own ability or past experience when making goals, and reflected on the process as difficult without guidance.

Outcome

Resulting system implements a goal builder, allowing for autonomy over goals while imposing limits to ensure goals are achievable. Avoiding demotivation from unrealistic goals.

Motivation

Method

What should the character say to children as they exercise? Workshop asked children to play a game in pairs, playing the role of 'motivator' or 'player'. Motivators were observed, recording phrases and other motivating methods to apply through the character in app.

Findings

Children used a variety of methods for motivating their partner, including cheering, shouting encouraging words or phrases, reminding them of goals and rules, counting score aloud, and communicating remaining time.

Outcome

This study produced a script that was derived from observed communication between children and provided to each voice actor for the three HomeExerciseBuddy characters. The app will additionally show an on screen timer while children exercise.

Character design

Throughout design workshops, children designed the supportive characters seen in HomeExerciseBuddy. Starting with a basic character sketch, I worked with an artist to realise children's drawings, and at each workshop children gave feedback on character and designed clothes and accessories to be bought with rewarded coins. The resulting artwork included 6 clothing sets for 3 characters comprising of over 40 distinct clothing items/accessories. The artist also provided a set of achievement badges, comprising of 4 levels from children's designs - bronze, silver, gold, and rainbow.

Prototyping

Using Flutter, wireframes were developed into functioning prototypes presented to children for feedback. Towards the end of the design process, children engaged in a live iterative design session in which feedback was applied to prototype immediately for further feedback and review. This helped child designers feel respected and valued members of the development process.

Next steps

Following the design and development of HomeExerciseBuddy, athletes from a childrens athletics club were invited to take part in a 4 week study to evaluate usability and assess impact of designed elements on user motivation
This was a key step for physiotherapists, proving the app could provide a home exercise program to children before asking injured children and their families to take part in a wider study asssessing feasbility as a physiothereapy tool and its impact on adherance
The evaluation showed that HomeExerciseBuddy can successfully provide a home exercise program, supporting users while they exercise, and allowing them to meet goals and earn rewards.
- Rewards and goals were motivating for children taking part, encouraging them to return to the app to complete goals to earn coins
- Character and rewards structure designs were very well received by children, reporting the app was "fun but fair"

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