DEVELOPMENT AND USABILITY OF A GAMIFIED APP TO HELP CHILDREN MANAGE STRESS: AN EVALUATION STUDY
Article Sidebar
Published:
Jul 1, 2019
Keywords:
Stress Management, Prevention Intervention, Children, Interactive Storytelling, Gamified Mobile Application (App), Educational Technology, Technology Enhanced Learning (TEL)
Main Article Content
Abstract
Children generally have difficulty managing stress. As a result, stress may escalate to anxiety. Informal-learning, stress prevention interventions that are easily accessible on mobile devices could be one way for children to learn how to manage stress before it reaches the levels of anxiety. There are less than a handful of stress management apps targeting children presently available and these do not combine gamification techniques with behavior change theory. This study describes the design and development of a gamified interactive storytelling mobile app to teach young children how to manage stress through relaxation exercises. It evaluates the app’s usability using learning analytics data and the SUS usability scale. The gamified app called Kids’ Stress Relief received a satisfactory usability score (73.55) and was well accepted by a sample of 71 children (5-12 years old). It may have the potential to support children in learning how to perform stress relief techniques as a stand-alone application. Instructional and design implications, of interest to developers of psychology-based apps, are drawn.
Article Details
Section
Articles - Special Issue
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons CC BY 4.0 Attribution 4.0 International License.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
References
Alonso-Fernandez, C., Calvo, A., Freire, M., Martinez-Ortiz, I., & Fernandez-Manjon, B. (2017). Systematizing game learning analytics for serious games. Proceedings of the Global Engineering Education Conference (EDUCON), 2017 IEEE (pp. 1111-1118). IEEE. doi: 10.1109/EDUCON.2017.7942988
Anderson, P., Jacobs, C., & Rothbaum, B. O. (2004). Computer‐supported cognitive behavioral treatment of anxiety disorders. Journal of Clinical Psychology, 60(3), 253-267. doi: 10.1002/jclp.10262
Bangor, A., Kortum, P. T., & Miller, J. T. (2008). An empirical evaluation of the system usability scale. International Journal of Human–Computer Interaction, 24(6), 574-594. doi:10.1080/10447310802205776
Beesdo, K., Knappe, S., & Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatric Clinics of North America, 32(3), 483-524. doi: 10.1016/j.psc.2009.06.002
Brooke, J. (1996). SUS-A quick and dirty usability scale. In P.W. Jordan, B. Thomas, B.A. Weerdmeester, & I.L. Mcclelland (Eds.), Usability evaluation in industry (pp. 189-194). London, UK: Taylor & Francis.
Cavazza, M., & Charles, F. (2017). User interaction for interactive storytelling. In R. Nakatsu, M. Rauterberg, P. Ciancarini (Eds.), Handbook of Digital Games and Entertainment Technologies (pp. 415-428). Singapore: Springer. doi: 10.1007/978-981-4560-50-4_57
Dennis, T. A., & O’Toole, L. J. (2014). Mental health on the go: Effects of a gamified attention-bias modification mobile application in trait-anxious adults. Clinical Psychological Science, 2(5), 576-590. doi: 10.1177/2167702614522228
Deterding, S., Dixon, D., Khaled, R., & Nacke, L. (2011). From game design elements to gamefulness: defining gamification. In Proceedings of the 15th international academic MindTrek conference: Envisioning Future Media Environments (pp. 9-15). ACM. doi: 10.1145/2181037.2181040
Dillon, A., Kelly, M., Robertson, I. H., & Robertson, D. A. (2016). Smartphone applications utilizing biofeedback can aid stress reduction. Frontiers in Psychology, 7. doi: 10.3389/fpsyg.2016.00832
Freire, M., Serrano-Laguna, Á., Iglesias, B. M., Martínez-Ortiz, I., Moreno-Ger, P., & Fernández-Manjón, B. (2016). Game learning analytics: Learning analytics for serious games. Learning, Design, and Technology, 1-29. doi: 10.1007/978-3-319-17727-4_21-1
Hoffmann, A., Christmann, C. A., & Bleser, G. (2017). Gamification in stress management apps: A critical app review. JMIR Serious Games, 5(2), 13. doi: 10.2196/games.7216
Hollis, C., Falconer, C. J., Martin, J. L., Whittington, C., Stockton, S., Glazebrook, C., & Davies, E. B. (2017). Annual Research Review: Digital health interventions for children and young people with mental health problems–a systematic and meta‐review. Journal of Child Psychology and Psychiatry, 58(4), 474-503. doi: 10.1111/jcpp.12663
Ly, K. H., Asplund, K., & Andersson, G. (2014). Stress management for middle managers via an acceptance and commitment-based smartphone application: A randomized controlled trial. Internet Interventions, 1(3), 95-101. doi: 10.1016/j.invent.2014.06.003
Malboeuf-Hurtubise, C., Lacourse, E., Herba, C., Taylor, G., & Amor, L. B. (2017). Mindfulness-based intervention in elementary school students with anxiety and depression: a series of n-of-1 trials on effects and feasibility. Journal of Evidence-based Complementary & Alternative Medicine, 22(4), 856-869. doi: 10.1177/2156587217726682
Manicavasagar, V., Horswood, D., Burckhardt, R., Lum, A., Hadzi-Pavlovic, D., & Parker, G. (2014). Feasibility and effectiveness of a web-based positive psychology program for youth mental health: randomized controlled trial. Journal of Medical Internet Research, 16(6). doi: 10.2196/jmir.3176
Marusak, H. A., Thomason, M. E., Elrahal, F., Peters, C. A., Kundu, P., Lombardo, M. V., ... & Rabinak, C. A. (2017). Mindfulness and dynamic functional neural connectivity in children and adolescents. Behavioural Brain Research, 336, 211-218. doi: 10.1016/j.bbr.2017.09.010
McCoy, L., Lewis, J. H., & Dalton, D. (2016). Gamification and multimedia for medical education: A landscape review. Journal of the American Osteopathic Association, 116(1), 22-34. doi: 10.7556/jaoa.2016.003
Merikangas, K. R., Nakamura, E. F., & Kessler, R. C. (2009). Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience, 11(1), 7-20.
Mohr, D. C., Schueller, S. M., Montague, E., Burns, M. N., & Rashidi, P. (2014). The behavioral intervention technology model: an integrated conceptual and technological framework for eHealth and mHealth interventions. Journal of Medical Internet Research, 16(6). doi: 10.2196/jmir.3077
Morgan, A. J., Rapee, R. M., & Bayer, J. K. (2016). Prevention and early intervention of anxiety problems in young children: a pilot evaluation of Cool Little Kids Online. Internet Interventions, 4, 105-112. doi: 10.1016/j.invent.2016.05.001
Morgan, A. J., Rapee, R. M., Salim, A., Goharpey, N., Tamir, E., McLellan, L. F., & Bayer, J. K. (2017). Internet-delivered parenting program for prevention and early intervention of anxiety problems in young children: Randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 56(5), 417-425. doi: 10.1016/j.jaac.2017.02.010
Nicolaidou, I., Tozzi, F., Kindynis, P., Panagiotou, M., & Antoniades, A. (2017). An interactive storytelling game for mobile devices for children’s stress management. In 11th European Conference on Games Based Learning (ECGBL) (pp. 967-971). Sonning Common , UK: Academic Conferences International Limited.
Pham, Q., Khatib, Y., Stansfeld, S., Fox, S., & Green, T. (2016). Feasibility and efficacy of an mHealth game for managing anxiety: “Flowy” randomized controlled pilot trial and design evaluation. Games for Health Journal, 5(1), 50-67. doi: 10.1089/g4h.2015.0033
Pramana, G., Parmanto, B., Kendall, P. C., & Silk, J. S. (2014). The SmartCAT: an m-health platform for ecological momentary intervention in child anxiety treatment. Telemedicine and e-Health, 20(5), 419-427. doi: 10.1089/tmj.2013.0214
Proudfoot, J., Clarke, J., Birch, M. R., Whitton, A. E., Parker, G., Manicavasagar, V., ... & Hadzi-Pavlovic, D. (2013). Impact of a mobile phone and web program on symptom and functional outcomes for people with mild-to-moderate depression, anxiety and stress: a randomised controlled trial. BMC Psychiatry, 13(1), 312. doi: 10.1186/1471-244X-13-312
Racic, M., Todorovic, R., Ivkovic, N., Masic, S., Joksimovic, B., & Kulic, M. (2017). Self-perceived stress in relation to anxiety, depression and health-related quality of life among health professions students: A cross-sectional study from Bosnia and Herzegovina. Slovenian Journal of Public Health, 56(4), 251-259. doi: 10.1515/sjph-2017-0034
Sauro, J. (2011, August 11). SUStisfied? Little-Known System Usability Scale Facts. User Experience Magazine, 10(3). Retrieved from http://uxpamagazine.org/sustified/
Schoneveld, E. A., Malmberg, M., Lichtwarck-Aschoff, A., Verheijen, G. P., Engels, R. C., & Granic, I. (2016). A neurofeedback video game (MindLight) to prevent anxiety in children: A randomized controlled trial. Computers in Human Behavior, 63, 321-333. doi: 10.1016/j.chb.2016.05.005
Serrano-Laguna, Á., Martínez-Ortiz, I., Haag, J., Regan, D., Johnson, A., & Fernández-Manjón, B. (2017). Applying standards to systematize learning analytics in serious games. Computer Standards & Interfaces, 50, 116-123. doi: 10.1016/j.csi.2016.09.014
Stiles-Shields, C., Ho, J., & Mohr, D. C. (2016). A review of design characteristics of cognitive behavioral therapy-informed behavioral intervention technologies for youth with depression and anxiety. Digital Health, 2, 1-13. doi: 10.1177/2055207616675706
Tozzi, F., Nicolaidou, I., Galani, A., Antoniades, A. (2018). eHealth Interventions for Anxiety Management Targeting Young Children and Adolescents: Exploratory Review. Journal of Medical Internet Research, Journal of Pediatrics and Parenting, 1(1), 1-15. doi: 10.2196/pediatrics.7248
Van Singer, M., Chatton, A., & Khazaal, Y. (2015). Quality of smartphone apps related to panic disorder. Frontiers in Psychiatry, 6. doi: 10.3389/fpsyt.2015.00096
Anderson, P., Jacobs, C., & Rothbaum, B. O. (2004). Computer‐supported cognitive behavioral treatment of anxiety disorders. Journal of Clinical Psychology, 60(3), 253-267. doi: 10.1002/jclp.10262
Bangor, A., Kortum, P. T., & Miller, J. T. (2008). An empirical evaluation of the system usability scale. International Journal of Human–Computer Interaction, 24(6), 574-594. doi:10.1080/10447310802205776
Beesdo, K., Knappe, S., & Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatric Clinics of North America, 32(3), 483-524. doi: 10.1016/j.psc.2009.06.002
Brooke, J. (1996). SUS-A quick and dirty usability scale. In P.W. Jordan, B. Thomas, B.A. Weerdmeester, & I.L. Mcclelland (Eds.), Usability evaluation in industry (pp. 189-194). London, UK: Taylor & Francis.
Cavazza, M., & Charles, F. (2017). User interaction for interactive storytelling. In R. Nakatsu, M. Rauterberg, P. Ciancarini (Eds.), Handbook of Digital Games and Entertainment Technologies (pp. 415-428). Singapore: Springer. doi: 10.1007/978-981-4560-50-4_57
Dennis, T. A., & O’Toole, L. J. (2014). Mental health on the go: Effects of a gamified attention-bias modification mobile application in trait-anxious adults. Clinical Psychological Science, 2(5), 576-590. doi: 10.1177/2167702614522228
Deterding, S., Dixon, D., Khaled, R., & Nacke, L. (2011). From game design elements to gamefulness: defining gamification. In Proceedings of the 15th international academic MindTrek conference: Envisioning Future Media Environments (pp. 9-15). ACM. doi: 10.1145/2181037.2181040
Dillon, A., Kelly, M., Robertson, I. H., & Robertson, D. A. (2016). Smartphone applications utilizing biofeedback can aid stress reduction. Frontiers in Psychology, 7. doi: 10.3389/fpsyg.2016.00832
Freire, M., Serrano-Laguna, Á., Iglesias, B. M., Martínez-Ortiz, I., Moreno-Ger, P., & Fernández-Manjón, B. (2016). Game learning analytics: Learning analytics for serious games. Learning, Design, and Technology, 1-29. doi: 10.1007/978-3-319-17727-4_21-1
Hoffmann, A., Christmann, C. A., & Bleser, G. (2017). Gamification in stress management apps: A critical app review. JMIR Serious Games, 5(2), 13. doi: 10.2196/games.7216
Hollis, C., Falconer, C. J., Martin, J. L., Whittington, C., Stockton, S., Glazebrook, C., & Davies, E. B. (2017). Annual Research Review: Digital health interventions for children and young people with mental health problems–a systematic and meta‐review. Journal of Child Psychology and Psychiatry, 58(4), 474-503. doi: 10.1111/jcpp.12663
Ly, K. H., Asplund, K., & Andersson, G. (2014). Stress management for middle managers via an acceptance and commitment-based smartphone application: A randomized controlled trial. Internet Interventions, 1(3), 95-101. doi: 10.1016/j.invent.2014.06.003
Malboeuf-Hurtubise, C., Lacourse, E., Herba, C., Taylor, G., & Amor, L. B. (2017). Mindfulness-based intervention in elementary school students with anxiety and depression: a series of n-of-1 trials on effects and feasibility. Journal of Evidence-based Complementary & Alternative Medicine, 22(4), 856-869. doi: 10.1177/2156587217726682
Manicavasagar, V., Horswood, D., Burckhardt, R., Lum, A., Hadzi-Pavlovic, D., & Parker, G. (2014). Feasibility and effectiveness of a web-based positive psychology program for youth mental health: randomized controlled trial. Journal of Medical Internet Research, 16(6). doi: 10.2196/jmir.3176
Marusak, H. A., Thomason, M. E., Elrahal, F., Peters, C. A., Kundu, P., Lombardo, M. V., ... & Rabinak, C. A. (2017). Mindfulness and dynamic functional neural connectivity in children and adolescents. Behavioural Brain Research, 336, 211-218. doi: 10.1016/j.bbr.2017.09.010
McCoy, L., Lewis, J. H., & Dalton, D. (2016). Gamification and multimedia for medical education: A landscape review. Journal of the American Osteopathic Association, 116(1), 22-34. doi: 10.7556/jaoa.2016.003
Merikangas, K. R., Nakamura, E. F., & Kessler, R. C. (2009). Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience, 11(1), 7-20.
Mohr, D. C., Schueller, S. M., Montague, E., Burns, M. N., & Rashidi, P. (2014). The behavioral intervention technology model: an integrated conceptual and technological framework for eHealth and mHealth interventions. Journal of Medical Internet Research, 16(6). doi: 10.2196/jmir.3077
Morgan, A. J., Rapee, R. M., & Bayer, J. K. (2016). Prevention and early intervention of anxiety problems in young children: a pilot evaluation of Cool Little Kids Online. Internet Interventions, 4, 105-112. doi: 10.1016/j.invent.2016.05.001
Morgan, A. J., Rapee, R. M., Salim, A., Goharpey, N., Tamir, E., McLellan, L. F., & Bayer, J. K. (2017). Internet-delivered parenting program for prevention and early intervention of anxiety problems in young children: Randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 56(5), 417-425. doi: 10.1016/j.jaac.2017.02.010
Nicolaidou, I., Tozzi, F., Kindynis, P., Panagiotou, M., & Antoniades, A. (2017). An interactive storytelling game for mobile devices for children’s stress management. In 11th European Conference on Games Based Learning (ECGBL) (pp. 967-971). Sonning Common , UK: Academic Conferences International Limited.
Pham, Q., Khatib, Y., Stansfeld, S., Fox, S., & Green, T. (2016). Feasibility and efficacy of an mHealth game for managing anxiety: “Flowy” randomized controlled pilot trial and design evaluation. Games for Health Journal, 5(1), 50-67. doi: 10.1089/g4h.2015.0033
Pramana, G., Parmanto, B., Kendall, P. C., & Silk, J. S. (2014). The SmartCAT: an m-health platform for ecological momentary intervention in child anxiety treatment. Telemedicine and e-Health, 20(5), 419-427. doi: 10.1089/tmj.2013.0214
Proudfoot, J., Clarke, J., Birch, M. R., Whitton, A. E., Parker, G., Manicavasagar, V., ... & Hadzi-Pavlovic, D. (2013). Impact of a mobile phone and web program on symptom and functional outcomes for people with mild-to-moderate depression, anxiety and stress: a randomised controlled trial. BMC Psychiatry, 13(1), 312. doi: 10.1186/1471-244X-13-312
Racic, M., Todorovic, R., Ivkovic, N., Masic, S., Joksimovic, B., & Kulic, M. (2017). Self-perceived stress in relation to anxiety, depression and health-related quality of life among health professions students: A cross-sectional study from Bosnia and Herzegovina. Slovenian Journal of Public Health, 56(4), 251-259. doi: 10.1515/sjph-2017-0034
Sauro, J. (2011, August 11). SUStisfied? Little-Known System Usability Scale Facts. User Experience Magazine, 10(3). Retrieved from http://uxpamagazine.org/sustified/
Schoneveld, E. A., Malmberg, M., Lichtwarck-Aschoff, A., Verheijen, G. P., Engels, R. C., & Granic, I. (2016). A neurofeedback video game (MindLight) to prevent anxiety in children: A randomized controlled trial. Computers in Human Behavior, 63, 321-333. doi: 10.1016/j.chb.2016.05.005
Serrano-Laguna, Á., Martínez-Ortiz, I., Haag, J., Regan, D., Johnson, A., & Fernández-Manjón, B. (2017). Applying standards to systematize learning analytics in serious games. Computer Standards & Interfaces, 50, 116-123. doi: 10.1016/j.csi.2016.09.014
Stiles-Shields, C., Ho, J., & Mohr, D. C. (2016). A review of design characteristics of cognitive behavioral therapy-informed behavioral intervention technologies for youth with depression and anxiety. Digital Health, 2, 1-13. doi: 10.1177/2055207616675706
Tozzi, F., Nicolaidou, I., Galani, A., Antoniades, A. (2018). eHealth Interventions for Anxiety Management Targeting Young Children and Adolescents: Exploratory Review. Journal of Medical Internet Research, Journal of Pediatrics and Parenting, 1(1), 1-15. doi: 10.2196/pediatrics.7248
Van Singer, M., Chatton, A., & Khazaal, Y. (2015). Quality of smartphone apps related to panic disorder. Frontiers in Psychiatry, 6. doi: 10.3389/fpsyt.2015.00096