Creating healthier futures for ill children

Insight into the user experience of Triumf digital therapeutics platform: usability and effectiveness

This spring, we created a new pathway to our disease management platform Triumf Health, which we launched as a separate public health app to all kids aged 7-14 to help them cope better during the coronavirus pandemic. Whilst our previous focus had been on delivering comprehensive care to pediatric patients, the new app caters for all children, irrespective of their health situation. We were very proud to see a significant interest for our solution - the application even reached a number one position on Google Play in Estonia. The extensive usage of Triumf health game created a great opportunity for us to further understand user behaviour in the game and evaluate retention and engagement based on real-life data. But at the same time, we also gathered qualitative user feedback and this post is all about that!

Our mission at Triumf Health is to provide healthier futures to children by delivering digital therapeutics through an environment that is safe and intuitive (and fun!) for them - a mobile game. Digital therapeutics, per se, mean that treatment is delivered in a form of software. In the context of our therapeutic game, it means providing evidence-based psychological and behavioural support to children in a personalised manner through an app to help them cope better with stressful conditions and promote the creation of healthy habits. Last year, our solution was chosen among the TOP 2 digital health companies in Europe and among 20 best startups across all industries.

We acted quickly in response to the coronavirus pandemic - during the initial periods of COVID19 outbreak, the Triumf Health game was launched as a free public health service. Although children and adolescents are not specifically in the risk group, they are the most vulnerable to the negative effects of the pandemic on mental health as they do not yet have the life experience and coping skills to help manage their own wellbeing. As such, in collaboration with health care providers and professionals, we created a public health pathway to our digital therapeutics solution to help mitigate the potential harm caused to children’s mental health by the pandemic.

Why is it important to gather insights on user behaviour?

Technology providers have been launching various innovations to fight the COVID-19 pandemic, however, the effectiveness (and safety) remains unknown. A recent review has also highlighted that although 38% of mental health app descriptions in app stores include phrases related to claims of effectiveness, only less than 3% provide scientific evidence for such claims. Furthermore, the issue to improve user engagement of existing solutions, especially targeted to children, remains.Digital tools need to be designed and developed with the user’s experience and preferences at the centre of decision-making and design choice processes to ensure user acceptability and intervention effectiveness. Children are used to interactive environments, making the game environment a promising avenue to deliver support to children.

Gamification creates an environment that is both appealing and supportive for children, which ensures enjoyable user experience and in turn increases the efficacy of the intervention. While gamification is being more widely used in the healthcare field, it’s application in the specific context of supporting mental health remains limited. Most applications have not gone through extensive clinical trials or science-based development or evaluation. Furthermore, the few studies of gamified mental health applications were mostly evaluated without a real-life data approach to support the design and analysis of gamified strategies. Consequently, our understanding of how gamification users perceive the impact of gamification on their subjective wellbeing remains limited. Hence, it is important to collect both quantitative as well as qualitative feedback on user experience in the game to make it more enjoyable and purposeful, and consequently boost user engagement.

General feedback

For us, it is very important to evaluate the game as a whole considering that the solution such comprehensive care, including psychoeducation, emotion regulation, information and techniques related to health behaviours but also cognitive distration and entertainment. On average, our game received a general evaluation of 4.5 points out of 6 in our target age group. As a comparison, based on 21 reviews on Google Play, the game rating is higher: 4.33/5. However, asking direct feedback from users in addition to the total score allows us to get more qualitative information regarding the likes and dislikes of the game - something we can use directly to improve the game. With that said, as expected, children like very different things in the game - some of the most liked components of one child were the least liked by somebody else. However, different daily missions and activities of keeping the Triumfland city healthy were the most liked features in general. It could be brought out that our graphics definitely need some extra work (we are on it!) - several children mentioned that they would like improve it. Our players didn't stop there and used their opportunity to speak along to also dive into the whole storyline. The narrative of Triumf health game evolves around taming the Disease Monster who is an abstract character in the game. However, children said they would like to know what the Disease Monster looked like and also expressed their wish to extend the storyline. This is a good sign for us as it shows that children like the narrative of the game and want to engage with it even more.

For us, the key areas for improvement arise from the suggestions from children. We consider our end-users to be our partners as they tend to be creative and honest about what they would like to see. Our players had quite a lot of suggestions on how to improve the game and we have highlighted key points to consider in the future updates. Several improvements have already taken place with many underway. We cannot wait to share the new looks (and feels) of the game!

Usability and acceptability

We are really proud that all the ratings for this section stayed above mean, showing that in general children were pleased with the solution. The lowest rating was received regarding the graphics of the game. We agree that the graphics of the game may have not met the expectations of children who come across many sophisticated entertainment games every day, which is why we are soon launching a new version with completely new graphics (which are amazing!). This would also help us expand the age range of our solution. Stay tuned for our next update! Aside from the looks of the game, it’s particularly great to see that kids find the health app engaging, something that has been brought out as a shortcoming of digital health solutions previously. If engagement remains low, it’s difficult to ensure that users will continue to use the solution also in the future and so the potential treatment effect is also reduced.

Effectiveness

The only below-average score we received was related to the amount of required reading in the game. A core aim of the game is to educate children on their health and wellbeing in an age-appropriate way. However, whilst we agree that there is a lot of content to go through, it is encouraging to see that children perceive the information delivered valuable and educating. It means they are learning something new about their health and well-being, which is highly important if we want the children to understand their emotions and feelings, and internalise healthy behaviours. Moreover, a high score was achieved for the advice that the sidekick gives inside the gameplay, confirming that the way we approach children is safe and appropriate for them. To make the learning process more engaging to children and take their feedback into account, we are launching a trivia game as part of the Triumf platform to make the educational component more fun. This feature will be added to the game in August.

We are grateful for our young players who thought along and provided useful feedback on our game. Changes to Triumf digital health solution are already happening based on children’s input as we speak. We are also currently evaluating retention and engagement based on the real-life data from the public launch. We look forward to sharing new insights with you soon.