Eindhoven University of Technology

MASTER

The potential of a mobile health rewarding app (GameBus) for people with intellectualdisabilities : different scenarios

Kooijman, M.R.A.

Award date:2016

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Eindhoven,February2016

by M.R.A. Kooijman

BSc Industrial Engineering and Management Sciences for Healthcare – TU/e 2012 Student identity number 0657614

In partial of the requirements for the degree of

Master of Science in Operations Management and Logistics for Healthcare

1stsupervisorTU/e:Dr.P.M.E.(Pieter)VanGorp,InformationSystemsIE&IS2nd supervisor TU/e: Prof. Dr. J.H.D.M (Joyce) Westerink, Human TechnologyInteractionSupervisorLunetzorg:P.(Patrick)LeijteR.(Ruud)KavelaarsH.J.(Henk)vanHeffen

Thepotentialofamobilehealth

rewardingapp(GameBus)for

peoplewithintellectual

disabilities–differentscenarios

amongclientsofLunetzorg

TUE.SchoolofIndustrialEngineering.

SeriesMasterThesisOperationsManagementandLogistics

Subject headings: HEALTH CARE; E-HEALTH; M-HEALTH, GAMIFICATION,

INTELLECTUALDISABILLITIES

i

Preface

Ihaveagreatinterestinhealthcare,butafterIhaddoneseveralassignmentsinhospitals,I

decidedIwouldliketoexploreanothergrowingsideofhealthcare:careforelderly.During

thenext30years,thegovernmentandhealthcareorganizationswillfaceahugechallenge,as

the Baby Boomer generationwill enter retirement. The government supports these older

adultsinstayingaslongaspossibleintheirhomes.Tele-caretechnologiescanbetheanswer

forelderlytostayaslongaspossibleintheirhomes.Therefore,Iwrotemyliteraturereview

aboutimplementationfactorsoftele-caretechnologiesinnursinghomes.Aninternshipwas

establishedatCareyn,viaanacquaintancewhowasthechiefexecutiveofficer.

However,duringmymaster’sthesisprojectnoteverythingwentasexpected.Thebeginning

wasverypromising,butIunexpectedlyfailedthreecourses,soIcouldnotstartmymaster’s

thesis.Inthemeanwhile,myacquaintanceatCareynswitchedjobsandCareynwasnolonger

interestedinaninternship.Alsoatthattime,mymentorwentonmaternityleave,andIhad

torestartwithmynewmentor.Unfortunately,itwasnotsoeasytofindaninternshiplocation

thatsuitedmyliteratureresearch.

IthenbecameinvolvedintheGameBusresearch,andIcaughttheenthusiasmofDr.P.M.E.

VanGorp.Therefore,Iwouldreallyliketothankmyfirstsupervisor,Dr.P.M.E.VanGorp,for

hisenthusiasm.IreallyhopethatIcanstayinvolvedintheGameBusprojectaftergraduating.

Also,specialthankstomycolleaguesPatrickLeijte,RuudKavelaarsandHenkvanHeffenat

Lunetzorg,whoofferedmetheopportunitytopursuemymaster’sthesis.InthebeginningI

wasalittleskepticaltoworkwithpeoplewithintellectualdisabilities,butitisgoodtoknow

thesepeoplebetter.Theirkindness,gratitude,enthusiasmandappreciationforsmallthings

islovelytosee,andIhopetoworkwiththeseclientsagaininthefuture.

Ialsowanttothankmyfamilyandfriends for theirunderstandingandsupportduringthe

entireschoolperiod.Andlastbutnotleast,IwanttothankmygirlfriendMilouforhersupport

ii

during good and not-so-goodmoments. The combinationwith the demands of high-level

sportsmadethishardforme.

Ihopeyouenjoyyourreading!

MaartenKooijman

Soest,February4,2016.

iii

Abstract

This researchdescribes the results of a six-month graduationprojectwithin theGameBus

project.GameBusisanovelapp,anideaofDr.P.M.E.VanGorpdevelopedwithinamulti-

nationality collaboration. The app engages families and friends to stay active physically,

cognitivelyandsociallyviaanenjoyablepersonalizedgamingexperience.GameBusconnects

children, colleagues, the elderly and other familymembers to join physical, cognitive and

socialchallenges,anditisuniquebecauseitcrossestheboundariesofexistinghealthapps.

Theappwasnotdesignedexplicitlyforpeoplewithintellectualdisabilities.However,some

issues(e.g.,socialisolation,insufficientphysicalexercise,etc.)playaroleinthecareforpeople

withintellectualdisabilities,astheydoincarefortheelderly.Therefore,itisworthwhileto

investigate if health-rewarding apps like GameBus can play a role within healthcare

organizationsforpeoplewithintellectualdisabilities.Viathismasterthesisproject,ithasbeen

examinedwhichclientsareeligibleforGameBusandhowtheappmightbeusedinthefuture.

ThefindingsandexperiencesofclientsandclientsupervisorswiththeapplicationofGameBus

are presented. Three promising use caseswere found inwhichGameBus can play a role.

GameBus is a valuable way tomotivate and stimulate clients to perform physical, social,

cognitiveandother(e.g.,domestic)activities.

iv

Managementsummary

Introduction

Increasinghealthcarecostsanddemandsareexpectedinfuture.Thisresultsinanincreasein

thetotalhealthcarecosts,andthereforethecaresystemswillbeunsustainableinthefuture.

The use of e-Health can make a significant contribution to the quality and efficiency of

healthcare.There isan increasinguseofmobiledevices,andthemarketformobilehealth

(rewarding)applicationsisincreasingtoo.

Most of the elderly prefer to live independently in their own houses. The new Dutch

governmentplansseemtosupportthesepreferences.Thegovernmentsupportstheelderly

in staying as long aspossible in their homes, and it hopes to avoidhighhealthcare costs.

However,becauseofthebusylifestylesofmanypeople,theelderlytendtobecomesocially

isolated.

Peopleuse their own (health) apps and favorite games, resulting in social islands.Health-

rewardingappsorplatformscouldbethesolutiontoengagingfamiliesandfriendstostay

activephysically,cognitivelyandsociallythroughapersonalizedgamingexperience.GameBus

issuchaplatformwherepeoplecanplaytheirfavoritegamestoearnpointsandwherethey

arepartofanintegratedsocialinteraction.Ascanbeseeninthefigurebelow,apersoncan

playtheirownfavoritephysicalorcognitivegame.Personaldataisproducedinthesegames.

Then, these data are fetched andmatched to team-oriented challenges in order towin a

challenge.

v

Figure1:datafetchingandmatchingtoteam-orientedchallengesinGameBus(VanGorp,2015)

GameBusissuchamobilehealth-rewardingapplications.AlthoughGameBusisnotdesigned

explicitly forpeoplewith intellectual disabilities, componentsofGameBus could alsobea

valuable solution for people with intellectual disabilities. However, there is a lack of

knowledge concerning thepossibilities of e-Health in the care for peoplewith intellectual

disabilities.

GameBusisaplatformwithabaseappandislinkedtoanecosystemofvariousotherapps.

The leadingprinciple is torewardtheclient’sbehavior.Peoplewith intellectualdisabilities

also face social isolation as a result of an individualized society, and physical inactivity is

particularlyprevalent.Increasingphysicalactivityamongpeoplewithintellectualdisabilities

is the most effective intervention of improving their health. Gamification concepts could

increasetheeffectivesofthesephysical,cognitive,orsocialinterventionsbecauseitstrongly

increasesmotivation.

Objectives

Health-rewardingappscouldbeavaluablesolutionforhealthcareorganizationsforpeople

withintellectualdisabilitiesifitcreatesvaluefortheorganizationandfortheclientsandtheir

vi

families.Astherehasbeenlittleresearchintohealth-rewardingplatformssuchasGameBus,

thefollowingmainresearchquestionisformulated:

How can mobile health-rewarding apps contribute to the quality of life of people with

intellectualdisabilities,andhowcanhealthcareorganizationsbenefitfromthis?

The aim of this study is to investigate whether health-rewarding apps (e.g., GameBus)

stimulatephysical,cognitiveandsocialactivitiesinhealthcareorganizationsforpeoplewith

intellectualdisabilitiestakingintoaccountthedifferenthousingfacilitiesanddifferentclients.

Method

First,acategorizationofdifferentclientsandtheir livingsituationsfromliteratureisgiven,

resultinginsevendifferentcategories.Theseliteraturecategoriesareusedtodefinedifferent

real-lifeclientswithinthepilot(i.e.,6personas).Thesepersonasareusedtoanswertheother

research questions to make a distinction between the different clients based on their

capabilitiesand livingsituations. Indeed,notallclientsreactthesametohealth-rewarding

apps. It isanalyzedhowGameBuscouldbe linkedwithcurrentmethodologies.Healthcare

organizations want that their staff work with existing proven methodologies. Then, the

research provides theoretical and practical information about the applied gamification

elementsandbehaviorchangetechniquesduringtheresearch.

The results are analyzed in the light of a psychological model of behavior, namely the

ReasonedActionApproach(RAA).TheRAAisoftenusedtoanalyzeotherhealthandbehavior

changeinterventions.ByapplyingtheRAA,userbehaviorandtheexperienceofGameBusis

bettertounderstand.BasedontheRAA,anevaluationframeworkisconstructedtoanalyze

theresults.

vii

Figure2:Thesisstructure

Duringtheresearch,qualitativedatafrom20clients,7clientsupervisors,andseveralexperts

werecollected.Attheend,6clientswerenotabletoparticipateinthefinalquestionnaire.

Literature research was done on the effects of health-rewarding apps for people with

intellectualdisabilities,anditwastakenintoaccountduringthewholeresearch.

Results

GameBusenabledclients,clientsupervisors,andfamilymemberstostimulate,monitor,and

supporteachother inhealthybehaviorandexecuting (domestic)activities throughshared

activities and challenges. Additionally, GameBus provided data for client supervisors,

increasedmotivationandself-esteemforclients,andincreasedthejoyofclients.

ThroughanalyzingbehaviorofclientsduringtheresearchviadeRAA,threecategorieswere

found.Acategoryincludesclientswiththesameintellectualdisabilitiesandsimilareffectson

behavior.

Table1:Corecategories

Category1 Category2 Category3Clients -Youngclient(age<30)with

behavioralproblemsandIQ>80;-Retardedclient(age30-65),liveindependent,IQ70-85.

-Adultclient(age30-65),IQ60-80

-Adultclient(age18-65),IQ40-60

Teamformation Playinteamsincludingclientsupervisor,familymembers,friends,otherclients

Smallteams,e.g.,clientsupervisorand1-2familymembersorgoodfriends

Only1team:client+clientsupervisor

viii

Conclusion

Inconclusion,thelevelofIQandtheextentoftelephoneskillsarethekeyfactorsfortheuse

ofGameBus.ClientswithanIQbelow40aredefinitelynotabletouseanycomponentsof

GameBus.Additionally,GameBuscannotbeusedbyclientswhodonothavesufficientphone

skills(i.e.,abletotakepictures,uploadpicturestoGameBus,switchbetweenmenus,enter

informationintheapp,etc.).

Basedontheresults,GameBuscouldbeappliedinthreedifferentways,dependingonthe

typeofclient.ThisarethefirstthreepromisingusecasesforLunetzorg,iftheywanttouse

GameBus.Allclientsfacethesameissuesinagreaterorlesserextent(e.g.,socialisolation,

insufficientphysicalexercise, lowself-esteem, lowmotivation).Below, theseusecasesare

explainedinmoredetail:

A. first potential use case: Play in teams including client supervisor, familymembers,

friendsandotherclients.

- Targetgroup:

o Youngclient(age<30)withbehavioralproblemsandIQ>80;

o Mentallydisabledclient,livesindependently(age30–65)andIQbetween

70and85.

- Problems: Insufficient physical exercise, lowmotivation, low self-esteem, social

isolation.

- Benefits:

o Healthierlifestyle;

o Clientenvironmentmoreinvolvedincare;

o Receivemorevisitsandcarefromfriendsandfamily(moreintegration);

o Increasedmotivationfortheclient;

o Supportrewardsystem;

o Clienthascloserrelationshipwithenvironment;

o Canbeusedtohavedailyactivitiesandroutine;

o Feeluseful.

ix

B. secondpotential use case: Teamwith client supervisor and1-2 familymembersor

goodfriends.

- Targetgroup:

o Adult client (age 30 – 65) with an IQ between 60 – 80 (mild mental

disability).

- Problems: Insufficient physical exercise, lowmotivation, low self-esteem, social

isolation.

- Benefits:

o Healthierlifestyle;

o UsingCogGamesincreasesfunfactorofotheractivitiesbecausepointsare

earned;

o Activitiestodoeveryday;

o Increasedmotivationfortheclient;

o Familyoftheclientmoreinvolved;

o Receivemorevisitsandcarefromfriendsandfamily.

C. thirdpotentialusecase:Onlyoneteam:clientandclientsupervisor

- Targetgroup:

o Adult client (age 18 – 65) with an IQ between 40 – 60 ((mild) mental

disability).

- Problems: Insufficient physical exercise, lowmotivation, low self-esteem, social

isolation.

- Benefits:

o Healthierlifestyle;

o Rewardsystemforactivitiesextrastimulatingforclient;

o Supportrewardsystem;

o Funandsimplegamestotraincognitiveaspects;

o Encouragetostayhealthy;

o Encouragetoexecutetasks.

x

GameBuscanbeanattractivewaytostimulatehealthybehavior,butitcanalsobeusedasan

additionaltooltoassistsclientswiththeirpersonalgoalsasdescribedintheirpersonalplan.

ThroughtheuseGameBus,Lunetzorgpositionsitselfasaninnovativeorganizationcompared

tootherhealthcareorganizations.

Budgetscandeclineto25%thisyear,andalsothedemandforcareforpeoplewithintellectual

disabilitiesisincreasing.Inordertocontinueprovidingthesamecare,addingGameBusand

familymemberscouldbeasolutiontodeliverthesamecarewithlessmoney.Lunetzorgcan

formulatechallengesandinvolvefamilymembersmoreinthecareprocess.

Insummary,GameBusisapromisingandambitiousproject.WithGameBus,Lunetzorgcan

increasethemotivationofclients,involvefamilyandfriendsinthecareprocess,makeclients

moreawareoftheir(health)behavior,increaseself-confidenceofclients,orstimulateclients

inanattractiveway.

xi

Tableofcontents

Preface i

Abstract iii

Managementsummary iv

Introduction iv

Objectives v

Method vi

Results vii

Conclusion viii

Tableofcontents xi

1. Introduction 1

1.1 Context 2

1.2 Lunetzorg 4

1.3 GameBus 4

1.4 ChangesinDutchlong-termcare 7

2. Methodology 10

2.1 Problemstatement 10

2.2 Objectiveandscope 10

2.3 Projectsteps 11

2.4 Researchquestions 11

2.5 Pre-testandpost-test 13

2.6 Interviews 14

2.7 Researchperiod 15

2.8 Scope 15

3. Definingdifferentclienttypes/housingsituations 16

3.1 Peoplewithdisabilities 16

3.1.1 Generalcharacteristicsofpeoplewithintellectualdisabilities 16

3.2 Careintensitypackages 18

3.3 Differentformsofhousing 19

3.4 Preconditions 21

3.5 Participantsinpilot 21

xii

3.6 ReallifePersonas 22

4. Currentmethodologies(AS-IS) 24

5. Whatisknownabout:gamificationandbehaviorchangetechniques 26

5.1 Gamification 26

5.1.1 Whatisknowabout:definitiongamification 26

5.1.2 Whatisknowabout:motivationfactorsinGameBus 27

5.1.3 Whatisknowabout:gamificationforpeoplewithmentaldisabilities 28

5.2 Behavioralchangetechniques 29

6. ReasonedActionApproach 31

7. EvaluationFramework 33

7.1 EvaluationoftheoverallexperienceofGameBusbyclientsandclientsupervisors 33

7.2 EvaluationwiththeRAA 33

7.2.1 Patternsandcontextofuse 33

7.2.2 Contextofuse(timeandenvironment) 33

7.2.3 Busylivesandroutines 33

7.2.4 Intensionsanddisappointment 33

7.2.5 Otherpeople 34

7.2.6 Appdesign 34

7.2.7 Coreconcern 34

7.3 Evaluationotherhealthgamificationfactors 34

7.3.1 Teams 34

7.3.2 Physicalactivitypromotion 34

7.3.3 Goalsetting 35

7.3.4 Presentationofinformation 35

8. Results 36

8.1 Post-test 36

8.1.1 Physicalactivities 36

8.1.2 Socialactivities 38

8.1.3 Motivation 39

8.2 Evaluationframework 40

8.2.1 EvaluationoftheoverallexperienceofGameBusbyclientsandclientsupervisors 40

8.2.1.1 Clientexperience 40

8.2.1.2 Clientsupervisorexperience 42

xiii

8.2.2 Evaluationofclients’behaviorviatheReasonedActionApproach 44

8.2.2.1 Patternsandcontextofuse 44

8.2.2.2 Contextofuse(time,location,andenvironment) 46

8.2.2.3 Busylivesandroutines 47

8.2.2.4 Intensionsanddisappointment 48

8.2.2.5 Otherpeople 49

8.2.2.6 Appdesign 49

8.2.2.7 Coreconcern 50

8.2.3 Evaluationofotherhealthgamificationfactors 52

8.2.3.1 Teams 52

8.2.3.2 Physicalactivitypromotion 54

8.2.3.3 Goalsetting 56

8.2.3.4 Presentationofinformation 56

9. Discussion 57

10. Conclusion 62

11. Futurework 65

12. References 66

Appendices 72

AppendixA:GameBusscreenshots 72

AppendixB:Explanationthesissteps 74

AppendixC:Healthbehaviorchangetechniques 75

AppendixD:Personas 78

AppendixE:AveragescoreperZZP 81

AppendixF:NewregistrationprocedureWMO 82

AppendixG:Ratesforintellectualdisabilitycarepercareintensitypackage 83

AppendixH:Generalimplementationplanofe-healthtechnology 85

AppendixI:Questionnairesclients 94

AppendixJ:Questionnairesclientsupervisors 164

1

1. IntroductionThereareclear trendsvisible inhealthcare that concern thecaretaker, caregiverandcare

financier.Oneofthemoststrikingtrendsistheincreaseindemandandfurtherexpansions

expectedinthefuture.Thisresultsinanincreaseinthetotalhealthcarecosts,andtherefore

thecaresystemswillbeunsustainableinthefuture(IBM,2006).Thereisanongoingdebate

aboutthecostofhealthcare,anditismainlyfocusedonthefinancingandsupplyside.Itis

still predicted that health expenses in theNetherlandswill increase every year (European

Commission, 2012). One possible way to reduce healthcare costs is the deployment of

technology.

Technologyhasbeenchangingrapidly,sothatpeoplearenowabletoaccessitwhereverand

whenevertheywant.Smartphones,tabletsandothertechnologicaltoolshaverevolutioned

ourworldinrecentyearsandthewayswecommunicatehavechangedconsiderably.They

havealsoenteredthemarketforpeoplewithdisabilities.Thesetechnicaldevicesuseapps

(softwareapplicationsthatrunonmobiledevicesandtablets)moreandmore.

Anotherdevelopment is the riseofhealth-relatedappsandplatforms.GameBus is sucha

platform,withanewapplicationdevelopedtotraincognitive,physicalandsocialactivitiesin

apleasantway.“Thekeyideaistoletpeopleplaythedifferentgamestheyenjoytrulyasan

individual, insuchaway that theyarepartofan integratedsocial interaction” (VanGorp,

2015).Forexample,olderpeoplewillbeabletoplaytheirfavoritebraingame(e.g.,Sudoku),

whiletheycanencourageyoungpeopletoperformphysicalactivities(e.g.,running).Players

ofthisnewapplicationencourageeachothertoachieve“teamgoals”,whichdirectlyfavor

theirhealth.AnothersideeffectisthatGameBusreducessocialisolation.GameBusgenerates

cognitive,physicalandsocialdatathatwillbemonitored.

CurrentdemographictrendsshowthattheEuropeanpopulationisaging.Thisresultsinmore

careresponsibilities forthefamiliesofdependentpeople.Eightypercentofcarehoursfor

disabledandagingpeopleareprovidedbyinformalcarersandfamilymemberswithoutany

financialcompensation(AmbientAssistedLiving,2014).GameBushasbeendevelopedasa

viablesolutiontosupportfamilieswiththeircareresponsibilitiesfortheirdependentfriends

2

and family members. Because people with intellectual disabilities also face with social

isolationasaresultofanindividualizedsocietyandphysicalinactivityisparticularlyprevalent,

it is worthwhile to examine whether GameBus can play a role in care for people with

intellectualdisabilities,howitshouldbepositionedwithinahealthcarefacility,andwhatthe

roleofthevulnerableelderlycanbeinthiscontext.

1.1 Context

NictizandNivelmadeagainavaluablecontributiontothemappingofthedigitizationofthe

DutchHealthcaresystemwiththeire-Healthmonitor2014.Themessageofthemonitor is

clear: e-Health supports trends in care, self-management, self-control and perception of

qualityofcare.Whenreadingthereport,onethingstandsout:theassociationfordisabled

peopleintheNetherlands(VGN)donotbelongtotheconsultedorganizationsinthereport.

Andthatisashame,becausetechnologymakesasignificantcontributiontoincreasingself-

controlandself-management,especiallyforpeoplewithintellectualdisabilities.Thee-Health

monitorprovidesfiverecommendations.Threeofthemaredirectlyrelatedtoclients,namely:

makehealthcareusersclearwhatispossiblewithtechnology,giveonlinefile inspectionto

clients, and focus on tangible advantages for the clients and organization. There are

interestingchallengesinthestettingofintellectualdisabledpeople.Howdoyoumakeclients

withdisabilitiesmakeawareoftheopportunitiespoweredbye-Health?Howcanyouconvince

clientsabouttheaddedvalueofe-Healthtechnology?Theanswerstothesequestionsarenot

foundinthee-Healthmonitor,butalsonotinotherresearch.Itisnotreallysurprisingthat

the answers on these questions are not available. After years of innovation, Rogers et al.

(2003)saysthatthereissomethingliketheinnovationparadox:thosewhoneedthebenefits

ofaninnovationthemost,areingeneralthelatestwhoadopttheinnovation.Atthismoment,

e-Health in the care for people with intellectual disabilities, especially focus on remote

healthcareanddomotica.Thereislackofknowledgeaboutthepossibilitiesofe-Healthinthe

careforpeoplewithintellectualdisabilities,andthisresearchcouldhelptofillthisresearch

gapalittlebit.

3

Figure3:Lackofknowledgeinthecareforpeoplewithintellectualdisabilities

TheuseofICTcanmakeasignificantcontributiontothequalityandefficiencyofhealthcare.

Lunet zorg shares the view that improving the quality, efficiency and affordability of

healthcare is inextricably linkedwith constant innovation, including e-health applications.

Lunetzorgisahealthcareorganizationforpeoplewithintellectualdisabilities.GameBuscan

beseenasane-healthinnovation.Animplementationofe-healththatinvolvestechnology,

acceptance,financial,organizational,policyandlegislation,andend-userfactors,islikelyto

leadtolong-termsuccess(Kooijman,2015).

InnovationisahighprioritywithinLunetzorg,andthereforetheywerealsointerestedinthe

GameBusproject.ThecompetitivecomponentofGameBus isveryappealingforthemand

couldhaveapositiveimpactonclients.Severalstudiesalsomentionthatthereisacorrelation

between social engagement and the advancement of cognitive and physical limitations

(Chodzko-Zajkoetal.,2009).

Lunet zorg is particularly interested in how GameBus could be positioned within the

organization.Theyprovidecareforchildren,youthandadultswithintellectualdisabilitiesin

different locations. Therefore, it will be very important to take into account the various

housingsituationsandclients.Thiswillbethefocusofthismaster’sthesisproject.

4

1.2 Lunetzorg

Lunetzorgsupportspeoplewithintellectualdisabilities.Morethan2,800clientsofallages

relyontheircaretoliveandwork,performdailyactivitiesandspendfreetime,andhave24/7

intensiveorlimitedcareandincidentalsupport.Twothousandandfivehundredprofessionals

workfortheorganization,andaround1,000volunteerssupporttheorganizationatnearly100

locationsorjustinclients’ownhomesinSoutheastBrabant(Lunetzorg,2015).Locationsare:

• Livingandcare

o 2residentialparks(EckertdalinEindhovenandDeDonksbergeninDuizel)

o Grouphomes(clientshaveaprivatespacebutsafetyofagroup)

o Privateapartmentorstudio

o Lodgings

• Daycare,learningandworkinglocations

• Neighborhoodsupportpoint(WSP)

• Traininghomes

1.3 GameBus

Playersofdifferentapplicationsareisolatedfromtheirfriendsandfamily,asshowninfigure

4.Children,parentsandadolescentsareplayingtheirownfavoritegames,andtheelderly

becomesociallyisolatedbecausetheyarenotplayinganything.

Figure4:Isolatedplayersinthenetwork(GomezNaranjo,2015)

5

“GameBusisaone-yearexternallyfundedprojectwithintheEITICTLabsactionline‘Health

and Wellbeing’. The project will deliver a novel App to turn currently perceived duties

regardingcognitive,physicalandsocialactivities intoanenjoyablegamingexperience.The

keyideaistoletpeopleplaythedifferentgamestheyenjoytrulyasanindividual,insucha

waythattheyarepartofanintegratedsocialinteraction”(VanGorp,2015).Forexample,the

grandmothercanplayherfavoritepuzzlegame(e.g.,Sudoku)whilecompetinginchallenges

with her grandchildren, who enjoy physical activities (e.g., using Strava to track running

activities),andthefatherisrewardedforvisitinghisgrandmother.SowithGameBus,elderly

peoplebecomemoreinvolvedinthesocialnetwork,asshowninfigure5(GomezNaranjo,

2015).

Figure5:GameBusbringspeopletogether(GomezNaranjo,2015)

By integrating social activities, games and activity-trackingmobile apps,GameBus aims to

provideanintegraloverviewofauser’shealthandwellbeingstate.Familyandfriendsengage

each other to create an environment of mutual support and motivation. But for every

participantinafamilythestatedependsonhisorherneeds,age,goals,andhealthstate.

6

GameBuswillsupportseveraldifferentgamesandapps,andplayersarefreetochosewhich

game theywant toplay (e.g.,memory, reaction time,physicalactivity trackers).GameBus

userscancommittochallengesasateam,whichfavorstheirhealthdirectly.Pointsareearned

when players reach a certain preset goal. At thismoment, GameBus offers a basic set of

challenges,but it is intendedthat inthenearfutureuserswillbeabletocreatetheirown

challenges.Besidesthesedirecthealthyadvantages,GameBusalsopreventssocialisolation

throughtheinteractionbetweenteammembers.Teammemberscanstimulateandmotivate

eachothertoperformhealthybehavior.

GameBususesanopenapplicationprogramminginterface(API),soapplicationsandwebsites

caneasilyinteractwitheachother.ThesewebsitesandapplicationsalsoneedanopenAPI.

Toillustratetheearningpointsprocess,anexampleisgiven:ifaplayercompletesapuzzle

using Griddlers (i.e., website with logic puzzles), data from this activity can be send to

GameBus.Ascanbeseeninfigure6,GameBususesthisdatatoawardindividuals(i.e.,give

points)intheirteamchallenges.

Figure6:EarningpointsforachallengeinGameBus(GomezNaranjo,2015)

7

GameBusisuniquebecauseitbringsphysical,cognitiveandsocialbehaviortogether.Most

applicationsonlyfocusononeortwooftheseaspects(VanGorp,2015).GameBususerscan

also use direct communication between nearby mobiles through device-to-device (D2D)

communicationwithanovelservicecalledTimeTogetherthatmonitorsphysicalandsocial

interactions.Forexample,thisservicefullyautomaticregisterifyouvisityourgrandparents,

notinvolvinganyscreeninteractionswhichwouldreducethequalityofthesocialinteraction.

Finally,fourkeycharacteristicsofGameBusareaslisted(Brouwers,2015):

- Playwhatyoulike:youcanearnpointsforawiderangeofactivities(physical,cognitive,

social)indicatedinthechallengeinwhichtheteamparticipates.

- Useanydeviceyouwant:chooseanydeviceyouprefertowear.Smartphones,smart

watchesandFitbits are supportedbyGameBusandcanbe connected toaGameBus

account.

- Everyoneisawinner:challengesarebuiltinsuchwaythateveryoneshouldbeableto

winchallenges,ontheconditionthatyouhavetherightmotivation.

- Unobtrusiveness:activitiescanbetrackedautomaticallywithoutmanuallyregistration

charge.

In appendix A some screenshots are shown to give a better idea about the GameBus

application.

1.4 ChangesinDutchlong-termcare

Long-term care has significantly changed in theNetherlands since 1 January 2015. This is

necessary,accordingtothegovernment,tokeepthefinancinglowandqualityofcarehigh.

Thesechangesaffectpeoplewhoneedcareathomeoratcareinstitutions.ThecurrentAWBZ

(ExceptionalMedicalExpensesAct)hasdisappearedandanewExceptionalMedicalExpenses

ACT(WLZ)forpeoplewithsevereintellectualdisabilitiesthatneedalotofcarehastakenits

place.Themunicipalitiesare responsible for the implementationof theSocialSupportAct

(WMO),whichappliestopeoplewholiveathomeandneedsupport.Municipalitiesarealso

responsibleforthenewjuvenilelawandtheParticipationAct.

IntheappendixFtheregistrationprocedureforthenewSocialSupportAct(WMO)isshown.

8

Currently,familiesandfriendsplayjustaminorroleinengagementandmotivationtowards

mentalandphysicalhealth.Theriseoftechnologyisreplacingthemeansofcommunication,

resultinginlessphysicalinteractionandgrowingphysicaldistance.ThenewDutchlong-term

carelawswillhavesomeeffectontheresponsibilitiesoffamiliesandfriends.GameBuscan

playanimportantroleininvolvingfamiliesandfriendsmoreinthedeliveryofcare.

TheDutchgovernmentdefineseightdifferent‘careservicepackages’.Package1isforpeople

whocansurvivewellwith littlehelp.Package8 isforpeoplewhoarenotmobileandwho

needall-daysupervision,completecareandnursing.Forpeoplewithintellectualdisabilities

therearedifferentformsofhousing,andthesettingsforpeoplewithintellectualdisabilities

areofteninlargeareaswheretheclientsliveasindependentlyandfairlyaspossible.Inthese

areas,therearemanydifferenthouseswhereclientshavetheirownrooms,andoftenthere

isacommonmeetingcentre.Thisisasafeandsecureenvironmentinwhichtolive.Thereare

alsomanyotherformsofhousing;forexample,independenthousingoutsidetheinstitution,

or clusteredhousingwhere severalpeoplewith intellectualdisabilities live close together.

They have ameeting centrewhere they can stay together (College voor zorgverzekering,

2013).

Depending on the care service package, healthcare organizations receive money/time to

spendsomehourswiththeclient.Thisindicationexplainswhatandhowmuchcaretheclient

canget.Thehealthcareorganizationisresponsibleforadditionalagreementswiththeclient.

Unfortunately,theAWBZischanging,andtheinsured“package”willfocusonlong-termcare

forpeoplewithmoreseveredisabilities.InJanuary,thefirstchangesweremade.Thus,people

withamilddisabilitynolongerreceivesupportfromtheAWBZ.TheindicationforotherAWBZ

care has also been narrowed, resulting in fewer nursing hours for clients (Nederlandse

Patienten Consumenten Federatie, 2015). To get a better understanding of the financial

consequences, the following factsheet estimates the new budgets after transferring the

budgets in 2015 (VGN, 2015). The figure shows that healthcare organizations receive on

average23%lessmoneyperclient.

9

Table2:Changingbudget

Amountwithoutdiscount

Discount NewbudgetWMO2015

Daycare €351 €88 €263Transport €25 €6 €19Supervision €450 €112 €337Personalcare €253 €38 €215Extramural €54 €13 €41Total €1.132 €257 €875

Theneedandwishforhealthcare-specificinnovationsisimmense.ThismakestheGameBus

researchrelevantandworthyofinvestigation.

10

2. Methodology

2.1 Problemstatement

Apps have been customized to meet the needs of people with (intellectual) disabilities.

GameBus isanappthatwillencourageandrewardfamilies (e.g., father,child,adolescent,

grandmother)andfriendstostayactivesocially,mentallyandphysically.GameBushasnot

beeninitiallydesignedforpeoplewith(intellectual)disabilities.However,someissues(e.g.,

social isolation, insufficient physical exercise, etc.) play a role in the care for peoplewith

disabilities,astheydoincarefortheelderly.Lunetzorgfounditworthwhiletoinvestigate

whethertheGameBusconceptisapplicableforpeoplewithintellectualdisabilities.Lunetzorg

wantstoactasacasestudyto investigatewhetherGameBuscouldbe implemented inan

organizationforpeoplewithintellectualdisabilities.

2.2 Objectiveandscope

Asalreadymentionedbefore, theaimof this studywas to to investigatewhetherhealth-

rewardingapps(e.g.,GameBus)stimulatephysical,cognitiveandsocialactivitiesinhealthcare

organizationsforpeoplewithintellectualdisabilities,takingintoaccountthedifferenthousing

facilitiesanddifferentclients.Thismainresearchquestionwasconstructedtoanswertwo

main questions from different parties. The first question was asked by the developer of

GameBus,PieterVanGorp:“Canhealth-rewardingappsbedeployedwithinanorganization

for people with intellectual disabilities?”. The second question was asked by Lunet zorg

because the research couldbedone in theirorganization, and Lunet zorgwasparticularly

interestedforwhichclients/locationsGameBuscouldbeavaluablesolution:“Which isthe

mostpromisingfirstusecaseforGameBus?”.Thisresultedinthemainresearchquestion:

How can mobile health-rewarding apps contribute to the quality of life of people with

intellectualdisabilities,andhowcanhealthcareorganizationsbenefitfromthis?

ThisthesiswillcontributetotheGameBusprojectbyreachingawholedifferentaudience.The

aimisthatGameBuswillleadtoareductionofprofessionalcareneededoranimprovement

of quality for clients. GameBus can contribute to the connection between informal

carers/familiesoutsidetheorganizationandclientsinsidetheorganization.Informalcarers,

11

municipalitiesandhealthinsurerswillbemoreimportantinahealthcareorganization.Now

thesocialneighborhoodteamsarebeingformedeverywhereandarecentered inthenew

decentralizedwayofworking.

Worldwide, all healthcare organizations are facing similar challenges. The advent of new

technologiescausesevenmorechallenges.Theagingpopulationandinsufficientfundingby

thegovernment,aremacroeconomicfactorswhichinfluencebothcaregiversandcaretakers

ofhealthcare. Inaddition, familiesand friends justplayminor roles in thedeliveryofcare

because their busy lifestyles. Also healthcare organizations for intellectual disabilities are

facing theseproblems. Lunet zorgwill actasa case study,however therearemanyother

healthcareorganizations (likeLunetzorg)whofacethesameproblems.So, theresultsare

generalizable.Thescopehasbeenlimitedtothewholeorganizationexceptsthe24/7-care

centre.

2.3 Projectsteps

Theprojectisdividedinto7projectsteps.Foreverystep,sub-questionsarelistedinthenext

paragraph.The7projectstepsareshowninfigure7.

Figure7:projectsteps

ThesestepsareexplainedinmoredetailinappendixB.

2.4 Researchquestions

Themainresearchquestionasalreadydescribed,whichderivesfromtheproblemstatement,

is:

MRQ:Howcanmobilehealth-rewardingappscontributetothequalityoflifeofpeoplewith

intellectualdisabilities,andhowcanhealthcareorganizationsbenefitfromthis?

12

Toanswerthisquestion,severalsub-researchquestionsthatguidethismaster’sthesisproject

havebeencomposed.Thequestionsarelistedbelowandserveasastructuredguidelinefor

theresearchdesign.

SQ1:Whichclienttypescanwedistinguishbasedonclients’competencesandtheirhousing

situation?

SQ1.1:Whichclienttypes/profilesareknowninliterature?

SQ1.2:Whichclientsareabletouse(mobile)technologyinahealthcareorganization

forintellectualdisabilities(e.g.,Lunetzorg)?

SQ2:Howcanhealth-rewardingappsbelinkedtocurrentmethodologies?

SQ3:Isgamificationaneffectivewaytochange(health)behavior?

SQ3.1:Whatgamificationelementshavebeenusedtochangebehavior?

SQ3.2:Whatbehaviorchangetechniquesareeffective?

SQ4:Aremanagers/clientsupervisors/clientsinterestedinGameBus?

SQ5:Whatareeffectsonclients/employees/organizationwhenusingGameBus?

SQ6:HowshouldLunetzorgpositionGameBuswithintheirorganization.

Figure8:Researchmethodology

13

In the figure 8, the researchmethodology and chapter overview is shown graphically. In

chapter1,thecontextoftheresearchwasgiven.Inchapter3,afirstcategorizationofdifferent

clientsandlivingsituationsfromliteratureisgiven,resultingin7differentcategories.These

literature categories are used to define different real life clients within the pilot (i.e., 6

personas). These personas are used to answer the other research questions, to make a

distinction between the different clients, based on their capabilities and living situations.

Indeed,notallclientsreactthesameonhealth-rewardingapps.Inchapter4,itisanalyzed

howGameBuscouldbelinkedwithcurrentmethodologies.Lunetzorgwantthattheirstaff

works with existing proven methodologies. Chapter 5, provides theoretical and practical

informationabouttheappliedgamificationelementsandbehaviorchangetechniquesduring

theresearch.

The results are analyzed in the light of a psychological model of behavior, namely the

ReasonedActionApproach(RAA)asdescribedinchapter6(Fishbein&Azjen,2011).TheRAA

isoftenusedtoanalyzeotherhealthandbehaviorchangeinterventions.ByapplyingtheRAA,

userbehaviorandtheexperienceofGameBusisbetterunderstand.BasedontheRAA,the

informationaboutgamificationelementsandbehavioralchangeinterventions,anevaluation

frameworkisconstructedfortheremainingresearch(seechapter7).Thisframeworkisused

toevaluatedGameBus.

Chapter8,showstheresultsofthisresearch.Basedonallfindingsoftheresearch,aValue

PropositionCanvas ismade inchapter9todescribeclient/clientsupervisorneedsandthe

addedvalueofGameBusinaclearmanner.Finally,theresultsarediscussedinchapter9.

2.5 Pre-testandpost-test

BeforestartingwiththeuseofGameBus,anevaluationofthecurrentphysicalconditionswas

attempted. A quantitative approach via a proven survey (e.g., SF-36) was to complicated

becausethelowintelligencelevelsoftheclients.Clientswerenotabletofullyunderstandthe

questionswithinthesurvey,andthereforeitwasdecidedtostopwiththis.

Secondly,aquantitativemeasurementofphysicalactivitylevelswasattemptedviainstalled

pedometers on their smartphone, but unfortunately clients had already changed their

14

physicalactivitylevelsenormouslyafterintroducingbackgroundinformationoftheresearch.

Clientswerenotabletocontinuetheir“normal”physicalroutine.

Therefore,aftertheresearchperiodwithGameBus,apost-testwasdonetoseeifphysical-,

cognitive-,socialbehaviorandmotivationwaschanged.Becausetheuseofaprovensurvey

(e.g.,SF-36)orquantitativemeasurementwasunsuccessful,thiswasbothdonequalitatively

andquantitativelyviaaquestionnaire.

2.6 Interviews

Semi-structured interviews were carried out to explore interest and user experience of

GameBusamongmanagers,clientsupervisorsandclientsofLunetzorg.

First,allmanagersofLunetzorgwerecontactedtocreatesupportwithintheorganization.

Afterthefirste-mails,theresponseratewas50%andthefirstmeetingswereheldwithin3to

4weeks.Managerswereinformedabouttheresearchandaskedwhichlocationscouldbest

qualifyfortheuseofGameBus.Theyshouldbelocationsthatwereagoodrepresentationof

theentireclientprofileofLunetzorg.

Then,coordinatingsupervisorswerecontactedtocreatesupport for theresearchwithina

specific location.Finally,clientswererecruitedfortheresearchfrominterviewswithclient

supervisors from different locations. Unstructured interviews were used to discuss the

possibilities.

Between 3 and 8 unstructured interviews and brainstorm sessionswith clients and client

supervisors tookplaceto followtheprogress.After the first interviewwithaclient, itwas

decidedhowGameBuscouldfitintotheirlifeanddailyroutine.Severaltopicswerediscussed

duringtheseinterviews,namelyGameBusinterest,goal-setting(i.e.,whatkindofgoal,who

shouldsetthegoal,conditionsforthegoal)andfeedbacksessions.Allfindingswereverified

withclientsupervisors.Attheend,questionnairesweregiventoclientsandclientsupervisors

tomeasuretheusabilityandexperienceofGameBus(seeappendixIandJ).

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Figure8:Interviewprocess

2.7 Researchperiod

Winningoverbigpartsoftheorganizationtooksometime.Therefore,theresearchperiod

varieswidelyamongdifferentclients.Theresearchperiodvariesbetween4and12weeks.

However,thiswasafeasibleperiodtobecomefamiliarwiththedifferentapplications,and

enoughinformationwasgatheredduringtheinterviews.

During the research period, clients used awide variety of apps to stimulate their healthy

behavior (i.e.., Endomondo, Strava, Moves, CogGames, Sudoku, MyFitnessPall). With

Endomondo, Strava and Moves, physical activity levels were measured. CogGames and

Sudokuwere used to earn points in cognitive challenges. AndMyFitnessPall was used to

registertheirdietarypattern(e.g.,numberofcaloriesorthenumberofglassesofwater).

Socialactivitieswereregisteredbymakingselfiesorotherpictures.Awidevarietyofsocial

activitiestookplace(e.g.,walkingtogether,gamingtogether,visitingthesocialneighborhood

point,visitingfriendsorfamilymembers).Also,householdchoresandotheractivitieswere

registered bymaking a picture (e.g.,make a picture after cleaning their room, ormake a

pictureoftheclockwhentheclientwasontimeonthedaycareactivity).

2.8 Scope

Interviewswereheldwithpeoplewithintellectualdisabilities.Peoplewithphysicalorsensory

disabilitieswereoutsidethescope.Complicatedmulti-disabledclientswerealsooutsidethe

scope.Additionally,thefocuswasonclientswithprivatesmartphones.

16

3. Definingdifferentclienttypes/housingsituations

Inthischapter,firstanoverviewofdifferentlevelsofclientswithintellectualdisabilitiesand

theirpossiblehousingfacilitiesispresentedfromliterature.Todeterminewhetherclientscan

use GameBus, some preconditions are formulated. These preconditions were used to

determinewhetheraclientcoulduseGameBusornot.ThiswasexplicitlyaskedbyLunetzorg.

When a healthcare organization decides to deploy GameBus for a specific client, these

preconditionscanbeusedasastartingpointtodeterminewhethertheclientiscapableto

usetheapp.

Theclient typesandhousing facilities fromthe literature, togetherwith thepreconditions

wereusedtofindappropriateclientsforthepilotwithinLunetzorg,whichoffersadiverse

overviewoftheorganization.

Finally,sixpersonashavebeenformulatedbasedontheresultsfromthischapter,whichwere

usedtoanswertheotherresearchquestions.

3.1 Peoplewithdisabilities

Thecareforpeoplewithdisabilitiescanbedividedintoseveralsectorsortargetgroups.These

target groups need different types of care. The report “Zorgzwaartepakketten sector GZ

(2008)”givesanoverviewofvariousformsofdisabilities.Thehandicapsaremental,physical

and sensory, but this research focuses only on mental or intellectual disabilities. In the

Netherlands,itisestimatedthattherearearound146,000peoplewithintellectualdisabilities,

roughly half intramural and half extramural (van der Kwartel, 2009). In this research, a

distinctionmustbemadebetweenclients,becausenoteverytechnologyissuitableforany

audience.Thishasnotonlytodowiththefunctionallimitationsoftheusers,butalsowiththe

functionofthetechnology.

3.1.1 Generalcharacteristicsofpeoplewithintellectualdisabilities

Table2showsthecharacterizationsofpeoplewithmildintellectualdisabilities.Thisisbased

onanextensiveliteratureresearchbyVlagsma(2014).Allpeoplewithintellectualdisabilities

17

have todealwith this to a greater or lesser extent. These characteristicswere taken into

accountduringtheinterviews.Peoplewithintellectualdisabilitiesoftenseemsmarterthan

theyactuallyare.Therefore,everythingmustbechecked twice todetermine if theclients

understandtheapplicationofGameBus.Operantconditioningtechniquesareregularlyused

inthetreatmentoftheseclients.

Table3:characteristicsofpeoplewithmildintellectualdisabilities

CognitivedevelopmentPeoplewithmildintellectualdisabilities- Havealimitedcapacitytostoreinformation;- Cannotfiltertheinformation:whatisimportantandwhatisnot;- Havetroubleconcentrating;- Cannotthinkproperlyintheabstract;- Maybeslowerintheirthinking;- Mayhavedifficultyorganizingandplanning;- Arenotcapableofself-reflection;- Haveimpairedimpulsecontrol.

LearningPeoplewithmildintellectualdisabilities- Encounterdifficultiesinlearning;- Therefore,cannotgeneralizeandbenefitlessfromwhatwaspreviouslylearned;- Arelesslikelytoexplore.

Social-emotionaldevelopmentPeoplewithmildintellectualdisabilities- Caninpracticaltermsdomorethantheycanhandleemotionally;- Havelimitedsocialadaptability;- Havelesswell-developedempathy;- Havelesswell-developedsocialskills;- Haveadelayedandlimiteddevelopmentofconscience;- Haveanincreasedriskofdevelopinglowself-esteem,lackofconfidenceandlackof

identity;- Havepoorself-management.

SensoryimpairmentPeoplewithmildintellectualdisabilities- Haveasignificantlygreaterchangeofadditiveandvisualimpairments

PhysicaldevelopmentChildrenwithmildintellectualdisabilities- Havemore(semi-)physicalproblemsthan“normallygifted”children

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3.2 Careintensitypackages

This research examines to what extent the degree of disability of the clients affects the

applicationofGameBus.Thissectiondescribesthedifferentdegreesofdisabilities inmore

detail.

About260,00Dutchpeoplecannot live independentlyandneedaprotectiveenvironment.

Since1January2009,careintensitypackagesaretheformoffundingforthisresidentialcare

(Min.VWS,2015).Since2015the“CentrumIndicatiestellingZorg”no longerrefer to ‘care

intensitypackages’butto‘careprofiles’.Intermsofcontent,everythingremainsthesame.

Organizationsinthecareandcuresectorforthedisabledandlong-termmentalhealthwill

give all residential care. Their clients receive a completepackageof EMEA-care (inDutch,

AWBZ):acareintensitypackage(ZZP)orcareprofile(Min.VWS,2015).ZZPsareintendedfor

careandsupportinordertobetterallocatebudgetstoinstitutions.TheZZPdoesnotindicate

howmuchcareaclientactuallyneeds.Forthisreason,careplansaredrawn.Onthebasisof

theclient’scareplan,aZZPindicationisgiven.Inthissituation,acareinstitutiononlyreceives

moneyfortheactualcaredeliveredforclients.

Thecareintensitypackagesconsistof:

- Thecomponentsresidentialcare,daycare,treatmentandresidence;

- ThefollowingfunctionsasdefinedintheDecreeonAWBZcare:

o Personalcare(PV);

o Nursing(VP);

o Supervision(BG);

o Treatment(BH);

o Residence(VB);

- Anaveragetimeperweek,intermsofdirectandindirectcustomerrelatedhoursforthe

functionsBG,PV,VPandBH;

- AfixedamountperdayfortheVBfunctionandifapplicable,thecare-relatedmaterial

costs.

19

AppendixGgivesan indicationofthemaximumfeepercare intensitypackage.Theactual

funding is very complicated and based on all sorts of extras (e.g., client needmedication

administration).

InappendixEtheaveragescorespercareprofileforpeoplewithlightmentaldisordersand

mentaldisordersaregiven,asdescribedinappendixA,Article2.1oftheregulationonlong-

termcare.Thegraphshowstheintensityofcarefordifferenttypesofclients.

3.3 Differentformsofhousing

Each type of housing has its own type of clients, or residents, in which there is a clear

hierarchy.Thelightestformoflivingisassistedliving.Nearlytwo-thirdsoftheclientsinthis

typeofhousingareslightlymentallyretardedormentallydisabled(carepackage1and2).The

oppositeofassistedlivingisprotectedhousing,themostrestrictedformofliving.Inthistype

ofhousing,90%ofclientsaremoderately,severelyorprofoundlyintellectualdisabled(care

package7and8).Thisclientgrouplivesinmostlyprotectedhousingbecausethisgroupoften

has additional restrictions. For those people with multiple disabilities, specialized and

intensivecareisnecessary(Woittiez&Ras,2006).

A number of characteristics determine the living situation of a client. There is a positive

correlationbetweentheprobabilityofshelteredhousingandthefollowingfactors:

- Degreeofintellectualdisability;

- Behavioralproblems;

- Problemswithself-careandself-reliance;

- Parentsdeceasedorotherwiseabsent;

- Bettereducatedparentsorparentswithhigherincomes.

The severity of intellectual disabilities and the extent of behavioral problems are leading

factors in determining the residential type. The above features are more common for

shelteredhousingclientsthanforclientswholiveunprotected.Clientswithmorethanoneof

theseattributesarealsocalledintensivecareclients(Woittiez&Ras,2006).

20

In the following table, the care intensity packages are described in more detail with

correspondinghousingsituation.Itdescribesforwhothepackageisintendedandhowmany

carehoursaclientcanexpect(Collegevoorzorgverzekeringen,2015).

Table4:Careintensitypackagesdescription

Packagenumber

Shortdescription Forwho?#hourscareforlivingp.Week

Daycarehoursp.Week

1Livingwithsomeassistance

Clientneedeverydayguidance,butclientstillcantakecareofthemselves.

5.0-7.0 10.0-12.0

2Livingwithassistance

Client need guidance during the day. Client can lifereasonably independent (e.g., small way of living orfoster-home)

7.5-9.5 12.5-15.0

3

Living with assistance andcare

Clientislimitedindependently.Clientneedsprotectedhousingwith constant supervision. Besides providingguidance,helpisrequiredwithpersonalcare.

10.5-13.0 15.0-18.5

4Living with assistance andintensivecare

Clientneedalotofsupportduringtheday.Andclientneedsalotofhelpwithpersonalcare.

12.5-15.5 17.0-21.0

5

Living with intensiveassistance and intensivecare

Clientneedsalotofsupportandalotofcare,becauseithasmultipledisabilities.

16.0-20.0 22.0-27.0

6

Living with intensiveassistance, care andbehaviorregulation

Client has a severe learning disability. Client istherefore socially very dependent. Client also needextraattentiontobehaviorandpsychiatricproblems.

15.0-18.5 21.0-26.0

7

(Closed)livingwithintensiveassistance, care andbehaviorregulation

Clienthasstrongbehavioraldisordersandbehavioralproblems.Clientsmayalsohavephysicaldisabilities.

20.5-25.0 30.5-37.0

8

Living with assistance andcomprehensive care andnursing

Client needs a lot of guidance, full care andnursing,becausetheclienthasmultipledisabilities.Clientisnotmobile.

20.5-24.5 26.0-32.0

Basedonthisinformation,theapplicationofGameBusforclientswithcareintensitypackage

8, seems very complicated. The use of smartphones is limited due tomultiple disabilities

amongclients.Therefore,itisdecidedthattheseclientscannotparticipateintheresearch.

Furthermore, the IQ level and social skills largely determine whether someone receive

subsidizedcare(i.e.,viaAWBZorWMO).ForpeoplewithanIQbetween70-85,theremustbe

additionalproblems(e.g.,personalorsocial)toreceivesubsidizedcare.

In the following table, IQ levels are compared with the ‘normal’ developmental age of

children. Based on this information, peoplewith an IQ below35were excluded from the

21

researchbecauselimitedempathyandverbalskillsoftheseclients.PeoplewithanIQbetween

35and49havebeenincludedinthisresearch,butwithsomereluctancealsobecausetheir

limited empathy. The developmental age says something about the cognitive level of the

client.

Table5:overviewofdegreesofintellectualdisabilitieswithcorrespondingIQ-scoresanddevelopmentalage.

Degreeofintellectualdisability IQ Developmentalage

Veryseriousmentaldisability 0–19 Upto2years

Seriousmentaldisability 20–34 2to4years

Moderatementaldisability 35–49 4to7years

Lightmentaldisability 50–69 7to12years

Retarded 70–85 12to14years

3.4 Preconditions

Afterthatpotentialclientgroupsweredescribedfromliterature,clientscouldbesearchedfor

thepilot.Therefore,clientsmustmeetcertainrequirements:

- Careintensitypackagebetween1and7;

- IQabove34,butpreferablyabove49;

- Technicalrequirements:

o Smartphone;

o Stableinternetconnection(Wi-Fior3G/4G);

- Telephoneskills:youshouldnowhowtomakepictures,uploadpicturestoGameBus,

switchbetweenmenus,enterinformationinapp,etc.;

- Abilitytoread.

3.5 Participantsinpilot

The goal was to apply GameBus on a diverse client population within Lunet zorg. In the

previousparagraphs, the clientpopulation is describedbasedon client types andhousing

facilitiesfromtheliteratureandIQlevels.Inthesearchforparticipants,theseconditionswere

included.GameBuswasintroducedtoseveralmanagersandclientsupervisors,resultingin14

22

clientswithvariousbackgrounds.Themeanageofclientswas36,andtheagevariedbetween

18and57.

Moreclientshavebeen interviewed,butnotallmeet thepredefinedconditionsor clients

werenot interestedtoparticipate intheresearch.Onlyclientswithcare intensitypackage

2,3,4,6and7werefound.Thiswasaverydiversesamplesizeandwasenoughforafeasible

studytoGameBusinthecareforpeoplewithintellectualdisabilities.

Additionally,anextracategorywasidentifiedwithinLunetzorg.Thisareclientswhovisita

socialneighborhoodpoint.Theseclientsarenotcategorizedwithacare intensitypackage,

butcare isdeliveredbasedona“kitchen table”conversationby themunicipality.A social

neighborhoodpointisforclientswithanindicationfor‘supervision’.

Figure9:ClientcategoriesforLunetzorgpilot

3.6 ReallifePersonas

Inthisparagraphpersonasarecreatedthatrepresentanenduser/clientgroupbasedontheir

interest,capabilitiesandothercharacteristics.Thepersonasarecreated inordertobetter

understandthecontextofGameBus.Thesepersonasarebasedonrealclients(onlynames

are changed) and locationswithin Lunet zorg thatwere part of the research.With these

23

personas,needsandgoalswerecreatedforspecificclientsandlocationswithinLunetzorg.

The personas include an overview of daily activities, living situation, types of (mental)

disabilities,independencyandfamilyrelationships.Theclientswereusedtotesttheconcept

ofGameBuswithdifferentusers,atdifferentlocationsandindifferentcircumstances.These

selectedgroupsofclientsgiveadiverseoverviewofthetotalclientpopulationofLunetzorg.

Thesepersonasareusedtodescribesomeresults(seechapter8),andactedasatoolforthe

valueproposition.AllpersonascanbefoundinappendixD,butasummaryisgiven:

Name Age(years) Carepackage(ZZP) IQlevelPeter 33 2 65Anouk 18 3 95Anke 37 4 40Nikki 19 7 60Tom 20 7 82Hilde 47 Supervision 95

Anexampleofonepersona,Anke:

ANKE(37years)

Disability:VGZZP:4Residence: Anke lives in a one-room apartment withcontinualassistance.IQ:40Aboutandfamily:Ankecanspeakclearlyandmostofthetimepeopleunderstandwhatshewants tosay.Shehasneverlearnedhowtowriteorread,thoughsheisabletodistinguish lettercombinations. If sheseesapictureshecan remember it for a long time. The client supervisorsalwaysmakeherschedulewithapicto-system.Socialactivity

Shehas lived inherhouse foraroundtenyearsandsheknowsalmostallpeopleinthebuilding.Shelikestodrink

coffeeontheweekendwithhergoodfriendPatrick.Herparentsalsovisitherontheweekend.FourtimesaweekabustakeshertoherdaytimeactivitieswhereshecanwatchTV,butalsoputstickersonboxes.Physicalactivity

Sheisnotallowedtogosomewherealone.Sometimestheclientsupervisorputsheronahometrainer.Motivation

Sheisverymotivatedifpeopleneedherhelp.Almosteverythingthesupervisorsask,shedoes.Technologyuse

Her parents have bought her a tablet to play somegames.Shedoesnothaveaphone.LimitationsShe does not really know what she does, but shecarriesoutallsheistoldbythesupervisors.

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4. Currentmethodologies(AS-IS)

Therearemethodologiesandmethodicalmethodsorapproachesinthecareofpeoplewith

intellectualdisabilities.TheresearchaskedaboutlinkingGameBuswithmethodologiesthat

areappliedwithinLunetzorg.Therefore,itaskedclientsupervisorsaboutwhatmethodsthey

use in their work. However, inquiries revealed that almost no one could tell what

methodologiestheyuseintheirwork.

ThewebsiteMethodischWerken (Bruijn,2015)was thereforeconsulted.Thiswebsitewas

developedtohavequicklyandeasilyaccessiblemethodicalteachingmethodsforthecareof

peoplewithintellectualdisabilities.GameBuscanbeusedtochangeandrewardcertaintypes

ofbehaviorwithinthecareofintellectualdisabilities.ThisresearchshowsthatGameBushas

apositiveeffectonthebehaviorofclients.Allclientsareconfrontedwithever-newproblems

thatrequireanadequateresponseandsolution.Thisperspectiveisreflectedinthenumerous

empiricallysupportedtreatmentprotocols,methodologiesandbehaviortherapiesthathave

been developed for people with intellectual disabilities. In the next paragraphs, three

commonly used methodologies are described, as well as the overlap between a specific

methodologyandGameBus.

AKSMethod:self-determinationofclients.Thecoreliesinapplyingadistinctionbetweenthe

varioustasksthatusuallyliewiththeclientsupervisor.Throughabetterorderingoftheroles,

clientsupervisorscouldspendmoretimeonrealsupport.

è ArrangementsmustbemadeclearbeforehandaboutwhatroleGameBuscanplayin

thecareprocessandwhohasthatresponsibility.Otherwise,theclientsupervisordoes

nothaveenoughtimeforrealsupport.Moreover,theclientistakenseriouslyinwhat

she/hewantstoregulate,asthemethodologysuggest.Inconsultationwiththeclient

supervisor, they can decide what activities can be rewarded in GameBus. Using

GameBuscanincreasethefeelingofself-determination.

EIM(EigenInitiatiefModel):whensomeonebetterthinksaboutwhatshe/hedoes,agreater

abilitytoactisdeveloped,andthisincreasestheoveralldevelopmentprospectofpeoplewith

25

intellectualdisabilities.Thismodelturnsagainstthedependencyofpeoplewithdisabilities,

and conversely at anemergency syndrome (they constantlyprone todeliver care). This is

betterexpressedwhattheindividualhimselfcanthinkandcando.Inpractice,thismodelis

anexplicitappealtoself-solvingskills.Thesearestimulatedbyspecificcontractstobesetup

asworkgoals.“Learningtolearn”appears:itisnotperformingtheactualactivity(connecting

withsomeoneelse,buyingfood,doinglaundry,etc.)butthinkingofwhatisnecessaryinorder

todotheactivity.

è GameBusencouragespersonalinitiativebyplacingtheresponsibilityontheclient,if

possible. GameBus could be the extrinsic motivator and learning tool in order to

achieveworkgoals.Workgoalsarediscussedwiththeclientsupervisorandtheclient

hastheresponsibilitytoperformtasksthemselvesandregisterthisinGameBus.

TokenEconomy:abehavioraltherapeuticapplicationthroughaconcretesystemofoffering

orwithholding rewards toachievea specific goal. The tokensare concrete “signs”ofpay,

whichfollowdirectlytothedesiredbehavior.Themethodisbasedontheviewthatbehavior

is determined bywhat follows, the consequences. The offered tokens can be all kinds of

concretethings,suchstickers,chipsandvouchers,whichcanbecollectedtoacertainnumber

andthenprovideagreaterreward.Thisshouldthereforebedoneconcretelywithinanagreed

timeframe.Sothetokenisasecondaryreinforcementtoreceiveaprimaryreward.Bythis

wayofworking,clientshavemorecontrolovertheoutcome.Theycanalsolosetheirtokens

againwhentheydonotshowtheintendedbehavior.Itisclearlystatedwhenthetokensare

received.

è ThismethodologyisinlinewiththeGameBusconcepts,althoughthe“tokens”arenot

tangible. InGameBus the tokens are called points that can later be exchanged for

tangibleandconcreterewards.

26

5. Whatisknownabout:gamificationandbehaviorchangetechniques

Having briefly outlined the current methodologies in care for people with intellectual

disabilities,thischapterbrieflyoutlineswhatisknowaboutgamificationandbehaviorchange

techniques.ThesearetwomainprinciplesofGameBusappliedinthisresearch.

5.1 Gamification

5.1.1 Whatisknowabout:definitiongamification

The first knownuseof the term“gamification”was in2008,but twoyears later the term

gainedglobalnotoriety(Deterdingetal.,2011).Thereisstillnoconsensusaboutacorrectand

usabledefinition.Inthisperiod,ZichermannandCunningham(2011)definegamificationas

“theprocessofgame-thinkingandgamemechanics toengageusersandsolveproblems”.

ZichermannandCunningham(2011)describegamificationasamethodtochangebehavior.

Lister et al. (2014) define gamification as follows: “Gamification is the use of game-like

rewardsandincentives,pairedwithdesiredbehaviors,to increasemotivationsandsustain

habitsofindividualsovertime”(Listeretal.,2014).ThegamificationcompanyBunchbaladds

theroleofthecollectionandcommunicationofstatisticsintheirdefinition(Bunchbal,2010).

Figure10:Bunchball'sviewofgamification(Bunchbal,2010)

WerbachandHunter(2012)definegamificationasawaytobringfunnyelementstoobligatory

activities.BothWerbarchandHunter(2012)andZichermannandCunningham(2011)saythat

27

a user’s engagement with a specific process or product is increased when introducing

gamificationconcepts.GameBusintroducedthesegamificationconceptsandcouldincrease

theengagementofclientsbymakingphysical,cognitiveandsocialactivitiesmoreattractive

tothem.

Severalauthorsanalyzedwhichgamificationelementsareusedinhealthapps(Listeretal.,

2014;Payneetal.,2015).Thesegamificationelementsare:

- Storyline;

- Fantasyenvironment;

- Competition;

- Possibilityoffailure;

- Leaderboards;

- Clearexpectations;

- Score;

- Rankingorstanding;

- Levels;

- Real-worldprizes.

Besides these gamification elements, there are also other prevalent health behavior

constructs: self-monitoring, self-reward, and goal-setting. It has been found that self-

monitoringinphysicalactivityinterventionsisthebestpredictorofsuccessinbehaviorchange

(Michieetal.,2009).Goal-settingisalsowidelyusedandshowspositiveeffectsonobesity

interventionsandphysicalactivity(Pearson,2012).Finally,rewards,modeling,feedbackand

self-monitoring are themost appliedHealth Behavior Theory elements in physical activity

videogames(Lyons&Hatkevich,2013).

5.1.2 Whatisknowabout:motivationfactorsinGameBus

PsychologicalresearchbyBecker(2005)hasshownpositiveandnegativerelatedfactorsto

gaming influencinghumanperformance.However, thereareonlya few factors thatmake

gamesasattractiveastheyare.Itdependsonthepersonandhowmuchone’sperformance

is influenced by these factors. Kelle (2012) described four factors influencing human

performance.

28

“Thefirstofthesefactorsistheabilitytoseeprogressinanobviousandcontinuallyavailable

manner”(Kelle,2012).Themostbasicformofgamingistocompareone’sownperformance

withothers.Thisispossiblewhenclientsrecognizetheeffectsoftheirperformance/actions

withregardtothepointsreceivedinthegameandtheabilitytogaugetheirownprogress.

Theabilitytoseeprogressisaformofdirectfeedbackwherethefeedbackcycleisminimized

(Sadler,1989).Thisfactornotonlyholdstruewhentheclientisaloneandcomparinghisor

herownperformancetopreviouspersonalperformance,butalsoinagroupandcomparing

hisorherperformancewithothers.

“Asecondfactorwouldbetheabilitytoaffecttheperformanceofothers”(Kelle,2012).This

factor isnot theeasiest factor to include inagame,but thereare severalpossibilities for

creating this kindof competition.Whena teamconsistofmore than twoclients, another

aspect of gaming is introduced, namely collaboration. Collaboration between people can

stronglyinfluencetheresultoftheteam.

“Athirdandverycrucialfactoristhechallengingroleofbeingincharge”(Kelle,2012).Games

couldstimulatethefeelingofcontrolandownershipintheclient.Thisespeciallyoccurswhen

theclientcan identifyhim-orherselfwith thegamecharacter.GameBusdoesnothavea

gamecharactertoidentifywith,butaclientcanidentifyhimselfwithanimportantpersonin

hislife(e.g.,brother,sister,clientsupervisor).

“Finallyandmostobviously, the ‘gamecontent’ itself isan importantfactor”(Kelle,2012).

GameBus made physical, social and cognitive activities more attractive. These game

characteristicsofGameBusarepowerfulwaystomotivateclients.

Because of the gamification elements in the app, GameBus used the abovemotivational

factorsinordertoincreasethemotivationoftheclients.Detailedinformationabouttheeffect

onmotivationisdescribedinthechapter8.

5.1.3 Whatisknowabout:gamificationforpeoplewithmentaldisabilities

The implementation of gamification concepts in the treatment of children with mental

disabilitiesseemshighlyfeasible(Frutosetal.,2011).Gamificationisagoodwaytodevelop

29

physical,cognitiveandsocialabilities (Frutosetal.,2011).All theseabilitiesare important

aspects in the development of peoplewithmental disabilities, especially for children and

young adults with autism spectrum disorder. The literature suggest that picture-based

systems for the treatment of people with autism work well (Lancioni & O'Reilly, 2001).

However,GameBusiscurrentlymissingapicture-basedinterface.

Another finding accounting for the use of gamification concepts within the treatment of

peoplewithmental disabilities is that gamification strongly increasedmotivation (Murray,

1997).Problemswithmotivationforperformingphysicalactivitiesareoneofthemainissues

for peoplewithmental disabilities. Research by Anton and Campbell (2008) showed that

gamificationcouldbeeffectiveforclientswithlowmotivationandlowself-efficacy.Research

hasalsoshownthatcognitivegamescanplayaroleinthedevelopmentofmemory(Brownet

al.,2008),decision-making (Standenetal.,2009)andreaction time (Standenetal.,2009).

Unfortunately,nogeneraloverview isavailable in the literatureabouttheeffectivenessof

gamificationconceptsinthetreatmentofmentaldisabilities.

The overall conclusion from this literature research, is that little is know about the

effectivenessofgamificationforpeoplewithintellectualdisabilities.Therefore,thisthesisis

avaluableresearchinthisarea.

5.2 Behavioralchangetechniques

During the research there will be an extensive use of behavioral change techniques and

motivation techniques. Because clients need to change their current daily routines, these

techniquescouldberelevant.IfGameBuswantstostrengthenphysicalandsocialactivities,it

shouldencouragephysicalandsocialbehaviororchangecurrentbehavior.Muchattentionto

intrinsicmotivationisneededifthisistohappeninaneffectiveandsustainableway.

Therearemany(sometimesoverlapping)strategiestoinfluencebehaviorandmotivation.An

overview of this is given below on the basis of the research byMichie et al. (2013) and

Abraham andMichie (2008). A study on effective online techniques for healthy behavior

change (e.g., in relation to food and exercise) showed that the effectswere biggerwhen

severaldifferentstrategieswereused.Italsoshowedthatuseofthethreestrategies(derived

30

fromtheTheoryofPlannedBehavior) led togreatereffects.However, increasingphysical,

cognitiveandsocialactivitiesismuchmorecomplexbecausetheeffectsonbehavioralsolie

outsidetheclienttoaconsiderableextent(Lagerveld&Bennenbroek,2015).

Generalbehaviorchangetechniques(Abraham&Michie,2008)(Michie,etal.,2013)include

thefollowing:

Ø Createapositiveattitudetowardsthebehaviorandoutcomes,by:

o Showingconsequencesofbehavior(e.g.,donothingorchangebehavior);

o Comparing effects/outcomes of behavior (e.g., putting advantages and

disadvantagesinarowfortheuseofGameBus);

o Givingasenseofautonomyandcontrol.

Ø Goal-setting/formulate behavioral intentions (e.g., make a stepwise action plan and

committobehavior);

Ø Giveinsightintotheattitudesofotherclientsinrelationtophysical,cognitiveandsocial

behavior;

Ø Rewardeffective/desiredbehavior(e.g.,giveacomplimentortakeawayapenalty);

Ø Increaseconfidence(e.g.,byfocusingonpastsuccess,verbalencouragement);

Ø Organize/offersocialsupport;

Ø Indirectlearning(e.g.,watchingothers:startwithoneclientinagroupandotherclients

orclient supervisorsbecome interested).The researchwasstartedwithoneclientat

Duizelwijk1(residentialfacilityLunetzorg),butafterafewweekstwoclientsupervisors

atDuizelwijk3and4alsowantedtojointheGameBusproject;

Ø Mapbarriersandsolutions;

Ø Repeatandpractice(activelearning,reinforceskills);

Ø Feedbackonbehavior;

Ø Connect negative consequences to behavior (punishment). However, this has only a

short-termeffectonbehaviororcanjustcauseresistance;

Ø Triggers/cuestoorganizebehavior(actionssothatpeoplerememberwhatpeopledo).

ThisisveryimportantforclientsofLunetzorg.Manyclientsforgettodotheirphysical

activitiesbecauseclientsupervisorsdidnotremindtheclientenough.

InappendixC,abriefdescriptionofelevenhealthbehaviorchangetechniquesisgiven.

31

6. ReasonedActionApproachThischapterdescribesTheReasonedActionApproach(RAA).TheRAAisoftenusedtoanalyze

otherhealthandbehaviorchangeinterventions.ByapplyingtheRAA,userbehaviorandthe

experience of GameBus is better understand. So, the RAA is used in the results section

(chapter8)toanalyzetheparticipationandbehaviorofdifferentclientsinthisresearch.

RAAisatheoryofhumanbehaviordevelopedbyMartinFishbeinandIcekAjzen.TheTheory

ofReasonedAction(Fishbein&Ajzen,1975)andtheTheoryofPlannedBehavior(TPB)(Ajzen,

1991)areearlierversionsofthistheory.TheTheoryofPlannedBehaviorhasbeenusedto

betterunderstandseveraldifferentformsofhealthbehavior,suchasdietarychange(Povey

etal.,2000)andphysicalactivity(Armitage,2005).Somemeta-studiesabouthealthbehavior

change interventions, suchasGodinandKok (1996), conclude that theTheoryofPlanned

Behaviorpredictsbothactualbehaviorandintentiontoactverywell.Thetheorystatesthat

acombinationofbeliefsaboutbehavior(i.e.,theyassumethatbehaviorhasanoutcomeand

thisoutcomeisofvaluetotheperson),self-efficacy(i.e.,apersonbelievesthathecanperform

a required behavior) and subjective norms (i.e., subjective reflections upon and

interpretationsofsocialattitudes)shapesthebehaviorandintentionsofpeople.

FishbeinandAzjen(2011)developedanactualversionofthismodel, theReasonedAction

Approach, by expanding the TPB in two ways. First, they added the construct of “actual

control”.Second,theydescribedhowbehavioral,normativeandcontrolbeliefsareinfluenced

by“backgroundfactors”.“Backgroundfactorsdescribeshowenvironmentalfactorsandskills

andabilitiesaffectthelikelihoodofintentionsbecomingactions”(Laurie,2013).Thefigure

belowgivesaschematicpresentationoftheReasonedActionApproach.

32

Figure11:TheReasonedActionApproachModel(Fishbein&Ajzen,2011)

WiththeRAA,behaviorcanbeanalyzed,becausethemodelgivessomeempiricallyverified

constructs(descriptivemodel).Therefore,themodelcouldbeusefulinaqualitativestudyin

order togain insightabout thehealthand technologybehaviorofGameBus. If theRAA is

appliedinthisway,thetheorygivesmoreinsightintoself-efficacy,inthepatternsofuse,the

roleofsocialnorms,andtheattitudeofclientstowardstheirbehaviorthatisinfluencedby

GameBus. The theory helps reveal strengths andweaknesses in GameBus related to self-

efficacy,norms,attitudesandintentiontoact.Thistheoryhelpedtoanalyzehowclientscould

useGameBusintheirdailyroutines.TheuseofGameBusinclient’sliveswasinfluencedby

patterns in daily activities, continuous reflections about possible consequences of using

GameBus,perceivedself-efficacy,emotionandmoodstates,personalrelationshipsandsocial

norms.Auto-ethnography(i.e.,anapproachthatseekstosystematicallyanalyzethepersonal

experienceandprovidesawaytodescribeit)andsemi-structuredinterviewsaregoodways

togaininsightintobothsubjectiveexperienceandpatternsofuseofGameBus(Laurie,2013).

Laurie (2013) suggests that the RAA is a useful theory to design mental wellbeing and

persuasive technology.Persuasive technology is technology that isdesigned tomodify the

behaviororattitudesofusersthroughsocialinfluenceandpersuasion.GameBuscanbeseen

as a persuasive technology because it wants to change the physical, cognitive and social

behaviorofpeoplebystimulatingtheminteams(socialinfluence).

33

7. EvaluationFramework

Inthischapteranevaluationframeworkwillbepresented.This frameworkwillbeusedto

evaluateresultsand findingsduring theGameBusresearch.During the interviews,surveys

and observations, GameBuswas evaluated on several aspects. The framework consists of

threemainevaluationparts:

1. EvaluationoftheoverallexperienceofGameBusbyclientsandclientsupervisors;

2. Evaluationofclients’behaviorwiththeRAA;

3. Evaluationofotherhealthgamificationfactors.

7.1 EvaluationoftheoverallexperienceofGameBusbyclientsandclientsupervisors

Basedonall interviews,questionnairesandobservations,GameBusoverallexperiencewas

evaluated.Clientsandclientsupervisorsanswershowtheyenjoyedtheresearch.

7.2 EvaluationwiththeRAA

The secondpart is theevaluationof clients’behavior via theRAA.This isdoneby several

aspectswhich have been identified during the research due to analysis of the interviews,

questionnaires and personal observations. By axial coding it was sought to find patterns,

contextofuse,andotherinformation.

7.2.1 Patternsandcontextofuse

Thefirstidentifiedaspectarethepatternsandcontextofuse.Thisaspectevaluatesifthere

arefoundcertainpatternsintheuseofGameBus,whattheintentionwas,orwheretheyuse

GameBus.

7.2.2 Contextofuse(timeandenvironment)

The second identified aspectwas the context of use expressed in time and environment.

ClientsuseGameBusondifferentmomentsduringtheday.

7.2.3 Busylivesandroutines

Oneof themain concernswas to seehowGameBus fit into the lifestyleof clients. Itwas

predictedthatGameBusshouldbepartofclients’routines,inordertobeasuccess.

7.2.4 Intensionsanddisappointment

The fourthaspect is the intention touseGameBus in thebeginning, comparedwhat they

actuallydidduringtheresearch.

34

7.2.5 Otherpeople

Thefifthaspectdescribestheinfluenceofotherpeopleduringtheresearch.

7.2.6 Appdesign

ThesixthaspectfoundbeanalyzingthedataviatheRAA,wasinformationabouttheactual

designofGameBusandtheinfluenceontheirbehavior.

7.2.7 Coreconcern

“Createcategoriesthataredirectly‘grounded’inyourdata.Groundedtheoryisacomparative

andinteractivemethod.Youbegintoconstructyouranalysisbycomparingbitsofdata–ideas

and incidents –with each other” (Smith, 2008). Strauss and Corbin (1990) say thatwhen

researchers use grounded theory data analysis methods, they should describe one core

categorythatsummarizesallinterviewsandcategories.Anotherstudysimilarlysuggeststhat

researchersshouldtrytodescribethecoreconcernofclientswithregardtoGameBus(Glaser,

1998).

BasedontheanalysisofbehaviorviatheRAA,categorieswillbecreatedtosummarizeresults

indifferentusecasesofGameBus.

7.3 Evaluationotherhealthgamificationfactors

The thirdpart is theevaluationofother factors in the research.These factorsaredefined

below.

7.3.1 Teams

Whatistherighttypeofteamsforthedifferenttypeofclients?Performinghealthactivities

in teams can be effective and motivational. This is teamwork with other clients, family

membersorclientsupervisors.

7.3.2 Physicalactivitypromotion

Client supervisors should encourage healthy behavior for their clients. Physical exercise

should become as part of clients’ lives as sleeping and eating. Physical activity decreases

cardiovascularendurance,reducestress,etc.Additionally,itappearsthatphysicalactivities

ensuretheyclientswithintellectualdisabilitiesarelessdependentonsupportandthatthere

islessofachangeofbehavioralproblems.Therefore,physicalactivitypromotionshouldbe

integratedinhealthcare.

35

7.3.3 Goalsetting

Another factor that will be evaluated in the next chapter is goal setting.Who should be

responsibleforthegoalsettingandwhatkindofgoalscouldbeusedinGameBus?Thisfactor

wasevaluatedwithclientsupervisorsandclients.

7.3.4 Presentationofinformation

In this section the presentation of data in GameBus is presented. Is the information of

challengesandgoalspresentedclearlyintheGameBusapp?Thissectionfocussesbrieflyon

thepresentationofpointsandchallenges.

36

8. ResultsThischapterroughlyconsistoftwoparts:

• Post-testresultsofphysicalactivities,socialactivitiesandmotivationchange;

• Resultsoftheevaluationframeworkasdescribedinchapter7.

8.1 Post-test

8.1.1 Physicalactivities

Seven questions in the questionnaireswere intended to detect possible anomalies in the

clients’physicalactivities.Onequestionwaswhetherclientsaremorephysicallyactivewhen

participatinginGameBus.

Figure12:Resultsquestionnaire:Physicalactivity

Toverifytheresults,thesamequestionswereaskedoftheclientsupervisors.Sevenoutof

eightclientsupervisorsconfirmedthattheirclients,toagreaterorlesserextent,performed

morephysicalactivitiesthanbeforetheresearch.Althoughthisisapromisingresult,itisnot

sufficientevidencethatGameBuschangesthephysicalroutineofclientsforalongerperiod.

However,stimulatingeachotherandreceivingpointsorotherrewardshasadirecteffecton

thephysicalactivitiesofclientsofalllevels.

0

1

2

3

4

5

6

7

muchmore more thesameamountof less muchless

ByworkingwithGameBusIget…..excersise

ByworkingwithGameBusIget…..excersise

37

Anattemptwasmadeatthebeginningoftheresearchtoreceivebaselineinformationabout

clients’physicalactivities.Clientswererequestedtoregistertheircurrentphysicalmovement

usingapedometerandtoldtheyshouldnotmovemorethanusual.However,afterexplaining

thattheresearchwasaboutstimulatingphysicalactivities inteams,clientsbegantomove

moretogetmoresteps.Therefore,asurveyaskedclientstoquantifytheirphysicalactivities

aftertheresearchincomparisonwiththeirphysicalactivitiesbeforetheresearch,withthe

followingresult:

Figure13:ResultsQuestionnaire:Extratimephysicalactivity

These answers are in line with previous answers. Additionally, it was asked if they could

explaininmoredetailhowtheynoticedtheirincreaseinphysicalactivities.

Question: “If you exercisemore than before the research, how did you noticed

this?”

Answer: “Iaskthesupervisorsatthedaycaretohaveawalkduringthebreakto

collectpoints.”

Answer: “In theweekends I often go out to have awalk, insteadof sitting at

home.”

0

1

2

3

4

0min 1-15min 15-30min 30-60min 60-120min Morethan120min

Unknown

IfyoushouldestimatehowmuchextrayouaremovingperweeknowcomparedtobeforetheGameBus

research.Howmuchisthat?

IfyoushouldestimatehowmuchextrayouaremovingnowcomparedtobeforetheGameBusresearch.Howmuchisthat?

38

So,theseareverypromisingresults.Eightoutoffourteenclientsreportedanincreaseintheir

physical levels.Additionally,clientswhoshowednoincrease intheirphysicalactivity,have

indicatedthattheyhavebecomemorehealthconscious.EventhecanteenladyofEckertdal

indicatedthattwoclientsdidnottakeunhealthyfoodanymore(e.g.,eatsaladinsteadofa

frikandel).

8.1.2 Socialactivities

ThisresearchfocusesonthepotentialofGameBusthatfacilitatesocialsupportandstimulate

physicalactivities.Socialactivitiesincludepositivefeedbackfromotherpeople,stimulating

eachother in thechat, challengingeachother toearnmorepointsor justdoingactivities

together(e.g.,walkingtogether,visitingfriends).GameBuscouldconnectpeopleandserveas

asupportbuddy(i.e.,peoplewiththesameproblemscouldformateamandstimulateeach

othertoreachtheir(physical)goals).

Threedifferentkindsofsocialsupportwerefound:

- esteemsupport:signsofapproval.

- informationalsupport:givingadviceandotherinformationabouttheexercise.

- companionshipsupport:doingexercisestogether.

All three kinds of social support are supported by the GameBus app and clients reacted

positivelytoallkindsofsupport.

There were numerous examples were clients did more social activities than before the

research.Afewexamples:

• Tomvisitedotherelderlyclientstomakeasocialselfie.Hedidnotknowtheseclients,

buthejustliketomakecontactwiththemtoearnpointinGameBus.

• Nikki and Tomhelpedother client supervisors to dophysical activitieswith severe

intellectual clients. Nikki and Tom walked with some clients and make pictures

together.

• Peteralsolikedtoplayvideogames.Insteadofplayinggamesalone,hevisitedsome

friendstoplaygamestogetherandearnpointsinGameBus.

• Hildevisitedtheneighborhoodsupportpointthreetimesoftenthanshenormallydid

becauseofGameBus.When sheentered thebuilding shemadeapicturewith the

39

supervisorsas‘evidence’inGameBus.

• Tomasked visitors to have awalk around the residence park Eckertdal, insteadof

drinkingcoffeeintherestaurant.

8.1.3 Motivation

Asmentionedbefore,whengamificationconceptsareappliedininterventionsforpeoplewith

intellectualdisabilities,motivationisincreased.Performingcertainactivitiesisnotboringor

uninterestinganymore,butratherisfun.

“WhenIstartusingGameBusitisfuntocleanmyroomorhaveawalkduringtheday,

insteadofstayingathome.AlsoIliketovisitmyfriendsnowbecausethenIreceivemore

pointsinGameBus.”

Thereare twokindsofmotivation thatdrive clients toperforma certainactivity, intrinsic

motivationandextrinsicmotivation.Intrinsicallymotivatedactionsareactionsthatclientsdo

by themselves. In contrast, extrinsically motivated actions are actions that clients do to

achieveacertainrewardorgoal.Althoughintrinsicmotivationismuchstrongerthanextrinsic

motivation,itseemsthatclientswithintellectualdisabilitiesaremoresensitivetotheextrinsic

motivatorsGameBusoffers.

Thequestionnaireincludedaquestiononwhetherclientsbecamemoremotivatedbyusing

GameBusintheiractivities.Theresultsareshownbelow,andtheseresultswereinlinewith

theobservationsoftheresearcherandtheclientsupervisors.

40

Figure14:Resultsquestionnaire:Motivationincrease?

So, the overallmotivation to perform certain activities increased for 11 out of 14 clients.

Especially,becauseGameBusissomething“technicalandcool”,clientsfeelmoreconfident

duringthedaythattheyareabletousethistechnique.

8.2 Evaluationframework

8.2.1 EvaluationoftheoverallexperienceofGameBusbyclientsandclientsupervisors

8.2.1.1 Clientexperience

Generally, all fourteen clients claimed to have a positive experience with the GameBus

research.Theclientsdescribed(componentsof)GameBusasamusingandstimulatingfortheir

physicalactivities:

Question: “Howdoyouexperiencetheresearchsofar?

Response: “Ithinktheresearchisgoingwell.ThroughGameBusIamoutsidealot.”

Response: “I think it isanice researchand Iamveryexcitedabout it.GameBus

encouragesmetobehealthy.”

TheevaluationalsoaskedclientstoidentifywhattheylikedthemostaboutGameBus.Almost

all clients liked receivingmore insight into their physical activities during theday and the

0

1

2

3

4

5

6

7

8

Completelytrue

Mostlytrue Somewhattrue

Notcorrect/notincorrect

Largelyincorrect

Completelyfalse

N.A.

Mymotivationincreasedtodomore(physical)activitiesthroughGameBus?

Mymotivationincreasedtodomore(physical)activitiesthroughGameBus?

41

number of steps that was illustrated by the appMoves. Some clients liked the research

becausetheycouldreceivepointsbyplayinggamesduringtheday.

Question: “WhatdidyoureallylikeaboutGameBus?

Response: “Itwasfunnytoaskmyclientsupervisoreverytimeforawalkaround

theresidencepark.AttheendofthedayIreceivedalotofpoints,when

IenteredtheamountofstepsandkilometersinGameBus.AlsoIliketo

makepicturesofmushroomsinthemorningatthepark.SometimesI

alreadyhad1500stepswhenIcamebackhome.”

Response: “WhenIwenttobedatnight,IalwaysplayCogGamestogetasmany

pointsaspossible.”

Unfortunately, someclientswereable topinpointsomenegativeaspectsaboutGameBus.

However,mostofthecommentswererelatedtothedifficultyofthelastlevelsofCogGames

(i.e.,agamedevelopedwithphysicianstotrainmemoryandreactiontime)andthenumber

of levels they could play with CogGames. The interest in continuing to play CogGames

decreasedsharplyafterclientshadreachedaroundlevel18.Theothernegativeaspectsclients

mentioned during the researchwere device-specific issues. Older smartphones or tablets

especiallyhadsomeproblemswhilerunningGameBus.Severalclientscouldnotparticipatein

theresearchbecausetheirdevicesweretooold,ortheydidnothaveenoughcapacityontheir

devicestoinstallGameBusandCogGames.Thirteenclientsalsoinstalledapedometerontheir

phones,andagaintheoldersmartphoneshaddifficultiesinshowingtherightnumberofsteps.

Clientswerewarnedinadvancethatthepedometeronlygaveanindicationofthenumberof

stepseachday.Therefore,clientswerelessupsetwhentheseissuesoccurred.

Aftertheresearchaquestionnairewasdistributedtoclientswiththequestion“Wouldyou

like to keep using GameBus after my research?” Only two clients would rather not play

GameBusanylongeraftertheresearch.Foroneoftheseclients,thiswasduetoherphone

problems. It tookaround2hours to installGameBus,CogGamesandapedometeronher

phone,andafter1weektheappshadproblemsagain.Therefore,itisveryimportantthatall

appsareworkingwellbeforehand;otherwisechancesareveryhigh thatGameBusproject

failedforthisspecificclient.Atthismomentitisverydifficulttopredictwhethertheclient

42

hasaworkabledeviceornot.Therefore,itiswisetodetermineinadvancewhichdevicesare

compatiblewithGameBusandhowmuchspaceisnecessaryfortheinstallation.

Figure15:Resultsquestionnaire:WouldyouliketokeepusingGameBus?

Theresultsinthequestionnairewerepositiveandinlinewiththeinformationgatheredduring

theunstructuredinterviews.

Almostallproblemsweresystem-relatedproblemscausedbythecontinuousdevelopmentof

theappduringtheresearch.Itisimportantthattheappisstableandthatclearinstructions

areavailableifGameBusisintroducedfurtherintheorganizationinordertoavoidnegative

emotionsinclients.Theclientsareverysensitivetosmallerrorsandcouldeasilybeupset.

Insummary,theclientswereveryenthusiasticaboutGameBus,talkingaboutitandwanting

toimprovescores,andtheyfeltspecialbecausetheycouldparticipateintheresearchand

givevaluableinformation.

8.2.1.2 Clientsupervisorexperience

AllclientsupervisorsagreedontheusefulnessofobtainingGameBusasasupportedtoolfor

stimulating different kind of activities. They found that clients weremoremotivated and

0

1

2

3

4

Yesdefinitely Yes Idonotcare Norathernot Nodefinitlynot

WouldyouliketokeepusingGameBusaftermyresearch?

WouldyouliketokeepusingGameBusaftermyresearch?

43

overallreactedpositivelyinreachingtheirpresetgoals.Themostcriticalpointswereabout

thenumberofquestionsfromclientsduetotechnicalproblemswiththeappinthebeginning.

Therefore,alltechnicalquestionswereonlydiscussedwiththeresearcher.Bythelastthree

weeksthenumberofquestionshadalreadydecreasedsignificantly.Clientsupervisorswho

participatedintheteamwerebetteratsolvingthesebarriers,resultinginmoreclientsactively

participatingintheresearch.

MostclientsandclientsupervisorsextremelylikedtheideathatusingGameBuswouldgive

theclienttheabilitytomonitorphysicalactivitiesinagamingexperience.Clientsupervisors

likedtheideathatGameBuscouldbeanextrinsicmotivatortostimulatephysicalactivitiesfor

clients.TheyappreciatedthatGameBuscouldbeusedtostimulatesocialactivities,butalso

that GameBus could be used in the future for other (domestic) challenges. The role of

CogGamestomakechallengesmoreattractivewasalsoconfirmed.Theyconfirmedtheadded

value of monitoring physical activities because clients often overestimate their level of

physicalactivity.

Themajorityofclientsupervisorswereenthusiastic,givingfeedbackontheactivitylevelsof

clientsduringregularmeetings,butwereconcernedaboutthefactthatitcouldbetootime-

consuming.Itwillcostthemextratimetotracktheirownactivitiesandmonitortheprogress

of all their clients. Two client supervisors reported that theywould probablymonitor the

activitylevelsoftheirclientsinGameBus.Thosewhodidnot,mentionedthattheywantto

receivenotificationsorreceivepushinformationwhenactivitylevelschange.However,this

wasonlythecaseforclientswhohave24-hoursupportduringtheday.Clientsupervisorsfor

clientswhoonlyreceiveafewhoursofcareaweeksaidthatthiswasaviolationoftheprivacy

oftheclient.Providingfeedbackorotherformsofstimulationinbetweenmeetingswastoo

mucheffortfortheseclientsupervisors.Anotherideawastohaveautomaticallygenerated

feedbackmessageswhenclientsperformedacertaintask.

MoreinformationcanbefoundinappendixJ.

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8.2.2 Evaluationofclients’behaviorviatheReasonedActionApproach

8.2.2.1 Patternsandcontextofuse

NineclientsreportedthattheyhadintendedtouseGameBusmorethantheyhad,butforgot

touseit.Generally,thesewereclientswithwhomtheclientsupervisorhadlittleinvolvement

intheresearch.Therewassomedisappointmentamongtheclientsthattheydidnotmanage

touseGameBusonaregularbasis.Theclientswhodidnotreportthiswereingeneralclients

withwhomtheclientsupervisorwasactivelyinvolvedintheresearch,i.e.,participatinginthe

teamordiscussingGameBus.

HildeandTomreportedusingtheappsonadailybasis.TomusedEndomondoandMoves

everydaytotrackhisphysicalmovementsandmanuallyenteredallhisresultsinGameBus.

Sometimes Tom needed some help to calculate the number of seconds. Tom also visited

unknown elderly clients once aweek in order to receive points in GameBus. Peoplewho

already visitedhimonaweeklybasiswereasked to takea social selfie. Tomasked client

supervisorsatthedaycareactivitytotakeawalkwithhimduringthebreak.Weeklyweighing

momentswereintroducedwithhisclientsupervisorinordertocheckhisweightloss.Tomhas

concocted another challenge to lose weight: reducing the amount of cola he drinks and

increasingtheamountofwater.After4weekshereporteda2.5-kiloweightloss,whichmade

him even more motivated to perform physical activities! He reported during one of the

interviews:

“GameBuswasthelastnudgetoahealthierlifestyle.Itwasdifficultformetostopdrinking

threelitersofcolaaday,butGameBusstimulatesmetodrinkmorewaterinsteadofcola.”

CogGameswasusedonadailybasis inorder to receivemorepoints.Whenhe reacheda

maximum level, he removed CogGames from his phone, installed it again, and started

receivingpointsagain.TomwasabletointegrateGameBusintohisdailylife.

Hilde visited the WSP (neighborhood support) Woensel three times a week and was

stimulatedtotakesocialselfieswiththesupervisorsandpullfunnyfaces.Duringtheresearch

shevisittheWSP2timesmoreoftenthannormalinordertoreceivemorepointsinGameBus.

Theclientsupervisorcouldusetheseextramomentstotalkaboutpersonalproblems.Hilde

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wasthemostactiveclientwithCogGames.Sheplayedeverydayforabout2hoursbecause

sheenjoyedthegamesverymuch.ShealsoreportedthatitwasveryenjoyabletouseMoves

andEndomondotogiveher insight intoherphysicalactivities.Shecheckedthenumberof

stepsshetookonadailybasisandentereditinGameBus.Shealsoreportedthatshewalked

morethannormal,butthisisdoubtful.

Anoukwas reallyenthusiastic in thebeginningabout trackingherphysical conditionswith

EndomondoandMoves.Sheworeherphonethewholeday.Inthebeginning,sheentered

thenumberofstepsinGameBustoreceivepoints,butphoneproblemswerethemainreason

thatshestoppeddoingthis.ShewasalsonotabletoinstallCogGamesonherphone.Shestill

usedEndomondoandMovestotrackherphysicalconditions,butpointswerecalculatedon

paper. Other agreements with her client supervisor were made to earn points, namely

cleaningherroomandgettingupontime.Apictureofhercleanedroomwasshowntothe

supervisorinordertoreceiveherpoints.

Peter did not use the actual app because itwas too complicated to enter all his physical

activitiesinGameBus.HealsousedMovesandEndomondototrackhisphysicalconditions.

During the week he worked hard and therefore arrived at home around 5:30PM. In

consultationwiththeclientsupervisor,itwasdecidedthatitwastoolate,toodark,andtoo

cooltogooutsideatthattimeoftheday;therefore,hedidsomephysicalexerciseduringthe

weekends.HeusedEndomondoandMovesat leastonedayaweek.HeplayedCogGames

everydayuntilhereachedhismaximumlevel.Otheragreementswithhisclientsupervisor

weremadetoearnpoints.Insteadofplayingvideogamesalone,heearnedpointswhenhe

visitedfriendsandplayedgamestogetherordidanotheractivitytogether.Again,apicture

wasshowninordertoreceivehispoints.

NikkiandAnkewerecognitively,sociallyoremotionallytoolimitedtousetheGameBusapp.

Nikki’sIQwasnotaslowasthatofAnke,buthersocial-emotionalbehaviorwastoolimited

tocontactotherpeople.Herlegalrepresentativehasforbiddenherfrommakingcontactwith

otherpeople,sothesocialcomponentofGameBuswasimpossibletofulfill.However,physical

improvementwasdesirable.Endomondowasusedtoregistersomephysicalactivityatleast

twotimesaweekforatleast20minutes.Nikkiwasallowedtomovefreelythroughoutthe

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residence park and therefore able to fulfill this challenge. However, she needed a lot of

supporttodothis.

However,Nikkiwasnotabletomovefreelyandneededconstantsupervision.Allactivities

wereperformed ingroups.Therewasnopossibilityofhavingawalk freely forat least20

minutesatherhomeandherdaytimeactivity.Therefore,Endomondowasused2timesa

weekatthedaytimeactivityinordertoregisterherphysicalactivityatanexercisebike.When

shefinished,shegotastickerfromtheclientsupervisors.

8.2.2.2 Contextofuse(time,location,andenvironment)

Therewasahugedifferenceintheusagetimethroughoutthedaybetweenclients.

“IstartusingGameBusduringthefirstbreakat10:30AMtowalkaroundtheresidencepark.

WhenIambackhomearound2:30PMIplaysomeCogGames,andafterdinerhaveawalk

withmymotheraroundtheresidencepark.”

“IonlyusedGameBuswhenmyclientsupervisoraskedmetousetheexercisebikeduringmy

daytimeactivities.Thisisnormallyafterlunch.”

“IonlyusedGameBusduringtheweekends.NormallyonSaturdayifIgotothecitywithmy

parents.”

MostclientsreportedthattheyusedGameBusimmediatelyaftercominghomefromdaytime

activitiesorwork.OtherclientspreferredtoplaysomeCogGamestorelaxjustbeforesleep.

ClientsalsoreportedusingCogGamesduringabreakatworkortheirdaytimeactivities.

Thefindingsaresummarizedinthefollowingtable.

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Table6:Summarytime,frequencyandlocationofusefordifferentscenarios

HildeTom

Anouk Peter NikkiAnke

Time CogGames:morning,lunchbreak,beforebedtimePhysical:coffeebreak,afterdaycare/work

CogGames:intheweekend,beforeandafterschoolPhysical:especiallyweekends

OntheweekendsPhysical:weekends

Whenclientsupervisorasktheclienttodoitduringdaytimeactivities

Frequency 7timesaweek 3-4timesaweek CogGames:everydayEndomondo:1timeaweek

2timesaweek

Location Everywhere Athome Athome Daycare

So, clientsusedGameBus indifferentwaysatdifferent times,dependingon theirhousing

situation.SomeclientsattheresidenceparkswereabletouseGameBuseverydaybecause

theyhadsufficienttime.Moreindependentclients,whoalsoliveindependentoratagroup

home,didnotdailyuseGameBusduetotheirbusyschedule(e.g.,schoolorwork).Clients

withalowIQonlyusedGameBus,whentheirclientsupervisorremembered.

8.2.2.3 Busylivesandroutines

Clientsupervisorsreportedthat itwasasignificantfactorforsuccess ifGameBuscouldbe

integratedbyoperantconditioningintothelifestyleofaclient.Clientsmentionedthatthey

only could use GameBus regularly if they had a routine. Some clients reported some

disappointmentwiththemselvesfornotusingGameBusasmuchastheyintended.

HildeandTomhadenoughtimetoplayGameBusduringthedayandmadeitpartoftheir

dailyroutine.Theydidn’tneedsupportfromtheirclientsupervisor.

Anoukgoestoschoolduringthedayandisnotallowedtouseherphonethere.Herclient

supervisorusedGameBustomotivateAnoukandaddedGameBustoherdailyroutineand

thereforeshesuccessfullyusedit(i.e.,moremotivationforphysicalandotheractivities).

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BecauseofPeter’sbusyworkroutine,heisnotabletouseGameBusduringtheday.However,

heisabletouseitintheeveningandontheweekends.HeisabletouseGameBusalonebut

heneededaspecificroadmapandawell-functioningapp.GameBuswasputonhispictoline

(i.e.,linewithpicturesofactivitiestodo),soherememberedtouseit.Infuture,hecanalso

useadigitalcalendarwithpushmessages.

AnkeisnotabletouseGameBusalonebecauseofhercognitivelevel.IfAnkeneedsphysical

exercise, the client supervisor should include this inherdayprogram.Nikki is able touse

Endomondo and Moves but her social/emotional status has a negative impact on her

motivation.TheclientsupervisorshouldstimulatehereverydayinorderforNikkitoperform

herphysicalactivities.GameBushelpedtoimprovethismotivationasmallamountandwas

includedinherdayprogramtwotimesaweek

8.2.2.4 Intensionsanddisappointment

Afewclientsshoweddifferentintentionsinthebeginningthanattheend.Oneclientreported

thefollowing:

“Iwanttowalkatleast30minuteseverydaytolosemoreweight.Iwillwalkwithmydog

everyday.”

However,itturnedoutinpracticethatshedidnotwalkatallforthreeweeks.Herdogwaslet

outbyafriendeveryday.Despiteherownintention,shewasnotabletotakeawalkathome.

Duringthelastinterviewshestillhadthesameintentionasinthebeginning,buttherewas

nobodytostimulateherwhenshewasathome.Shesimplyforgotiteverytime.

Anotherclientshowedlowself-beliefinhercapacitytodophysicalactivities.

“Itisreallydifficultformetowalkseveraltimesaweek.Iprefertowatchtelevision.”

However,duringthelastinterviewshereportedthatsheactuallyenjoyedusingGameBusand

thatshewalkedseveraltimesaweektohavemoresteps.

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“IquiteenjoyedGameBus.Itfeltgoodtolosesomeweight,insteadofwatchingtelevisionat

home.”

Finally, she reportedan increase inself-efficacyand increasedmotivation.Again, it isvery

importanttorememberclientsaboutGameBuseverydayuntilitispartofthedailyroutine.

8.2.2.5 Otherpeople

SomeclientsreportedthatclientsupervisorsinfluencedtheiruseofGameBus.Forinstance,

oneclientsupervisorintroducedthesubjectofGameBusduringdailymeetingstokeepthe

clientmotivated.

Threeclientsupervisorsreportedthattheirclientswereproudtotellanyoneatschoolorwork

thattheyparticipatedinaresearchstudy.Clientsgotthefeelingthattheywere“special”and

askedotherpeopleiftheyalsowantedtoinstalltheapp.However,thisdidnotdirectlymean

thattheywantedtoplayonthesameteam.Othersupervisorsplayedwellwiththisbyasking

oftenabouttheprogress.

8.2.2.6 Appdesign

MostclientsreportedthatGameBuswaswelldesignedandhelpedthemtobemoresocially,

cognitivelyandphysicallyactive.Someclientsexperiencedsomedifficultieswiththedifferent

languagesintheavailableapp.

Severalclientsupervisorspointedout thatGameBusneededmorevisualcharacteristics to

reachawideraudience.Manyclientshavereadingproblems,andabettervisualaspect is

thereforemoreaccessibleforclients.

Almostallclientsreportedthatitwasannoyingtoseethenumberofpointsofotherteams

theydidnotknow.Althoughitwasclearlydescribedthattheseteamswerenotpartofthe

study,clientsfounditdifficultnottoseetheseotherteams.

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8.2.2.7 Coreconcern

Inparagraph3.5,sixclientcategoriesweredefinedwithinLunetzorg.Thesecategorieswere

keptinmindduringthefirststagesoftheresearch.However,Lunetzorghasawidevarietyof

clients livingatdifferent locations,whichmade it impossible toconceptualize toonecore

category.

Clientswereselectedbasedoninterviewswithmanagersand(client)supervisors,takeninto

account the predefined conditions (e.g., technical requirements). Most clients began the

researchwiththeintentiontoloseweightorplaycognitivegames.Twousersdidnotwantto

useGameBusanymoreafter4usesbecauseofalackofmotivationorinsufficientchallenges.

For the remaining clients, it was impossible to define one core concern. Additionally, it

required somephone skills ormathematical skills in order to perform specific challenges.

DependingonIQlevelandsmartphoneabilities,twomaingroupswereformed:

- Clientswhoactuallyusedthenewapp.

- ClientswhoonlyusedcertainGameBusconcepts,butnotthenewappitself.

ClientswhodidnotusethenovelGameBusappcouldprobablyuseawell-functioningappin

future. Both main groups could also be divided into two subgroups according to their

capabilities or phone restrictions, resulting in four different use caseswith corresponding

personas(seefigure17).

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Figure16:Definedcorecategories

So,fourdifferentusecaseswereidentifiedviatheRAA.Category1and2actuallyusedthe

appGameBus.Category3and4onlyusedGameBusprinciplesandtrackingapps,butnotthe

actualGameBusapp.Forexample,theyusedapedometertotrackphysicalactivity,andpoints

werecalculatedonpaperinsteadofinGameBus.

Category1usedGameBuscompletely,as itwas intended.Category2was intendedtouse

GameBus completely, however some technical problems causeda slightly differentuseof

GameBus.However,ifcategory2hadagoodsmartphone,category1and2couldbetreated

inthesameway.Category3alsousedallconceptsofGameBus,howevertheregistrationof

pointswas tocomplicated for them inGameBus.Their registrationofpointswasdoneon

paper. Category 4 could only track physical activities. The four identified use cases are

summarizedintable6.

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Table7:Summaryusecases

MadeuseofGameBusapp DidnotmakeuseofGameBusCorecategory1:HildeTom

Corecategory2:Anouk

Corecategory3:Peter

Corecategory4:NikkiAnke

Physical:Endomondo,MovesCognitive:CogGamesSocial:visitfamilymembers,meetnewpeople,competeinteams,stimulateeachother

Physical:Endomondo,MovesCognitive:-Social:playwithclientsupervisor,stimulateeachother

Physical:Endomondo,MovesCognitive:CogGamesSocial:playwithfriendsandclientsupervisor,playtogether

Physical:MovesCognitive:-Social:-

8.2.3 Evaluationofotherhealthgamificationfactors

8.2.3.1 Teams

Duringtheresearchmanyclientsdescribedhowtheirclientsupervisorservedasanexample

forthem.Therefore,clientsandclientsupervisorswereputtogetherinoneteam,sotheclient

could compare their resultswith the client supervisor. In somecases, the researcher (i.e.,

MaartenKooijman)actasaclientsupervisor,becausesomeclientsupervisorsweretobusy

ordidnotwanttoparticipateintheresearchyet.Therefore,hereplacedthem.

GameBusdisplayspointscompared tootherpeople.Clientsearnpointsandare ranked in

descendingorder.Comparingclients’scores inthiswayprovokescompetition,andclients’

self-esteemchanges.

“Thekeyideaistoletpeopleplaythedifferentgamestheyenjoytrulyasanindividual,insuch

away that theyarepartof an integrated social interaction” (VanGorp, 2015).As already

describedbefore,GameBususerscancommittochallengesasateamthatfavortheirhealth

directly.Thisconceptwasdiscussedwithallmanagersandclientsupervisors.However,many

peoplegavethefollowingreaction:

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“Playinginteamsandseeingscoresofotherpeoplecouldhaveanegativeimpactonthe

motivationofclientsandthenthepositiveimpactofGameBusisovershadowedbythe

negativeimpactofseeingscoresofotherpeople.”

Theseexpectationswerekept inmindduring theentire researchprocessbutnoalarming

resultswerefound.Attheend,fourteenclientsansweredthequestionnaire,whichaskedwho

theylikedtoplaywithinateam.Multipleanswerswerepossible,withthefollowingresults:

Figure17:Resultsquestionnaire:WithwhomdoyouliketoplayGameBus?

Only one client reported that she wanted to play GameBus alone, but she was actually

participatinginagroup.Sheprobablymisunderstoodthequestion.Allclientsdescribedhow

they wanted to play GameBus with friends/acquaintance or their client supervisor. The

motivationlevelswerealsomonitoredduringtheresearchandnoevidencewasfoundthat

playinginsmallorbigteamscausednegativeemotions,aslongastheclientsupervisorskept

givingcomplimentstotheclients.

Furthermore,theteamcompositionisexaminedinmoredetail.Ingeneral,stimulatingeach

otherhasapositiveeffectontheperformanceofanindividualclient.However,threemain

categorieswereidentified:

0123456789

10

Withmyfamily Withfriends/acquaintances

Withmyclientsupervisor

WithotherclientsofLunetzorg

Alone

WithwhowouldyouliketoplayGameBus?

WithwhowouldyouliketoplayGameBus?

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Table8:Teamcompositiondifferentclients

Category1 Category2 Category3Clients -Youngclient(age<30)with

behavioralproblemsandIQ>80;-Retardedclient(age30-65),liveindependent,IQ70-85.

-Adultclient(age30-65),IQ60-80

-Adultclient(age18-65),IQ40-60

Teamformation Playinteamsincludingclientsupervisor,familymembers,friends,otherclients

Smallteams,e.g.,clientsupervisorand1-2familymembersorgoodfriends

Only1team:client+clientsupervisor

ItisstrikingthattheIQlevelisanimportantfactorinthesizeoftheteam.ThelowertheIQ,

thesmallertheteam.Clientsof‘category3’areonlyabletoplayGameBuswiththeirclient

supervisor.Additionofanextraplayerhasnoaddedvalue,becauseitistocomplicateforthe

client.Theclientsupervisoristheidealpersonforthis,becauseclientsupervisorsservesasan

example/rolemodelforclients.

ClientswithanIQbetween60–80canhandlecollaboration,butitistoocomplicatedforthem

ifmorethan3-4peoplejoinateam.Especiallytheseclientsreportedthattheyweredistracted

bythepresenceofotherteamsinthescoringtable.

ClientswithanIQ>80canjoinseveralteams,indifferentsettings,withdifferentchallenges.

However,challengesshouldbeorganizedforoneortwocommongoals(e.g.,increasephysical

health).

8.2.3.2 Physicalactivitypromotion

Althoughclientsupervisorsknowthatclientsshouldimprovetheirlifestyles(e.g.,eathealthier

orimprovephysicalactivity),consequentlypromotingandteachingtheclientsischallenging.

Question:“Didyounoticeanincreaseinweightduringthelastcoupleofyearsforyour

client?Ifyes,whatdoyoudotoreducehisweightgain?

Answer:“Theweightofmyclientincreasestenkilosinlasttwoyears.Sometimeswetalk

abouthisweight,butIamnotconsequentlypromotinghealthybehavior.Ionlyseehimafew

hoursaweek,andIdon’tknowhowtomotivatehim.”

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People with mental disabilities experience more problems in becoming physically active.

Therefore, client supervisors should promote and teach their clients who have additional

problems in meeting these challenges more, by providing more support for performing

physical activities. Additionally, for clients with an intellectual disability, it appears that

physicalactivitiesensurethattheyarelessdependentonsupportandthatthereislessofa

chanceofbehavioralproblems.Healthinsurersrecognizethisandin2012fundedtheproject

“bewegenbiedtpreventie”.Themaincomponentsofthisprojectwere:

- Offeringclassesforallclientsupervisors.

- Implementationofthe“handboekbewegen”withmanyexamplesandideastoentice

clientstosportsandexercise.

- AdoptingphysicalactivitiesasapermanentfeatureofthePersonalPlan.

Therefore,the“handboekbewegen”andsomePersonalPlanswerecheckedinmoredetailto

seewhethersomeaspectsfromthisprojectwererecognizedinthesedocuments.Lunetzorg

indeeddevelopeda “handboekbewegen”,but it is really focusedon clientswithmultiple

disabilities.Mostexercisesaretoochildishforpeoplewithmiddleandmildmentaldisabilities.

The document shows just some basic examples of games to play, and there is a lack of

informationabouthowtointegratethisindailylifeorhowtosupporttheseactivitiesindaily

life.Additionally,3PersonalPlanswere read (between53–97pagesperplan!) todetect

whetherphysicalactivitieswereincluded.IntwooutofthethreePersonalPlans,something

wasmentionedabout stimulatingorperformingphysical activities. Inboth thesePersonal

Plans,onlyonesentencewasincludedintheplan:

“Clientswims1xperweekatthelocomotivecenterwithmotherbecausesupervisorscannot

offerone-on-oneassistancewiththeclienttoundress.”

AND

“HelpmewithfindingrecipesandphysicalactivitiesthatensurethatIcanloseweightand

makesurethatIwillloseweight.”

ItseemsthatstimulatingandperformingphysicalactivitiesisnotamainpartofthePersonal

Plan.Clientsupervisorscouldnotexplainwhatconcretestepstheytaketostimulatetheclient

intheirphysicalactivities.Tocombattheinactivityofclientswithintellectualdisabilities, it

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would be advisable for a client supervisor to consider physical activities as “medicine”;

physicalactivityindailyactivitiesshouldbeseenanddealtwithinthesamewayasdoctors

andnursesdoformedicalinterventions.

8.2.3.3 Goalsetting

Clientsupervisorswereuncertainwhethertheyweretherightpersontohelpwithgoal-setting

fordailyactivities.Theyindicatethat2-3peoplecouldberesponsibleforthewholeGameBus

process (e.g., the innovation team), instead of all client supervisors in the organization.

Additionally,theymentionedthatchallengesandgoalsshouldbetailoredtotheindividual

client,andthatphysicalcomplaintsandlackoftimeshouldbetakenintoaccountwhensetting

specificgoals.

ItwillbeagreatopportunityforLunetzorgtomakeGameBuspartofthedailylifeofaclient.

Opportunities lay intheconnectionwiththepersonalplanofaclient. Inthepersonalplan

there are also social, physical and cognitive goals described, which can be linked with

challengesinGameBustoincreasemotivationofclients.Afewclientsupervisorssuggested

toaddalsootheractivitiesorapps,likenutritionappsordomesticactivities(e.g.,cleanroom).

8.2.3.4 Presentationofinformation

Generally,allintervieweesfoundthatthedatawereclearlypresented,buttheinformationof

otherunknownteamsorchallengesshouldbehidden.

“Ireallylikedtoseehowmyteam(WSPWoenselgroupA)isdoing.Ireallylikedtoseehow

theotherteamisdoing(WSPWoenselgroupB),butitisconfusingandvisibleunattractiveto

seethescoresofstrangers.Thiswillhaveanegativeimpactontheperformanceofmy

team.”

Additionally,clientsupervisorsmentionedthatthedescriptionofchallengeswastoolargeand

couldbecomplicatedforclientswithreadingproblems.Amorevisualrepresentationcould

helpwiththisproblem.

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9. DiscussionTherehasbeenmuchresearchonphysicalactivityinterventionsinprimarycare.Accordingto

Hillsdonetal.(2005),aneffectiveinterventiontoincreasephysicalactivitiesincludesatleast

achievable goals, follow-up meetings to discuss progress and targeted information. The

chancesofaneffectiveinterventionaregrowingrapidly,asinterventionsarebasedonhealth

behaviorchangetheory(Abraham&Michie,2008).VanAchterbergetal.(2011)alsonoted

that individual tailored feedbackaboutphysical activities givesbetter results thangeneral

information.Interventionsforpeoplewithmentaldisabilitiesshouldreachbeyondonevisita

weekormonthtoaphysiotherapist;theyshouldbeintegratedintopeople’sdailylives.Health

status,self-efficacy,motivation,ageandsexaredeterminantsassociatedtophysicalactivity.

Therefore, there is an emerging need for physical interventions that are tailored to these

specificdeterminants.GameBusalreadydifferentiatesinageandsex,butthisresearchshows

thatself-efficacyandmotivationarealsoimprovedusingGameBus.

TheGameBus research showed a positive outcome in the increase in social, physical and

cognitive activitieswhen clients used the apps in daily life.Other physical activity studies

described moderate positive effects in the short term (Neidrick et al, 2012). From the

GameBus research it canbeconcluded that self-monitoring, gamification,goal-settingand

feedbackarethemostpowerfulfactorsintheresearch.Thesefindingsareinlinewithfindings

inotherreviews.Bravataetal.(2007)alsofoundthatanincreaseinphysicalactivitylevelsis

reachedthroughtheuseofpedometers.Additionally,whenself-monitoringiscombinedwith

feedbackthroughclientsupervisors,theseinterventionsalsoarecost-effective(Leungetal.,

2012).Clientsupervisorsplayanimportantroleinsocialnetworksforpeoplewithintellectual

disabilities. In a studyby vanAsselt-Govertset al. (2015), itwas found that thequalityof

contactwithaclientsupervisorisoneofthemostimportantfactorsfortheoverallwellbeing

of clients with intellectual disabilities. According to Hermsen et al. (2014), a high-quality

interpersonalrelationshipbetweentheclientandclientsupervisorispartofthe“professional

lovingcare”.Thenumberoffriends,familymembersorotheracquaintancesisalsoimportant

fortheclient’ssatisfaction level.Additionally,thenetworkoffamilymembers isextremely

important foraclientwith intellectualdisabilities.ViaGameBus,clientscanbecomemore

involvedintheirfamilyandfamilymemberscanprovidepracticalandemotionalsupport.This

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factorisalsorelatedtotheperceivedqualityoflifefortheclients.Itshouldbenotedthatthe

researcher (i.e.,MaartenKooijman)actasa supervisorduring this research,because time

constraintsorlackofinformationabouttheprojectofotherclientsupervisors.Hewasable

tocoordinateGameBusforaround20clientsofLunetzorg.Thequalityofcontactbetween

clientandclientsupervisorswasanimportantfactorforthesuccessofGameBus.Theideal

solution is thatall client supervisorswill coordinate theGameBusproject for their clients,

howevertheexpectationisthatthiswillbetomuchtimeconsuming.Analternativeistomake

twopeopleresponsibleintheorganizationforGameBus,andseehowfamilymembersand

friendscouldbeinvolvedinthisprocess.Byinvolvingfamilymembersinthecareprocessvia

GameBus,somecaretaskscouldberemovedfromtheclientsupervisor.Sinceonlyonefamily

hasbeeninvolvedinthisresearch,thiscompletionneedfurtherresearch.

Behavior change strategiesaremoreeffective thancognitive strategies inphysical activity

behaviorchange(Connetal.,2011).GameBusintegratedmanybehavioralaspects(i.e.,goal-

setting, self-monitoring) and can be used as a health education tool. However, health

educationdoesnot increasephysicalactivity levelsperse,probablybecausemanypeople

already know the physical benefits of exercise (Conn, Hafdahl, & Mehr, 2011). Client

supervisorsmentionedthattheyhadalreadydiscussedthebenefitsofphysicalexerciseoften

withclientsbeforetheresearchbegan.GameBuscouldpossiblybethelastnudgeandamore

attractiveway (i.e., becauseof gamification elements) to change the social, cognitive and

physicalbehavioroftheclients.

During the first interviewswith clients and client supervisors, itwas askedwhat behavior

should be changed and how. A broad variety of options were given to change physical,

cognitiveorsocialbehaviordependingoneachperson’swishesandcapabilities.Someclients

increasedtheirphysicalactivitiesenormouslyandcreatednewphysicalactivityhabits.These

newphysicalhabitsshould fit intodailyroutinesandareofgreat importanceforbehavior

change(Gradneretal.,2012).Clientsupervisorsshouldputemphasisonembeddingthese

activitiesindailyroutines,repeatingcertainbehavioroverandoveragainuntilitispartofthe

daily routine of a client. Further research is needed to identify which specific

activities/challengesareeffectiveforclientsofLunetzorg.

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GameBusisapromisingandambitiousproject.WithGameBus,Lunetzorgcanincreasethe

motivationofclients,involvefamilyandfriendsinthecareprocess,makeclientsmoreaware

of their (health) behavior, increase self-confidence of clients, or stimulate clients in an

attractiveway.Unfortunately,sometechnicalproblemsoccurredduringtheresearchandthe

user interfacewas not developed enough to testwith clientswith low cognitive abilities.

Ideally,theresearchwouldbecarriedoutwithafullyworkingapptotestonallclients.This

goalwasnotachievedduetotechnicaldevelopmentsduringtheresearch.Therefore,some

clientsdidnotusetheactualGameBusapp,butGameBusconceptsweretested(e.g.,reward

healthy behavior on paper).When a fullworkable version is available, clients can test all

available features over a longer period. However, the present research gave a good first

impressionaboutthepossibilitiesforGameBusinanenvironmentforpeoplewithintellectual

disabilities.Also, theactual testingperiodwas shorter thanexpected,because it required

muchtimetofirstspeakwithallmanagers,coordinatingsupervisorsandclientsupervisors

before the research could start with the clients. Still, further research is needed to see

whethertheseresultsapplyforallclientsandoveralongerperiod.

Asalreadymentionedbefore, clientswith lowcognitiveabilities (IQ<60)didnotuse the

actualGameBusapp.WhentheGameBusappworkscompletely,itcanalsobetestedonthis

groupofclientswhetherGameBusisalsosuccessfulforthem.Onethingiscertain:rewarding

healthybehaviorforthisgroupiseffective!

Analternativecouldbetoaddressphysicalactivitiesmorebroadly.Severalhousesinavillage

canjoinforcestoperformphysicalactivitiestogether.Thisdoesreducetheworkloadforall

clientsupervisors.Insteadofthattheclientsupervisorhasanindividualwalkwithaclient,the

clientsupervisorcanalsowalkwithalargergroupofclients.Indeed,notallclientcanwalk

independently and need constant supervision. Of course, healthcare organizations can

encourage family members to help the client to accomplish their preset challenges in

GameBus.During this research, one familywas involved in the researchand inpractice it

turnedoutthattheclientstimulatedfamilymembersduringtheirweeklyvisitstohaveawalk

together.

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ThepresenceofasmartphonewithInternetaccesswasnotascommonasinthe“normal”

world.Astheseverityofthedisabilityincreases,thepercentageofclientswithsmartphones

decreases.However,smartphoneusageamongretardedclientsseemstobeveryhigh(80%),

andthenumberamongyoungerclients(e.g.,clientsatDuizelwijk) isalsoquitehigh(65%).

Thenumberofsmartphonesforothermildlyintellectuallydisabledpeopleseemstobequite

low(30%)butisincreasingeverymonth.Thesenumbersareobtainedfromasmallsample,

anditwasunsurewhetherthesenumberswererepresentativeforthewholepopulationof

Lunetzorg.Furtherresearchisneededtoverifytheseresultsoverthewholepopulationof

Lunetzorg.

After the research all measured results and insights were incorporated in the Value

PropositionCanvastodescribeclient/clientsupervisorneedsandtheaddedvalueofGameBus

inaclearmanner.

Figure18:ValuePropositionCanvas

Clientsupervisorsrecognizea lackofphysical,socialandcognitiveactivities,butnotmuch

timeisspentduringtheregularmeetingsbetweenclientsandsupervisorsonstimulatingthis.

Therefore, the use of GameBus to stimulate clients in an attractive way was considered

valuable.GameBuscanbeanattractivewaytostimulatehealthybehavior,butitcanalsobe

61

usedasadditionaltooltoassistsclientswiththeirpersonalgoalsasdescribedintheirpersonal

plan.ThroughtheuseGameBus,Lunetzorgpositionsitselfalsoasaninnovativeorganization

comparedtootherhealthcareorganizations.

AnotheradvantageforLunetisthatfamilymembersaremoreinvolvedinthecare.Together

with familymembers, challenges can be formulated,which can then help relatives in the

supportofthesechallenges.Wehaveseenthatthebudgetforaclientdeclinesto25%this

year,andalsothedemandforcare forpeoplewith intellectualdisabilities is increasing. In

ordertocontinueprovidingthesamecare,addingGameBusandfamilymemberscouldbea

solutiontodeliverthesamecarewithlessmoney.However,furtherresearchisneededto

quantifybenefitsforLunetzorg.

62

10. Conclusion

ThemainconclusionisthatthelevelofIQandtheextentoftelephoneskillsarethekeyfactors

for the use of GameBus. Clients with an IQ below 40 are definitely not able to use any

componentsofGameBus.Additionally,GameBuscannotbeusedbyclientswhodonothave

sufficientphoneskills(i.e.,abletotakepictures,uploadpicturestoGameBus,switchbetween

menus,enterinformationintheapp,etc.).

Basedontheresults,GameBuscouldbeappliedinthreedifferentways.Thisarethefirstthree

promisingusecasesforLunetzorg,iftheywanttouseGameBus.Thefirstusecaseconsistsof

youngclients(age<30)withbehavioralproblemsandIQ>80,oraretardedclientwholives

independently(age30–65)andIQ70–85.Theyplayinateamwiththeirclientsupervisor,

familymembers,friendsandotherclients.Thesecondusecaseconsistsofadultclients(age

30–65)andanIQbetween60–80.Theyplayinsmallerteams(e.g.,clientsupervisorand1-

2familymembersorfriends).Thelastusecaseconsistsofadultclients(age18–65)andan

IQbetween40–60.Theycanonlyplayin1teamwithclientandclientsupervisor.Figure20

showsagraphicalrepresentationabouthowtheseusescaseswerefound,andtableXgivesa

moredetailedsummaryaboutthedifferencesoftheseusescases.

Figure19:FirstthreepromisingusecasesLunetzorg

63

GameBususagewasevaluatedonseveralfactors,resultinginthesethreepromisingusecases.

Thefindingsshowedthatthemotivationtoperformphysical,socialandcognitiveactivitiesis

increasedenormously.Manypositiveresultswerefoundandsomeclientsactuallylostsome

weight.However,itiscurrentlydifficulttopredictwhetherthemotivationwillremainhigh

foralongerperiod.

GameBus was not only tested for physical, cognitive and social activities, but also other

activities,forexample,cleaningone’sroom,beingontimetothedaycareactivityordrinking

more water instead of cola. The conclusion was that the use of GameBus requires

customization,butmotivationandself-esteemisincreased.Additionally,theinvolvementin

ateamwiththeclientsupervisorhadpositiveeffectsontheresults.

However,manyclientswithanIQbelow60neededconstantsupervision.Therefore,theclient

couldnotfulfillallthephysicalchallenges.Someclientswereputonanexercisebiketoearn

points inGameBus. Further development for these clients should be focused on the user

interface, notifications and easy-to-use wearable tracking devices. These clients found it

difficulttounderstandtheappbecauseofreadingproblems.Onlythroughtheuseofoperant

conditioningwereclientsabletoregistersomeactivities.Clientsupervisorscouldalsoregister

theactivities,butthisneedsfurtherresearchabouttheconsequences.

Furthermore,clientsupervisorssuggestedthattheinnovationteamcouldplayaroleinthese

activities.Fourclientsupervisorswerenotconvincedthattheyshouldbeintegratedinthe

teamofaclient;theysaidthisisanimportantroleforfamily,friendsortheinnovationteam.

Finally,GameBusenablesclients,clientsupervisorsandfamilymemberstostimulate,monitor

andsupporteachotherinhealthybehaviorandexecuting(domestic)activitiesthroughshared

activities and challenges. Additionally, GameBus provided data for client supervisors,

increasedmotivationandself-esteemforclientsand,lastbutnotleast,increasedthejoyof

clients.ThisshouldbefullytestedwithanexpandedandstableversionofGameBus.

64

Table9:DifferencesusescasesLunetzorg

1stpromisingusecase 2ndpromisingusecase 3rdpromisingusecase

Targetgroup

Youngclient(age<30)withbehavioralproblemsand

IQ>80OR

Retardedclient,livesindependently(age30–65)andIQbetween70-

85

Adultclient(age30–65)andIQbetween60–80(mildmentaldisability)

Adultclient(age18–65)andIQbetween40–60((mild)

mentaldisability)

ApplicationGameBus

Playinteamsincludingclientsupervisor,familymembers,

friends,otherclients

Smallteams,e.g.clientsupervisorand1-2familymembersorgoodfriends

Only1team:client+clientsupervisor

Physicalactivities

UseEndomo,Strava,RunkeeperorPedometer,otherphysicalactivities

(e.g.,swimming)

UseEndomo,Strava,RunkeeperorPedometer,otherphysicalactivities

Advice:onlyusepedometer.Otherformsoftrackingcouldbetoocomplicated.Otherphysicalactivitiesadvisedby

physiotherapist.Social

activitiesExtensive:

-Visitfriends,family,clients-Takepictureswithotherclients-Dothingstogether-Stimulateteammembers-Helpotherseverelylimitedclientswithactivities-Visitneighborhoodsupport(WSP)

Moderate:-Dothingstogether(e.g.,walk,playgames)-Visitfriends

Limited:-Dothingstogetherwithclientsupervisor

Otheractivities

Householdchores,prepareamealforsomeoneelse

Beontime,followdailyprogram

Householdchores,accomplishagreements

Rewards Points,smallpricestobediscussed. Points,smallpricestobediscussed.

Directrewards,rewardparticipationofclient

EaseofUse Clientisabletosolveproblemsafterfirstintroduction.

Clientrepeatswhathehasseenbutisabletosolvesomesmallproblems

Clientrepeatswhathehasseen(operantconditioning)

Cost Low:Familymembercouldbe

responsibleforimplementation.Littleextratimeisneededduringmeetingswithclientsupervisor.

Average:Importantroleforclientsupervisor;shouldstayconnectedwithclient.

High:Continuemonitoringof

progress.

Benefits -Healthierlifestyle-Clientenvironmentmoreinvolvedincare-Receivemorevisitsandcarefromfriendsandfamily(moreintegration)-Increasedmotivationfortheclient-Supportrewardsystem-Clienthascloserrelationshipwithenvironment-Canbeusedtohavedailyactivitiesandroutine-Feeluseful

-Healthierlifestyle-UsingCogGamesincreasesfunfactorofotheractivitiesbecausepointsareearned-Activitiestodoeveryday-Increasedmotivationfortheclient-Client’sfamilymoreinvolved-Receivemorevisitsandcarefromfriendsandfamily

-Healthierlifestyle-Rewardsystemforactivitiesextrastimulatingforclient-Supportrewardsystem-Funandsimplegamestotraincognitiveaspects-Encouragementtostayhealthy-Encouragementtoexecutetasks

Limitations -Overchargeclientsupervisorwithapps

-Sensitivityforrewardsisuncertainforlongerperiod-Panicwhenapphasproblems

-Littleempathyforthetarget-Clientisnotable/allowedtoindependentlyperformtask

65

11. Futurework

Theresultsofthisresearchgiveinputforfutureresearch.Inthediscussionsection(Chapter

10) already many future research opportunities are introduced. These recommendations

mainly focused on the extension of the testing phase in order to prove effectiveness of

GameBus. However, if an organization decides to use GameBus in the organization, it is

importantthatthetechnologyisembeddedwellintheorganization.Theorganizationshould

think about matching work process on GameBus. The caregiver must realize what all

adjustmentsmeanfortheirown(process)organizationifGameBusisimplementedandthe

use of GameBus has to be part of the care plan. However, embedding technology in the

organizationisfarfromthecaseeverywhere.InappendixHasketchismadeaboutageneral

implementationplanofGameBus,whichcanbeusedasstartingpoint.

66

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Appendices

AppendixA:GameBusscreenshots

Figure21:Mainscreen Figure22:Newsfeed

Figure23:Achievements Figure24:Progressoverview

73

Figure25:Activitiesoverview Figure26:Recentactivities

Figure27:Teams Figure28:Createnewteam

74

AppendixB:Explanationthesissteps

Table10:explanationthesissteps

Locationselection Differenttypesoflocationswillbeselectedforfurtherexamination.

Acquaintancelocations Theselectedlocationsareexaminedinmoredetail.

TestinterestGameBus Itisexaminedwhetherlocationmanagers,teamleadersandclients

areinterestedinGameBus.

DefinehowtouseGameBus ItisdefinedhowGameBuscanbedeployedforaspecific

client/location.

Effects Alongwithbehavioralspecialistseffectsonclients/employees/

organizationwillbeexamined.

Valueproposition DeresultsandinsightsofGameBuswillbepresentedhere.

Advice BasedonallinformationanadvicewillbegeneratedforLunetzorg

howtopositionGameBuswithintheorganization.

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AppendixC:Healthbehaviorchangetechniques

Thisappendixprovidesasummaryofeffectivehealthbehaviorchangetechniques.Thetextis

retrieved from the NZGG systematic review RapidE Chronic Care: A systematic review of

literatureonhealthbehaviorchangeforchroniccare2011(pages19-26).

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77

78

AppendixD:Personas

ANOUK(18years)

Disability:-ZZP:3Residence:Traininghome(24-hourassistance)IQ:95Aboutandfamily:Anouklivesinaspecialtraininghome.She wants to live independently in the future, andthereforeshelearnshowtocook,plan,dealwithmoney,etc.HerparentsbothworkfulltimeanddonothavealotoftimetospentwithAnouk.ShehasoneoldersisterwhohaslivedinAmsterdamasahairdresserfor6years.Socialactivity

Sometimestheydoactivitiestogetherwithotherclientsatthe training home. She has some friends at school andtheyliketotalkthewholedayoverWhatsApp.Physicalactivity

Shehasamountainbikeanduses thisbiketo go to theforest.Thenshebikesaround60minutes.Shealsousesanormalbiketogotoschoolandbuyfood.Motivation

Shelikestodiscovernewthings,butifitdoesnotworkasexpected,shedirectlyquitsdoingit.Technologyuse

Hersmartphoneisabigpartofhereverydaylife.Sheusesherphonethewholedayforeverythingyoucanimagine.Unfortunately, her smartphone is very slow at themomentbutshecannotaffordtobuyanewone.LimitationsHerphoneworksveryslowlyandthereforehasproblemswhilerunningGameBus.

PETER(33years)

Disability:VG+autismZZP:2Residence:Assisted independent living (on call +weeklymeetings).IQ:65Aboutandfamily:Peterworksfivedaysaweekatasocialworkplace.Mostofthetimeheisbusypackingboxes.Intheeveninghelikes towatchsoaps.Peterhastwoolderbrothers.Ontheweekendhespendsatleastonedaywithhisparents.Hisparentsalwaysbuythenewesttabletsandphonesforhim.Socialactivity

Petervisitshisparents2-3daysaweekfordinner.Hehassomefriendsathisworkbuttheynevermeetafterwork.Physicalactivity

Healwaysrideshisbicycletowork(around2km),buthehasnomorephysicalmovementduringtheweek.Motivation

Peterisveryhelpfulandattentive.Becausehelikestohelpother people, he is very motivated to participate in theresearch.Helikestheattention.Technology

Peter alwayshas the latest tablets andphones.Heusesthesedevicestocommunicatewiththesupervisors,checkFacebook,playgamesanduseWhatsAppwithhisparents.However,everything is installed forhim,andhecallshisfatherdirectlyifanappdoesnotworkanymore.LimitationsPeterpanicsiftheappstopsworking.

79

ANKE(37years)

Disability:VGZZP:4Residence: Anke lives in a one-room apartment withcontinualassistance.IQ:40Aboutandfamily:Ankecanspeakclearlyandmostofthetimepeopleunderstandwhatshewants tosay.Shehasneverlearnedhowtowriteorread,althoughsheisabletodistinguishlettercombinations.Ifsheseesapictureshecan remember it for a long time. The client supervisorsalwaysmakeherschedulewithapicto-system.Socialactivity

Shehaslivedinherhouseforaroundtenyears,andsheknowsalmostallpeopleinthebuilding.ShelikestodrinkcoffeeontheweekendwithhergoodfriendPatrick.Herparentsalsovisitherontheweekend.Fourtimesaweekabus takesher toherdaytimeactivitieswhere she canwatchTV,butalsoputstickersonboxes.Physicalactivity

Sheisnotallowedtogosomewherealone.Sometimestheclientsupervisorputsherwithahometrainer.Motivation

She is very motivated if people need her help. Almosteverythingthesupervisorsask,shedoes.Technologyuse

Herparentsboughtheratablettoplaysomegames.Shedoesnothaveaphone.LimitationsShedoesnot reallyknowwhatshedoes,butshecarriesoutallsheistoldbythesupervisors.

NIKKI(19years)

Disability:SociallevelofatoddlerZZP:7Residence: Nikki lives in a one-room apartment in anassistedlivinghouseattheresidencepark.IQ:60Aboutandfamily:Nikkidoesnothaveanybrothersorsisters. Her parents live in Hungary and therefore anaunthascustody.Socialactivity

Nikkihasonefriendatherdaytimeactivity.Shedoesnotwanttomeetorcontacthimintheevening.Shealsohasanotherfriendwholivesinanotherplace,butshedoesnot seehimoften. It is not allowed for supervisors tovisit her spontaneously; they have to call her first.Therefore,thedoortothecentraldinnerroomislocked,and they built a fence so she has her own garden.Sometimeshergrandparentsvisitherathome.Physicalactivity

Shewalksonetimeeveryotwoweekswithaclientfromverylowlevel(IQ<40).Shegoestoschoolbybus,whereshehastwo-hourgymclassaweek.Motivation

She will never do something without any reward inreturn.Technologyuse

She is allowed touse the Internetonher smartphonetwohoursadayifshebehaveswell.SheusesWhatsAppandFacebookandplayssomegames.LimitationsTheworldrevolvesmainlyaroundherratherthantoherfellow humans. She only shows social behavior if sherecognizesacertainlevelofprofitforit,andsherarelydoessomethingpurelyforanother.

80

TOM(20years)

Disability:Autism+ADHDZZP:7Residence: Tom lives in a one-room apartment in anassistedlivinghouseataresidencepark.Hehaslivedtherefortwoyearsnow.IQ:82Aboutandfamily:Tomdoesnotwantagirlfriendduetosomebadexperiences inhis past.Hismother visits himaround three times a week. His old painting coach alsovisits himonceaweekand theydrink something in thelocalbar.Hehasoneolderbrother,whoishisbestfriend.TheycommunicatealotviaWhatsAppandvisiteachother2timesamonth.Around4timesaweekhespendshalfadayatthedaycaredepartmentoftheresidentialpark.Socialactivity

Tom knows everybody in his apartment complex. He isconsiderablyoverweightandlooksatdietforumstolearnhowtoloseweight.Byvisitingthesewebsites,hemade2onlinefriends.Physicalactivity

He enjoys walking, but his physical conditions oftenpreventhimfromit.Motivation

Tomhasdystrophyandthereforehehasalotofphysicalcomplaints. His physiotherapist helps Tom to stayphysicallyactiveasmuchaspossibleeveryday.Althoughheisverymotivatedtoloseweight,hepreferstodrinkcolaandstayathome.Heenjoyslivingattheresidentialparkandhopestostayphysicallyactiveaslongaspossible.Technologyuse

Hissmartphoneishisbestfriend.Thewholedayhetexts,checksFacebook,andlooksaroundatforums.LimitationsHisphysicalconditionlimitshimfromperformingphysicalactivities.

HILDE(47years)

Disability:retardedZZP:-Residence:Hildeliveswithherhusbandinsocialhousing.IQ:95Aboutandfamily:Hildereceivesahousingallowanceandbringsthenewspaperin6timesaweekat5:00.Therestofthedayshespendswithherhusband.Sheneverseesherparentsanymore.Socialactivity

Nikki and her husband eat three times a week at WSPWoensel. Sometimes they participate in shulcompetitions.ShehastwofriendswhoalsovisittheWSP.Onceamonththeydrinkcoffeetogether.Physicalactivity

Nikki’shusbandrunseveryweekwith10peopleandNikkisometimesjointhisweeklymeeting.Motivation

She is really interested in GameBus and would like toparticipate. Maybe she can make new friends withGameBus.Technologyuse

She has the newest smartphone and plays games thewholeday (e.g., CandyCrush).However, ifanappstopsworkingshegoesdirectlytothephonecompany.LimitationsShesaysthatsheunderstandseverythingbutsheforgetshalfoftheinstructionseverytime.

81

AppendixE:AveragescoreperZZP

0 0,5 1 1,5 2 2,5 3 3,5

lifeskills

psychosocial/cognitive

generaldailyexercise

mobility

nursing

behavioralproblems

ZZPVG

VG08Livingwithsupervisionandfullcareandnursing

VG07(Private)livingwithintensivesupervision,careandbehavioralregulation

VG06Livingwithintensivesupervision,careandbehavioralregulation

VG05Livingwithintensivesupervisionandintensivecare

VG04Livingwithsupervisionandintensivecare

VG03Livingwithsupervisionandcare

0 0,5 1 1,5 2 2,5 3

lifeskills

psychosocial/cognitive

generaldailyexercise

mobility

nursing

behavioralproblems

ZZPLVG

LVG05Privatelivingwithveryintensivetreatmentandsupervision

LVG04Livingwithveryintensivetreatmentandsupervision

LVG03Livingwithintensivetreatmentandsupervision,smallgroup

LVG02Livingwithtreatmentandsupervision

LVG01Livingwithsometreatmentandsupervision

82

AppendixF:NewregistrationprocedureWMO

83

AppendixG:Ratesforintellectualdisabilitycarepercareintensitypackage

ZZP Notallowedfortreatment

Excl.daycare Incl.daycare

Totalvalueperday Totalvalueperday

3VG €98,46 €134,08

4VG €111,83 €147,47

5VG €134,95 €183,70

6VG €127,94 €176,65

7VG €166,08 €248,49

8VG €161,32 €210,07

ZZP Allowedfortreatment

Excl.daycare Incl.daycare

Totalvalueperday Totalvalueperday

3VG €114,43 €150,05

4VG €129,50 €165,13

5VG €157,60 €206,35

6VG €151,48 €200,21

7VG €194,74 €277,13

8VG €183,96 €232,70

ZZP Excl.daycare

Totalvalueperday

1VG €66,70

2VG €83,90

ZZP Incl.daycare

Totalvalueperday

1VG €102,32

2VG €119,52

84

ZZP Allowedfortreatment

incl.daycare

Totalvalueperday

1LVG €141,25

2LVG €181,99

3LVG €224,56

4LVG €264,14

5LVG €262,93

ZZP Allowedfortreatment

incl.daycare

Totalvalueperday

1SGLVG €342,28

85

AppendixH:Generalimplementationplanofe-healthtechnology

AlsotheICTmanagementorganizationmustbearranged24hoursaday,sevendaysaweek

(and52weeksperyear) toprovide first line supporton the technology (de Jong&Kunst,

2005).Automationemployeesandemployeesofthetechnicalserviceorfacilityshouldalso

providethemselvesofknowledgeofthetechnologyifitisdeployedintheorganization(de

Jong & Kunst, 2005). Although, these articles in particular focus on home automation

technologies,thesefactorsarealsorelatedtofactorsofGameBus.

TheorganizationalarchitectureofLunetzorg (seepictureabove)showsthat technology is

alreadyembeddedintheorganization,asalsothe24hours’support.However,technologyis

stillnotfullyembeddedintheorganization,butstepbysteptheyworktowardsatechnology

drivenorganization.Lastyeartheyalreadyintroducedthefirsttechnologiesaimedforclients

(i.e.,Qwiekup,Cowin),andtheuseofGameBuscouldbethenextstep.

Figure29:ArchitectureLunetzorg

86

Inadditiontoembeddingtechnologyintotheorganization,goodinformationisnecessaryfor

proper implementationof the technology: the reason for the changes (suchas theuseof

GameBusasrewardingtoolinsteadoftokens)towardsclients,relativesandstaffmembers.

Thisismentionedinapublicationaboutthecareforpeoplewithdisabilities(SIGRA,2005).

Alsotheclientsmustbeconvincedofthebenefits(CollegeBouwZorginstellingen,2006).

Implementation is not limited tomatching the processes and good IT support. Caregivers

oftenhavetolearntotrustnewtechnology,otherwiseresistanceoranxietycouldbeabarrier.

Aperiodofadjustmentandattentiontoemployees’questionsisimportant(Nouws,Sanders,

&Heuvelink,2006).Whendeployingnewtechnology,thecaregivermustlearntomoveaway

fromthepatientand learn to trust the technology.This requiresacultural changeamong

caregivers(deJong&Kunst,2005).

Roadmap

WhenahealthcareorganizationdecidestouseGameBus,thisparagraphpresentsaroadmap

fortheuseofGameBus.Thisroadmapcanbeusedtoidentifytheenvironmentoftheclient

andexaminehowGameBuscouldbeusedforaspecificclient.

Figure30:Roadmapclientsupervisors

87

1. Preparation

a. Decidewhich client is eligible to useGameBus. Bear inmind the boundary

conditions.

b. DecidewhichclientsupervisorsareinvolvedintheapplicationofGameBus.

c. Involvethefamily

d. ConvincetheclienttouseGameBus.

e. Planning

i. Whodoeswhat(i.e.,familyorclientsupervisor)

ii. Whocoordinatestheproject

iii. Determinefixedevaluationsessions.

2. Describe

a. Describetheproblembehavior

b. Describe what activities are included in GameBus (i.e., physical, social,

cognitive,other?)

c. Collectallpieces

3. Multidisciplinarymapping

a. Variablesinenvironment

i. Physicalenvironment

ii. Socialenvironment

iii. Dailyschedule

b. Variablesinperson

i. Medical

ii. Personality

iii. Psychic

4. Understandingbehaviorofclient

a. Assemblingpuzzle

b. Thestoryoftheclientandbehavior

i. Whyistheclient(not)motivated?

ii. Whatcausesthisbehavior?

c. Trytounderstanditandwritethestoryjointlywithotherdisciplines.

5. Determinetarget

a. ChooseforwhatGameBuswillbeused.

88

b. Whichbehavior/activitiesshouldbechanged?

6. Intervention

a. Considerwhatyouwilldo.

b. Consistentwiththe‘understandingofbehavior’.

c. Whatdoyoudo,frequency,etc.?

d. Whoisgoingtodothat?(i.e.,family,clientsupervisor)

e. Organization

i. Conditionsmonitoring

f. Whataretheexpectedresults?

7. Execute

a. ExecuteGameBus.

b. Keepeachotherontheagreements.

8. Results

a. Discusstheresultswitheachother

b. Interprettheresults

i. IsGameBuswell-executed?

ii. Aretheresultsexpectedtobe?

iii. Arisesthereanother(problem)behavior?

9. Conclusion

a. Ifitworks

i. Continue,intensify,stop?

ii. Howdoyouholdontothisresult?

iii. Targetingother(problem)behavior?

b. Ifnot(yet)work

i. Whichadjustmentisneeded?

ii. Areotheractivitiesneeded?

iii. Backtothefirststep

c. Reflection

i. Whathavewelearned?

ii. Hodowekeeptheseresults?

89

E-Healthreadiness

Theimplementationoftechnologyinhealthcareorganizationsisonly20%aboutthetechnical

aspects,but80%oforganizationchanges.Inalmostallimplementationmodelsandarticles

aboutcriticalsuccessfactorsthesenumbersarementioned.Inatimeofvirtuallyunlimited

technicalpossibilities,thisisanimportantobservation,especiallyastheorganizationaland

culturalchangeisoftenacomplexprocess.

AsuccessfulimplementationofGameBusdependsontheuseofthetechnologybyhealthcare

professionalsandclients.Therefore,itisofgreatimportanceinordertodeterminewhether

the relevant technology is truly integrated in the primary care process, and if the use of

GameBus indeed leads to higher quality, efficiency and/or effectiveness (Dohmen, 2012).

Dohmen(2012)developedabasismodelfortheimplementationoftechnologyinhealthcare.

His thesis reveals five steps which are required to use the best modern technology in

healthcareandtocreatesufficientsupportwithintheorganization.Dohmen(2012)processed

thesefivestepsinitsso-called‘E5-model’.Thismodelshouldprovideanswerstothebarriers

thatexistintheintroductionofnewtechnologyinhealthcare.“Animplementationshouldbe

stepbystep”,saysDohmenwhobaseshisconclusionontheinvestigationofmanycases.The

E5-modeldescribeswhoisimportantintheprocess,sothattheenergyofthepeopleinvolved

canbeusedattherighttime.Inthebeginningtheroleofcaregivers(i.e.,clientsupervisors)is

crucial,morethanclients.Theclientfollowsasco-creator,butonlyiftheclientsupervisors

areconvincedoftheusefulnessofGameBus.

TheE5-modeldescribesfivephasestodeploytechnologyinhealthcare:

1. Explore

2. Experiment

3. Evaluate

4. Effectuate

5. Evolve

90

Themodelensuresthatfifteencriticalsuccessfactorsareaddressedintheimplementationof

GameBus inacorrectorder.Also,by following theE5-model,healthcareorganizationsare

protectedfromunnecessaryinvestments.Thiscanoccurwhenanorganizationhasawrong

approachorunrealisticexpectationsatthebeginningoftheprocess.

Abasicmodel isdevelopedtoprovideastructuredanalysisofpractical implementationof

technologyandisbasedonanimplementationmodelofDamsgaard&Scheepers(1999).This

modelwas created after analyzing implementations and it uses the basis ‘trainingmodel’

thoughtbyNolan(1973).Dohmen(2012)didacomprehensiveliteraturereviewondifferent

implementationvisions,modelsandroadmapsforthis.Thepresentedbasicmodelpretends

to be a generic standard for optimal implementation that results in the highest level of

success:thestructuredandstructuraluseoftechnologyforendusers,sothattheintended

effectsofhealthcare innovation(e.g.,efficiency,qualityorcosts)canberealized.Bygoing

91

through the nine stages of the revisedmodel and its technical, organizational and socio-

technical issues, no aspect of this complex and comprehensive implementation process is

overlooked.

AlthoughLunetzorghasnotyetdecidedtouseGameBus,thefollowingroadmapcouldbe

usedtoincreasethesuccessoftheimplementation.Theroadmapwithanitemizedlistoffall

thataccordingtotherevisedmodelmustbedoneineverystageduringthedevelopmentand

implementation of GameBus. In this overview all critical success factors for a successful

implementationare included. It is infactnotamanualhowtodosomething,buttheplan

consists of a number of logical steps that follow each other. By following these steps

systematically,alogicalunderstandingoftheprocesswillbecreated.Thesestepsshouldbe

takenifahealthcareorganizationdecidestorolloutGameBusacrosstheentireorganization.

However,itmayalsobeintroducedbyfamilymembers.Thentheresponsibilitylieswiththe

family.

Stage1:Initiationofmanagement

- Find in themanagement an idea-champion topromoteGameBus: -> Innovation

team.

- PromotethediscussionofGameBuswithinthemanagement,sothatthereiswillingness

topermitGameBusfinanciallyandorganizationally: ->Duringthe interviewswith

managerstherewasagreatinterestinGameBus,butfinancialandorganizationalaspects

haveyettobediscussed.

- IntroduceGameBuswithinasmallcircleoffellowprofessionalsintheorganization: -

>alreadydoneduringtheresearch.

- Workouttheideainanunderstandableandappealingplanforthecaregiverswhohave

toworkwiththeinnovation,andindicatewhatvalueGameBuscouldhaveforthemand

their patients: -> already done during the research, but this plan needs further

development.

Stage2:Globaldesign

- Setafixedvisionandsubstantiveframeworkfortheplan,plusanendgoal.

- Identifythetechnicalandorganizationalinfrastructurethatisneededtorealizetheplan.

92

- Presenttheoverallplantoafirstgroupofhealthcareprofessionalsothattheycanstart

promotingtheplanwithintheorganization.

- Investinthenetworktoattractmorestakeholdertotheplan.

- Introduceadesigngroupandasteeringcommittee.

- Provides the necessary support to the initiator in the design group and steering

committeetofurthershapehisplan.

Stage3:Initiationhealthcareprofessional

- Presenttheplanfromthesteeringcommitteetoawidergroupofpotentialusers:client

supervisorsandclients.

- ConvinceallstakeholdersofthevalueofGameBus.

- Initiate a discussion between health professionals about care-related and medical

(boundary)conditions.

- Determinewhetherthere issufficientcriticalmassandsupport intheorganizationto

proceedwiththeplan.

Stage4:Functionaldesign

- Let the steering committee appoint a projectmanagerwho can compose the design

group.

- Checkiftheendusers,stakeholdersandexternal(IT)partneraresufficientlyinvolvedin

theinnovation.

- MakeadetaileddescriptionandSWOTanalysisofGameBus.

- Workoutseveralmeasurablegoalsthatshouldbeachievedduringallstages.

- Makeaschedule

- Clarifyanytechnicalambiguities

- Analyzetheusabilityoftheserviceforclients

- Determinewhetheritisnecessarytosetuptrainingcourses,whichenduserslearnhow

touseGameBus.

- Ensure that the existing organizational and technical infrastructure is ready for the

implementationoftheapplication.

- Determinewhetherthereareformalbarriersinlawsandgovernmentregulations,fees

andcharges.

Stage5:Pilot

- Makeabudgetforthepilot

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- Determineatwhichpointthepilotwillbeevaluatedafterwards.

- RollGameBusoutinasmallcontextinwhichithasthegreatestchanceofsuccess.

- Letthesteeringcommitteemakeagoorno-godecisionbasedontheevaluationofthe

pilot.

- Checkthequalityoftheinformationprovidedtoend-usersandstakeholders.

Stage6:Commitment

- Findwherenecessaryagreementswithstakeholderandmakeappropriatearrangements

orarrangementstofitGameBusinexistingfinancialandlegalstructures.

- Determinewhichpartyhasthefinalresponsibilityoftheprocess.

- Checkallnecessaryprivacysafeguardsforclients.

Stage7:Rollout

- StarttherolloutandcreateopportunitiestoallowenduserstogetusedtoGameBus.

- Facilitate the end-users with the necessary guidance, training and support from a

helpdeskortechnicalservice.

Stage8:Adaptionandoptimization

- Evaluate the deployment and verify whether the previously defined (sub)goals are

achieved.

- Analyzewhethertheinnovationachievedtechnical,organizationalandcontentresults,

andareconsistentwiththepreviouslyformulatedgoalsandvision

- Implement if necessary organizational adjustments for any deficiencies which are

prohibitivetoparticipateinthestandardizationofGameBusintheorganization.

Stage9:Integration

- Loose the steering group and design group, and evaluate the functioning and

cooperationofbothgroups.

94

AppendixI:Questionnairesclients

EvaluationGameBusresearch:Client1

Goal:evaluatingfindingsGameBusQuestion1Name: Date: 24-11-2015Why do you stay atLunetzorg?

Autism+ADHD

ZZPclassification:: 7Question2Howdoyouexperiencetheresearchuntilnow?Iliketheresearchverymuchanditisveryexcited.Question3aWhatdidyoureallylikeaboutGameBus?Thegamesandthestimulationtobehealthy.Itwasfunnytoaskmyclientsupervisoreverytimeforawalkaroundtheresidencepark.AttheendofthedayIreceivedalotofpoints,whenIenteredtheamountofstepsinGameBus.AlsoIliketomakepicturesofmushroomsinthemorning.SometimesIalreadyhad1500stepswhenIcamebackhome.Question3bWhatdidyounotlikeaboutGameBus?Idonotalwaysknowreallygoodhowtheappandchallengeswork.AndbecauseIaminasmallteamitisdifficulttowin.Question3cWouldyouliketokeepusingGameBusaftermyresearch?

a. Yes,definitelyb. Yesc. Idonotcared. Norathernote. Nodefinitelynot

Question4WithwhowouldyouliketoplayGameBus?(morepossibilitiespossible)

a. Withmyfamilyb. Withfriends/acquaintancesc. Withmyclientsupervisord. WithotherclientsofLunetzorge. Alone

95

Question5a(physical)WhatkindofphysicalexercisedidyouhadinanormalweekbeforetheGameBusresearch?Hardly. I walked at most half an hour per day and especially strength training at thephysiotherapist.Question5b(physical)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question5c(physical)ByworkingwithGameBusIget….exercise

a. Muchmoreb. Morec. Thesameamountofd. Lesse. Muchless

Question5d(physical)Ifyoushouldestimatehowmuchextrayouare moving now compared to before theGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question5e(physical)Ifyouexercisemorethanbeforetheresearch,howdidyounoticedthis?IamdependentonmyphysicalhealthQuestion5f(physical)My motivation increased to do more(physical)activitiesthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question5g(physical)Ifyes,howdidyounotice?Iwasimmediatelyveryexcitedabouttheinterpretationoftheprogramandwantedtogetstarted.AndondayswhenitgoeswellIwalkedreallyfar.

96

Question6a(cognitive)Whatkindofbrainteasers(sudoku,memory,reactiontime,candycrushetc.)didyoudobeforetheresearch?NothingQuestion6b(cognitive)Howmuchminutesperweekwasthis?

a. 0–15minb. 15–30minc. 30–60mind. 60–120mine. Morethan120min

Question6c(cognitive)By working with GameBus I did morebrainteasers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6d(cognitive)Ifyoushouldestimatehowmuchextrayou are doing brain teasers nowcompared to before the GameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question6e(cognitive)Whichbrainteasersdoyoumostlikenow?Catchfruit,redcherryandsudokuQuestion6f(cognitive)My motivation increased to do morebrainteasersthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6g(cognitive)Ifyes,howdidyounotice?Thegamesareeasierthancandycrush

97

Question7a(social)What kind of social connections did you have in oneweek before the GameBusresearch?(e.g.,visitingfriends,visitingWSP,visitingotherclients,etc.)AlotQuestion7b(social)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question7c(social)Byworkingwith GameBus I hadmoresocialcontactsthanbeforetheresearch.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question7d(social)Ifyoushouldestimatehowmuchextraminutes of social contacts you havenow,comparedtobeforetheGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question7e(social)Ifyouhavemoresocialcontactsnowthanbeforetheresearch,whatkindofcontactsarethis?SometimesImakeapicturewithelderlyclientstoreceivepointsinGameBus.Question7f(social)Did your motivation increased to findmoresocialcontactthroughGameBus?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question7g(social)Ifyes,howdidyounotice?

98

Question8aIreallylikeditsoseethatIreceivemorepointsbydoingmorephysicalactivities,doing brain teasers, or search contactwithothers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question8bDidyourmotivationthereforeincreasedtogetmorepoints?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question9aWhat did you think of the challenges inGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9bWhatdidyouthinkaboutthescoretableinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9cWhatdidyouthinkoftheteamchatinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question10Forwhatpurpose(s)didyouuseGameBus?Physicalexercise,drinkinglesscolaQuestion11Doyouhaveanyfurtherinformationthatyouwanttosayabouttheresearch?no

99

EvaluationGameBusresearch:Client2Goal:evaluatingfindingsGameBusQuestion1Name: Date: 25-11-2015Why do you stay atLunetzorg?

ADHDdiagnosed,easilyinfluencedbyenvironment

ZZPclassification:: ZZP7, TIQ 78, VIQ 78, PIQ 82. Behavior regulating medication.Complexanddisturbedbehavior

Question2Howdoyouexperiencetheresearchuntilnow?Itwasoke.Isometimesfounditquitedifficultanditgetsboring.Question3aWhatdidyoureallylikeaboutGameBus?PedometerQuestion3bWhatdidyounotlikeaboutGameBus?IdidnotlikeCogGamesbecauseitgetboringQuestion3cWouldyouliketokeepusingGameBusaftermyresearch?

a. Yes,definitelyb. Yesc. Idonotcared. Norathernote. Nodefinitelynot

Question4WithwhowouldyouliketoplayGameBus?(morepossibilitiespossible)

a. Withmyfamilyb. Withfriends/acquaintancesc. Withmyclientsupervisord. WithotherclientsofLunetzorge. Alone

100

Question5a(physical)WhatkindofphysicalexercisedidyouhadinanormalweekbeforetheGameBusresearch?Walingonworkwithclients,cyclingtoworkQuestion5b(physical)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question5c(physical)ByworkingwithGameBusIget….exercise

a. Muchmoreb. Morec. Thesameamountofd. Lesse. Muchless

Question5d(physical)Ifyoushouldestimatehowmuchextrayouare moving now compared to before theGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question5e(physical)Ifyouexercisemorethanbeforetheresearch,howdidyounoticedthis?IsnottrueQuestion5f(physical)My motivation increased to do more(physical)activitiesthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question5g(physical)Ifyes,howdidyounotice?

101

Question6a(cognitive)Whatkindofbrainteasers(sudoku,memory,reactiontime,candycrushetc.)didyoudobeforetheresearch?Iplaycandycrush,butespeciallyshootinggamesonmyPS3.Question6b(cognitive)Howmuchminutesperweekwasthis?

a. 0–15minb. 15–30minc. 30–60mind. 60–120mine. Morethan120min

Question6c(cognitive)By working with GameBus I did morebrainteasers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6d(cognitive)Ifyoushouldestimatehowmuchextrayou are doing brain teasers nowcompared to before the GameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question6e(cognitive)Whichbrainteasersdoyoumostlikenow?Ilike‘redcherry’themostbutIamnotcomingfurtheranditstartgettingboring.Question6f(cognitive)My motivation increased to do morebrainteasersthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6g(cognitive)Ifyes,howdidyounotice?

102

Question7a(social)What kind of social connections did you have in oneweek before the GameBusresearch?(e.g.,visitingfriends,visitingWSP,visitingotherclients,etc.)Contactsatworkandonthegroup.Sometimesfamilybuttheylivefaraway.Question7b(social)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question7c(social)Byworkingwith GameBus I hadmoresocialcontactsthanbeforetheresearch.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question7d(social)Ifyoushouldestimatehowmuchextraminutes of social contacts you havenow,comparedtobeforetheGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question7e(social)Ifyouhavemoresocialcontactsnowthanbeforetheresearch,whatkindofcontactsarethis?Question7f(social)Did your motivation increased to findmoresocialcontactthroughGameBus?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question7g(social)Ifyes,howdidyounotice?

103

Question8aIreallylikeditsoseethatIreceivemorepointsbydoingmorephysicalactivities,doing brain teasers, or search contactwithothers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question8bDidyourmotivationthereforeincreasedtogetmorepoints?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question9aWhat did you think of the challenges inGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9bWhatdidyouthinkaboutthescoretableinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9cWhatdidyouthinkoftheteamchatinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question10Forwhatpurpose(s)didyouuseGameBus?Playgames,countingsteps/movementQuestion11Doyouhaveanyfurtherinformationthatyouwanttosayabouttheresearch?

104

EvaluationGameBusresearch:Client3Goal:evaluatingfindingsGameBusQuestion1Name: Date: 7-12Why do you stay atLunetzorg?

Cosiness,playgamesanddailyactivities

ZZPclassification:: care is delivered based on kitchen table conversation bymunicipality

Question2Howdoyouexperiencetheresearchuntilnow?NicetogetinvolvedandtolearnQuestion3aWhatdidyoureallylikeaboutGameBus?GamesPedometerQuestion3bWhatdidyounotlikeaboutGameBus?-Question3cWouldyouliketokeepusingGameBusaftermyresearch?

a. Yes,definitelyb. Yesc. Idonotcared. Norathernote. Nodefinitelynot

Question4WithwhowouldyouliketoplayGameBus?(morepossibilitiespossible)

a. Withmyfamilyb. Withfriends/acquaintancesc. Withmyclientsupervisord. WithotherclientsofLunetzorge. Alone

105

Question5a(physical)WhatkindofphysicalexercisedidyouhadinanormalweekbeforetheGameBusresearch?LotsofwalkingQuestion5b(physical)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question5c(physical)ByworkingwithGameBusIget….exercise

a. Muchmoreb. Morec. Thesameamountofd. Lesse. Muchless

Question5d(physical)Ifyoushouldestimatehowmuchextrayouare moving now compared to before theGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question5e(physical)Ifyouexercisemorethanbeforetheresearch,howdidyounoticedthis?MoreoftenwalktothestoreandIvisittheWSPmoreoftenQuestion5f(physical)My motivation increased to do more(physical)activitiesthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question5g(physical)Ifyes,howdidyounotice?BykeepingtrackofhowmuchIwalkwithapedometer

106

Question6a(cognitive)Whatkindofbrainteasers(sudoku,memory,reactiontime,candycrushetc.)didyoudobeforetheresearch?Bubbiewitchsaga,golegameswithoutmoneyQuestion6b(cognitive)Howmuchminutesperweekwasthis?

a. 0–15minb. 15–30minc. 30–60mind. 60–120mine. Morethan120min

Question6c(cognitive)By working with GameBus I did morebrainteasers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6d(cognitive)Ifyoushouldestimatehowmuchextrayou are doing brain teasers nowcompared to before the GameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question6e(cognitive)Whichbrainteasersdoyoumostlikenow?Question6f(cognitive)My motivation increased to do morebrainteasersthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6g(cognitive)Ifyes,howdidyounotice?Myphonewasbroken

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Question7a(social)What kind of social connections did you have in oneweek before the GameBusresearch?(e.g.,visitingfriends,visitingWSP,visitingotherclients,etc.)Clients(friends),somefamilyandsupervisorsQuestion7b(social)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question7c(social)Byworkingwith GameBus I hadmoresocialcontactsthanbeforetheresearch.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question7d(social)Ifyoushouldestimatehowmuchextraminutes of social contacts you havenow,comparedtobeforetheGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question7e(social)Ifyouhavemoresocialcontactsnowthanbeforetheresearch,whatkindofcontactsarethis?-Question7f(social)Did your motivation increased to findmoresocialcontactthroughGameBus?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question7g(social)Ifyes,howdidyounotice?

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Question8aIreallylikeditsoseethatIreceivemorepointsbydoingmorephysicalactivities,doing brain teasers, or search contactwithothers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question8bDidyourmotivationthereforeincreasedtogetmorepoints?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question9aWhat did you think of the challenges inGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9bWhatdidyouthinkaboutthescoretableinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9cWhatdidyouthinkoftheteamchatinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question10Forwhatpurpose(s)didyouuseGameBus?Especiallymovingandthegames,butalsovisitingWSPQuestion11Doyouhaveanyfurtherinformationthatyouwanttosayabouttheresearch?CalculatethedistanceinGameBuswasdifficult

109

EvaluationGameBusresearch:Client4Goal:evaluatingfindingsGameBusQuestion1Name: Date: 24-11-2015Why do you stay atLunetzorg?

ZZPclassification:: 7Question2Howdoyouexperiencetheresearchuntilnow?Itisreasonable.IliketogiveyouadviceaboutwhatcouldbeimprovedinGameBusQuestion3aWhatdidyoureallylikeaboutGameBus?ThatIcouldseethenumberofstepsthatIwalkedadayQuestion3bWhatdidyounotlikeaboutGameBus?ThatCogGamescouldnotbeinstalledonmyphoneQuestion3cWouldyouliketokeepusingGameBusaftermyresearch?

a. Yes,definitelyb. Yesc. Idonotcared. Norathernote. Nodefinitelynot

Question4WithwhowouldyouliketoplayGameBus?(morepossibilitiespossible)

a. Withmyfamilyb. Withfriends/acquaintancesc. Withmyclientsupervisord. WithotherclientsofLunetzorge. Alone

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Question5a(physical)WhatkindofphysicalexercisedidyouhadinanormalweekbeforetheGameBusresearch?IwalkalotonmyworkQuestion5b(physical)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question5c(physical)ByworkingwithGameBusIget….exercise

a. Muchmoreb. Morec. Thesameamountofd. Lesse. Muchless

Question5d(physical)Ifyoushouldestimatehowmuchextrayouare moving now compared to before theGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question5e(physical)Ifyouexercisemorethanbeforetheresearch,howdidyounoticedthis?Iwalkmoreonworknowandgooutsidesomeextratimesaweek.Question5f(physical)My motivation increased to do more(physical)activitiesthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question5g(physical)Ifyes,howdidyounotice?Iwanttohavemarestepseveryday.

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Question6a(cognitive)Whatkindofbrainteasers(sudoku,memory,reactiontime,candycrushetc.)didyoudobeforetheresearch?IplayalotofdifferentgamesonmyxBoxQuestion6b(cognitive)Howmuchminutesperweekwasthis?

a. 0–15minb. 15–30minc. 30–60mind. 60–120mine. Morethan120min

Question6c(cognitive)By working with GameBus I did morebrainteasers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6d(cognitive)Ifyoushouldestimatehowmuchextrayou are doing brain teasers nowcompared to before the GameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question6e(cognitive)Whichbrainteasersdoyoumostlikenow?Question6f(cognitive)My motivation increased to do morebrainteasersthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6g(cognitive)Ifyes,howdidyounotice?

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Question7a(social)What kind of social connections did you have in oneweek before the GameBusresearch?(e.g.,visitingfriends,visitingWSP,visitingotherclients,etc.)AtworkandfriendswhovisitmesometimesQuestion7b(social)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question7c(social)Byworkingwith GameBus I hadmoresocialcontactsthanbeforetheresearch.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question7d(social)Ifyoushouldestimatehowmuchextraminutes of social contacts you havenow,comparedtobeforetheGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question7e(social)Ifyouhavemoresocialcontactsnowthanbeforetheresearch,whatkindofcontactsarethis?Clientisnotallowedtohavemoresocialcontactsfromhisfamily.Question7f(social)Did your motivation increased to findmoresocialcontactthroughGameBus?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question7g(social)Ifyes,howdidyounotice?

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Question8aIreallylikeditsoseethatIreceivemorepointsbydoingmorephysicalactivities,doing brain teasers, or search contactwithothers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question8bDidyourmotivationthereforeincreasedtogetmorepoints?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question9aWhat did you think of the challenges inGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9bWhatdidyouthinkaboutthescoretableinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9cWhatdidyouthinkoftheteamchatinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question10Forwhatpurpose(s)didyouuseGameBus?CountingsteppsQuestion11Doyouhaveanyfurtherinformationthatyouwanttosayabouttheresearch?

114

EvaluationGameBusresearch:Client5Goal:evaluatingfindingsGameBusQuestion1Name: Date: 7-12Why do you stay atLunetzorg?

Forfunandfood

ZZPclassification:: care is delivered based on kitchen table conversation bymunicipality

Question2Howdoyouexperiencetheresearchuntilnow?InterestingQuestion3aWhatdidyoureallylikeaboutGameBus?Games,walking,biking.ThatisseehowmuchstepsIhaveduringthedayQuestion3bWhatdidyounotlikeaboutGameBus?nothingQuestion3cWouldyouliketokeepusingGameBusaftermyresearch?

a. Yes,definitelyb. Yesc. Idonotcared. Norathernote. Nodefinitelynot

Question4WithwhowouldyouliketoplayGameBus?(morepossibilitiespossible)

a. Withmyfamilyb. Withfriends/acquaintancesc. Withmyclientsupervisord. WithotherclientsofLunetzorge. Alone

115

Question5a(physical)WhatkindofphysicalexercisedidyouhadinanormalweekbeforetheGameBusresearch?Irunwithagrouponceaweek.Ibikeeverydaytoworkandshop.Walk.IdoalotofchoresfortheWSPasbringflyersintheneighborhood.Question5b(physical)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question5c(physical)ByworkingwithGameBusIget….exercise

a. Muchmoreb. Morec. Thesameamountofd. Lesse. Muchless

Question5d(physical)Ifyoushouldestimatehowmuchextrayouare moving now compared to before theGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question5e(physical)Ifyouexercisemorethanbeforetheresearch,howdidyounoticedthis?Question5f(physical)My motivation increased to do more(physical)activitiesthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question5g(physical)Ifyes,howdidyounotice?IshowtheclientsupervisorhowmuchstepsIhadduringthedayorhowmuchIbiked.

116

Question6a(cognitive)Whatkindofbrainteasers(sudoku,memory,reactiontime,candycrushetc.)didyoudobeforetheresearch?NogamesQuestion6b(cognitive)Howmuchminutesperweekwasthis?

a. 0–15minb. 15–30minc. 30–60mind. 60–120mine. Morethan120min

Question6c(cognitive)By working with GameBus I did morebrainteasers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6d(cognitive)Ifyoushouldestimatehowmuchextrayou are doing brain teasers nowcompared to before the GameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question6e(cognitive)Whichbrainteasersdoyoumostlikenow?CatchfruitQuestion6f(cognitive)My motivation increased to do morebrainteasersthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6g(cognitive)Ifyes,howdidyounotice?Iliketogatherpoints.

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Question7a(social)What kind of social connections did you have in oneweek before the GameBusresearch?(e.g.,visitingfriends,visitingWSP,visitingotherclients,etc.)FriendsofWSP(groupofeight)visiteachotheroutsideWSP.Mymother.5-7timesaweekavisittheWSP.Question7b(social)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question7c(social)Byworkingwith GameBus I hadmoresocialcontactsthanbeforetheresearch.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question7d(social)Ifyoushouldestimatehowmuchextraminutes of social contacts you havenow,comparedtobeforetheGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question7e(social)Ifyouhavemoresocialcontactsnowthanbeforetheresearch,whatkindofcontactsarethis?Question7f(social)Did your motivation increased to findmoresocialcontactthroughGameBus?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question7g(social)Ifyes,howdidyounotice?IfounditfuntocometotheWSPtoearnpoints

118

Question8aIreallylikeditsoseethatIreceivemorepointsbydoingmorephysicalactivities,doing brain teasers, or search contactwithothers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question8bDidyourmotivationthereforeincreasedtogetmorepoints?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question9aWhat did you think of the challenges inGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9bWhatdidyouthinkaboutthescoretableinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9cWhatdidyouthinkoftheteamchatinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question10Forwhatpurpose(s)didyouuseGameBus?VisitingWSP,walking/running/bikingQuestion11Doyouhaveanyfurtherinformationthatyouwanttosayabouttheresearch?

119

EvaluationGameBusresearch:Client6Goal:evaluatingfindingsGameBusQuestion1Name: Date: 7-12Why do you stay atLunetzorg?

Formysocialcontats

ZZPclassification:: care is delivered based on kitchen table conversation bymunicipality

Question2Howdoyouexperiencetheresearchuntilnow?GoodQuestion3aWhatdidyoureallylikeaboutGameBus?EveryhtingQuestion3bWhatdidyounotlikeaboutGameBus?NothingQuestion3cWouldyouliketokeepusingGameBusaftermyresearch?

a. Yes,definitelyb. Yesc. Idonotcared. Norathernote. Nodefinitelynot

Question4WithwhowouldyouliketoplayGameBus?(morepossibilitiespossible)

a. Withmyfamilyb. Withfriends/acquaintancesc. Withmyclientsupervisord. WithotherclientsofLunetzorge. Alone

120

Question5a(physical)WhatkindofphysicalexercisedidyouhadinanormalweekbeforetheGameBusresearch?Runninggroup,WSPQuestion5b(physical)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question5c(physical)ByworkingwithGameBusIget….exercise

a. Muchmoreb. Morec. Thesameamountofd. Lesse. Muchless

Question5d(physical)Ifyoushouldestimatehowmuchextrayouare moving now compared to before theGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question5e(physical)Ifyouexercisemorethanbeforetheresearch,howdidyounoticedthis?NAQuestion5f(physical)My motivation increased to do more(physical)activitiesthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question5g(physical)Ifyes,howdidyounotice?NA

121

Question6a(cognitive)Whatkindofbrainteasers(sudoku,memory,reactiontime,candycrushetc.)didyoudobeforetheresearch?NothingQuestion6b(cognitive)Howmuchminutesperweekwasthis?

a. 0–15minb. 15–30minc. 30–60mind. 60–120mine. Morethan120min

Question6c(cognitive)By working with GameBus I did morebrainteasers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6d(cognitive)Ifyoushouldestimatehowmuchextrayou are doing brain teasers nowcompared to before the GameBusresearch.Howmuchisthat?

a. 0minf. 1–15ming. 15–30minh. 30–60mini. 60–120minj. Morethan120min

Question6e(cognitive)Whichbrainteasersdoyoumostlikenow?NAQuestion6f(cognitive)My motivation increased to do morebrainteasersthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6g(cognitive)Ifyes,howdidyounotice?NA

122

Question7a(social)What kind of social connections did you have in oneweek before the GameBusresearch?(e.g.,visitingfriends,visitingWSP,visitingotherclients,etc.)Question7b(social)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question7c(social)Byworkingwith GameBus I hadmoresocialcontactsthanbeforetheresearch.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question7d(social)Ifyoushouldestimatehowmuchextraminutes of social contacts you havenow,comparedtobeforetheGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question7e(social)Ifyouhavemoresocialcontactsnowthanbeforetheresearch,whatkindofcontactsarethis?NAQuestion7f(social)Did your motivation increased to findmoresocialcontactthroughGameBus?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question7g(social)Ifyes,howdidyounotice?NA

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Question8aIreallylikeditsoseethatIreceivemorepointsbydoingmorephysicalactivities,doing brain teasers, or search contactwithothers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question8bDidyourmotivationthereforeincreasedtogetmorepoints?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question9aWhat did you think of the challenges inGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9bWhatdidyouthinkaboutthescoretableinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9cWhatdidyouthinkoftheteamchatinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question10Forwhatpurpose(s)didyouuseGameBus?TimekillingQuestion11Doyouhaveanyfurtherinformationthatyouwanttosayabouttheresearch?NA

124

EvaluationGameBusresearch:Client7Goal:evaluatingfindingsGameBusQuestion1Name: Date: 3-12-2015Why do you stay atLunetzorg?

Ineedhelpwithmoney

ZZPclassification:: 2Question2Howdoyouexperiencetheresearchuntilnow?YeahIthinkitisgoingwell.WithGameBusIcanmovemuchQuestion3aWhatdidyoureallylikeaboutGameBus?IlikedCogGamesinthebeginningandthepedometerQuestion3bWhatdidyounotlikeaboutGameBus?CogGames is really difficult now. The app sometimes do notworks and I can not sendpicturesanymore.Question3cWouldyouliketokeepusingGameBusaftermyresearch?

a. Yes,definitelyb. Yesc. Idonotcared. Norathernote. Nodefinitelynot

Question4WithwhowouldyouliketoplayGameBus?(morepossibilitiespossible)

a. Withmyfamilyb. Withfriends/acquaintancesc. Withmyclientsupervisord. WithotherclientsofLunetzorge. Alone

125

Question5a(physical)WhatkindofphysicalexercisedidyouhadinanormalweekbeforetheGameBusresearch?Question5b(physical)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question5c(physical)ByworkingwithGameBusIget….exercise

a. Muchmoreb. Morec. Thesameamountofd. Lesse. Muchless

Question5d(physical)Ifyoushouldestimatehowmuchextrayouare moving now compared to before theGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question5e(physical)Ifyouexercisemorethanbeforetheresearch,howdidyounoticedthis?IntheweekendsIoftengoouttohaveawalk,insteadofsittingathomeQuestion5f(physical)My motivation increased to do more(physical)activitiesthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question5g(physical)Ifyes,howdidyounotice?Ilikeitmorenowtohaveawalk

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Question6a(cognitive)Whatkindofbrainteasers(sudoku,memory,reactiontime,candycrushetc.)didyoudobeforetheresearch?CandycrushandracegamesQuestion6b(cognitive)Howmuchminutesperweekwasthis?

b. 0–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question6c(cognitive)By working with GameBus I did morebrainteasers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6d(cognitive)Ifyoushouldestimatehowmuchextrayou are doing brain teasers nowcompared to before the GameBusresearch.Howmuchisthat?

a. 0minh. 1–15mini. 15–30minj. 30–60mink. 60–120minl. Morethan120min

Question6e(cognitive)Whichbrainteasersdoyoumostlikenow?RedcherryIlikedthemostQuestion6f(cognitive)My motivation increased to do morebrainteasersthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6g(cognitive)Ifyes,howdidyounotice?Thelevelsgoestofastnow

127

Question7a(social)What kind of social connections did you have in oneweek before the GameBusresearch?(e.g.,visitingfriends,visitingWSP,visitingotherclients,etc.)Parents,supervisors,workQuestion7b(social)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question7c(social)Byworkingwith GameBus I hadmoresocialcontactsthanbeforetheresearch.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question7d(social)Ifyoushouldestimatehowmuchextraminutes of social contacts you havenow,comparedtobeforetheGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question7e(social)Ifyouhavemoresocialcontactsnowthanbeforetheresearch,whatkindofcontactsarethis?Question7f(social)Did your motivation increased to findmoresocialcontactthroughGameBus?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question7g(social)Ifyes,howdidyounotice?Outofscope

128

Question8aIreallylikeditsoseethatIreceivemorepointsbydoingmorephysicalactivities,doing brain teasers, or search contactwithothers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question8bDidyourmotivationthereforeincreasedtogetmorepoints?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question9aWhat did you think of the challenges inGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9bWhatdidyouthinkaboutthescoretableinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9cWhatdidyouthinkoftheteamchatinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question10Forwhatpurpose(s)didyouuseGameBus?Playgames,walkoutsideafterworkorinweekendsQuestion11Doyouhaveanyfurtherinformationthatyouwanttosayabouttheresearch?No

129

EvaluationGameBusresearch:Client8Goal:evaluatingfindingsGameBusQuestion1Name: Date: 25-11Why do you stay atLunetzorg?

Iwanttolearnlivingindependently

ZZPclassification:: 3Question2Howdoyouexperiencetheresearchuntilnow?Ilikedtheapp.Itmotivatedmetohavemorephysicalexerciseandcountmystepsandtosport.Question3aWhatdidyoureallylikeaboutGameBus?Thepedometer.AndthatIsawhowmuchIwalkedorbikedwasamazing!Question3bWhatdidyounotlikeaboutGameBus?Thattheappdidnothavecoverageintheforestandthattheresearchdidnotwentquitewell.Question3cWouldyouliketokeepusingGameBusaftermyresearch?

a. Yes,definitelyb. Yesc. Idonotcared. Norathernote. Nodefinitelynot

Question4WithwhowouldyouliketoplayGameBus?(morepossibilitiespossible)

a. Withmyfamilyb. Withfriends/acquaintancesc. Withmyclientsupervisord. WithotherclientsofLunetzorge. Alone

130

Question5a(physical)WhatkindofphysicalexercisedidyouhadinanormalweekbeforetheGameBusresearch?Ibiketoschool.Sometimesbikeintheforest.Question5b(physical)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question5c(physical)ByworkingwithGameBusIget….exercise

a. Muchmoreb. Morec. Thesameamountofd. Lesse. Muchless

Question5d(physical)Ifyoushouldestimatehowmuchextrayouare moving now compared to before theGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question5e(physical)Ifyouexercisemorethanbeforetheresearch,howdidyounoticedthis?IwentoutsidetowalkandcyclemoreoftenQuestion5f(physical)My motivation increased to do more(physical)activitiesthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question5g(physical)Ifyes,howdidyounotice?IliketoseehowmuchIdidandreceivepointsforthis.

131

Question6a(cognitive)Whatkindofbrainteasers(sudoku,memory,reactiontime,candycrushetc.)didyoudobeforetheresearch?CandycrushQuestion6b(cognitive)Howmuchminutesperweekwasthis?

a. 0–15minb. 15–30minc. 30–60mind. 60–120mine. Morethan120min

Question6c(cognitive)By working with GameBus I did morebrainteasers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6d(cognitive)Ifyoushouldestimatehowmuchextrayou are doing brain teasers nowcompared to before the GameBusresearch.Howmuchisthat?

f. 0minh. 1–15mini. 15–30minj. 30–60mink. 60–120minl. Morethan120min

Question6e(cognitive)Whichbrainteasersdoyoumostlikenow?RedcherryQuestion6f(cognitive)My motivation increased to do morebrainteasersthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6g(cognitive)Ifyes,howdidyounotice?

132

Question7a(social)What kind of social connections did you have in oneweek before the GameBusresearch?(e.g.,visitingfriends,visitingWSP,visitingotherclients,etc.)FriendsatschoolandonthegroupQuestion7b(social)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question7c(social)Byworkingwith GameBus I hadmoresocialcontactsthanbeforetheresearch.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question7d(social)Ifyoushouldestimatehowmuchextraminutes of social contacts you havenow,comparedtobeforetheGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question7e(social)Ifyouhavemoresocialcontactsnowthanbeforetheresearch,whatkindofcontactsarethis?Question7f(social)Did your motivation increased to findmoresocialcontactthroughGameBus?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question7g(social)Ifyes,howdidyounotice?

133

Question8aIreallylikeditsoseethatIreceivemorepointsbydoingmorephysicalactivities,doing brain teasers, or search contactwithothers.

g. Completelytrueh. Mostlytruei. Somewhattruej. Notcorrect/notincorrectk. Largelyincorrectl. Completelyfalsem. N.A.

Question8bDidyourmotivationthereforeincreasedtogetmorepoints?

n. Yes,increasedaloto. Yes,increasedalittlebitp. Didnotincrease/decreaseq. No,decreasedalittlebitr. No,decreasedalots. N.A.

Question9aWhat did you think of the challenges inGameBus?

t. Veryniceu. Nicev. Normalw. Notreallyfunnyx. Definitelynotfunny

Question9bWhatdidyouthinkaboutthescoretableinGameBus?

y. Verynicez. Niceaa. Normalbb. Notreallyfunnycc. Definitelynotfunny

Question9cWhatdidyouthinkoftheteamchatinGameBus?

dd. Veryniceee. Niceff. Normalgg. Notreallyfunnyhh. Definitelynotfunny

Question10Forwhatpurpose(s)didyouuseGameBus?Health(losingweight),morephysicalexerciseQuestion11Doyouhaveanyfurtherinformationthatyouwanttosayabouttheresearch?

134

EvaluationGameBusresearch:Client9Goal:evaluatingfindingsGameBusQuestion1Name: -Date: 1-12-2015Why do you stay atLunetzorg?

Becauseofmyautismproblems

ZZPclassification:: 7Question2Howdoyouexperiencetheresearchuntilnow?Ithinktheresearchgoeswell.ThroughtheresearchIamoutsidealotQuestion3aWhatdidyoureallylikeaboutGameBus?IfoundCogGamesquiteniceQuestion3bWhatdidyounotlikeaboutGameBus?ThethelevelsinCoGagmesgoesveryfestatsomepointQuestion3cWouldyouliketokeepusingGameBusaftermyresearch?

a. Yes,definitelyb. Yesc. Idonotcared. Norathernote. Nodefinitelynot

Question4WithwhowouldyouliketoplayGameBus?(morepossibilitiespossible)

a. Withmyfamilyb. Withfriends/acquaintancesc. Withmyclientsupervisord. WithotherclientsofLunetzorge. Alone

135

Question5a(physical)WhatkindofphysicalexercisedidyouhadinanormalweekbeforetheGameBusresearch?Ididnotalotofexercise,butIwalksometimes.Question5b(physical)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question5c(physical)ByworkingwithGameBusIget….exercise

a. Muchmoreb. Morec. Thesameamountofd. Lesse. Muchless

Question5d(physical)Ifyoushouldestimatehowmuchextrayouare moving now compared to before theGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question5e(physical)Ifyouexercisemorethanbeforetheresearch,howdidyounoticedthis?“Iaskthesupervisorsatthedaycaretohaveawalkduringthebreaktocollectpoints” Question5f(physical)My motivation increased to do more(physical)activitiesthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question5g(physical)Ifyes,howdidyounotice?Ifeelalittlefitterthanbeforetheresearch.Restaurantlady:“Xhasbecomeawareofitshealthandeatslesssnacksduringthelunchbreak.

136

Question6a(cognitive)Whatkindofbrainteasers(sudoku,memory,reactiontime,candycrushetc.)didyoudobeforetheresearch?Candycrush,BejeweldQuestion6b(cognitive)Howmuchminutesperweekwasthis?

a. 0–15minb. 15–30minc. 30–60mind. 60–120mine. Morethan120min

Question6c(cognitive)By working with GameBus I did morebrainteasers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6d(cognitive)Ifyoushouldestimatehowmuchextrayou are doing brain teasers nowcompared to before the GameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question6e(cognitive)Whichbrainteasersdoyoumostlikenow?‘Duizenden’/Rolleccoastertycoon3Question6f(cognitive)My motivation increased to do morebrainteasersthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6g(cognitive)Ifyes,howdidyounotice?

137

Question7a(social)What kind of social connections did you have in oneweek before the GameBusresearch?(e.g.,visitingfriends,visitingWSP,visitingotherclients,etc.)FacebookQuestion7b(social)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question7c(social)Byworkingwith GameBus I hadmoresocialcontactsthanbeforetheresearch.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question7d(social)Ifyoushouldestimatehowmuchextraminutes of social contacts you havenow,comparedtobeforetheGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question7e(social)Ifyouhavemoresocialcontactsnowthanbeforetheresearch,whatkindofcontactsarethis?Viafacebook-whatsappQuestion7f(social)Did your motivation increased to findmoresocialcontactthroughGameBus?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question7g(social)Ifyes,howdidyounotice?

138

Question8aIreallylikeditsoseethatIreceivemorepointsbydoingmorephysicalactivities,doing brain teasers, or search contactwithothers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question8bDidyourmotivationthereforeincreasedtogetmorepoints?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question9aWhat did you think of the challenges inGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9bWhatdidyouthinkaboutthescoretableinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9cWhatdidyouthinkoftheteamchatinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question10Forwhatpurpose(s)didyouuseGameBus?PedometerQuestion11Doyouhaveanyfurtherinformationthatyouwanttosayabouttheresearch?No

139

EvaluationGameBusresearch:Client10Goal:evaluatingfindingsGameBusQuestion1Name: Date: 7-12-2015Why do you stay atLunetzorg?

Totalkwithclientsupervisorssometimes

ZZPclassification:: care is delivered based on kitchen table conversation bymunicipality

Question2Howdoyouexperiencetheresearchuntilnow?Nice,differentthanothergamesQuestion3aWhatdidyoureallylikeaboutGameBus?WhenIwenttobedatnight,IalwaysplayCogGamestogetasmanypointsaspossible,andtofollowmysteppsQuestion3bWhatdidyounotlikeaboutGameBus?-Question3cWouldyouliketokeepusingGameBusaftermyresearch?

a. Yes,definitelyb. Yesc. Idonotcared. Norathernote. Nodefinitelynot

Question4WithwhowouldyouliketoplayGameBus?(morepossibilitiespossible)

a. Withmyfamilyb. Withfriends/acquaintancesc. Withmyclientsupervisord. WithotherclientsofLunetzorge. Alone

140

Question5a(physical)WhatkindofphysicalexercisedidyouhadinanormalweekbeforetheGameBusresearch?Bringingthenewspaper,walktosupermarketQuestion5b(physical)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question5c(physical)ByworkingwithGameBusIget….exercise

a. Muchmoreb. Morec. Thesameamountofd. Lesse. Muchless

Question5d(physical)Ifyoushouldestimatehowmuchextrayouare moving now compared to before theGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120ming. Unknown

Question5e(physical)Ifyouexercisemorethanbeforetheresearch,howdidyounoticedthis?Extra-largesteps,afterworkIhaveaextrawalksometimestogetmoresteps.Question5f(physical)My motivation increased to do more(physical)activitiesthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question5g(physical)Ifyes,howdidyounotice?Iwanttohavemoreandmoresteps.

141

Question6a(cognitive)Whatkindofbrainteasers(sudoku,memory,reactiontime,candycrushetc.)didyoudobeforetheresearch?Waterplash,gummydrop,alphabettyQuestion6b(cognitive)Howmuchminutesperweekwasthis?

a. 0–15minb. 15–30minc. 30–60mind. 60–120mine. Morethan120min

Question6c(cognitive)By working with GameBus I did morebrainteasers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6d(cognitive)Ifyoushouldestimatehowmuchextrayou are doing brain teasers nowcompared to before the GameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question6e(cognitive)Whichbrainteasersdoyoumostlikenow?RedcherryQuestion6f(cognitive)My motivation increased to do morebrainteasersthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6g(cognitive)Ifyes,howdidyounotice?Iwanttoearnpoints

142

Question7a(social)What kind of social connections did you have in oneweek before the GameBusresearch?(e.g.,visitingfriends,visitingWSP,visitingotherclients,etc.)Oldcolleges,clientsWSPQuestion7b(social)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question7c(social)Byworkingwith GameBus I hadmoresocialcontactsthanbeforetheresearch.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question7d(social)Ifyoushouldestimatehowmuchextraminutes of social contacts you havenow,comparedtobeforetheGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question7e(social)Ifyouhavemoresocialcontactsnowthanbeforetheresearch,whatkindofcontactsarethis?IcomemoreoftentotheWSPQuestion7f(social)Did your motivation increased to findmoresocialcontactthroughGameBus?

g. Yes,increasedaloth. Yes,increasedalittlebiti. Didnotincrease/decreasej. No,decreasedalittlebitk. No,decreasedalotl. N.A.

Question7g(social)Ifyes,howdidyounotice?

143

Question8aIreallylikeditsoseethatIreceivemorepointsbydoingmorephysicalactivities,doing brain teasers, or search contactwithothers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question8bDidyourmotivationthereforeincreasedtogetmorepoints?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question9aWhat did you think of the challenges inGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9bWhatdidyouthinkaboutthescoretableinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9cWhatdidyouthinkoftheteamchatinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question10Forwhatpurpose(s)didyouuseGameBus?GamesQuestion11Doyouhaveanyfurtherinformationthatyouwanttosayabouttheresearch?

144

EvaluationGameBusresearch:Client11Goal:evaluatingfindingsGameBusQuestion1Name: Date: 23-11-2015Why do you stay atLunetzorg?

Complexbehavior

ZZPclassification:: 7Question2Howdoyouexperiencetheresearchuntilnow?IlikeitQuestion3aWhatdidyoureallylikeaboutGameBus?ThatIcanseehowmuchIbikeQuestion3bWhatdidyounotlikeaboutGameBus?ThattheappsometimesworknottotallyperfectwhenIbiked.Question3cWouldyouliketokeepusingGameBusaftermyresearch?

a. Yes,definitelyb. Yesc. Idonotcared. Norathernote. Nodefinitelynot

Question4WithwhowouldyouliketoplayGameBus?(morepossibilitiespossible)

a. Withmyfamilyb. Withfriends/acquaintancesc. Withmyclientsupervisord. WithotherclientsofLunetzorge. Alone

145

Question5a(physical)WhatkindofphysicalexercisedidyouhadinanormalweekbeforetheGameBusresearch?BikingtoschoolQuestion5b(physical)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question5c(physical)ByworkingwithGameBusIget….exercise

a. Muchmoreb. Morec. Thesameamountofd. Lesse. Muchless

Question5d(physical)Ifyoushouldestimatehowmuchextrayouare moving now compared to before theGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question5e(physical)Ifyouexercisemorethanbeforetheresearch,howdidyounoticedthis?SometimesIwalkedaroundtheresidentialparkQuestion5f(physical)My motivation increased to do more(physical)activitiesthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question5g(physical)Ifyes,howdidyounotice?IreallyliketoseehowmuchIwalked.

146

Question6a(cognitive)Whatkindofbrainteasers(sudoku,memory,reactiontime,candycrushetc.)didyoudobeforetheresearch?CandycrushQuestion6b(cognitive)Howmuchminutesperweekwasthis?

a. 0–15minb. 15–30minc. 30–60mind. 60–120mine. Morethan120min

Question6c(cognitive)By working with GameBus I did morebrainteasers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6d(cognitive)Ifyoushouldestimatehowmuchextrayou are doing brain teasers nowcompared to before the GameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question6e(cognitive)Whichbrainteasersdoyoumostlikenow?Question6f(cognitive)My motivation increased to do morebrainteasersthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6g(cognitive)Ifyes,howdidyounotice?

147

Question7a(social)What kind of social connections did you have in oneweek before the GameBusresearch?(e.g.,visitingfriends,visitingWSP,visitingotherclients,etc.)SchoolandathomeQuestion7b(social)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question7c(social)Byworkingwith GameBus I hadmoresocialcontactsthanbeforetheresearch.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question7d(social)Ifyoushouldestimatehowmuchextraminutes of social contacts you havenow,comparedtobeforetheGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question7e(social)Ifyouhavemoresocialcontactsnowthanbeforetheresearch,whatkindofcontactsarethis?Question7f(social)Did your motivation increased to findmoresocialcontactthroughGameBus?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question7g(social)Ifyes,howdidyounotice?

148

Question8aIreallylikeditsoseethatIreceivemorepointsbydoingmorephysicalactivities,doing brain teasers, or search contactwithothers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question8bDidyourmotivationthereforeincreasedtogetmorepoints?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question9aWhat did you think of the challenges inGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9bWhatdidyouthinkaboutthescoretableinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9cWhatdidyouthinkoftheteamchatinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question10Forwhatpurpose(s)didyouuseGameBus?MorephysicalexerciseQuestion11Doyouhaveanyfurtherinformationthatyouwanttosayabouttheresearch?no

149

EvaluationGameBusresearch:Client12Goal:evaluatingfindingsGameBusQuestion1Name: Date: 21-12Why do you stay atLunetzorg?

Forsocialcontactsandrelaxtion

ZZPclassification:: care is delivered based on kitchen table conversation bymunicipality

Question2Howdoyouexperiencetheresearchuntilnow?FunnyandinstructiveQuestion3aWhatdidyoureallylikeaboutGameBus?MakeselfiesandCogGames(e.g.redcherry)Question3bWhatdidyounotlikeaboutGameBus?TappingredcarQuestion3cWouldyouliketokeepusingGameBusaftermyresearch?

a. Yes,definitelyb. Yesc. Idonotcared. Norathernote. Nodefinitelynot

Question4WithwhowouldyouliketoplayGameBus?(morepossibilitiespossible)

a. Withmyfamilyb. Withfriends/acquaintancesc. Withmyclientsupervisord. WithotherclientsofLunetzorge. Alone

150

Question5a(physical)WhatkindofphysicalexercisedidyouhadinanormalweekbeforetheGameBusresearch?WeinigQuestion5b(physical)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question5c(physical)ByworkingwithGameBusIget….exercise

a. Muchmoreb. Morec. Thesameamountofd. Lesse. Muchless

Question5d(physical)Ifyoushouldestimatehowmuchextrayouare moving now compared to before theGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question5e(physical)Ifyouexercisemorethanbeforetheresearch,howdidyounoticedthis?walkingQuestion5f(physical)My motivation increased to do more(physical)activitiesthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question5g(physical)Ifyes,howdidyounotice?

151

Question6a(cognitive)Whatkindofbrainteasers(sudoku,memory,reactiontime,candycrushetc.)didyoudobeforetheresearch?CandycrushQuestion6b(cognitive)Howmuchminutesperweekwasthis?

a. 0–15minb. 15–30minc. 30–60mind. 60–120mine. Morethan120min

Question6c(cognitive)By working with GameBus I did morebrainteasers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6d(cognitive)Ifyoushouldestimatehowmuchextrayou are doing brain teasers nowcompared to before the GameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question6e(cognitive)Whichbrainteasersdoyoumostlikenow?TappingcherriesandkiwisQuestion6f(cognitive)My motivation increased to do morebrainteasersthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6g(cognitive)Ifyes,howdidyounotice?

152

Question7a(social)What kind of social connections did you have in oneweek before the GameBusresearch?(e.g.,visitingfriends,visitingWSP,visitingotherclients,etc.)FriendsandotherclientsQuestion7b(social)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question7c(social)Byworkingwith GameBus I hadmoresocialcontactsthanbeforetheresearch.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question7d(social)Ifyoushouldestimatehowmuchextraminutes of social contacts you havenow,comparedtobeforetheGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question7e(social)Ifyouhavemoresocialcontactsnowthanbeforetheresearch,whatkindofcontactsarethis?Question7f(social)Did your motivation increased to findmoresocialcontactthroughGameBus?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question7g(social)Ifyes,howdidyounotice?

153

Question8aIreallylikeditsoseethatIreceivemorepointsbydoingmorephysicalactivities,doing brain teasers, or search contactwithothers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question8bDidyourmotivationthereforeincreasedtogetmorepoints?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question9aWhat did you think of the challenges inGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9bWhatdidyouthinkaboutthescoretableinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9cWhatdidyouthinkoftheteamchatinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question10Forwhatpurpose(s)didyouuseGameBus?Exercise,gamesQuestion11Doyouhaveanyfurtherinformationthatyouwanttosayabouttheresearch?Noitwasreallyhelpful.

154

EvaluationGameBusresearch:Client13Goal:evaluatingfindingsGameBusQuestion1Name: Date: 21-12-2015Why do you stay atLunetzorg?

Socialcontacts

ZZPclassification:: care is delivered based on kitchen table conversation bymunicipality

Question2Howdoyouexperiencetheresearchuntilnow?Good.Unfortunately,thattheappdidnotworkalwayscorrectly.Problemstologin.Question3aWhatdidyoureallylikeaboutGameBus?ThatyoucouldseetheresultsasateamQuestion3bWhatdidyounotlikeaboutGameBus?NoideaQuestion3cWouldyouliketokeepusingGameBusaftermyresearch?

a. Yes,definitelyb. Yesc. Idonotcared. Norathernote. Nodefinitelynot

Question4WithwhowouldyouliketoplayGameBus?(morepossibilitiespossible)

a. Withmyfamilyb. Withfriends/acquaintancesc. Withmyclientsupervisord. WithotherclientsofLunetzorge. Alone

155

Question5a(physical)WhatkindofphysicalexercisedidyouhadinanormalweekbeforetheGameBusresearch?Swimming–fitness–gotostorebyfootQuestion5b(physical)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question5c(physical)ByworkingwithGameBusIget….exercise

a. Muchmoreb. Morec. Thesameamountofd. Lesse. Muchless

Question5d(physical)Ifyoushouldestimatehowmuchextrayouare moving now compared to before theGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question5e(physical)Ifyouexercisemorethanbeforetheresearch,howdidyounoticedthis?GotothestoremoreoftenbyfootQuestion5f(physical)My motivation increased to do more(physical)activitiesthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question5g(physical)Ifyes,howdidyounotice?BecauseIhadmorestepsonmypedometer

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Question6a(cognitive)Whatkindofbrainteasers(sudoku,memory,reactiontime,candycrushetc.)didyoudobeforetheresearch?NothingQuestion6b(cognitive)Howmuchminutesperweekwasthis?

a. 0–15minb. 15–30minc. 30–60mind. 60–120mine. Morethan120min

Question6c(cognitive)By working with GameBus I did morebrainteasers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6d(cognitive)Ifyoushouldestimatehowmuchextrayou are doing brain teasers nowcompared to before the GameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question6e(cognitive)Whichbrainteasersdoyoumostlikenow?RedcherryandkiwigameQuestion6f(cognitive)My motivation increased to do morebrainteasersthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6g(cognitive)Ifyes,howdidyounotice?IwanttoreceivepointandIsucceeded.

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Question7a(social)What kind of social connections did you have in oneweek before the GameBusresearch?(e.g.,visitingfriends,visitingWSP,visitingotherclients,etc.)WithpeopleoftheWSPandfriends3-4timesaweekQuestion7b(social)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question7c(social)Byworkingwith GameBus I hadmoresocialcontactsthanbeforetheresearch.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question7d(social)Ifyoushouldestimatehowmuchextraminutes of social contacts you havenow,comparedtobeforetheGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question7e(social)Ifyouhavemoresocialcontactsnowthanbeforetheresearch,whatkindofcontactsarethis?Question7f(social)Did your motivation increased to findmoresocialcontactthroughGameBus?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question7g(social)Ifyes,howdidyounotice?

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Question8aIreallylikeditsoseethatIreceivemorepointsbydoingmorephysicalactivities,doing brain teasers, or search contactwithothers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question8bDidyourmotivationthereforeincreasedtogetmorepoints?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question9aWhat did you think of the challenges inGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9bWhatdidyouthinkaboutthescoretableinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9cWhatdidyouthinkoftheteamchatinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question10Forwhatpurpose(s)didyouuseGameBus?Forthepoints->competitionExercise/Games/contactsQuestion11Doyouhaveanyfurtherinformationthatyouwanttosayabouttheresearch?Morevariationingames

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EvaluationGameBusresearch:Client14Goal:evaluatingfindingsGameBusQuestion1Name: Date: 17-12Why do you stay atLunetzorg?

IliveatLunetzorg

ZZPclassification:: 6Question2Howdoyouexperiencetheresearchuntilnow?SometimesdifficultQuestion3aWhatdidyoureallylikeaboutGameBus?WalkingandbikingQuestion3bWhatdidyounotlikeaboutGameBus?-Question3cWouldyouliketokeepusingGameBusaftermyresearch?

a. Yes,definitelyb. Yesc. Idonotcared. Norathernote. Nodefinitelynot

Question4WithwhowouldyouliketoplayGameBus?(morepossibilitiespossible)

a. Withmyfamilyb. Withfriends/acquaintancesc. Withmyclientsupervisord. WithotherclientsofLunetzorge. Alone

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Question5a(physical)WhatkindofphysicalexercisedidyouhadinanormalweekbeforetheGameBusresearch?WalkingwithmydogQuestion5b(physical)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question5c(physical)ByworkingwithGameBusIget….exercise

a. Muchmoreb. Morec. Thesameamountofd. Lesse. Muchless

Question5d(physical)Ifyoushouldestimatehowmuchextrayouare moving now compared to before theGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question5e(physical)Ifyouexercisemorethanbeforetheresearch,howdidyounoticedthis?MorewalkingandmorebikingQuestion5f(physical)My motivation increased to do more(physical)activitiesthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question5g(physical)Ifyes,howdidyounotice?Getmorephysicalexerciseformyself.

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Question6a(cognitive)Whatkindofbrainteasers(sudoku,memory,reactiontime,candycrushetc.)didyoudobeforetheresearch?NothingQuestion6b(cognitive)Howmuchminutesperweekwasthis?

a. 0–15minb. 15–30minc. 30–60mind. 60–120mine. Morethan120min

Question6c(cognitive)By working with GameBus I did morebrainteasers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6d(cognitive)Ifyoushouldestimatehowmuchextrayou are doing brain teasers nowcompared to before the GameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question6e(cognitive)Whichbrainteasersdoyoumostlikenow?Tappingcherries.Question6f(cognitive)My motivation increased to do morebrainteasersthroughGameBus?

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question6g(cognitive)Ifyes,howdidyounotice?Mybrainismoreactive

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Question7a(social)What kind of social connections did you have in oneweek before the GameBusresearch?(e.g.,visitingfriends,visitingWSP,visitingotherclients,etc.)DailyvisitofafriendQuestion7b(social)Howmuchhoursperweekwasthis?

a. 0–0,5hourb. 0,5hours–1hourc. 1hour–2hoursd. 2hours–4hourse. Morethan4hours

Question7c(social)Byworkingwith GameBus I hadmoresocialcontactsthanbeforetheresearch.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question7d(social)Ifyoushouldestimatehowmuchextraminutes of social contacts you havenow,comparedtobeforetheGameBusresearch.Howmuchisthat?

a. 0minb. 1–15minc. 15–30mind. 30–60mine. 60–120minf. Morethan120min

Question7e(social)Ifyouhavemoresocialcontactsnowthanbeforetheresearch,whatkindofcontactsarethis?SporttogetherQuestion7f(social)Did your motivation increased to findmoresocialcontactthroughGameBus?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question7g(social)Ifyes,howdidyounotice?Mymotivationincreased

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Question8aIreallylikeditsoseethatIreceivemorepointsbydoingmorephysicalactivities,doing brain teasers, or search contactwithothers.

a. Completelytrueb. Mostlytruec. Somewhattrued. Notcorrect/notincorrecte. Largelyincorrectf. Completelyfalseg. N.A.

Question8bDidyourmotivationthereforeincreasedtogetmorepoints?

a. Yes,increasedalotb. Yes,increasedalittlebitc. Didnotincrease/decreased. No,decreasedalittlebite. No,decreasedalotf. N.A.

Question9aWhat did you think of the challenges inGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9bWhatdidyouthinkaboutthescoretableinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question9cWhatdidyouthinkoftheteamchatinGameBus?

a. Veryniceb. Nicec. Normald. Notreallyfunnye. Definitelynotfunny

Question10Forwhatpurpose(s)didyouuseGameBus?Walking,biking,trainbrainsQuestion11Doyouhaveanyfurtherinformationthatyouwanttosayabouttheresearch?

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AppendixJ:Questionnairesclientsupervisors

Vraag1Naam: 1Datum: 03-12-2015Functie: ClientbegeleidsterTeam: Vraag2aHoevindtuhetonderzoektotnutoegaan?Goed(alleenn.a.v.heteerstegesprekwasersprakevanmiscommunicatie,ditwasjammer)Vraag2bHoeervaartdecliënt(en)hetonderzoektotnutoe?ClientispositiefVraag2cHoeervareneventueelanderecollega’svanuithetteamhetonderzoek?Onderzoekisbenoemdindevergadering.Verderzijnzeernietbijbetrokken.Vraag3a(fysiek)Stelling: Door te werken met GameBus is decliëntmeergaanbewegen.(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3b (fysiek) Waar merkte u dat aan? Client is gemotiveerd om te gaan wandelen in zijn vrijetijd. Dit is terug te zien op de app en cliënt verteld er zelf over. Vraag3c(cognitief) Stelling: Door te werken met GameBus is decliënt meer denkspelletjes (reactiesnelheid,memory,etc.)gaandoen.(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

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Vraag 3d (cognitief) Waar merkte u dat aan? Client geeft aan de spelletjes van Gamebus lastig te vinden (sluiten niet geheel bij hem en zijn cognitief niveau aan). Vraag 3e (sociaal) Stelling:DoortewerkenmetGameBusheeftdecliënt meer sociale contacten gezocht metandere personen (bv. bezoekenvrienden/familie, bezoeken WSP, bezoekanderecliëntenetc.).(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3f (sociaal) Waar merkte u dat aan? Client heeft voornamelijk alleen met Gamebus gewerkt. Vraag 4 Nam de motivatie van uw cliënt toe om fysieke, cognitieve en/of sociale activiteiten uit te voeren?

a. Ja, heel erg b. Ja, een beetje c. Nam niet toe / nam niet af d. Weet ik niet e. Nee, niet echt f. Nee helemaal niet g. N.v.t.

Vraag 4b Waar merkte u dat aan? Client brengt het vaak positief te spraken in de begeleidingsgesprekken die we samen voeren. Vraag5aDenkt u dat GameBus zinvol kan zijn voor cliënten van uw locatie (woonlocatie,dagbestedingslocatie,WSP,etc.)?Ophetgebiedvanbewegenm.b.tcliëntwel.Vraag5bZo ja,hoeenmetwelkdoel zouGameBus ingezet kunnenwordenvoor cliëntenvanuwlocatie?ClientGamebuslatenhanteren,ditzodathijgemotiveerdisenblijftomtebewegenopeenmanierdiebijhemaansluit.Vraag5c

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DenktudatGameBuseentoegevoegdewaardekanhebbenvoordezorgverleningvanLunetzorg?Enverhoogtditdekwaliteitvanzorg?Zoja,waarom?Mogelijkwel,hetkandezelfredzaamheidvaneencliënt/cliëntenvergroten.Vraag6aStelLunetzorgbesluitomGameBustegaangebruikenvoorcliëntenvanLunetzorg.Wiezouverantwoordelijkmoetenzijnvoordeimplementatievandezeappbinnenuwlocatie?MogelijkafdelingICTVraag6bWaarom?Zijbeschikkenaloverkennis/ervaringopditgebied. Vraag7aWaarvoorzouuGameBuswillengebruiken?Omdathetmeerwaardekanhebbenvooreencliënt/cliënten.Vraag7bZijnerpuntendieutoegevoegdofanderszouwillenzienaanGameBus?Dathet(indetoekomst)beteraangaatsluitenopdeindividuelecliënt.Vraag8Heeftuverdernoginformatiedieukwijtwiltoverhetonderzoek?Nee,opditmomentniet.

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Vraag1Naam: 2Datum: 23-11-2015Functie: ClientondersteunerTeam: Vraag2aHoevindtuhetonderzoektotnutoegaan?Zoverikeroverkanoordelen,goedVraag2bHoeervaartdecliënt(en)hetonderzoektotnutoe?Hij is enthousiast, voelt zich een uitzondering op de rest en dat is goed voor zijneigenwaardeVraag2cHoeervareneventueelanderecollega’svanuithetteamhetonderzoek?Ikhebniethetideedathetgedeeldwordtmetanderecollega’smaarweethetnietzekerVraag3a(fysiek)Stelling: Door te werken met GameBus is decliëntmeergaanbewegen.A

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3b (fysiek) Waar merkte u dat aan? Zijn verhalen, hoeveel stappen hij had gezet of hoeveel kilometer hij had gelopen. Vraag3c(cognitief) Stelling: Door te werken met GameBus is decliënt meer denkspelletjes (reactiesnelheid,memory,etc.)gaandoen.Voorhemnognietvantoepassing,zoverikweet

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3d (cognitief) Waar merkte u dat aan? G

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Vraag 3e (sociaal) Stelling:DoortewerkenmetGameBusheeftdecliënt meer sociale contacten gezocht metandere personen (bv. bezoekenvrienden/familie, bezoeken WSP, bezoekanderecliëntenetc.).G

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3f (sociaal) Waar merkte u dat aan? G Vraag 4 Nam de motivatie van uw cliënt toe om fysieke, cognitieve en/of sociale activiteiten uit te voeren? A

a. Ja, heel erg b. Ja, een beetje c. Nam niet toe / nam niet af d. Weet ik niet e. Nee, niet echt f. Nee helemaal niet g. N.v.t.

Vraag 4b Waar merkte u dat aan? Zijn enthousiasme en (voor zo’n gesloten jongen) open verhalen Vraag5aDenkt u dat GameBus zinvol kan zijn voor cliënten van uw locatie (woonlocatie,dagbestedingslocatie,WSP,etc.)?VoorsommigenwelVraag5bZo ja,hoeenmetwelkdoel zouGameBus ingezet kunnenwordenvoor cliëntenvanuwlocatie?Vooreenbeterbeweegplan.DerestkaniknietoveroordelenomdatiknietweetwatderestpreciesinhoudVraag5cDenktudatGameBuseentoegevoegdewaardekanhebbenvoordezorgverleningvanLunetzorg?Enverhoogtditdekwaliteitvanzorg?Zoja,waarom?Zie5B

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Vraag5aStelLunetzorgbesluitomGameBustegaangebruikenvoorcliëntenvanLunetzorg.Wiezouverantwoordelijkmoetenzijnvoordeimplementatievandezeappbinnenuwlocatie?ICTofmensendieervooropgeleidwordenVraag5bWaarom?ZodatwijwetenbijwiewemoetenzijnalserietsmisgaatVraag6aWaarvoorzouuGameBuswillengebruiken?Voorhetbeweegplan,maarookeventueelvoorbeterevoedingenvoedingsadviezenalsdatmogelijkisVraag6bZijnerpuntendieutoegevoegdofanderszouwillenzienaanGameBus?Hetbelangvangezondetenwordtnogonderschatindeverstandelijkgehandicaptenzorg.Cliëntenwetenvaaknietwatgezondetenisofhoeveelzemoetenofmogeneten.EenappmetgezonderecepteneneventueeladviezenoverhetkopenenmakenzoudecliëntergkunnenhelpenVraag7Heeftuverdernoginformatiedieukwijtwiltoverhetonderzoek?Zounogwelwatmeerwillenwetenoverdeontwikkeldeapps,ookovercognitiefensociaalwantdatisbijmijnietvantoepassing.Maarookhetvervolgwanthetzoujammerzijnalshetovereenpaarwekenzoustoppen.

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Vraag1Naam: 3Datum: 25-11-2015Functie: ClientbegeleiderTeam: Vraag2aHoevindtuhetonderzoektotnutoegaan?Helaas,warenernoggeen/weinigappsdieaansluitenbijdedoelenvandecliënt,maarikvinddaterwelgoedmeegedachtwerdhoeditwelkon.Vraag2bHoeervaartdecliënt(en)hetonderzoektotnutoe?Clientheefthetgoedervaren.Denkdatzijernietzoveel lastvanhaddatdeappnoginontwikkelingis.Vraag2cHoeervareneventueelanderecollega’svanuithetteamhetonderzoek?NvtVraag3a(fysiek)Stelling: Door te werken met GameBus is decliëntmeergaanbewegen.(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist X c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3b (fysiek) Waar merkte u dat aan? Client was enthousiast met de app en vond het leuk om te zien dat ze steeds meer stappen haalde. Waardoor ze dus steeds meer ging bewegen. Vraag3c(cognitief) Stelling: Door te werken met GameBus is decliënt meer denkspelletjes (reactiesnelheid,memory,etc.)gaandoen.(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.X

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Vraag 3d (cognitief) Waar merkte u dat aan? Client heeft geen gebruik gemaakt van de denkspelletjes. Ze geeft aan dat ze dit wel leuk had gevonden om te doen. ( ging nu helaas niet omdat het niet geïnstalleerd kon worden op de gsm) Vraag 3e (sociaal) Stelling:DoortewerkenmetGameBusheeftdecliënt meer sociale contacten gezocht metandere personen (bv. bezoekenvrienden/familie, bezoeken WSP, bezoekanderecliëntenetc.).(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.X

Vraag 3f (sociaal) Waar merkte u dat aan? / Vraag 4 Nam de motivatie van uw cliënt toe om fysieke, cognitieve en/of sociale activiteiten uit te voeren?

a. Ja, heel erg b. Ja, een beetje X c. Nam niet toe / nam niet af d. Weet ik niet e. Nee, niet echt f. Nee helemaal niet g. N.v.t.

Vraag 4b Waar merkte u dat aan? Voor op gebied van meer bewegen. De ander aspecten hebben we niet kunnen uitproberen . ik schat in dat dit voor de andere 2 ook minder het effect had gehad. Vraag5aDenkt u dat GameBus zinvol kan zijn voor cliënten van uw locatie (woonlocatie,dagbestedingslocatie,WSP,etc.)?JaVraag5bZo ja,hoeenmetwelkdoel zouGameBus ingezet kunnenwordenvoor cliëntenvanuwlocatie?Veel cliënten hebben wensen rondom meer gezondheid en meer bewegen en socialecontacten.Ikdenkdatdegamebuseengoedmiddelkanzijnomdittestimuleren.

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Vraag5cDenktudatGameBuseentoegevoegdewaardekanhebbenvoordezorgverleningvanLunetzorg?Enverhoogtditdekwaliteitvanzorg?Zoja,waarom?Vinddatikdaarvoorteweinigmetdegamebushebkunnenwerken,omhiereengoedantwoordoptegeven.Vraag6aStelLunetzorgbesluitomGameBustegaangebruikenvoorcliëntenvanLunetzorg.Wiezouverantwoordelijkmoetenzijnvoordeimplementatievandezeappbinnenuwlocatie?Geenidee.Iemanddiegoedekennishiervanheeft.KanvanuitLunetzorgzijn,kaniemandzijndiedegamebusheeftontwikkeld.Vraag6bWaarom?Vraag7aWaarvoorzouuGameBuswillengebruiken?Meer beweging stimuleren en ik ben nieuwsgierig wat het op sociaal vlak zou kunnenbrengenvooronzecliënten.Vraag7bZijnerpuntendieutoegevoegdofanderszouwillenzienaanGameBus?Meerappsgerichtoptrainingsvlakkenentrucs.Bijvoorbeeldomdingenop te zoeken voor onze cliënten. Zoals een in een recept staatgebruik1dlwater,hoeveelmlisdatdan.Nietalleengerichtopactiveringmaarookwatpraktischedingenerbij.Zodatallesineenis.Vraag8Heeftuverdernoginformatiedieukwijtwiltoverhetonderzoek?

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Vraag1Naam: 4Datum: 24-11-2015Functie: ClientbegeleiderTeam: Vraag2aHoevindtuhetonderzoektotnutoegaan?Client:“Hetgaatredelijk,ikprobeermijnbesttedoen.Tochlukthetnietiederedagevengoed.”Vraag2bHoeervaartdecliënt(en)hetonderzoektotnutoe?Client:“Ikvindhetwelleuk.Hetishandigombijtehouden.”Vraag2cHoeervareneventueelanderecollega’svanuithetteamhetonderzoek?Collega’s hebben de presentatie gezien, maar krijgen verder niet veel mee van hetonderzoek.Depresentatievielinsmaak,wasduidelijkenheeftaanhetdenkengezet.Vraag3a(fysiek)Stelling: Door te werken met GameBus is decliëntmeergaanbewegen.(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3b (fysiek) Waar merkte u dat aan? Client: “Ik merk het omdat ik toch wel echt aan het afvallen ben.” Begeleiding: “Client is niet afgevallen.” Vraag3c(cognitief) Stelling: Door te werken met GameBus is decliënt meer denkspelletjes (reactiesnelheid,memory,etc.)gaandoen.(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3d (cognitief) Waar merkte u dat aan?

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Vraag 3e (sociaal) Stelling:DoortewerkenmetGameBusheeftdecliënt meer sociale contacten gezocht metandere personen (bv. bezoekenvrienden/familie, bezoeken WSP, bezoekanderecliëntenetc.).(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3f (sociaal) Waar merkte u dat aan? Vraag 4 Nam de motivatie van uw cliënt toe om fysieke, cognitieve en/of sociale activiteiten uit te voeren?

a. Ja, heel erg b. Ja, een beetje c. Nam niet toe / nam niet af d. Weet ik niet e. Nee, niet echt f. Nee helemaal niet g. N.v.t.

Vraag 4b Waar merkte u dat aan? Client: “Mijn doel is om elke dag meer stappen te hebben.” Vraag5aDenkt u dat GameBus zinvol kan zijn voor cliënten van uw locatie (woonlocatie,dagbestedingslocatie,WSP,etc.)?Vande12cliënten,zijnermaar2cliëntenmeteensmartphone,kijkendnaardegroepisGameBusdannietzinvol.Echtervindtdecliënthetleuk,hijisenthousiast.Vraag5bZo ja,hoeenmetwelkdoel zouGameBus ingezet kunnenwordenvoor cliëntenvanuwlocatie?Voor de cliënt om hem aan zijn belafspraken te houden, op tijd te komen op werk,beloningsysteemomdingentedoen,motiverentotmeerbewegen.Vraag5cDenktudatGameBuseentoegevoegdewaardekanhebbenvoordezorgverleningvanLunetzorg?Enverhoogtditdekwaliteitvanzorg?Zoja,waarom?Alshet cliëntenmethogerniveaubetreftwel. Echter is dit nietoponzedoelgroep vantoepassing.

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Vraag6aStelLunetzorgbesluitomGameBustegaangebruikenvoorcliëntenvanLunetzorg.Wiezouverantwoordelijkmoetenzijnvoordeimplementatievandezeappbinnenuwlocatie?Ikdenkdatdekeuzemoetliggenbijhetteam.Alshetteamdemeningvanlunetzorgnietdraagt,zalhetooknietgedragenworden.Dangaathetsowiesogeenzinhebben.Vraag6bWaarom?Vraag7aWaarvoorzouuGameBuswillengebruiken?Vraag7bZijnerpuntendieutoegevoegdofanderszouwillenzienaanGameBus?Vraag8Heeftuverdernoginformatiedieukwijtwiltoverhetonderzoek?

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Vraag1Naam: 5Datum: 23-11-2015Functie: cliëntbegeleiderTeam:

Vraag2aHoevindtuhetonderzoektotnutoegaan?Ikvindhetonderzoektotnutoegoedverlopen.Aanvankelijkwasdecommunicatiemetdeclientevenwatlastigmaarnaeengewenningsfaseliepheteenstukbeter.Declientwerdenthousiastdoordeapp’senlijktdewaardeervanintezienalishetmaardevraaghoelangdemotivatieblijft.Vraag2bHoeervaartdecliënt(en)hetonderzoektotnutoe?Inhetbeginalslastigenwatmoeilijktebegrijpen.Daarnazietzedemeerwaardeerwelvaninenvindtzehetleukomtezienwathetresultaatisvanhaarfysiekeinspanningen.Vraag2cHoeervareneventueelanderecollega’svanuithetteamhetonderzoek?Dieervarenhetookwelaanpositiefmaarhebbenwelhunbedenkingentenaanzienvanhetgebruikvandeappsopdelangeretermijn.Vraag3a(fysiek)Stelling: Door te werken met GameBus is decliëntmeergaanbewegen.(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist X d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3b (fysiek) Waar merkte u dat aan? Minder weerstand om dagelijkse beweging te doen en trots als ze het resultaat van haar wandeling kan laten zien aan groepsleiding. Vraag3c(cognitief) Stelling: Door te werken met GameBus is decliënt meer denkspelletjes (reactiesnelheid,memory,etc.)gaandoen.(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.X

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Vraag 3d (cognitief) Waar merkte u dat aan? --- Vraag 3e (sociaal) Stelling:DoortewerkenmetGameBusheeftdecliënt meer sociale contacten gezocht metandere personen (bv. bezoekenvrienden/familie, bezoeken WSP, bezoekanderecliëntenetc.).(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.X

Vraag 3f (sociaal) Waar merkte u dat aan? Vraag 4 Nam de motivatie van uw cliënt toe om fysieke, cognitieve en/of sociale activiteiten uit te voeren?

a. Ja, heel erg b. Ja, een beetje X c. Nam niet toe / nam niet af d. Weet ik niet e. Nee, niet echt f. Nee helemaal niet g. N.v.t.

Vraag 4b Waar merkte u dat aan? Dat de client vol trots op school haar resultaten laat zien als ze daar naar toe is gefietst. Vraag5aDenkt u dat GameBus zinvol kan zijn voor cliënten van uw locatie (woonlocatie,dagbestedingslocatie,WSP,etc.)?ZeerzekerVraag5bZo ja,hoeenmetwelkdoel zouGameBus ingezet kunnenwordenvoor cliëntenvanuwlocatie?Ontwikkelen van sociale contacten, meer beweging en trainen van cognitievevaardigheden.Vraag5cDenktudatGameBuseentoegevoegdewaardekanhebbenvoordezorgverleningvanLunetzorg?Enverhoogtditdekwaliteitvanzorg?Zoja,waarom?MitsdecliëntgemotiveerdenerookdaadwerkelijkietsaanheeftisdekwaliteitvandezorgwelbeterenkanhetbeslisttoegevoegdewaardehebbenvoordezorgverleningvanLunetzorg.

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Vraag5aStelLunetzorgbesluitomGameBustegaangebruikenvoorcliëntenvanLunetzorg.Wiezouverantwoordelijkmoetenzijnvoordeimplementatievandezeappbinnenuwlocatie?IkzoueencliëntbegeleideraanwijzenVraag5bWaarom?Hij/zijstaatdichterbijdecliëntenenkentdediversedoelen. Vraag6aWaarvoorzouuGameBuswillengebruiken?Vraag6bZijnerpuntendieutoegevoegdofanderszouwillenzienaanGameBus?Vraag7Heeftuverdernoginformatiedieukwijtwiltoverhetonderzoek?

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Vraag1Naam: 6Datum: 25-11-2015Functie: Woonbegeleidercomplex,terreingebondenjeugdTeam: Vraag2aHoevindtuhetonderzoektotnutoegaan?Decliëntwasinhetbeginvanditonderzoekreuzeenthousiast.Hijvoeldezichvereerdengroeidehierzichtbaardoor.Tezijnertijdzwakteditenthousiasmeaf.De cliënt geeft naar eigen zeggen aan dat het soms temoeilijk is. (Ik denk dat hij zijnconcentratieverliest,omdathijhetsomsmoeilijkvindt)Vraag2bHoeervaartdecliënt(en)hetonderzoektotnutoe?Declientgeeftaandatermeerafwisselingmagkomenindespellen.Hijervaartheteenbeetjealssaai.Sommigespellenkanhijnietoptimaaluitvoeren,omdaterinzijnomgevingniemandisdieouderisdaneenbepaaldeleeftijdenhijvindtsommigeopdrachtenmoeilijkuitvoerbaar.Alstipgeeftdecliëntaandatermeerspellenmogenkomendieaanzijndoelenwordengekoppeld.Verdergeeftdecliëntaanhetnietvaaktespelen,omdathijhetdrukheeftmetwerk.Vraag2cHoeervareneventueelanderecollega’svanuithetteamhetonderzoek?Collega’szijntevensenthousiastoverhetonderzoek.Alsteamzijnwijervanovertuigddatde GameBus een effectieve bijdrage kan leveren aan het toekomstperspectief van decliënten.Vraag3a(fysiek)Stelling: Door te werken met GameBus is decliëntmeergaanbewegen.

F

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3b (fysiek) Waar merkte u dat aan? De cliënt

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Vraag3c(cognitief) Stelling: Door te werken met GameBus is decliënt meer denkspelletjes (reactiesnelheid,memory,etc.)gaandoen.

F

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3d (cognitief) Waar merkte u dat aan? Vraag 3e (sociaal) Stelling:DoortewerkenmetGameBusheeftdecliënt meer sociale contacten gezocht metandere personen (bv. bezoekenvrienden/familie, bezoeken WSP, bezoekanderecliëntenetc.).

F

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3f (sociaal) Waar merkte u dat aan? Vraag 4 Nam de motivatie van uw cliënt toe om fysieke, cognitieve en/of sociale activiteiten uit te voeren?

E

a. Ja, heel erg b. Ja, een beetje c. Nam niet toe / nam niet af d. Weet ik niet e. Nee, niet echt f. Nee helemaal niet g. N.v.t.

Vraag 4b Waar merkte u dat aan? De cliënt gamet graag op zijn kamer. Hij vindt het lastig om hiermee te stoppen en vindt het daarom lastig om dingen te ondernemen.

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Vraag5aDenkt u dat GameBus zinvol kan zijn voor cliënten van uw locatie (woonlocatie,dagbestedingslocatie,WSP,etc.)?Woonlocatie;Duizelwijk4,Hetiszinvol,omdatonzecliëntengevoeligzijnvoorbeloningen/succeservaringen.Hetisbelangrijk voor deze doelgroep om succeservaringen op te doen. Door kleine, simpelespellen en/of activiteiten aan te bieden krijgen ze inzicht in hun handelen, omdat deGameBusisafgestemdophetindividueleontwikkelingsplanvandedesbetreffendecliënt.Doorhunbeperktedenk-enhandelingsvermogenvindenzehetlastigominteschattenwatzewel en niet aankunnen. Hierdoor overschatten of onderschatten zichzelf. Bovendienzorgtditvaakvoornegatieveervaringen,wathunontwikkelingnietbevordert.Wedenkendat de GameBus (uiteindelijk) een positieve bijdrage kan leveren aan de individueleontwikkeling.Vraag5bZo ja,hoeenmetwelkdoel zouGameBus ingezet kunnenwordenvoor cliëntenvanuwlocatie?Methetdoeldatzedeindividueledoelenkunnenbehalendoormiddelvankleinestapjesindevormvaneenspelen/ofactiviteit.(Zoalsnuookis)Vraag5cDenktudatGameBuseentoegevoegdewaardekanhebbenvoordezorgverleningvanLunetzorg?Enverhoogtditdekwaliteitvanzorg?Zoja,waarom?Hetisafhankelijkvanhetniveauendebeperkingvandecliënt.Nietallecliëntenhebbeneentelefoonennietallecliëntenzijninstaatomtelezen.Hetzoueenmeerwaardekunnenzijnvoordecliëntendieinstaatzijnomtelezen,omdatdespellengekoppeldwordenaandeindividueledoelenvandecliënt.Opdezemanierkunjeefficiëntwerkenaanhetindividueleontwikkelingsplanvandecliënt.Thisdependsonthelevelandlimitationoftheclient.Notall clients have a smartphone,andnotallclientsareabletoread.Itcouldbeanaddedvaluefortheclientsthatareabletoreadandwhenthegamesarelinkedtoindividualgoalsoftheclient.Inthiswayyoucanworkefficientlywiththeindividualdevelopmentplanofaclient.Vraag5aStelLunetzorgbesluitomGameBustegaangebruikenvoorcliëntenvanLunetzorg.Wiezouverantwoordelijkmoetenzijnvoordeimplementatievandezeappbinnenuwlocatie?Ikzouhetbijeenvastaanspreekpunthouden,zoalsopditmoment?Vraag5bWaarom?Ditzorgtvoorduidelijkeenrechtstreeksecommunicatie.

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Vraag6aWaarvoorzouuGameBuswillengebruiken?Voordeindividuelebehoefte/hulpvraagvandecliënt.Vraag6bZijnerpuntendieutoegevoegdofanderszouwillenzienaanGameBus?Onzecliëntgeeftaandathijsommigespellenmoeilijkvindtendathijmeervariatiezouwillen.Voorsommigecliëntenwordteenbeperktekeuzealsnelstandaardofsaaienvoordeanderewordtditimmerstelastigwaardoorzehunconcentratiegaanverliezen.Hetisgoedomditinderdaadaftestemmenopdeindividuelebehoeftevandecliënt.Doorspelleneenvoudiger te houden trigger je zowel het doorzettingsvermogen alsconcentratievermogenvandecliënt.Hierdoorzoujenogeffectieverenefficiënterkunnenwerkenaandeindividueledoelenvandecliënt.Vraag7Heeftuverdernoginformatiedieukwijtwiltoverhetonderzoek?/

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Vraag1Naam: 7Datum: 26/11/15Functie: Coördinerend/clientbegeleiderTeam: Vraag2aHoevindtuhetonderzoektotnutoegaan?Watikbegrepenhebvandeclientloopthetgoed.

Vraag2bHoeervaartdecliënt(en)hetonderzoektotnutoe?PrimazeheeftgereldcontactVraag2cHoeervareneventueelanderecollega’svanuithetteamhetonderzoek?Weinigzichtopisooknietveelovergesproken.(leeftooknietzobijhen)Vraag3a(fysiek)Stelling: Door te werken met GameBus is decliëntmeergaanbewegen.(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist x d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3b (fysiek) Waar merkte u dat aan? Middels een app wandelt ze meer als ze er fysiek toe in staat is Vraag3c(cognitief) Stelling: Door te werken met GameBus is decliënt meer denkspelletjes (reactiesnelheid,memory,etc.)gaandoen.(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet x e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3d (cognitief) Waar merkte u dat aan?

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Vraag 3e (sociaal) Stelling:DoortewerkenmetGameBusheeftdecliënt meer sociale contacten gezocht metandere personen (bv. bezoekenvrienden/familie, bezoeken WSP, bezoekanderecliëntenetc.).(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet x e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3f (sociaal) Waar merkte u dat aan? Vraag 4 Nam de motivatie van uw cliënt toe om fysieke, cognitieve en/of sociale activiteiten uit te voeren?

a. Ja, heel erg b. Ja, een beetje x c. Nam niet toe / nam niet af d. Weet ik niet e. Nee, niet echt f. Nee helemaal niet g. N.v.t.

Vraag 4b Waar merkte u dat aan? Ze wil meer competitie met ondergetekende Vraag5aDenkt u dat GameBus zinvol kan zijn voor cliënten van uw locatie (woonlocatie,dagbestedingslocatie,WSP,etc.)?IkdenknietvoordezelocatieVraag5bZo ja,hoeenmetwelkdoel zouGameBus ingezet kunnenwordenvoor cliëntenvanuwlocatie?Vraag5cDenktudatGameBuseentoegevoegdewaardekanhebbenvoordezorgverleningvanLunetzorg?Enverhoogtditdekwaliteitvanzorg?Zoja,waarom?Ikdenkvooreenenkelebewonerwel

185

Vraag5aStelLunetzorgbesluitomGameBustegaangebruikenvoorcliëntenvanLunetzorg.Wiezouverantwoordelijkmoetenzijnvoordeimplementatievandezeappbinnenuwlocatie?GeenideeVraag5bWaarom? Vraag6aWaarvoorzouuGameBuswillengebruiken?Vraag6bZijnerpuntendieutoegevoegdofanderszouwillenzienaanGameBus?Vraag7Heeftuverdernoginformatiedieukwijtwiltoverhetonderzoek?

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Vraag1Naam: 8Datum: 15december2015Functie: CliëntbegeleiderdagbestedingTeam: Vraag2aHoevindtuhetonderzoektotnutoegaan?Prima.Duidelijkeuitleg.Vraag2bHoeervaartdecliënt(en)hetonderzoektotnutoe?Leuk.Sommigecliëntenzijnheelenthousiastendaarhoorjeveelvan.Sommigeietsminder.(vaakheeftdittemakenmettelefoonsdiehetnietgoeddoen.)Vraag2cHoeervareneventueelanderecollega’svanuithetteamhetonderzoek?nvtVraag3a(fysiek)Stelling: Door te werken met GameBus is decliëntmeergaanbewegen.(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3b (fysiek) Waar merkte u dat aan? Cliënten vinden de stappenteller erg leuk. Sommigen zijn vaker te voet ergens heen gegaan. Er zijn ook cliënten die al veel bewogen maar het wel erg leuk vonden om dit via de app overzichtelijk te hebben. Vraag3c(cognitief) Stelling: Door te werken met GameBus is decliënt meer denkspelletjes (reactiesnelheid,memory,etc.)gaandoen.(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

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Vraag 3d (cognitief) Waar merkte u dat aan? Cliënten vinden het leuk om punten te verdienen. Een aantal zijn vaker spelletjes gaan doen door de app. Een aantal zijn ook andere spelletjes gaan doen door de app. (een aantal deed bijvoorbeel Candy Crush maar is ipv Candy Crush de denkspelletjes gaan doen. Vraag 3e (sociaal) Stelling:DoortewerkenmetGameBusheeftdecliënt meer sociale contacten gezocht metandere personen (bv. bezoekenvrienden/familie, bezoeken WSP, bezoekanderecliëntenetc.).(Kruisjuisteantwoordaan)

a. Volkomen juist b. Grotendeels juist c. Enigszins juist d. Weet ik niet e. Grotendeels onjuist f. Volkomen onjuist g. N.v.t.

Vraag 3f (sociaal) Waar merkte u dat aan? De meeste cliënten zijn niet vaker naar Pluspunt gekomen door het onderzoek op 1tje na. Dit omdat de meeste al komen op vaste dagen. Vraag 4 Nam de motivatie van uw cliënt toe om fysieke, cognitieve en/of sociale activiteiten uit te voeren?

a. Ja, heel erg b. Ja, een beetje c. Nam niet toe / nam niet af d. Weet ik niet e. Nee, niet echt f. Nee helemaal niet g. N.v.t.

Vraag 4b Waar merkte u dat aan? De motivatie nam zeker toe. Een aantal clíënten is vaker gaan lopen en meer spelletjes gaan doen. Vraag5aDenkt u dat GameBus zinvol kan zijn voor cliënten van uw locatie (woonlocatie,dagbestedingslocatie,WSP,etc.)?Ikdenkdathetzekerzinvolkanzijn.Vraag5bZo ja,hoeenmetwelkdoel zouGameBus ingezet kunnenwordenvoor cliëntenvanuwlocatie?Voor sommige cliënten is de drive om iets competitiefs te doen leuk en daarnaast ommisschienietsdaarbijtekunnenwinnen.Alsmendaardoormeergaatbewegen,vakeropbezoekkomtofmeercognitievespelletjesgedaanwordenisdatmooimeegenomen.

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Voor sommige cliënten zou het ook op individuele basis gebruikt kunnen worden.(bijvoorbeelddestappenteller)bijmensendiebezigzijnmetdelijn.Daarnaastishetmisschienookleukomverschillendewijksteunpuntentegenelkaartelatenstrijden.(erzijnnuookalcompetitiesopgebiedvanvrijetijd(sjoelenendarten)Daarzouhierookietsmeekunnen.Vraag5cDenktudatGameBuseentoegevoegdewaardekanhebbenvoordezorgverleningvanLunetzorg?Enverhoogtditdekwaliteitvanzorg?Zoja,waarom?IkdenkdathetweleentoegevoegdewaardezoukunnenhebbenvoordezorgverleningvanLunet.Hetzoudekwaliteitvanzorgkunnenverhogenbijvoorbeelddusvoormensendiemeerzoudenmoetenbewegen.Doordeappzijncliëntenhiermeertoetemotiveren.Ookdoorhetbelonenvanbezoekenrakenmensenminderineenisolement.Ookditisdusmetdeappmakkelijkertemotiveren.Het is wel de vraag of de cliënten die het echt nodig hebben met de app (met eensmartphone)omkunnengaan.Vraag6aStelLunetzorgbesluitomGameBustegaangebruikenvoorcliëntenvanLunetzorg.Wiezouverantwoordelijkmoetenzijnvoordeimplementatievandezeappbinnenuwlocatie?Begeleidingvanhetwijksteunpuntzelf.

Vraag6bWaarom?Ikdenkdatdeapppasteimplementerenisophetmomentdatdezeautomatischupdate.Ikhebgemerktdatditergveeltijdkostombij10telefoonsdituptodatetehouden,laatstaanbijmeer.Omdatlangnietallecollega’s(encliëntenzelf)heelhandigzijnmoetditwelgoedwerken.Verdermoetdiegenediehetmoetimplementerenzelfookwelhandigzijnmeteentelefoonomdathetnietbijallecliëntenallesevengoedwerkt.(ouderetypestelefoonsetc)Ikweetnietofhethandigisombijeenexternepartijteleggen.(bijvict)omdaterregelmatigwatismettelefoons.)

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Vraag7aWaarvoorzouuGameBuswillengebruiken?VoorhetWSPishetdenkikvooralinteressantomhettegebruikenomtekijkenofmensenvakernaarhetwijksteunpuntkomen.(beloningssysteem?)Vraag7bZijnerpuntendieutoegevoegdofanderszouwillenzienaanGameBus?

- Datallecliëntenuitallegroepenookineenindividuelescorelijstkunnenstaan.Dusgroepaengroepbtegenelkaarenalledeelnemersuitbeidegroepenooknogonderelkaar.(ofbijvoorbeeldalleenwijksteunpuntvanlunetzichtbaarvoorelkaar)

- Datalleinformatiedienietgebruiktwordtooknietzichtbaaris.Denkhierbijaangroepenwaarzenietinzittennietzichtbaar.Enbijactiviteithandmatigtoevoegendatalleendeactiviteitentezienzijnwaarzeaandeelnemen.(bijvsocialselfieensportactivity

- EnbijbijvoorbeelddesportactiviteiteenpulldownmenuomuittekiezeninplaatsvantypeninhetEngels.

Vraag8Heeftuverdernoginformatiedieukwijtwiltoverhetonderzoek?Volgensmijniet..J