Paz: An Application to Help Treat Childhood Anxiety and Depression
Mark Andrew Curry
A thesis submitted to the faculty at the Lindsey Wilson College in partial fulfillment of the requirements for the degree of Masters of Arts in the Interaction Design Program in the School of Graduate Studies.
Online 2017
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ABSTRACT Mark Andrew Curry: Paz: An Application to Help Treat Childhood Anxiety and Depression (Under the direction of Jason Occhipinti)
Several studies have been done about kids and teens who suffer from depression and/or anxiety and they have found that somewhere between 811 percent of adolescents (018 years old) have depression and/or anxiety. That means that somewhere between 5.9 to 8.2 million adolescents suffer from one or both of these mental illnesses. Understanding and treating these illnesses in children is essential to helping them have a happy and healthy development. The alternative is horrifying. According to a CDC study released in 2014 suicide is the second leading cause of death of people aged 1218. Suicide kills more adolescents every year than cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease, combined! There is an average of 5,240 attempts by young people in grades 712 every day! I want to create a mobile application that will help adolescents of any age learn about and deal with their illness, will help parents learn to effectively care for their kids, and will equip care providers with a tool to extend their treatment outside of the normal sessions. What exactly that will look like will be explored through extensive user research, agile development, and iterative prototyping.
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DEDICATION To my wife, Hayley: you helped me out of a dark place and inspired me to find and pursue my new passion. Thank you for everything!
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TABLE OF CONTENTS Introduction ……………………………………………………………...………………………1 Thesis Statement …………………………………………………...……..…………………...3 Childhood Anxiety and Depression ……………………………………..……………………3 Target Audiences ……………...…………..………………………………………………….. 7 Research ………………...……………………………………………..……………………… 8 Design Considerations ………...………………………...………………………………….. 26 Branding …………..……………………………...…………………………………….......... 27 Application Development …………………………………………………….….……......... 33 User Testing ………………………………………………………………………………….. 42 Final Application ……………………………………………………………………………... 44 Conclusion ……………………………………………………………………………….…… 47 APPENDIX: User Testing ………………………………………....………………………... 48 BIBLIOGRAPHY …………………………………………………………………………...… 58
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There is a plethora of reasons that may drive someone to create a digital application. Many people develop an application as a way to disrupt a market. For example, Uber was developed to change the way we get around. It disrupted the established transportation model where the only options were owning a car, taking a taxi, or riding public transportation by offering a new means of transportation. Another major reason someone may develop an application is out of necessity, in some cases filling a need we didn’t even know we had. Instagram is a perfect example of this. People have been sharing photographs ever since the camera was invented, but before the Internet, sharing them was a timeconsuming, expensive process. Because it meets a perceived consumer need, Instagram continues to flourish, while traditional film photography struggles to remain viable. Instagram has greatly changed how people take and share pictures, but until the application was developed consumers remained unaware that they needed a better way to share their photos. Yet another reason someone may choose to develop an application is because of personal experience. An event or experience in someone’s life has affected them in such a way that the creator is compelled to develop something to enhance, improve, or change the event or experience they had. This is the reason I created my application Paz. I grew up as the only child in a single parent family. My mother worked two jobs to provide everything that we needed, and I learned to keep my head down, get my work done, and to be selfreliant. I didn’t really talk about my feelings, and in all areas, including school, sports, or personal relationships, I simply did my part and suppressed
my feelings in an effort to keep moving forward. When I began my career, this behavior continued, except this time it was much to my detriment. I had been working odd jobs since I was 17, but finally at the age of 24, after receiving my first master’s degree, I started on my career path. Unfortunately, I found myself in a toxic situation in my first job. After two and a half years, I finally got out of the bad situation, but it was too late. After just nine months at the new job, I had a mental breakdown. It had gotten to the point that simply sending an email caused me to break down and cry. My emotions were spent, and I needed help. Thankfully, I was now in an incredibly supportive work environment and I had an amazing wife who helped me get help. I was diagnosed with Generalized Anxiety Disorder, an anxiety movement disorder, and depression. Through therapy and medication, I learned to deal with my mental illnesses. This is the event that led me to pursue this new career path, and ultimately inspired me to develop this application that I call Paz. I have had the emotions and tendencies that define anxiety and depression throughout my life, yet these problems went undiagnosed until I was 27 years old. Thankfully, today awareness and acceptance of mental health issues are on the rise. People are getting diagnosed earlier and getting help sooner than ever before. But the problem remains: outside of medication and therapy sessions, few solutions exist to help with these mental health issues. While mobile applications exist for adults who suffer from these mental illnesses, few options exist for kids who suffer from the same issues. As you might imagine, adults and children are treated differently according to their developmental needs, and the truth is, many parents do not know how to help their
children. Parents need guidance and support themselves when helping their children deal with their mental health. Mental health experts also have difficulty extending their services beyond their scheduled appointment times with their patients. Another hurdle for care providers is tracking the progress and mood of younger patients between sessions. Between 5.9 to 8.2 million children and adolescents in the United States suffer from depression and/or anxiety, and oftentimes they do not know how to cope. My goal is to create a mobile application that will help children learn about and deal with their mental health in developmentally appropriate ways, equip parents to better care for their children, and provide care providers with feedback and tools to extend their care outside of standard therapy sessions.
Before getting into details of the application development process, it is important
to establish what childhood anxiety and depression are, how these illnesses manifest in children, how prevalent they are in American society, and how they are currently treated within the mental health community. Let’s start with how prevalent this illness is in our society. The exact numbers vary by source, but “it is speculated that as much as 12 to 20% of children seen in the mental health settings suffer from extremes of anxious nervous manifestations” (Dr. Susan Carter, 2009). This estimate only includes those who seek help, however. According to the Centers for Disease Control and Prevention, or CDC, “it is estimated that 1320 percent of children living in the United States (up to 1 out of 5 children) experience a mental disorder in a given year” (Center for Disease Control and Prevention, 2017). The CDC goes on to report that of children aged 317,
3.0% are currently diagnosed with anxiety, and 2.1% are currently diagnosed with depression (Center for Disease Control and Prevention, 2017). Given the high estimated number of children with mental disorders and the low number of children diagnosed, we can infer that there is a disconnect between the number of kids with mental illness and those who get treatment. The Anxiety and Depression Association of America supports this idea by reporting that: “As many as 2 to 3 percent of children ages 6 to 12, and 6 to 8 percent of teens may have serious depression, and an estimated 2.8 million adolescents (ages 12 to 17) in the United States had at least one major depressive episode in 2014. Furthermore, about 80 percent of kids with anxiety disorder and 60 percent with depression are not getting treatment.” (Anxiety and Depression Association of America, 2016) Those numbers were staggering to me, and one of the goals I hope to accomplish with my application is to help address the need for treatment. Having explored the statistics on the prevalence of anxiety and depression in children, let’s take a look at the symptoms of each and how one might go about recognizing them, beginning with depression and the many forms it may take in children. KidsHealth.org list several different forms that depression may take, these include major depression, chronic depression, adjustment disorder with depressed mood, seasonal affective disorder, bipolar disorder (also called manic depression or bipolar depression), and “disruptive mood dysregulation disorder” (The Nemours Foundation, 2016). Identifying depression in children requires careful attention to the child’s symptoms, which can be varied. GoodTherapy.org has compiled an extensive list
of symptoms to watch out for when trying to diagnose depression. Their list includes the following symptoms: frequent crying and overwhelming feelings of sadness, feelings of hopelessness and worthlessness, changes in sleep such as excessive sleeping or the insomnia, anxiety, anger, difficulty taking pleasure in previously enjoyed activities, unexplained physical ailments such as headaches or muscle pain, difficulty concentrating, changes in weight or eating habits, and thoughts of suicide (Goodtherapy.org, 2017). Anxiety in children can also take a variety of forms. The KidsHealth.org site houses a list of anxiety disorders which includes generalized anxiety, obsessive compulsive disorder, phobias, social phobia (social anxiety), panic attacks, and post traumatic stress disorder (The Nemours Foundation, 2014). Though theirs is not a comprehensive list, GoodTherapy.org provides some general signs and symptoms to watch out for. Many people experience some of these from time to time, but if the following signs persist for six months or more one or more of the anxiety disorders listed above may be present. The list of signs and symptoms for an anxiety disorder include frequent feelings of fatigue, restlessness, feeling tense or on edge, irritability, difficulty focusing, drawing a blank, sleep problems, and muscle tension (GoodTherapy.org, 2017). Finally, in order to gain an understanding of what anxiety and depression are, one must consider the available treatment options. Medication is the number one treatment for either depression or anxiety, though I know from personal experience and observation that finding the right medication can be an arduous process. Many
medications have serious side effects, and not all medications help all people. Even so, medication an essential part of treatment for many people, myself included. Medication is only one avenue of treatment, however, and the effectiveness of medications can be greatly increased by combining the use of medication with therapy. There are two major types of therapy that are commonly used to treat anxiety and depression in children: play therapy and cognitive behavioral therapy, also known as CBT. According to GoodTherapy.org: “Play Therapy is a form of therapy primarily geared towards children. In this form of therapy, a therapist encourages a child to explore life events that may have an effect on current circumstances, in a manner and pace of the child’s choosing, primarily through play but also through language.” (GoodTherapy.org, 2015) GoodThrapy.org goes on to explain exactly play therapy might help when it says “Play therapy can help individuals communicate, explore repressed thoughts and emotions, address unresolved trauma, and experience personal growth” (GoodTherapy.org, 2015). Because play therapy is mainly aimed at children, it benefits many children who have not been able to receive help from other treatment methods. Cognitive behavioral therapy (CBT), on the other hand, is “a shortterm, problem focused form of behavioral treatment that helps people see the relationship between beliefs, thoughts, and feelings, and subsequent behavior patterns and actions” and is used to treat both children and adults (GoodTherapy.org, 2017). CBT can help an individual with anxiety disorder or depression by teaching them “that their perceptions directly influence their responses to specific situations. In other words, a person’s thought process informs his or her
behaviors and actions” (GoodTherapy.org, 2017). While these two forms of treatment are often used in conjunction with one another, the idea to use them in tandem was originally conceived by “Roger Phillips, who posited the idea to combine cognitive therapy and play therapy in the early 1980s. Cognitive behavioral play therapy has been used to treat children as young as two years old” (GoodTherapy.org, 2015). Prevalence, symptoms, and treatments for anxiety and depression in children are all key to understanding why I made some of the choices that I did later in the design of my mobile application, Paz. An important part of the design process is figuring out who exactly your target audience is and what their wants and needs are. For my mobile application, I identified three target audiences I thought would benefit from my application: kids with an anxiety disorder or depression, parents of the children who have an anxiety disorder and/or depression, and care providers who may have to diagnose and/or treat patients with an anxiety disorder and/or depression. Children with anxiety and depression are an obvious choice as a target audience for an application meant to assist in the treatment of children with these mental health issues. Therefore, kids who suffer from these illnesses are my core audience, and most of the application will be designed with them in mind. The majority of the features will be dedicated to them and to helping them feel better in conjunction with the treatment methods mentioned above. The alltoooften forgotten group that I also hope to target and serve with my application is the parents of children who suffer from anxiety and depression. Many times, parents are either also suffering from similar illnesses or are unsure how to treat and take care of an illness that
they cannot see. My application will serve as a means of support and guidance for them in dealing with their own emotions and teaching how they can help their children deal with anxiety or depression. The last of my target audiences that complete my holistic approach to mental health treatment for children is care providers themselves. Many care providers already have resources such as electronic medical records that allow them to track their patients’ visits and make notes regarding their symptoms and care. Rather than replacing the current system, I intend for the care provider section of the application to be a place where providers can assign certain care tracks for children to use and then monitor their progress on the tracks they have assigned via daily check ins. The goal is to give care providers insight into the patient’s attitude and overall emotional state between visits, allowing them to have some potential starting points for their conversation during the patient's next appointment. Having learned what anxiety and depression look like and identified my target audiences, I began to assemble some research that would drive the development of my application. The first thing I wanted to do was see what, if anything, was currently available that was similar to what I wanted to create. I discovered that there wasn’t anything exactly like my idea; most of the applications currently available were directed at adults and had little to no content for children. Of the applications I analyzed, only one had any kind of care provider interaction or oversight, and while that application was relatively affordable for patients, it was prohibitively expensive for care providers. See the figure on the next page for more details on my competitive analysis of the applications Pacifica, Calm, and HelloMind:
Figure 1Competitive Analysis
Next, I developed personas based upon my target audiences. Personas are reasonable facsimiles of the people one hopes to target and engage with an application. I created five personas: one child with anxiety, one child with depression, a parent of a child with a mental illness, a counselor, and a pediatrician. These personas helped me get a better picture of my target audiences. The personas can be seen below:
Figure 2 – Persona of girl with depression
Figure 3 Persona of boy with anxiety
Figure 4 Persona of father of child with anxiety and depression
Figure 5 Persona of Child Counselor
Figure 6 Persona of Pediatrician
My final and most substantial research took the form of expert interviews. I interviewed a pediatrician, a child therapist, a general therapist, and a school psychologist. Each of them offered interesting insights and brought a different perspective to the questions I asked them. I have posted the interview results in full below, starting first with the pediatrician, Dr. Tim Waer: Tell me a little bit about your background and your qualifications to speak to anxiety and depression in children. I never myself have had to struggle with anxiety or depression, but as a pediatrician and a psychology major, I have encountered many children who struggle with anxiety and depression day in and day out and have tried my best to listen to their stories and help them the best way I can. How would you diagnose a child with anxiety? Diagnosing anxiety is a difficult task, as many times the person that you are interviewing does not want to admit their anxieties to others. As a pediatrician we use the SCARED Questionnaire (Screen for Child Anxiety Related Disorders), which is filled out by the parent and child. It asks a variety of questions that help us distinguish between a panic disorder, generalized anxiety disorder, separation anxiety, social anxiety or school avoidance. The key for diagnosing an anxiety disorder, however, is the fact that the thought/action causes impairment in normal function. How would you diagnose a child with depression? Diagnosing depression is similarly difficult to diagnosing anxiety. In medical school, we are taught the Acronym SIG E CAPS. That stands for sleep (increased/decreased), interest (decreased), guilt (worthlessness), energy (decrease/fatigue), concentration (difficulty making decisions),
appetite (weight gain/loss), psychomotor activity and suicidal ideation. That is the criteria for major depression, but there are many variations of depression that are more fully laid out in the DSM – V that we use to diagnose depression. What would be your recommended treatment for a child who suffers from anxiety? Anxiety can be treated in a variety of ways, but the most effective way is through some kind of talk therapy. This can be cognitive behavioral therapy or other forms of psychotherapy. Group therapy is also helpful, as those who suffer from specific anxieties can form a community and come together to help each other in their battle against their specific anxiety. Medications also play a role for generalized anxiety disorder to acutely calm nerves during an anxietyrelated event. There is also a role for immersion therapy, but this does not work for everyone and should only be used after a therapist has been able to form a therapeutic relationship with their patient and determine whether they think they would benefit from immersion therapy and/or flooding. What would be your recommended treatment for a child who suffers from depression? Depression is best treated by a combination of psychotherapy and medication. SSRIs are the primary firstline medication used, but medication alone usually does not do the trick. Providing an avenue for those who are depressed to openly and honestly discuss their thoughts and feelings allows for an opportunity for the patient to openly process their emotions with a nonjudgmental source who can then provide the patient with an outsider’s perspective on the patient’s thoughts/feelings and give them insight into how they are processing their thoughts and emotions.
Are there any alternative treatments that you would also consider for anxiety? Play therapy works very well in children. It gives them a space to act out their fears in a nonthreatening space, but the key to play therapy is trust in those who are overseeing the play, so there needs to be lowkey, nonthreatening interactions with the therapist prior to initiating play therapy. Are there any alternative treatments that you would also consider for depression? Group therapy is probably the best form of alternative therapy for children who suffer from depression. To your knowledge are there any digital products, websites or mobile applications, that are designed to help treat anxiety and/or depression in children? If so, what are they? I am not personally familiar with any digital/mobile applications or websites to help with children who suffer from anxiety/depression, but I would not be surprised if there were some out there and would be very open to learning about those that exist. If such a digital product existed, what would you consider essential to its success? The beauty of the internet is connectivity with others, not just in your community but around the world, so I would say that a key to a mobile app’s success for helping in anxiety and/or depression would be a way to build community. Digital media also thrives with interactive and creative video formats so having a product that engages the viewer with videos would also be helpful.
Are there any potential drawbacks as you see it to a website or mobile application that would help children deal with anxiety and/or depression? If so, what are they? Drawbacks would be cyberbullying, formation of cliques, or lack of anonymity. What method of implementation, website or mobile application, do you feel would work best to accomplish the desired goal of helping to treat children with anxiety and/or depression and why? I think a mobile app that allows for message boards, shared videos of personal testimonies, and gamification of informational material would be a great start for a mobile app. Which treatment method you listed in questions 47 in your opinion lends itself to become a website or mobile application and why? I’ve kind of covered this, but group therapy or shared community allows for children to share their stories with each other. That said, it would be important for these communities to have a group moderator trained in child psychiatry to help direct conversations. It would also be beneficial to limit the amount of people in a group so relationships can be formed and meaningful conversation can be had rather than being one voice in thousands of people (Waer, 2017). Next I was able to interview a counselor who works primarily with children, a specialty that gives her a focused and much needed viewpoint from which to contribute to my research. Here is my interview with Catie Bilz: Tell me a little bit about your background and your qualifications to speak to anxiety and depression in children. I am a Licensed Professional Clinical Counselor,
[and I have been] working in the field since I graduated in 2012. I previously worked for three years with atrisk children ages 717 in homebased and school settings, and now work with children ages birth to 6 years old. How would you diagnose a child with anxiety? Generally, all clinicians use the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders in order to appropriately diagnose children with an anxiety disorder in addition to other formal assessments provided by agencies. Also, a clinician uses symptom reports from parents as well as clinical observations of the child. How would you diagnose a child with depression? Generally, all clinicians use the diagnostic criteria in the Diagnostic and Statistical Manual of Mental disorders in order to appropriately diagnose children with a depression disorder in addition to other formal assessments provided by agencies. Also, a clinician uses symptom reports from parents as well as clinical observations of the child. What would be your recommended treatment for a child who suffers from anxiety? I find that one would need a number of strategies to approach an anxiety disorder in children, as you have to treat clients on a case by case basis. The approach that works for one child will often not work for another. However, I have found that play therapy techniques, Theraplay ® techniques, [and] narrative therapies often work with children. Behavioral techniques such as CBT (Cognitive Behavioral Therapy) are also used. I also highly recommend involving parents in treatment if only for more education regarding childhood mental illness and strategies for supporting their child. For
teenagers and older children, I would incorporate more talk therapy into treatment. For severe cases, psychopharmacological treatments may be needed. What would be your recommended treatment for a child who suffers from depression? I find that one would need a number of strategies to approach a depressive disorder in children, as you have to treat clients on a case by case basis. The approach that works for one child will often not work for another. However, I have found that play therapy techniques, Theraplay ® techniques, narrative therapies, often work with children. Behavioral therapies such as CBT are also used. I also highly recommend involving parents in treatment if only for more education regarding childhood mental illness and strategies for supporting their child. For teenagers and older children, I would incorporate more talk therapy into treatment. For severe cases, psychopharmacological treatments may be needed. Are there any alternative treatments that you would also consider for anxiety? Some alternative treatments that I recommend to parents and children are deep pressure treatments, weighted blankets, and activities such as yoga to calm the mind. Are there any alternative treatments that you would also consider for depression? I usually recommend yoga to parents and children in order to increase movement and direct body movement. To your knowledge are there any digital products, websites or mobile applications, that are designed to help treat anxiety and/or depression in children? If so, what are they? There are a few apps that I have used in the past with
children with anxiety to increase feeling identification and for developing coping skills, but I am unaware of any that are specifically for treating symptoms of anxiety and depression. Below [is a link to] some apps suggested by anxiety.org: https://www.anxiety.org/giftappschildrenanxiety. If such a digital product existed, what would you consider essential to its success? I think that it would be difficult to create a digital product that could be used as a standalone product for treating mental health issues. The field has had a lot of struggles with being able to incorporate satellite treatment such as on Skype and other types of digital media due to ethical issues. If such an app existed, it would need to ensure that it was able to protect the client’s information and work in congruence with other forms of treatment, such as therapy. Are there any potential drawbacks as you see it to a website or mobile application that would help children deal with anxiety and/or depression? If so, what are they? The biggest drawback that I would see to a website or app is missing out on the reparative relationship between a client and therapist. This relationship has been found to be the biggest factor in client success, and taking this aspect out of treatment may impact the client’s success. What method of implementation, website or mobile application, do you feel would work best to accomplish the desired goal of helping to treat children with anxiety and/or depression and why? I think that an app would be helpful in that a child or parent would have quick access to help if needed, as most people are not able to
access a computer at all times and some websites require a computer in order to utilize all aspects of the site. Which treatment method you listed in questions 47 in your opinion lends itself to become a website or mobile application and why? I think that it is very difficult to utilize a treatment method within a website or app, as so much of the therapeutic relationship and treatment process involve the constant assessment by a skilled professional in order to determine which treatment will be successful. If I had to recommend one, I would say narrative therapy would be best, as it involves writing, which would be more easily used by a therapist receiving the information. (Bilz, 2017) Next, I interviewed a counselor who, though he doesn’t just treat children, specializes in mental health issues. The following is my interview with Sam Staggs: Tell me a little bit about your background and your qualifications to speak to anxiety and depression in children. My background is that I am a current mental health counselor in the state of Kentucky. I have had over a decade of experience working with children in a variety of capacities. How would you diagnose a child with anxiety? With help and support of the DSMV How would you diagnose a child with depression? Same as above What would be your recommended treatment for a child who suffers from anxiety? Regular therapy visits with a professional counselor. No medications unless absolutely needed. Preferably someone with a background or certification with the Association of Play Therapy (APT).
What would be your recommended treatment for a child who suffers from depression? Regular therapy visits with a professional counselor. No medications unless absolutely needed. Are there any alternative treatments that you would also consider for anxiety? Nondirective play therapy. Therapy for parents as well. Are there any alternative treatments that you would also consider for depression? Nondirective play therapy. To your knowledge are there any digital products, websites or mobile applications, that are designed to help treat anxiety and/or depression in children? If so, what are they? I use resources from a site called Therapistaid.com. If such a digital product existed, what would you consider essential to its success? It is just tools to use to help support. Are there any potential drawbacks as you see it to a website or mobile application that would help children deal with anxiety and/or depression? If so, what are they? It stays pretty vanilla in treatment. Different children need different interventions. Also some good apps for iPhone/Android. I was just saying that there is no “one size fits all” treatment there are just different types of treatment that work differently for different children, electronic or not. What method of implementation, website or mobile application, do you feel would work best to accomplish the desired goal of helping to treat children with anxiety and/or depression and why? I think anything that provided soothing sounds, rather
than pictures, would be beneficial to calming an anxious child, such as natural sounds, white noise, etc. Which treatment method you listed in questions 47 in your opinion lends itself to become a website or mobile application and why? See above (Staggs, 2017). Finally, I interviewed a school psychologist, Samantha Hunter, who works with kids every day. My interview with her is as follows: Tell me a little bit about your background and your qualifications to speak to anxiety and depression in children. I have a Bachelor of Science degree in psychology. I have an M.Ed. and E.Ds. in school psychology. I have taken classes at the undergrad and graduate level in abnormal psychology and childhood psychopathology. I am currently working as a school psychologist for Davidson County Schools [in North Carolina]. How would you diagnose a child with anxiety? In my specific role, I do not diagnose students with anxiety. Students normally come to my attention when they are struggling in school. If my team (comprised of myself, classroom teacher, principal, special ed. teacher, school counselor, parent, and any other relevant parties) believe the student is struggling because of some sort of disability, I do a psychoeducational assessment with the student. This involves an IQ test, achievement testing, and sometimes rating forms that teachers and parents complete that measure adaptive behaviors and internalizing (depression, anxiety, etc.) and externalizing behaviors (hitting, arguing, etc.). After getting all the results and writing a report putting all the information together, I meet with my team again to decide the best placements for the student. This isn’t a one man
show; while I do my testing, the teachers collect classroom specific data of their own and sometimes the parents obtain medical records. There are 13 educational categories that we can find a student eligible for special education under. These were determined in the Individuals with Disabilities Education Act (IDEA). If my team and I think the student is struggling in school because they have anxiety (and the parent brought a medical report saying they have a medical diagnosis of anxiety), then we can find them eligible for services under the IDEA category of Other Health Impaired (OHI). However, just because the student has a medical diagnosis of anxiety does not mean they automatically qualify under OHI. If they are not struggling in school and therefore are able to access their education, we would not find them eligible. There also has to be some sort of proof that the primary reason they are struggling is because of the anxiety. This is where classroom data and the rating forms I do come into play. How would a medical person diagnose someone with anxiety? Much the same as we do in the schools. They do interviews with the student and families, do rating forms and use the DSM5 as a guide and then use their expertise to decide. How would you diagnose a child with depression? Same as anxiety. What would be your recommended treatment for a child who suffers from anxiety? This is tough because it can be so different for different people. As a school psychologist, I would most frequently recommend lighter workloads and separate non timed testing environments because testing can be a major stressor for kids with anxiety. I did a group in the past for elementary kids with anxiety/anxietylike symptoms.
We did guided breathing exercises, made stress balls, practiced journaling, and talked about our feelings as a group so they wouldn’t feel alone. Not all of these things worked for all the kids in my group, but all of them got something from at least one of the strategies we learned about. I don’t have as much experiences with these, but yoga, meditation, and mindfulness are huge in helping people with anxiety. It really just depends on the person, giving them as many tools as possible and letting them decide what works for them is normally the best. In my role, I can’t prescribe medicine or recommend outside counseling, but these things are always really important pieces. What would be your recommended treatment for a child who suffers from depression? See above, finding what works for the individual along with medicine and counseling. Also, kids with depression often have [a] high [rate of] absences they literally can’t get out of bed in the morning. Having a point person to help them keep their assignments in order and extended deadlines can be helpful. These students also lose interest in things they were once interested in and don’t socialize as much. Encouraging them to join an extracurricular activity can also be helpful. Are there any alternative treatments that you would also consider for anxiety? I’ve said everything I have to say for treatment in the last answer. Are there any alternative treatments that you would also consider for depression? See above.
To your knowledge are there any digital products, websites or mobile applications, that are designed to help treat anxiety and/or depression in children? If so, what are they? Not that I’m aware of. If such a digital product existed, what would you consider essential to its success? Flexibility. As I said in previous answers, what works for some won’t work for others, so the ability to customize would be essential so the most amount of people could get something from it. Are there any potential drawbacks as you see it to a website or mobile application that would help children deal with anxiety and/or depression? If so, what are they? I wouldn’t want it to be seen as a “cure” for anxiety or depression, which is how people may see such a product. It should be seen as a tool to help with anxiety and depression. What method of implementation, website or mobile application, do you feel would work best to accomplish the desired goal of helping to treat children with anxiety and/or depression and why? Advertising with people who work with these people such as counselors, psychiatrists, psychologists, and medical doctors. The professionals would be able to show the child and family how to appropriately use the website or app, which would maximize its effectiveness. It would also help keep my reservations outlined in the previous question at bay. Which treatment method you listed in questions 47 in your opinion lends itself to become a website or mobile application and why? Keeping it as open as possible
and customizable. For example, if a student needs a guide to help with deep breathing exercises, having a visual to help them breathe in and out would be really good. If someone likes listening to music while meditating, having a place they can download music to would be helpful. If the student likes journaling, having a screen they can type and save their thoughts might help. A calendar might help. So, basically, having flexibility is key, I believe (Hunter, 2017). One of the major insights I gleaned from my interviews that guided me through the design process is that this application shouldn’t be pitched as a cure or standalone treatment, but as something care providers and parents can use to assist in treatment. I also learned that I need to have multiple treatment paths because each child is unique and thus needs unique treatment. I can’t just make an anxiety treatment and a depression treatment; rather, I need to drill down and treat the symptoms and causes instead of going for a larger, “one size fits all” approach. The final and possibly biggest insight I got from these interviews is that I should develop an application instead of a website. An application would be easier to use in treatment sessions, and young kids are generally accustomed to regularly using tablets and/or smartphones, while not all of them have developed the skills to use or have access to a computer. The mobile aspect and the fact that you can take an application anywhere also worked in its favor. The interviews I conducted solidified my goal to create an application. I had identified my target audiences: children, parents, and care providers. I had studied the signs and symptoms of each illness and identified those that could potentially be treated using an application. In addition, I researched what my competitors are doing, including
what they are doing right and what can be improved. I also learned what experts think and what they would like to see from an application. At this point, I was ready to move on to the design aspect of the creative process. Throughout this program, I have designed several websites and applications, but until now I had never designed something that would be used primarily by children. Therefore, I needed to do some research on design considerations when designing for children. One of the first considerations I found, and one of the most important to remember was “They will touch and interact with everything on screen, searching to discover content interactions with the interface” (Smyk, 2014). Kids like to touch and explore they will try everything just to see where it leads and what it does, and because of this I need to make as much of the application as I can clickable and responsive. Another big consideration when designing for children is how they navigate around an application. Andrew Smyk says in his article on UXDesign.cc that “One of the major problems for children is not exploration or interaction but ending the engagement with the interface by accidentally removing themselves from the experience” (Smyk, 2014). Popups, ads, and other things that interrupt a child’s natural exploration and interaction with the interface will frustrate them and cause them to quickly lose interest. Similarly, complicated actions such as twofinger swiping, pinching, and other gestures are often difficult for young children to grasp and make them unwilling to use applications that require them to do these gestures.
The final design consideration to consider that I felt was very important to remember when designing for kids is to use aspects of design that will be familiar to them from other popular applications. Basically, you don’t need to reinvent the wheel to design for children. In an article in Smashing Magazine, Trine Falbe had this to say about transferring conventions from different interfaces: “[children] become used to interfaces that have a lot of graphics and large navigation buttons and little written content. And they are familiar with core videocontrol elements, like play, pause and full screen buttons, as well as key interactions such as tapping to pause and play” (Falbe, 2015). Therefore, I knew I needed to use elements that would already be familiar to children. Kids know how to do certain things on applications, and I sought to limit myself to these types of interactions. In tandem with application development, which I will cover last, I also developed branding in terms of a name and logo for my application. First, let’s look at how I came up with the name Paz. The first thing I did was brainstorm possible names, resulting in the following options: Giggle – Name evokes thoughts of happy laughing children. Taken by baby registry app already. May be too childish for older users. Smile – Name exemplifies the feeling of happiness. It is simple and easily recognizable. Surprisingly not already taken as app name. Could easily be confused with a very popular application called Smule. Pax – Name is Latin for peace. Commonly used in other titles, as well as a major convention that shares the name, could make finding the correct application difficult.
Pace – Name is the Italian word for peace. Shared name among many running applications. Also, does not translate well to English as the definition is different. Paix – Name is the French word for peace. Used in several predominantly French apps. No good English equivalent word. Paz – Name is the Spanish word for peace. It also sounds like the English word pause when pronounced. There are also no other apps that use this name in any way. Very simple to understand and remember. I came up with all the names listed above and narrowed it down to either Smile or Paz. Both are simple and would be easy for a child, parent, or care provider to remember. Smile was appealing because of its availability and recognizability. Paz means peace and can be inferred to mean pause, and it also has the advantage of there not being any other applications with names that could be confused with this one. Given this information and research, I decided to go with Paz. Now that I had a name for my application, I needed to design a logo that would stand out and represent my application. I wanted a logo that was understated and subtly referenced the fact that Paz sounds like the English word pause. I again brainstormed and sketched out some potential logos that I could use. See the figure below:
Figure 7 Paz logo sketches
After getting feedback, I determined I would go with the second design of the traditional pause symbol with the name of the application layered on top of the icon. Then I started to design the logo using Adobe Illustrator, and here is my first attempt:
Figure 8 First Paz logo attempt
Overall, I was satisfied with how the logo turned out. I believe the design with the words overlaid on the pause symbol is aesthetically pleasing and that the use of a font that has a swooping handwritten feel lends itself to the notion of relaxation. The main thing that didn’t work in this first attempt was the color scheme. The dark blue and dark green
used in the logo and application icon proved to be too similar and potentially difficult to see. So I decided to keep the design and try a different color scheme as seen below:
Figure 9 Paz logo development, new color scheme
For this new design, I tried to go with colors that I thought were very different from the original design and that would hopefully contrast better. While the background color used in the application icon does well to make the other colors stand out, the orange and green colors are too similar with the dark shade of their respective colors, and so the contrast between the wording and the logo were still not what I wanted. While the second design was more colorblindness friendly than the first because it used colors
from two different color spectrums, it was still not exactly right. So, for my third attempt, with the help of additional feedback, I decided to go with a more monochromatic color scheme, which can be seen below:
Figure 10 Final Paz logo development
This monochromatic color scheme finally gave me the look I wanted. There is high contrast between the muted colors of the background, the logo, and the dark color of the name of the app. Using a monochromatic scale such as this also makes it
colorblindness friendly because it essentially operates on a grayscale, therefore making it easy for colorblind individuals to distinguish between different variations of the same color. This is the logo, application icon, and overall color swatch I decided to use as the final version. Finally, I began the process of actually developing the application. The first thing I needed to do was to sketch out a concept of what exactly I thought this application might look like. Here are my initial sketches of what I thought the child sections of my application could potentially look like:
Figure 11 Homepage, Videos, CheckIn, and Audio sketches
I imagined the homepage to be bubbly, happy, and somewhat whimsical in order to appeal to children. Calling back to my original design considerations, bubbles are
something children could touch and interact with. All kids are familiar with popping bubbles, and whether they are popping the bubbles in the background or the main navigation buttons, this presents them with a way to navigate doing something they should find familiar. The checkin screen is based on the basic pain chart that many doctors use when treating kids, except it is used to track mood instead of pain. The audio and video screen present large touch options with familiar symbols. The large back arrow in the top left is also there as an easily recognizable symbol indicating how to get back to the previous screen. Moving beyond the home screen and the main menus for the children’s section of the application, let’s take a look at what my first sketches for the rest of the app were and the ideas behind them:
Figure 12 Games, Parent, Care Provider, and Sign In sketches
Games are the last of the child specific pages that I sketched, again utilizing a simple, easily understood layout with large touchable tiles and an oversized back button. Next, there is a standard signin screen that parents and care providers alike would navigate to from the home page. On this screen, users can sign in to an existing account or sign up for a new account. After this is the parent screen. For consistency’s sake, I brought over many of the oversized and recognizable icons from the children’s side of the application. For care providers, I wanted them to have a way to view information about a patient's’ participation and completion of assigned tasks. That is why I put in a graph representative of tracking a child’s daily emotional checkins.
After roughly sketching out the concept of what I wanted my application to look like, I needed to plan out the structure of my application. I developed a site map for my application. The first interaction can be seen below:
Figure 13 First Site Map
This first site map was a good start and was close to what the final product would actually look like. It clearly lays out the different paths you can take throughout the application as well as how the different pages interact with one another and with the different databases when necessary. The main issues with this site map are that it was missing a necessary page that had to be included in the next version and that it was difficult to differentiate what was actually a page and what was just a section title that
merely directed you to the next page in the line. I corrected these issues with the final site map seen below:
Figure 14 Final Site Map
After having laid out the concept of my application and its overall structure in a sitemap, it was finally time to start developing wireframes. Since my concept sketches were on the level of a low fidelity wireframe, I decided to jump straight to a medium fidelity wireframe for my first digital edition. For this medium fidelity wireframe, I limited color to the pictures that I used to represent where video and audio tracks would later go. To display the progress of the application, instead of showing every screen from every iteration, I’m going to show an overall display of all of the screens for a broad
overview, then include larger versions of three screens to show in more detail how they progress throughout the user experience. See the overview below:
Figure 15 Medium Fidelity Wireframes Overview
The three screens I decided to show to demonstrate the progression are the home screen, the care provider landing page, and the video display screen. I believe that over the course of the three iterations that the application went through, these three screens in particular show how the design and style changed overall. Below are closeups of the three screens in the medium fidelity state:
Figure 16 Medium Fidelity Homepage
Figure 17 Care Provider Landing Page
Figure 18 Medium Fidelity Video Player
As you can see from the screens above, I kept everything simple in the first digital version. One feature I would like to highlight is the fact that all major buttons are very large and would be easy for a child to use. In addition, the use of basic iconography make things easily identifiable for small children, even those who may not be able to read. Now let’s take a look at my first attempt at a highfidelity prototype. There is a missing link between my medium fidelity wireframe and this first high fidelity prototype namely, I am missing a round of user testing. I will go into more detail about this in the user testing section that follows this section, but wanted to briefly make note of it here. For my first high fidelity wireframe, I added a color scheme to the overall application. I went with a blue monochrome color scheme because blue is widely considered the most calming and relaxing color in the color spectrum. I also put a background on the homepage that represents a dynamic background with bubbles floating up users can
pop. I also added graphics wherever appropriate throughout the application. See the overview and screen on the following pages:
Figure 19 High Fidelity Overview
Figure 20 High Fidelity Homepage
Figure 21 High Fidelity Care Provider Landing Page
Figure 22 High Fidelity Video Player
As you can see, there were major changes to each of the screens between the medium and high fidelity wireframes. The home page features an ungraded background that will eventually be dynamic. The care provider landing page has undergone a couple of updates, including the addition of a status light that allows providers to quickly see how well a patient is completing their assigned tasks and the relocation of the edit button from the side to being a small icon on each patient’s individual bar. Finally, the video feed has been completely redesigned; I opted to use large, familiar individual elements instead of the much smaller ones from the previous version in order to make it more kid friendly and easier to use. Before we look at the final iteration of the application, let’s explore the user testing process and how the application’s development progressed from the first
medium fidelity wireframe to the final version that will follow this section. I must start this section with full disclosure: I had to throw out the round of user testing between my medium fidelity and high fidelity wireframes. This was due to my failure to obtain written consent to test minors, because I was unaware that this step was required. I falsely assumed that verbal consent was enough, as it had been in the past for adult subjects, and therefore failed to secure written consent. So, while I was able to perform the user test and glean some information from them that influenced later designs, after consulting with my advisor, we felt it appropriate to leave the test and findings out of the paper due to the aforementioned lack of consent. Having learned this crucial lesson, I proceeded with my final round of user testing between my high fidelity wireframe and the final wireframe version of my application. For this round, I was able to test two care providers, two parents of children with mental illness, and two children suffering from mental illness. I developed slightly different criteria to test for each group and developed a consent form to be signed by the parents of the children I would be testing. The test forms for all three groups as well as the consent form can be found in Appendix: User Testing at the end of this paper. Each group was asked baseline questions to determine their internet usage, and if they used the Internet or applications to provide care or get relief/support. The test subjects were then asked to complete a list of four tasks testing their ability to navigate the user interface. Finally, they were asked some followup questions about their experiences using the application. Though many elements remained the same between the high fidelity wireframe and the final wireframe, these tests provided helpful insights into how
each of the target audiences interacted with the user interface, and the tests did lead to some minor changes as well as the addition of a few new screens. Below is the table of the user testing results:
Figure 23 User Test Results
From this feedback, I could tell that many things were working well. The user interface is pleasant and calming. The bubbles I used in the interface are a big hit, even though they are not yet dynamic or clickable. Everyone seemed to be drawn first to the games section of the site, even the adult users for whom that wasn’t the primary intention. Both care providers were very excited about the potential use of the application as an extension of conventional care. In fact, the only real negative was from one of the kids when she said she wouldn’t recommend it because the videos and games didn’t actually work. As a sixyearold, she found it hard to understand that it was not fully functional the word prototype is not a part of her vocabulary.
With the feedback from these user tests, I was able to move on and make the final wireframe iteration of my mobile application. The user feedback guided me to make some subtle adjustments like adding the logo to the parent and care provider sections; tapping this logo allows the user to jump back to the landing pages for those sections. I also added a feedback page for kids to encourage them to continue to check in and give them a shortcut to their other sections of the application. Finally, I added a graphic underlay to each of the buttons on the homepage to make them look like bubbles and not just white circles. This should make the icons and words easier to see. Below is a picture of the overall structure of the finished application wireframe as well as some of the screens showing the changes that I have made:
Figure 24 Final Wireframe Overview
Figure 25 Final Homepage
Figure 26 Child CheckIn Feedback Page
Figure 27 Parent Video Player with Logo
In conclusion, I set out to make an application that would serve kids who deal with anxiety and depression, help support their parents, and allow care providers as a way to extend their ability to care for their patients. I believe I achieved what I set out to do, and the final round of user testing clearly demonstrates this success. While I was only able to test a small sample size, the users overwhelmingly praised the application. The app was also very successful in interface design; users failed only one of the 24 tasks they were asked to perform. Moving forward, the biggest obstacle I will have is creating content for the application. The creation of video, audio, and games that would work within the application would prove expensive, which is why it would be the biggest hurdle for me in bringing the app to market. In
the future, I would love to move forward with this project if I could obtain funding to support content creation.
Appendix: User Testing Child User Test Script Introduction Hello, welcome and thank you for giving me some of your time. How are you today? I’m Drew Curry and today I am here for my Thesis project at Lindsey Wilson College. I am trying to understand how an application we designed works for the people who may use it. I have asked you here to see what you think of the application, how it works, what doesn’t, etc. This evaluation should take (insert time) Like I said, I would like your help with an application we are developing. You are one of the people this application is designed to be used by and I would really like to know to know what you think about it, what you think works and doesn’t work for you. We are currently still in and early stage of development, so not everything you see might work right. The procedure we’re going to go through today goes like this: We’re going to start out and talk for a few minutes about how you use the web, what you like and those sort of things. Then I am going to show you the application we are designing for my class and have you try out a couple things with it. Then we’ll wrap up, I’ll ask you a few more questions about it and we’re done. Any questions about anything I have said so far? Now I would like to read you what’s called a statement of informed consent. It is a standard thing that I read to everyone I interview. It sets out your rights as a person who is participating in this kind of research. As a participant in this research: • You may stop at any time. • You may ask questions at any time. • You may leave at any time. • There is no deception involved. • Your answers are confidential. As an added layer of protection for the child and my institution I must have a signed consent form of their consent to be a part of the testing and to being recorded. Any questions? (Hand out consent form)
Thanks so much, shall we begin? Preliminary Interview (Video On) How much time do you usually spend on the internet in a given week? How much of that is for school, and how much is for personal use? What is the one thing you do the most online? How does it feel when you get anxious or sad? What do you do that helps when you get anxious or sad? Do you use the internet or applications to help when you are anxious or sad? How do you use the internet or applications to help when you are anxious or sad? Evaluation Instructions In a minute, we will open the computer and we will look at the application, but first let me give you some instructions about how to use it. The most important thing to remember when you’re using it is that you are testing the application, the application is not testing you. There is absolutely nothing you can do wrong. Period. If anything seems to be broken, wrong, weird, confusing, or messed up it’s not your fault. However, we would like to know about it. So please tell us whenever anything isn’t working for you. Likewise, tell us if you like something. Even if it’s a feature, a color, or the way something is laid out, we’d like to hear about it. Be as candid as possible. If you think something is awful, please say so. Don’t be shy; you won’t hurt anyone’s feelings. Since it’s designed for people like you, we really want to know exactly what you think and what works and doesn’t work for you. Also, while you are using the product I’d like you to say your thoughts aloud. That gives us an idea of what you’re thinking when you’re doing something. Just narrate what you’re doing, sort of a playbyplay, telling me what you’re doing and why you’re doing it. Does that make sense? Any questions? Open the laptop and adjust the computer and mouse so it is comfortable for you to use. First Impressions: What is the first things your eyes are down to? What next? What’s the first thought that comes to mind when you see this home screen? What is the application about?
Are you interested in it? If this was your first time here, what would you do next? What would you click on? What would you be interested in investigating? Tasks: Now I would like you to try a few of things with the interface. Work just as you would normally, narrating your thoughts as you go along. Here is the list of the four task I would like you to complete. The first scenario goes as follows: Let’s say you want to watch a video, how would you do that? Go ahead and show me. (Perform first task) Great thanks. The second thing I would like you to do is return to the first page we were on, how would you do that? Go ahead and show me. (Perform second task) Great thanks. The third task I would like you to do is pretend you want to play a game, how would you do that? Go ahead and show me. (Perform third task) Great thanks. For the final task I would like you to pretend the is a game you would like to play, how would you do that? Go ahead and show me. (Perform fourth task) Wrap Up: Thank you very much. Please close the laptop and we will finish with some wrapup questions. How would you describe the website to someone who had a similar level of computer and web experience as yourself? Is this an interesting application? Is it something you would use? Is this something you would recommend? Why or why not?
Do you have any final questions? Comments? Thank you. If you have any other thoughts or ideas on your way home or tomorrow, or even next week, please feel free to email me. Thanks again. That’s it. We’re done. (Video Off)
Parent User Test Script
Introduction Hello, welcome and thank you for giving me some of your time. How are you today? I’m Drew Curry and today I am here for my Thesis project at Lindsey Wilson College. I am trying to understand how an application we designed works for the people who may use it. I have asked you here to see what you think of the application, how it works, what doesn’t, etc. This evaluation should take (insert time) Like I said, I would like your help with an application we are developing. You are one of the people this application is designed to be used by and I would really like to know to know what you think about it, what you think works and doesn’t work for you. We are currently still in and early stage of development, so not everything you see might work right. The procedure we’re going to go through today goes like this: We’re going to start out and talk for a few minutes about how you use the web, what you like and those sort of things. Then I am going to show you the application we are designing for my class and have you try out a couple things with it. Then we’ll wrap up, I’ll ask you a few more questions about it and we’re done. Any questions about anything I have said so far? Now I would like to read you what’s called a statement of informed consent. It is a standard thing that I read to everyone I interview. It sets out your rights as a person who is participating in this kind of research. As a participant in this research: • You may stop at anytime. • You may ask questions at any time. • You may leave at any time. • There is no deception involved. • Your answers are confidential. • Any questions before we begin? • Let’s Start! Preliminary Interview
(Video On) How much time do you usually spend on the web in a given week? How much of that is for work, and how much is for personal use? Other than email, what is the one thing you do the most online? What is your experience with children with mental illness? Has your experience with childhood mental illness changed how you perceive the topic? How do you use the internet or applications to help provide care? How do you use the internet or applications to support yourself? Evaluation Instructions In a minute, we will open the computer and we will look at the application, but first let me give you some instructions about how to approach it. The most important thing to remember when you’re using it is that you are testing the application, the application is not testing you. There is absolutely nothing you can do wrong. Period. If anything seems to be broken, wrong, weird, confusing, or messed up it’s not your fault. However, we would like to know about it. So please tell us whenever anything isn’t working for you. Likewise, tell us if you like something. Even if it’s a feature, a color, or the way something is laid out, we’d like to hear about it. Be as candid as possible. If you think something is awful, please say so. Don’t be shy; you won’t hurt anyone’s feelings. Since it’s designed for people like you, we really want to know exactly what you think and what works and doesn’t work for you. Also, while you are using the product I’d like you to say your thoughts aloud. That gives us an idea of what you’re thinking when you’re doing something. Just narrate what you’re doing, sort of a playbyplay, telling me what you’re doing and why you’re doing it. Does that make sense? Any questions? Open the laptop and adjust the computer and mouse so it is comfortable for you to use. First Impressions: What is the first things your eyes are down to? What next? What’s the first thought that comes to mind when you see this home screen? What is the application about? Are you interested in it? If this was your first time here, what would you do next?
What would you click on? What would you be interested in investigating? Tasks: Now I would like you to try a few of things with the interface. Work just as you would normally, narrating your thoughts as you go along. Here is the list of the four task I would like you to complete. (hand task list) The first scenario goes as follows: You are a parent and you need to navigate to your section of the application, how would you do that? Go ahead and show me. (Perform first task) Great thanks. The second thing I would like you to do is pretend that it is your first time using the site and you need to sign up for an account, how would you do that? Go ahead and show me. (Perform second task) Great thanks. The third task I would like you to do is navigate to where the video library is located, how would you do that? Go ahead and show me. (Perform third task) Great thanks. For the final task, I would like you to watch a video from the library, how would you do that? Go ahead and show me. (Perform fourth task) Wrap Up: Thank you very much. Please close the laptop and we will finish with some wrapup questions. How would you describe the website to someone who had a similar level of computer and web experience as yourself? Is this an interesting service? Is it something you would use? Is this something you would recommend? Why or why not? Do you have any final questions? Comments?
Thank you. If you have any other thoughts or ideas on your way home or tomorrow, or even next week, please feel free to email me. Thanks again. That’s it. We’re done. (Video Off)
Care Provider User Test Script Introduction Hello, welcome and thank you for giving me some of your time. How are you today? I’m Drew Curry and today I am here for my Thesis project at Lindsey Wilson College. I am trying to understand how an application we designed works for the people who may use it. I have asked you here to see what you think of the website, how it works, what doesn’t, etc. This evaluation should take (insert time) Like I said, I would like your help with an application we are developing. You are one of the people this website is designed to be used by and I would really like to know to know what you think about it, what you think works and doesn’t work for you. We are currently still in and early stage of development, so not everything you see might work right. The procedure we’re going to go through today goes like this: We’re going to start out and talk for a few minutes about how you use the web, what you like and those sort of things. Then I am going to show you the application we are designing for my class and have you try out a couple things with it. Then we’ll wrap up, I’ll ask you a few more questions about it and we’re done. Any questions about anything I have said so far? Now I would like to read you what’s called a statement of informed consent. It is a standard thing that I read to everyone I interview. It sets out your rights as a person who is participating in this kind of research. As a participant in this research: • You may stop at anytime. • You may ask questions at any time. • You may leave at any time. • There is no deception involved. • Your answers are confidential. • Any questions before we begin?
• Let’s Start! Preliminary Interview (Video On) How much time do you usually spend on the web in a given week? How much of that is for work, and how much is for personal use? Other than email, what is the one thing you do the most online? What kind of care do you provide to children? Are children the primary group you treat or do you treat people of different ages as well? How do you use the internet or applications to help provide care? How do you use the internet or applications to manage and track your current patients care? Evaluation Instructions In a minute we will open the computer and we will look at the application, but first let me give you some instructions about how to approach it. The most important thing to remember when you’re using it is that you are testing the application, the application is not testing you. There is absolutely nothing you can do wrong. Period. If anything seems to be broken, wrong, weird, confusing, or messed up it’s not your fault. However, we would like to know about it. So please tell us whenever anything isn’t working for you. Likewise, tell us if you like something. Even if it’s a feature, a color, or the way something is laid out, we’d like to hear about it. Be as candid as possible. If you think something is awful, please say so. Don’t be shy; you won’t hurt anyone’s feelings. Since it’s designed for people like you, we really want to know exactly what you think and what works and doesn’t work for you. Also, while you are using the product I’d like you to say your thoughts aloud. That gives us an idea of what you’re thinking when you’re doing something. Just narrate what you’re doing, sort of a playbyplay, telling me what you’re doing and why you’re doing it. Does that make sense? Any questions? Open the laptop and adjust the computer and mouse so it is comfortable for you to use. First Impressions: What is the first things your eyes are down to? What next? What’s the first thought that comes to mind when you see this home screen? What is the application about?
Are you interested in it? If this was your first time here, what would you do next? What would you click on? What would you be interested in investigating? Tasks: Now I would like you to try a few of things with the interface. Work just as you would normally, narrating your thoughts as you go along. Here is the list of the four task I would like you to complete. (hand task list) The first scenario goes as follows: You are a care provider and you need to navigate to your section of the application, how would you do that? Go ahead and show me. (Perform first task) Great thanks. The second thing I would like you to do is sign in as if you already have an existing account, how would you do that? Go ahead and show me. (Perform second task) Great thanks. The third task I would like you to do is pretend you have a new patient under your care and want to add them, how would you do that? Go ahead and show me. (Perform third task) Great thanks. For the final task I would like you to do is to view information about how the child under your care is doing at completing their treatment, how would you do that? Go ahead and show me. (Perform fourth task) Wrap Up: Thank you very much. Please close the laptop and we will finish with some wrapup questions. How would you describe the website to someone who had a similar level of computer and web experience as yourself? Is this an interesting service? Is it something you would use?
Is this something you would recommend? Why or why not? Do you have any final questions? Comments? Thank you. If you have any other thoughts or ideas on your way home or tomorrow, or even next week, please feel free to email me. Thanks again. That’s it. We’re done. (Video Off)
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Date: _________
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Staggs, S. (2017, January 30). Childhood Anxiety and Depression Expert Interview. (D. Curry, Interviewer) The Nemours Foundation. (2014, March 1). Anxiety Disorders. Retrieved from KidsHealth.org: http://kidshealth.org/en/parents/anxiety-disorders.html?view=ptr&WT.ac=p-ptr The Nemours Foundation. (2016, August 1). Depression. Retrieved from Kidshealth.org: http://kidshealth.org/en/parents/understanding-depression.html?view=ptr&WT.ac=p-ptr Waer, D. T. (2017, January 30). Childhood Anxiety and Depression Expert Interview. (D. Curry, Interviewer)