Ethical design and evaluation of digital technology to support play behaviours: a hospital case study with young children, parents and practitioner

Abstract

In the last decade, children’s access to a variety of applications on tablet devices has increased. Similarly, there has been an increase in the technology used in paediatric clinical settings, with the aim of improving children’s wellbeing, primarily for distraction or therapeutic purposes. The benefits of employing play strategies for therapeutic intervention purposes in hospitals has been well researched. Nonetheless, the potential of technology to support and encourage playful behaviour in hospital environments is underexplored. In particular, the ways in which apps can foster playful interactions between children and their parents or carers in hospitals has not been investigated. Therefore, this thesis qualitatively explores the ethical design and evaluation of an iPad application (Lolli and Friends) aimed at fostering play behaviours with young children, parents and practitioners in a hospital setting. Through analysis of an evaluation in a children’s hospital, the findings provide evidence of the potential of apps to facilitate various play behaviours in a digital environment, when targeted at young children aged 3-5 in a clinical context, and employed together with adults. The results of the iterative design process and the evaluations of the two prototypes developed during the doctoral study indicate that the Lolli and Friends app was enjoyable to use, having the potential to foster several play behaviours (such as creative, exploratory or imaginative play) when used by various young children with different abilities and needs. The interactions of the children and parents with the digital system also revealed a dyadic social dimension, which supported play and learning behaviours. The main contributions of the thesis are the design of an application, derived from a comprehensive user-centred design approach which capture the needs and preferences of different stakeholders, the findings of the in-depth hospital evaluation of the application, as well as a transparent and thorough account of institutionalised and situational ethics practices entailed by this hospital study. The contextual implications of evaluating technology in a sensitive context are reflected upon. Qualitative case study analysis, based on frameworks including Hughes (2002), Marsh et al. (2015), Broadhead (2006) and Plowman and Stephen (2007), was conducted to understand and explain young children’s digital play behaviours, as well as to unravel the social dimension of their parents’ interactions. Furthermore, design requirements and guidelines for designing digital media are established and discussed, as a result of the design process and evaluation analysis.