PROMOTING SEXUAL HEALTH THROUGH HCI

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Designing for adolescent children

In order to identify which features should be implemented in a digital product so that users such as teenage foster children would feel secure and motivated, we should first of all, look at the specific target groups and understand their issues and needs. Second of all, we need to observe similar studies where different design elements are used in order to immerse, motivate and teach users such as children and adolescents in an efficient way. Each point that is mentioned below is related to studies that revolve around adolescents users and different design features used for solving specific issues for the user.

Adolescent users

Concerning cognitive development during adolescence, according to Steinberg (2005), many of the sections of the brain being developed during that period of time, are responsible for regulating emotion and behavior, and to evaluate risk and rewards. Furthermore, the changes in motivation and changes that occur during puberty, creates a disconnection between the adolescent’s ability to regulate motivating and effective experience. Steinberg (2005) compares developments of early adolescence with starting an engine without having an experienced driver behind the wheel. Even though the brain is still being developed during early adolescence, Steinberg (2005) states that individuals show progress in, information processing and deductive reasoning.
As mentioned earlier, when it comes to adolescent users and user experience design, there might be many differences when compared to younger children. According to Arteaga and Kurniawan (2011), adolescent users also known as teenagers, often want to socialize with their friends and peers. By implementing features and functions that can assist adolescent users in socialize with each other; the user experience can improve significantly. The authors suggest other aspects that can be effective for this particular user group which are competition, self-competition and rewards. Presenting challenges will encourage user in using critical thinking in an effective way which leads to relevant information being processed more efficiently. Another feature that is suggested by Arteaga and Kurniawan (2011) is simplicity. Most adolescent users are not interested in spending time learning how the product functions. This means that the product should be easy to use and understand for the users.

Social Component

In Arteaga and Kurniawan’s (2012) study which revolves around designing an application in order to motivate teenagers’ in physical activity, it is mentioned that teenagers are usually motivated in using exercise applications if socialization and socializing are involved. Knowing this, by implementing social components in a digital product, teenage users can be encouraged to socialize with other users. This can lead to users communicating, interacting and sharing information with each other. One example is sharing your experience and information on an online forum where other users can provide feedback by using the digital product. Another example can be the ability to create and invite other users to an outdoor activity by using a mobile application. The authors also suggest motivating users in socializing through virtual prizes which can be shared by friends. In addition, presenting users with challenges can also motivate teenage users in socializing with each other.

Text

Continuing with Arteaga and Kurniawan’s (2012) research in regards to presenting text to the users, the authors mention the minimum use of instructional text in their app. Since teenagers are not interested in reading or receiving too much information, designers should be cautious in presenting irrelevant information for the user. One method that is used in Arteaga and Kurniawan’s (2012) application regarding information is the top-down approach. This approach focuses on placing essential information and options on the top. Gelmen (2014) writes that while designing for children and adolescent users, designers should rely more on the visual display and less on text explanations, considering that children and young adolescents have difficulties in scanning words on a screen. At the same time, designers should not make the information too simple for the user or in other words “dumbing down” the information. There should also be a right balance between text and white space on the display. If the users are presented with too much text, they will have difficulties in processing and identifying relevant information.
According to Mayer (2001), compared to adults, teenagers are less tolerant towards pages that include a high amount of text. In order to make reading less overwhelming for the users, the design should break up the text using visuals. Here, Mayer uses cognitive theory to explain that having too many visuals and text, can overload the visual channels of the user. Furthermore, Mayar, Heiser and Lonn (2001) indicate that extraneous visuals which are purely decorative will take away the user’s attention from relevant content on a screen. A theory also known as the “multimedia principle” which was presented by Mayer (2001), suggests that people are able to process information better if words are associated with pictures than from using only words. Nevertheless, this does not mean that by only adding pictures to words will make receiving information more efficient. To summarize, to present information efficiently one should “select relevant information, organize it into coherent representations, and integrate it with other knowledge” (Mayer & Moreno, 2002, p. 111). However, as Mayer (2001) stated, in order to process information efficiently, the user needs to have a deep understanding of the material which includes mentally organizing the important aspects of the materials into a coherent cognitive structure when later is integrated with relevant prior knowledge. This means that the materials should be presented in specific ways in order to learn the materials with less difficulty.
In order to prevent the user’s cognitive channels to overload, Mayer and Moreno’s (2003) suggest different methods for reducing cognitive overload in specific scenarios. One scenario is when one or both visual and auditory channels are overloaded by incidental and essential processing. Here, interesting but irrelevant materials should be eliminated in order to avoid cognitive overload. Also, providing signs and cues for how the materials should be processed will reduce the processing of irrelevant materials. In the next scenario, similar to the previous one, both of the channels are overloaded by incidental and essential processing. The difference is that the materials are presented in a confusing manner. By placing words close to the corresponding parts of graphics and avoiding the use of identical spoken and printed words, irrelevant cognitive load can be reduced.

Sound

Regarding sound and audio, Gelman (2014) mentions in her book that combining short audio segments with reading and animations works perfectly with adolescent users, specifically for users that have a short attention span. Mayer’s (2001) redundancy principle also suggests that by implementing sound alongside text, cognitive overload can be reduced. However, sound should not replicate, but to complement the text that appears on screen and designers should avoid presenting identical content in different methods. Additionally, environmental sounds and background music should be avoided according to Moreno & Mayer (2000). Particularly when a high amount of information is being presented to the user and heavy cognitive processes are required.

Rewards

As mentioned earlier, one aspect that can motivate adolescent users in better critical thinking and processing information more efficiently is rewards, competition and self-completion. Regarding teenage users, Fitton and Bell (2014) mention that the users’ sense of understanding inside their brain increases when they are presented with rewards and risks. When it comes to rewards and motivators, Arteaga et al. (2010) categorize the motivators into two groups, external motivators and internal motivators. The first type of motivators which are called external motivators can be defined as rewards for behaviors such as receiving a medal for winning a sporting activity, getting money for doing chores or praise from the teacher for doing your homework. Internal motivators however, are associated with personal rewards such as being happy, being excited or being satisfied.
One example of rewards being used in a digital product is a family health app developed by Katule, Rivett and Densmore (2016) where virtual rewards motivate users in using the health app. The app uses badges as rewards in order to provide the user with a sense of accomplishment while at the same time uses leaderboards to help players feel socially connected and that they are collaborating with each other. Another example of using rewards to motivated users is a mobile fitness app called BunnyBolt. In this app, created by Lee et al. (2013), badges are used as a reward system and are given to the player by completing a variety of tasks. This way, by combining the practical concern of workouts with the entertaining aspect of an interactive game, the players will have an incentive to continue playing.
It is commonly known in the field of design that keeping the user’s attention on the information presented in a digital product can be difficult. Regarding adolescent foster children, in order to integrate into the foster system more efficiently, a large amount of information needs to be processed by the user. By implementing a reward component into the product, users’ engagement and motivation for going through the information might increase. A summary of the design features for adolescent children mentioned in this chapter can be found in table 1 below.

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Related Work

Promoting sexual health through HCI

In a study related to promoting sexual health by using HCI (Human-Computer Interaction), Wood et al. (2017) use user-centered design process and include 58 adolescents as participants. In the study which lasted for 18 months, the participants were involved in the design and evaluation process for a multiplayer mobile game. The authors argue that technologies such as mobile phones have recently become a primary source for information about health and if used properly, many of the problems regarding health awareness can be solved. The game aims to promote sexual health by peer-led interactions and bringing the participants out of their comfort zone when it comes to discussing sex and sexuality. Wood et al. (2017) use two different techniques for involving adolescent participants in the center of the design process. The first method was to treat the participants as ‘research informants’ while the second method was to treat them as ‘design partners’ where their suggestions and design input are included in the design process. In the end, Wood et al. (2017) suggest that digital approaches that are lightweight can be successful in making it easier among adolescents to talk about sex. Furthermore, the control of the conversation should be shared between all stakeholders and even problematic and uncomfortable interactions can turn into opportunities to discuss sex.

Application to Motivate Teenagers’ Physical Activity

When it comes to physical activity for adolescents, Arteaga and Kurniawan (2012) realized that the lack of motivation for physical activity might be due to obstacles such as the parent’s busy schedule or the lack of safe environments. To solve this, community intervention programs were tested with some success. However, one issue with intervention program is that they can be problematic and expensive to maintain. This is why the authors believe that many of these issues can be solved by using technologies such as mobile applications. In their study, Arteaga and Kurniawan (2012) present design guidelines for developing applications that are aimed to motivate adolescents to do more physical activity. Some of these design features include implementing voiceover for text inside the app or presenting users with rewards when completing a physical activity goal.
The prototype which was developed for second-generation iPhones or iPod Touch platform includes a carnival theme where players (teenagers) can play two games, earn points and later trade those points for virtual rewards. The application consists of six components which include the simplicity component, variation component, socialization component, competition component, outdoors component and activity detection. By the end of the study, a modified set of design guidelines that included playing audio with texts that were believed the teenagers needed to read. Furthermore, it was revealed that collection rewards and bonuses for completing a physical activity task kept the players more motivated and happy.

Evaluation of Web Usability Guidelines for Teens

As mentioned earlier, very little research has been done regarding human-computer interaction and adolescents. Therefore, Bailey and Seals (2017) conducted a study in order to identify which design features are more appealing and satisfactory for the user. In their research, the authors use a web usability design guidelines created by McCloskey et al. (2013) and an evaluation method named BAM! The evaluation was done by asking eight teenager participants to rate a website based on aesthetic appeal, satisfaction, engagement and ease of use. McCloskey et al. (2013) usability guidelines cover a range of design recommendations amid for teenagers such as music, multimedia, videos, images, mobile devices social networking and so on.
For this study, Bailey and Seals (2017) developed a web page that was based on McCloskey et al. (2013) usability guidelines. After interacting with the website, the participants rated “ease of use” as the best element of the site. The reason for this is that according to the users, making the information presented on the web page easier to read and understand made it easier for them to navigate throughout the web page. The satisfactory element was rated second while engagement and the aesthetic appeal were rated the lowest. In the end, the findings that were gathered in the study confirmed that the website and many of its design features are consistent with the guidelines that were used in this study. Three of the main elements that highlighted by Bailey and Seals (2017) was designing a teen-specific website and using mega menus and large clickable areas.
While the studies that were mentioned above revolves around adolescent users and design guidelines, none of them focuses on identifying the needs for vulnerable users such as foster children. And since different types of users have different needs, it is essential that the user experience for a product is designed in a certain way that would assist the user in achieving their particular needs. As previously mentioned, one part of this study aims to identify the needs of adolescent foster children which will assist in creating a set of design guidelines. The guidelines will essentially contribute to designing and evaluating digital services for adolescent children in foster care.

Method and implementation

 Design

In order to solve the problem presented earlier in this study, a new set of UX design guidelines needs to be presented, tested and evaluated. In order to do so, a type of prototype which includes these particular guidelines is needed. Having this in mind, the most suitable and efficient research method for this project would be “Design Science research methodology”. According to Peffers et.al. (2007):
“It (design science) involves a rigorous process to design artefacts to solve observed problems, to make research contributions, to evaluate the designs, and to communicate the results to appropriate audiences. Such artefacts may include constructs, models, methods, and instantiations. They may also include social innovations or new properties of technical, social, or informational resources; in short, this definition includes any designed object with an embedded solution to an understood research problem.” (Peffers et.al., 2007, p.49)
In their research, Peffers et.al. (2007) present six activities that should be conducted in a design science research methodology. These activities include problem identification, defining the objectives for a solution, design and development, demonstration, evaluation and communication.

Contents
1 Introduction
1.1 BACKGROUND
1.2 PURPOSE AND RESEARCH QUESTIONS
1.3 DELIMITATIONS
1.4 OUTLINE
2 Theoretical background
2.1 EHEALTH
2.2 ADOLESCENCE
2.3 FOSTER CHILDREN
2.4 FOSTER CHILDREN AND THEIR NEEDS
2.5 ACCESS TO INFORMATION
2.6 USER EXPERIENCE DESIGN
2.7 SOCIAL SUSTAINABILITY
2.8 USER CENTERED DESIGN
3 Designing for adolescent children 
3.1 ADOLESCENT USERS
3.2 SOCIAL COMPONENT
3.3 TEXT
3.4 SOUND
3.5 REWARDS
4 Related Work 
4.1 PROMOTING SEXUAL HEALTH THROUGH HCI
4.2 APPLICATION TO MOTIVATE TEENAGERS’ PHYSICAL ACTIVITY
4.3 EVALUATION OF WEB USABILITY GUIDELINES FOR TEENS
5 Method and implementation
5.1 DESIGN
5.2 SEMI-STRUCTURED INTERVIEWS
5.3 HEURISTIC EVALUATION
5.4 WIREFRAMES AND USER FLOW
5.5 PROTOTYPE
5.6 PARTICIPANTS
5.7 PROCEDURE
5.8 ETHICAL CONSIDERATIONS
6 Findings and analysis 
6.1 FIRST INTERVIEW WITH VÄSTRA HISINGENS COMMUNITY
6.2 SECOND INTERVIEW WITH VÄSTRA HISINGENS COMMUNITY
6.3 HEURISTIC EVALUATION
6.4 USABILITY TEST
6.5 GUIDELINES
7 Discussion and conclusions 
7.1 DISCUSSION OF METHOD
7.2 DISCUSSION OF FINDINGS
7.3 CONCLUSIONS
8 Future Work
9 References
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User experience design for adolescent children in foster care: Considerations and guidelines

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