Exploring ambient technology for connecting hospitalised children with school and home

https://doi.org/10.1016/j.ijhcs.2014.04.003Get rights and content

Highlights

  • Hospitalised children suffer isolation which impacts their well-being.

  • Attempts have been made to use off-the-shelf ICT to ameliorate isolation.

  • Sensitive contexts at hospital and school make the use of existing technologies problematic.

  • We trialled lightweight communication technology for hospitalised children.

  • Ambient awareness and photo-sharing show promise for creating social connectedness.

Abstract

Children undergoing long-term hospital care face problems of isolation from their familiar home and school environments. This isolation has an impact on the emotional wellbeing of the child. In this paper we report on research that explores the design of technologies that mitigate some of the negative aspects of separation, while respecting the sensitivities of the hospital, school and home contexts. We conducted design workshops with parents, teachers and hospital staff and found that there was a strong desire for mediated connection, but also a significant need to protect privacy and avoid disruption. In response we designed a novel technology that combined an ambient presence with photo-sharing to connect hospitalised children with schools and families. This paper reports on the field trial of the technology. The research provides new insights into how technology can support connectedness and provides a foundation for contributing to the wellbeing of children and young people in sensitive settings.

Introduction

Children who are hospitalised for significant periods of time face a number of challenges to their wellbeing. Apart from distress caused by physical symptoms, children are likely to experience social dislocation from family, community and peers. This is exacerbated because the dislocation is occurring at a time in the young person׳s life when engagement with peers is critical (Hopkins et al., 2014b). Prolonged absence from school can lead to isolation from friends and disruption to learning. While some paediatric hospitals offer education programs, hospitalised children miss out on opportunities to play and to engage in joint activities with friends. At the same time there is a risk that being “out of sight and out of mind” will disrupt friendships and lead to anxiety about returning to school.

Communication technology is frequently used to bridge geographical separation and to mediate support over a distance. Some schools and parents are already using off-the-shelf technology to connect with children in hospital (Nisselle et al., 2012), and research in the hospital setting has shown that children want to feel connected to their classrooms and friends and to feel ‘normal’ despite hospitalisation (Nisselle et al., 2012, Hopkins et al., 2014a, Hopkins et al., 2014b). However there is little research into the effects and suitability of this mediated communication with hospitalised children. The consequence is that there is little evidence about the specific communication challenges faced in this situation, and how hospital, school and home environments affect the use and usefulness of existing technologies.

This paper explores issues concerning the contextual factors surrounding mediated child–school–family interactions. Following exploratory work using ambient technology to connect the hospitalised child with their school (Vetere et al., 2012), we conducted design workshops with parents and hospital and school staff to better understand the problems they face in maintaining connection over a distance. We designed a tablet-based technology and conducted a field trial over several weeks in a paediatric hospital and in several homes and schools. We report on the results of the trial below. Our work contributes to an understanding of the challenges and constraints that apply in these sensitive contexts. It details our design of a technological support to address them and the impact of the technology on the users.

Section snippets

The impact of hospitalisation on wellbeing

Hospitalisation can be upsetting and stressful for children (Vernon et al., 1962, Bossert, 1994, Thomson, 2012). Protracted periods of hospitalisation and repeat admissions can result in a disrupted school experience and discontinuity of learning (Wolfe, 1985, Shiu, 2001). This places children at risk of social isolation from their school community (Martinez and Ercikan, 2009). For families, having a child in hospital means changes to routines and responsibilities. Siblings may respond

Research design

We conducted our work in three phases.

  • Phase A: Co-Design Workshops – in phase A we held a series of co-design workshops to explore the desirability of, and constraints upon, mediated communication for children in hospital and their teachers and parents, with a view to informing the design of a supporting technology. We held workshops with stakeholders corresponding to each of the three contexts of hospital, school and home. This phase generated a rich understanding of the divergent needs of

Phase A: co-design workshops

We conducted workshops with three stakeholder groups: parents, teachers, and hospital staff. The aim of the workshops was to clarify the needs and constraints faced in the contexts of hospital, school and home and to generate and discuss ideas for technologies.

Understanding contexts of use was critical in this phase. Schools and hospitals are highly structured and regulated, particularly in relation to care of children, where the institution stands in loco parentis for a broad range of children

Phase B: technology design and implementation

Based on the workshop findings we designed the Presence App to explore the role of technology in mediating social connections for hospitalised children.

Participants

We conducted a study with nine inpatients at a paediatric hospital using the Presence App. The hospitalised children were aged between seven and twelve years and were enroled in a primary (elementary) school. Each child recruited to the trial had a serious health condition involving an expected inpatient stay of two weeks or more. They varied in the degree to which they were already using mediated connections to school and home. Their families were offered the opportunity to trial the tablet at

Results

The use of an ambient technology to support the social presence of a hospitalised child was generally well received by children and teachers in this trial, though less so by parents (which is explored further in Section 8).

Analysis of interview data revealed the following themes emerging in the research: the impact of a child׳s illness: use of existing technologies; Connection to social life; and Ambience, awareness and presence. These themes are discussed below, while implications for

Discussion

Prolonged or frequent hospitalisation can present significant challenges to the social and emotional wellbeing of young patients and their connectedness with family and peers. Hospitals and classrooms are uniquely challenging contexts for the use of communication technology. Through human-centred design and evaluation this study sought to shed light on the complex issues relating to communication between a hospitalised child and their family and friends, and on the basis of this understanding

Conclusion

Children who are absent from school for long periods due to hospitalisation can benefit from a mediated connection with their school, friends and family. The views expressed during co-design and the positive reaction to our technology, as well as prior work on mediated connection, indicate that awareness of activity and a sense of daily rhythms at school assists with maintaining and strengthening connections between hospital and school. But significant constraints regarding privacy and

Acknowledgements

The authors gratefully acknowledge financial support from the Institute for a Broadband Enabled Society at the University of Melbourne, and the Department of Education and Early Childhood Development, Government of Victoria. The Royal Children׳s Hospital Education Institute is funded by the Victorian Government Department of Education and Early Childhood Development. We thank Huawei Australia for providing tablet computers. Our funding sources and supporters had no role in designing the study,

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