International Journal of Human-Computer Studies
Exploring ambient technology for connecting hospitalised children with school and home
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,
References (48)
- et al.
Students׳ perspectives on cyber bullying
J. Adolesc. Health
(2007) - et al.
Lovers׳ box: designing for reflection within romantic relationships
Int. J. Human–Comput. Stud.
(2011) - et al.
On phatic technologies for creating and maintaining human relationships
Technol. Soc.
(2011) - et al.
Making love in the network closet: the benefits and work of family videochat
Computer Supported Cooperative Work
(2010) - et al.
Live interactive frame technology alleviating children stress and isolation during hospitalization
Ambient Assist. Living Lect. Notes Comput. Sci.
(2011) Stress appraisals of hospitalized school-age children
Child. Health Care
(1994)- Brush, A.J.B., Inkpen, K.M., Tee, K., 2008. SPARCS: exploring sharing suggestions to enhance family connectedness. In:...
- Campbell, M.A., 2005. The impact of the mobile phone on young people׳s social life. In: Proceedings of the Social...
- et al.
Is biology destiny? Birth weight and life chances
Am. Sociol. Rev.
(2000) - et al.
Social presence in a home tele-application
CyberPsychol. Behav.
(2001)
The role of children in the design of new technology
Behav. Inf. Technol.
Personality and online/offline choices: MBTI profiles and favored communication modes in a Singapore study
CyberPsychol. Behav.
Health and the educational attainment of adolescents: evidence from the NLSY97
J. Health Soc. Behav.
Staying engaged: the role of teachers and schools in keeping young people with health conditions engaged in education
Aust. Educ. Res.
Embedding learning in a paediatric hospital: changing practice and keeping connected
Int. J. Incl. Educ.
Adolescents with health conditions at risk of educational disengagement: how hospital practice mitigates risk
Youth Stud. Aust.
Chronic physical illness and mental health in children. Results from a large-scale population study
J. Child Psychol. Psychiatry
Supporting pupils in mainstream school with an illness or disability: young people׳s views
Child Care Health Dev.
Control over social interactions: an important reason for young people׳s use of the Internet and mobile phones for communication?
CyberPsychol. Behav.
Cited by (32)
Understanding research related to designing for children’s privacy and security: A document analysis
2023, Proceedings of IDC 2023 - 22nd Annual ACM Interaction Design and Children Conference: Rediscovering ChildhoodCritical analysis of the potential of social robotics in higher education for the management of illness and bereavement
2023, International Conference on Higher Education AdvancesResearch on online inclusive education in Taiwan in the era of COVID-19
2023, International Journal of Inclusive EducationUse of Telepresence Systems to Enhance School Participation in Pediatric Patients with Chronic Illnesses Involving the CNS
2022, Zeitschrift fur NeuropsychologieThe effectiveness of a training program at improving integrated classroom teachers’ skills in distance education during the COVID-19 Pandemic.
2022, Journal of the Faculty of Education, Alexandria University