*5.4. Focus Groups*

TikiTako adventure game—With regard to the adventure game, participants from the pre-pilot study indicated that they got stuck after a few levels. It was too difficult for them to continue the game and therefore they stopped playing. Several participants said that the hints in the game were too cryptic and that advice from the virtual coach (as a game guide) was difficult to understand. Furthermore, they said the look and feel of the game was childish and did not match the difficulty level of the game. Even after in-game feedback was simplified and made less cryptic, participants from the pilot study generally indicated that the TikiTako adventure game was too childish in terms of its graphics and storyline and this simplicity did not match with the difficult and highly complex puzzles.

Mini games—Participants from both study groups indicated that the interface was not user friendly as users did not know they could use the "help" button to get more information about how to play the game. One participant suggested that it might be good to receive information about this before or during the mini game. In addition, participants found the (menu) buttons too small. Mini games about food and intake of insulin were seen as more useful for children recently diagnosed with diabetes. Furthermore, the look and feel of the mini games was described as childish and did not match with the difficulty level of the mini games. Even after the number of points needed to reach the goal at the end of the games was lowered, puzzles remained highly complex according to the pilot study participants.

Virtual coach—Participants in both study groups were positive about the timing of messages and the number of reminders sent. Participants also provided positive feedback about the weekly overview messages given by the virtual coach, although they were not noticed by all participants. One participant from the pre-pilot study explained that receiving messages (or notifications) from the virtual coach helped to support their self-management. Participants in the pre-pilot group indicated that an overlay image of the virtual coach on their screen was annoying when they received a message from the coach. Therefore, the interface of the virtual coach was revised for the pilot study (i.e., messages were made clickable so that the whole message was visible at first instance) so that participants could be aware that more content was available than just the label text on the message box. Participants in both the pre-pilot and the pilot study said that educational movies presented by the virtual coach about diabetes were nice but became boring after multiple viewings. During both studies participants said that because of synchronization problems and requirements to enter data on a daily basis (and not after each measurement), feedback from the virtual coach was not up-to-date and therefore perceived as incorrect. More importantly, the coach was not developed to respond immediately to high or low glucose readings leading participants to suggest that it would be good if the virtual coach could send messages when measurements differed from normal values.

Sensors—Participants from both study groups liked the idea that sensor data can automatically be sent to the PERGAMON platform. However, not every participant was enthusiastic about wearing a Mi-Fit band or changing their trusted blood glucose meter for a new meter that automatically sends the glucose data to the platform (i.e., most participants used a pump and other glucose monitors). Entering the glucose measurements by hand was perceived as a lot of extra work and a hurdle with this technology.
