Applied gaming for a non-smoking generation

Hester van Zuthem

End of March the project 'Applied gaming for a non-smoking generation' started. In this project we collaborate with the Dutch Youth Health Centre (Nederlands Centrum Jeugdgezondheid, in Dutch), VUmc, GGZ Amsterdam and the end users, to develop game elements for young (expectant) mothers in order to help them quit smoking.

The challenge
If you have ever watched the tv-programme ‘Four hands on a belly’ (‘Vier handen op een buik’, in Dutch), you can imagine what it is like: young women, or girls actually, pregnant of their first child. Taking responsibility and adopting a healthy lifestyle, including not smoking, is an everyday challenge. Although these girls know about the potential harms of smoking for their baby, stop smoking is easier said than done. Commonly heard excuses to not quit smoking are: “If I quit smoking I feel stressed, which is even more harmful for my baby.” “If I quit smoking I’ll gain weight.” Or “My mom also continued smoking during her pregnancy.” How can we break this circle with playful design interventions?

Facts & figures
In the Netherlands, 22% of pregnant women with a low social-economical status smoke.[1] Smoking behaviour of those mothers-to-be is often related to other factors such as social, financial or health issues. Smoking hinders a healthy development of the upcoming child and increases their chance of having lung diseases, cardiovascular diseases and cancer. Also, children of smoking parents are more inclined to start smoking themselves, which further increases these risks on the long run.

Fortunately, these women are not alone in this. There is a national program to support young (expectant) mothers named VoorZorg. The program is organized by the Dutch Youth Health Center and offers intensive support in health and lifestyle. VoorZorg focuses on low educated young women (aged under 25) who are pregnant of their first child. They are supported until two years after delivery. The VoorZorg program has been proven effective both the Netherlands and abroad. Many women stop or reduce smoking during pregnancy.[2] However, 33% of the participants continue smoking and 49% started smoking again after they gave birth. [3]

Where to start?
In the project, we will work closely with VoorZorg nurses and other stakeholders. The first phase of the project is dedicated to user research and co-creation with the end users: young (expectant) mothers, someone from their social network, and VoorZorg nurses. This is quite a challenge, because how do you do you put yourself in the shoes of a target group that is so different from yourself? How to involve them in the co-creation process and make them feel a sense of ownership over the interventions that we will develop?

With the use of (mobile) contextmapping tools we will try to get as close as possible to the world of women. Questions to be answered are: How does their daily life look like? At which moments do they feel the need for a cigarette, and where does this need come from? What do they know about the possible harmful effects of smoking? What would motivate them to stop, and what not?

This way, we will develop smart interventions with the users instead of for them.

[1] TNO Innovations for Life. Factsheet Roken tijdens de zwangerschap. Percentages over de periode 2001-2015. September 2015.

[2] VoorZorg voorkomt verwaarlozing en kindermishandeling in risicogezinnen

[3] Mejdoubi J, Van den Heijkant S, Van Leerdam F, Crone M, Crijnen A, HirsaSing R. Effect of nurse home visitation on cigarette smoking, pregnancy outcomes and breastfeeding: A randomized controlled trial. Midwifery 2014 30:688–695

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