P oceedings 2019, 31, 68; doi:10.3390/p oceedings2019031068 www.mdpi.com/jou nal/p oceedings
P oceedings
Close2U: An App o Moni o ing Cance Pa ien s
wi h a Gami ica ion Sys em o Imp o e he
Engagemen †
Ja ie Na a o-Alamán 1,*, Raquel Lacues a 1,2, I án Ga cía-Maga iño 3 and Jesús Galla do 1
1 Depa men o Compu e Science and Sys em Enginee ing, Uni e si y o Za agoza, 50009 Za agoza, Spain;
[email p o ec ed] (R.L.); jesus.galla do@uniza .es (J.G.)
2 Ins i u o de In es igación Sani a ia A agón, Uni e si y o Za agoza, 50009 Za agoza, Spain
3 Depa men o So wa e Enginee ing and A i icial In elligence, Complu ense Uni e si y o Mad id,
28040 Mad id, Spain; [email p o ec ed]
* Co espondence: [email p o ec ed]; Tel.: +34-978-618-102
† P esen ed a he 13 h In e na ional Con e ence on Ubiqui ous Compu ing and Ambien In elligence
Decembe 2019.5 –2UCAmI 2019, Toledo, Spain,
Published: 21 No embe 2019
Abs ac : Nowadays, gami ica ion o e s se e al ad an ages in o de o mo i a e a change in he
beha io owa ds heal h and wellness. Al hough i is a ela i ely new end, many ields ha e
al eady ealized i s po en ial, and hose ela ed o heal h ha e also begun o make use o i . This
pape in oduces an applica ion de eloped o imp o e pa ien moni o ing and mo i a ion h ough
he use o gami ica ion. We ha e applied he mechanics and dynamics o games in a non-game
con ex , such as he in oduc ion o da a o heal h moni o ing, in o de o a ac he pa ien . Wi h
he use o gami ica ion, we make he in oduc ion o da a less edious and, in addi ion, inc ease
le els o mo i a ion, as a u he bene i . In his wo k we ha e conduc ed a use s udy aimed a
e alua ing he usabili y o gami ica ion. We also s udied he esou ces ha encou age pa ien s o
use he applica ion and how o inc ease hei mo i a ion and sa is ac ion. The esul s show ha he
app is easy o use. Second, hey show ha we implemen ed a scalable and sel - ecu si e sys em.
Finally, hese esul s indica e ha ou sys em o esou ces sha ing is a sys em in which pa ien s eel
com o able when sha ing and ecei ing hose esou ces and hey encou age us o u he
de elopmen s and s udies based on he eedback ecei ed.
Keywo ds: gami ica ion; social in e ac ion; heal h; cance ; mo i a ion; esou ces
1. In oduc ion
Gami ica ion is a e m ha e e s o he use o ideo game elemen s in non-gaming sys ems in
o de o ge a be e use expe ience (UX) and use engagemen [1]. I e e s o he use o game
mechanics in non-play en i onmen s and applica ions in o de o enhance mo i a ion, concen a ion,
e o and loyal y, among o he s, and is abou es ablishing a s a egy o in luence and mo i a e
g oups o people. Gami ica ion is s uc u ed on he mechanics and dynamics o games.
The e has been conside able in e es in applying gami ica ion in he digi al heal hca e indus y.
This g owing in e es was o some ex en spawned by he inequi y o access o heal hca e esou ces,
he lack o adhe ence o ea men and he inc ease in heal hca e cos s [2]. Al hough gami ica ion is
inc easingly used in in e en ions, e idence on i s e ec i eness emains spa se [3]. Howe e , in a
e iew o he li e a u e o gami ica ion in heal h [4], Johnson shows esul s in which 59% a e posi i e
and 41% mixed o neu al. A posi i e no e is ha se e al s udies ound e idence ha applica ions
wi h gami ica ion o ien ed o heal h di ec ly inc eased he well-being o he pa icipan s. When he
end use s a e cance pa ien s, an e alua ion o all he possible in luen ial ac o s in he e olu ion o
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applica ions using gami ica ion is undamen al. Fu he mo e, he need o moni o oncological
pa ien s is conside ed a undamen al aspec in hei ollow-up [5].
In some s udies, such as [4,6], i is shown ha gami ica ion could ha e a posi i e e ec on heal h
and wellbeing, imp o ing hem in a wide a ie y o a eas, o a a ie y o sociodemog aphic g oups,
especially when applied in a skilled way. The e idence is s onge o he use o gami ica ion o a ge
beha io al ou comes, pa icula ly physical ac i i y, and weakes o i s impac on cogni ion. The e is
also an ini ial suppo o gami ica ion as a ool o suppo o he physical heal h ela ed ou comes,
including nu i ion and medica ion use, as well as men al heal h ou comes, including wellbeing,
pe sonal g ow h, lou ishing, s ess and anxie y.
The objec i e in his pape is o in eg a e gami ica ion in an applica ion o he ollow-up o
cance pa ien s, which allows he egis e ing o ea men s and medica ion and includes su eys o
know how hey eel each day. We can unde s and ha moni o ing he eeling o pa ien s by means
o an applica ion is one o a du y o obliga ion. The e o e, in his wo k we ha e added gami ica ion
o gi e mo e dynamism o he pa ien and ha e ied o mi iga e he mono ony and he epe i ion o
ha ing o do he same ac ion e e y day. We ha e applied he mechanics and he dynamics o a game
o ou applica ion, in o de o make hese obliga ions less edious and less o a bu den.
The es o he pape is s uc u ed as ollows. Sec ion 2 analyzes he ela ed wo k. The Close2U
applica ion is desc ibed in Sec ion 3. Sec ion 4 analyzes he me hods ha we use in his esea ch.
Sec ion 5 p esen s he esul s and discussion. Finally, ou conclusions and sugges ions o u u e
wo k a e gi en in Sec ion 6.
2. Rela ed Wo k
We ha e ca ied ou a s udy o applica ions in which gami ica ion has helped pa ien s and in
u n allowed ad ances and disco e ies in medicine. In [7] i can be ound a e iew o some popula
axonomies o iden i y he common s a egies lis ed by some au ho s. A e he s udy, Cugelman
iden i ies six co e ing edien s o gami ica ion, wi h he excep ion o un and play ulness in he ambi
o heal h, because i is impo an no o igno e his and keep i in mind, al hough i is some hing ha
has no ecei ed much a en ion in he heal h beha io change li e a u e. These six mechanics o
gami ica ion a e: goals, challenges, eedback, ein o cemen , p og ess and social. Fu he mo e, o
know be e abou he use s o gami ica ion, Ma czewski p oposed six use ypes ha di e in he
deg ee o which hey can be mo i a ed by ei he in insic o ex insic mo i a ional ac o s [8]:
philan h opis s, socialize s, ee spi i s, achie e s, playe s and dis up o s.
Phy oCloud is a mobile web applica ion ha ocuses on b eas cance pa ien s and which enables
use s o eco d hei die a y habi s and physical ac i i y and mo i a es hem o consume ood wi h
es ogen-like p ope ies. This allows hem o con ol hei own goals and mo i a es hem o achie e
hem and adop heal hie ea ing habi s, while also inc easing physical ac i i y, in o de o ensu e an
imp o emen in hei li es yle and wellbeing [9].
The Pain Squad applica ion collec s in o ma ion abou pain su e ed and he e ec s ha cance
ea men s ha e on child en. This ask mus be done wice a day so ha he collec ed da a can be
aken in o accoun in esea ch. In he case o child en, i is usually a e y edious ask. The game
ollows a heme in which a police pa ol mus sol e a c ime. The child en answe a se ies o ques ions
h ough a sma phone applica ion, whe eby when hey inish, hey ecei e a ewa d o a p ize ha
hey mus collec . The e is also he possibili y o p omo ion wi hin he pa ol and he use can go up
in ank. Each comple ed epo helps he eam o sol e he case. In addi ion, i includes some ideos
in which eal agen s cong a ula e he use o hei achie emen [10].
To help all ypes o pa ien s in hei day- o-day ea men , we ha e s udied he applica ion
Mango Heal h. This applica ion coun s he numbe o imes he pa ien emembe s aking hei
medica ion and ewa ds he pa ien o i inancially. The applica ion sends ale s a he momen a
which he pa ien mus ul ill hei obliga ion in he ea men , and a e aking hei medica ion, hey
a e ewa ded by ob aining poin s. I hey main ain hei commi men o a ce ain ime wi hou e o ,
hese poin s ansla e in o up o 5 o 10 dolla s in gi ca ds o , depending on he ype o a ge ,
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dona ions can e en be made o cha i ies. In addi ion, i shows he p og ess made in he ea men ,
he bene i s i b ings, a his o y and wha emains o he pa ien o do in o de o hei ewa d [11].
The objec i e o Re lexion Heal h is o, as i s mo o says, “ ein en he expe ience o physical
he apy”. Ra i Koma i eddy is also a co- ounde o ‘Re lexion Heal h’, he company ha owns he
p ojec , and he was he one who de ec ed a p oblem when ea ing his pa ien s in ha he e is a lack
o con inui y and commi men on he pa o he pa ien s du ing physical he apies. They de eloped
a i ual pla o m wi h ins uc ions o use a home, which is wa ched h ough a ele ision o any
ype o image playe , and an anima ed ins uc o shows he exe cise o be pe o med. The applica ion
asks he pa ien o ollow he exe cises by copying he a a a ha appea s on he sc een, and o e i y
ha he he apy is ac ually being pe o med, he p og am has a ‘Kinec ’ mo ion cap u e echnology
[12] which compa es he pe o mance o he pa ien wi h ha as equi ed by he p e-con igu ed
i ual he apis . The pla o m acks he pa ien and sends in o ma ion o he doc o , wi h he
necessa y checks pe o med in eal ime o de e ed, o e iew hei p og ess and be co ec ed i
necessa y [13].
In Table 1 we can see he six mechanics o gami ica ion om he s udy o Cugelman [7]
compa ed wi h he a o emen ioned applica ions. I can be seen ha none o he applica ions mee all
he gami ica ion mechanics.
Table 1. The six mechanics o gami ica ion compa ed wi h he applica ions s udied.
Pain Squad Mango Heal h Re lexion Heal h Phy oCloud
Goals Yes Yes Yes Yes
Challenges No Yes Yes Yes
Feedback No No Yes No
Rein o cemen Yes Yes No No
P og ess Yes Yes Yes Yes
Social Yes
1 No No Yes
1
1 Only sha e he classi ica ion wi h all use s.
In conclusion, acco ding o he a o emen ioned wo ks, gami ica ion has been use ul o imp o e
some heal h applica ions. This mo i a es he inclusion o gami ica ion in he de elopmen o he
Close2U applica ion. This app can p o ide analyses o physicians o helping hem o imp o e he
ea men o pa ien s. The no el y o he Close2U applica ion is o include gami ica ion illing he gap
o he li e a u e o he social componen abou connec ing cance pa ien s wi h each o he , o imp o e
he mo i a ion and expe ience o pa ien s. Thus, his app gene a es a social en i onmen o
pa icipa ion ewa ding he sha ing o esou ces by pa ien s. These esou ces (e.g. songs) should
make o he cance pa ien s eel good. A co ec implemen a ion o gami ica ion s a egies [14] allows
o go om me e connec i i y o commi men , achie ing ha any ype o collec i e pa icipa e in a
dynamic and p oac i e way in ac ions ha gene ally equi e an e o o he will.
3. The Close2U Applica ion
This sec ion p esen s he app speci ica ion ha was ag eed a e se e al mee ings wi h pa ien s
and psychologis s, pe o ming usabili y es s, such as Cogni i e Walk h ough. Th ee psychologis s
om he AECC (Spanish Associa ion agains Cance ) in Te uel and wo cance pa ien s we e p esen
h oughou he design and de elopmen p ocess. We imp o ed he app wi h hei eedback,
ollowing a use -cen e ed design. Fo example, we inco po a ed mo i a ion exe cises and hei
acking hanks o he use s’ eedback.
To make he whole sys em easy o use, he use in e ace has been concei ed om a Use -
Cen e ed Design pe spec i e. The applica ion ocuses on all ypes o cance pa ien s, aking bo h
psychological and emo ional aspec s in o accoun , e lec ing he expe ience in he collabo a ion wi h
AECC.
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Sec ion 3.1 p esen s he app speci ica ion, sec ion 3.2 in oduces he sys em a chi ec u e, and
sec ion 3.3 desc ibes he use in e ace, ocusing he gami ica ion pa .
3.1. App speci ica ion
In he app, pa ien s shall be able o c ea e, upda e, dele e and see he de ails o hei medica ion
and appoin men s. Also, hey shall be able o comple e wo dia y su eys, ha ing he op ion o
comple e hem o no , since we do no wan he pa ien o eel i as an obliga ion.
The gami ica ion sys em allows he pa ien s o sha e esou ces wi h he o he pa ien s, no as a
“social ne wo k” i sel , bu as a ne wo k wi h which pa ien s in e ac wi h each o he bu in an
anonymous way.
The ewa ds o pa ien s a e hei own sha ed mo i a ions, being alida ed by he psychologis s
be o e being in oduced hem in o he ewa d sys em. We wan ed ha he con en ha a pa ien can
sha e is no ha m ul o o he pa ien s o is able o demo i a e hem. The p oblem would be no only
ha hey would no use he applica ion, bu also some hing mo e se ious, since i could a ec hem
emo ionally and cause damage in hei way o hinking o his way o dealing wi h he disease. We
mus no o ge ha we a e dealing wi h e y speci ic use s, which a e cance pa ien s.
To ge ewa ds, pa ien s should comple e he daily su ey. They always ge a mo i a ing ph ase
and can choose ano he ewa d. They can choose be ween a mo i a ing esou ce, an exe cise o no
ge ing any hing. The pa ien s shall be able o a e he ph ases and mo i a ional esou ces on a scale
o 1 o 5. The pa ien shall also be able o pe o m an exe cise, p e iously c ea ed by he psychologis s
wi h some s eps o make and some epe i ions.
The pa ien has a pe sonal poin s classi ica ion, in which he gains expe ience e e y ime he
pe o ms ac ions in he app. The o al poin s co espond o a classi ica ion (a) F om 0 o 5000 poin s,
B onze (b) F om 5001 o 10,000 poin s, Sil e and (c) F om 10,001, Gold.
Each ime hey pe o m one o he ollowing ac ions he pa ien ecei es poin s: Conduc a
su ey, c ea e an appoin men , modi y an appoin men , c ea e a medica ion, modi y a medica ion,
upload a ewa d, ge he ewa d accep ed by he psychologis , assess a ewa d ecei ed, and pe o m
an exe cise. All he ac ions be o e men ioned has a alue o 50 poin s.
We wan o ewa d he pa ien whene e hey sha e some hing, e en i hey sha e some hing
ha is sensi i e o o he pa ien s. In his way, hey a e in ended o mo i a e hem, since he o he
esou ces hey sha e can be good o o he pa ien s, and so we do no punish o cu some hing ha
we wan o encou age. I some p oblem is de ec ed in a e y popula esou ce, he psychologis s will
be in cha ge o elling he pa ien some hing ela ed o ha esou ce o why he has done i . On he
o he hand, i he esou ce is sui able, we will gi e he pa ien mo e poin s in o de o ewa d him.
The esou ces aised by he pa ien s ha e o keep a con ol, so ha hey could no sha e hings
ha could be ha m ul o o he pa ien s. The psychologis s can check he assessmen ha pa ien s ha e
gi en he esou ce, and i a esou ce is anked e y low by o he pa ien s, he psychologis will alue
i is necessa y o deac i a e i , i hey hink i is ha m ul o o he pa ien s. The psychologis s will be
able o make cus om exe cises o he pa ien s, which can ha e he subjec ha psychologis s hink is
con enien .
3.2. Sys em A chi ec u e
Figu e 1 shows he Close2U sys em a chi ec u e. As i can be seen, o he on -end o bo h
applica ions, he mobile applica ion and he web applica ion, we use one o he mos succes ul and
known so wa e a chi ec u e pa e ns, he Model View Con olle (MVC) pa e n. Hence, when he
modules and unc ionali y a e expanded o changed, only he modi ied pa s will be a ec ed and he
o he s will be able o unc ion as be o e wi hou making any subs an ial changes. We belie e ha his
is essen ial o co ec ly pe o m a use -cen e ed design. The web on -end is buil as a empla ed
CodeIgni e websi e ha communica es wi h he API and he mobile on -end is build in Ja a and
XML. XML is used only o he iew o he applica ion, bu no o da a, which is always managed in
JSON.
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Figu e 1. Close2U sys em a chi ec u e
The back-end applica ion p og amming in e ace (API) is an MVC s uc u ed REST ul JSON API
buil wi h PHP, aided by he amewo k CodeIgni e . The da abase d i e is MySQL and i makes
h ps eques s o connec he API wi h he da abase.
3.3. Use In e ace
Figu e 2a shows he sc een ha appea s a e comple ing a su ey. A mo i a ional ph ase will
appea , and he use can e alua e i om 1 o 5. The sys em ells he pa ien ha a ewa d is a ailable
o comple ing he su ey and gi e his h ee op ions, (a) mo i a ional esou ce, (b) exe cise and (c)
no hing. On he mo i a ion sc een a mo i a ion i em ha has been sha ed by ano he pa ien is shown
o he pa ien wi h a name and desc ip ion as we show in Figu e 2b. This i em will be able o be a ed
om 1 o 5, and he use shall be able o p e iew i in he applica ion, as shown in Figu e 2c, o iew
i ou side he applica ion, showing he esou ce in he co esponding applica ion o ha esou ce.
The pa ien can a e bo h esou ces o Figu es 2a and 2b, using a ank mechanism based on s a s.
(a) (b) (c)
Figu e 2. Sc eens o he use in e ace: (a) Rewa d a e comple ing a su ey, (b) Mo i a ion ewa d
and (c) Rewa d p e iew
I he pa ien selec s an exe cise, he sc een o Figu e 3a will be shown, in which he pa ien will
isualize a message wi h he ins uc ion o be pe o med. He will ha e he op ion o mo ing on o

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he nex o p e ious ins uc ion. When a pa ien eaches he end o a epe i ion, he sys em will show
him he missing ones and a bu on o epea , as seen on Figu e 3b. The use is allowed o inish he
exe cise be o e doing all he epe i ions, bu in ha case, he is asked why he did no inish i . In his
way, we wan he psychologis s o see i he p oblem comes om he pa ien (e.g., heal h s a us,
i edness o pain), o om he exe cise (e.g. long, bo ing o oo many epe i ions), so ha hey ha e
ha in o ma ion in o de o imp o e hei moni o ing o jus o see i i is necessa y o e ine he
exe cise, imp o ing i o o he pa ien s.
(a) (b)
Figu e 3. Sc eens o he use in e ace: (a) Exe cise ewa d i s sc een and (b) Exe cise ewa d when
he pa ien had o do a epe i ion
To comple e he pa o he gami ica ion, he e is a sc een in which pa ien s can see bo h hei
la es mo i a ion i em and hei las exe cise (Figu e 4a), so he pa ien can see i again i he wan s, o
i he did no ha e ime enough o e alua e i . I is also shown whe he he esou ce has al eady been
alued o no , since hey can only be assessed once. F om his sc een you can also access o see you
poin s as you can see in Figu e 4b. The use will see his classi ica ion, he o al poin s ea ned, and he
poin s needed o each he nex le el. The le els a e (a) b onze, (b) sil e and (c) gold.
The sha e bu on on he sc een, as seen in Figu e 4a, will ake he use o he sc een o sha ing
wi h Close2U (Figu e 4c), whe e you can choose a ca ego y and en e a name o he mo i a ion, a
desc ip ion and a URL, excep in he ph ase ca ego y, whe e he only possibili y is o en e a ph ase.
We wan he pa ien o be able o sha e any hing ha comes him o mind, ei he while wa ching a
ideo on YouTube, lis ening o a song in Spo i y, a podcas , eading, e c. In his way hey can copy
he link and pas e i in o he sha e wi h Close2U sc een a e choosing a ca ego y, bu we wan ed o
make i easie and implemen he sha e op ion ha any And oid applica ion has. Thus, ou applica ion
can be seen as an op ion o sha e wi h, as shown in Figu e 5a, and so, he URL is au oma ically copied
in o ou app. In he sc een o Figu e 5b, jus a name and a desc ip ion o he esou ce ha e o be
p o ided in o de o sha e i .
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(a) (b) (c)
Figu e 4. Sc eens o he use in e ace: (a) Rewa ds sc een, (b) Poin s sc een and (c) Sha e sc een.
(a) (b)
Figu e 5. Sc eens o he use in e ace: (a) Sha e wi h Close2U in o he applica ion and (b) Sha e a
esou ce wi h he URL aken om sha e op ion om o he applica ion.
F om he web applica ion, psychologis s can see he esou ces ha pa ien s upload (Figu es 6
and 7), can see he a ing and he numbe o o es ha a gi en esou ce has, he s a us o his esou ce
(i.e. ac i a ed o deac i a ed), and hey can elimina e, ac i a e o deac i a e i . Rega ding he
mo i a ional esou ces ha a e no ph ases, hey will be able o isualize wha he pa ien s ha e
sha ed and see i i is adequa e o be shown o o he pa ien s.
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Figu e 6. Sc eens o he web in e ace whe e he psychologis s can see and manage he mo i a ions.
Figu e 7. Sc eens o he web in e ace whe e he psychologis s can see and manage he ph ases.
The psychologis can c ea e o modi y exe cises as i is shown in Figu e 8, de ining a name and
a numbe o epe i ions. S eps can be added one by one wi h he add s ep bu on o by en e ing a
numbe o s eps and p essing he Add bu on in he ex ield Add s eps. In he same way, we allow o
emo e he s eps all a once wi h he Clean s eps bu on o o emo e hem one by one om he las
s ep added wi h he Remo e s ep bu on.
Figu e 8. Sc eens o he web in e ace whe e he psychologis s can manage he exe cises.
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4. Valida ion
This sec ion desc ibes he s udy conduc ed o e alua e he gami ica ion pa o he Close2U
applica ion, in oducing he sample o pa icipan s and he measu emen me hods.
4.1. Pa icipan s
The e we e 15 use s ha olun a ily pa icipa ed in his s udy, wi hou any economical
compensa ion. They we e 40.53 yea s old in a e age wi h a s anda d de ia ion (SD) o 16.85. They
we e 7 males and 8 emales. All o hem we e cance pa ien s o cance su i o s.
4.2. Measu es
4.2.1. App Usabili y and Ease o Use
We used he Sys em Usabili y Scale (SUS) [15] o measu e he usabili y, which is measu ed wi h
a ques ionnai e wi h 10 i ems. We also used he Use ulness, Sa is ac ion and Ease o Use (USE) [16]
o measu e he ease o use, which measu es ou dimensions: (a) Use ulness (8 ques ions), (b) Ease o
use (11 ques ions), (c) Ease o lea ning (4 ques ions) and (d) Sa is ac ion (7 ques ions).
We u ge pa icipan s o undamen ally alue he mo i a ion pa in he use o he applica ion,
anking he sys em, mo i a ional esou ces, he exe cises and he esou ce-sha ing unc ionali y.
The a e age esul s o SUS we e in he 1–5 ange and he a e age esul s o USE we e in he 1–7
ange. We con e ed hese esul s o he same ange o 0–100 o he SUS and USE ques ionnai es, in
o de o be able o easily compa e bo h esul s.
4.2.2. App Gami ica ion
We wan ed o know i ou way o applying he gami ica ion in ou applica ion was app op ia e
and use ul, so we c ea ed a su ey wi h he ollowing ques ions:
1. P io i ize he aspec s ha mos mo i a e you in he use o he applica ion.
2. O he aspec s o ideas ha mo i a ed you o use he applica ion mo e o en.
3. Did he ph ases, mo i a ional esou ces and exe cises a he end o he su eys mo i a e you o
con inue doing he su eys?
4. Did i mo i a e you o ha e he op ion o upload esou ces and sha e hem wi h o he use s o
he applica ion?
5. Did you ind in e es ing ha you esou ces we e e alua ed and ob ained poin s o con ibu ion?
6. Do you hink he way o sha ing esou ces was in ui i e?
I em 1 was eplied by o de ing he ollowing aspec s: anking o poin s, sha e esou ces, do
exe cises, ob aining esou ces, ob aining medals/le el up and o he s. I em 2 was eplied wi h an
op ional ex , in o de o ge he eedback o hei ideas o news mo i a ions o ways ha we can
imp o e he applica ion. Finally, I ems 3, 4, 5 and 6 we e eplied wi h a i e-poin Like scale.
5. Resul s and Discussion
Rega ding usabili y, he a e age esul o SUS es was 72.67 in he ange o 0–100, and he
s anda d de ia ion (SD) was 10.83. The a e age esul o USE es was 80.64 and he SD was 15.08.
Figu e 9 shows he esul s o bo h ques ionnai es in o de o compa e he esul s o usabili y and he
h ee dimensions o he USE ques ionnai e (Ease o use dimension is sepa a ed in o wo ac o s, Ease
o Lea ning and Ease o Use).