Design Thinking Process for a Gamified Mobile App to Improve

Migrants’ Well-Being and Inclusion

Francesca Pia Travisani

, Veronica Rossano

and Enrichetta Gentile

Department of Computer Science, University of Bari, Via Orabona, 4, Bari, Italy

Keywords: Mobile Health App, Multiculturality, Gamification and Game-Based Learning, Mobile-Assisted Learning.

Abstract: An app with digital storytelling and gamification represents a key element in promoting the learning of the

typical terminology of the socio-health context that aims to ensure the psychophysical well-being and

inclusion of migrants by removing language and cultural barriers, improving access to essential Italian health

and social services by using sports as a vehicle for learning and socialization. The application could be

integrated as an educational tool in integration centres or schools to encourage understanding of health

concepts in an interactive and engaging way. The research study conducted the iterative user-centred “Design

Thinking Process”, which includes the phases of empathy, definition, ideation, prototyping, and testing. In

the living labs, we have gathered feedback from ten adolescent migrants who were co-designers of the iterative

development, which enabled us to collect data to evaluate the app's usability, effectiveness, and social impact

on migrant quality of life. Analysis of the feedback revealed that the app's usability and intuitiveness have the

potential to be effective and well-accepted, as they enable language skills about social and health terms simply

and pleasantly and consequently facilitate access to social and health services by improving migrants' mental-

physical health and social integration.

1 INTRODUCTION

The ability to understand and speak the language of

the host country is a fundamental key to the social

inclusion and psychophysical well-being of migrants.

However, this ability may turn into an

insurmountable obstacle when a migrant tries to

access health services.

As stated by (Harsch and Bittlingmayer, 2018)

Health literacy (HL) is important for migrants' health

as they often have difficulties interacting with the

host health system and HL is not only about learning

words and procedures but also about developing skills

and confidence. This study states that different

approaches help migrants to acquire the necessary

language skills, but traditional language courses are

only partially useful for learning health literacy.

Tangible evidence is provided by (Peguero,

2024) in which language acquisition was considered

a key pillar for the successful integration of refugees

and immigrants into host societies.

https://orcid.org/0009-0007-4248-2692

https://orcid.org/0000-0002-4079-9641

https://orcid.org/0000-0002-4502-030X

Furthermore, an important issue is the lack of

inclusivity dimensions in traditional language

teaching methods. The context of migrants requires

the alignment of the language teaching process with

the cultural background of both the target migrants

and the host country. In addition, the intersection of

migrants' different personalities and caregivers

including ethnicity, religion and economic status

influences the experience and treatment in society of

these people, which further illustrates the need to

design training programs tailored to the target

learners. In this perspective, this study (Peguero,

2024) highlights how innovative language learning

approaches that consider social integration and

multiculturalism have a positive effect on migrants'

well-being.

Moreover, it is essential to realize that cultural

differences between doctors and migrants may

influence their perception and understanding of

healthcare concepts. Therefore, it must be ensured

that their cultural knowledge is enhanced and

944

Travisani, F. P., Rossano, V. and Gentile, E.

Design Thinking Process for a Gamiﬁed Mobile App to Improve Migrants’ Well-Being and Inclusion.

DOI: 10.5220/0013378900003911

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 18th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2025) - Volume 2: HEALTHINF, pages 944-950

ISBN: 978-989-758-731-3; ISSN: 2184-4305

gradually integrated with the new healthcare practices

of the host country. A strategic point is precisely the

health domain where migrants' needs are met, paying

attention to cultural differences starting with

greetings, then physical contact, and, finally in the

description of symptomatology. The last is very much

influenced by the migrant's concept of illness as this

very often comes from the theories of his/her religion

and superstitions that are different from Western

medical culture as pointed out by data collected by

Italian Government (Italian Government, 2024). This

cultural influence may compromise the

understanding of pathology and its therapeutic plan.

Therefore, it is crucial to compare migrants'

conceptions of health with those of Western medical

culture to successfully deal with relational and

communication problems with physicians to achieve

an inclusive and respectful health service.

For the protection of migrants' health and

integration in Italy and in Europe, regulations and

guidelines have been defined with the aim of

promoting equal access to the various services offered

to migrants.

Indeed, the Italian Constitution (art. 32) declares

as fundamental the right to health of all human beings

regardless of socio-economic status. In fact, this is

how the Action Plan for Integration Inclusion 2021-

2027 (European Commission, 2021) presented by the

European Commission opens: “The European way of

life is inclusive. Integration and inclusion are the key

for people coming to Europe, for local communities,

for the long-term well-being of our societies and for

the stability of our economies” and this underlines

that “Integration and inclusion are the key for people

coming to Europe, for local communities, for the

long-term well-being of our societies and for the

stability of our economies because integration is a

right and a duty for all.

Consistent with the objectives of sustainable

development, these directives contribute to the

physical, mental and social wellbeing of migrants but

also to the economic development of host

communities. In fact, there are international

organizations such as (Rocca, 2017) the International

Organization for Migration (IOM) that collaborate

with the Italian government to improve the living and

health conditions of migrants, promoting inclusive

health policies and programs to ensure a growing

awareness of the state of health and a greater cultural

sensitivity in the prevention, diagnosis and treatment

paths of the Italian and European health system.

Within this political and humanitarian scenario,

day by day there are more and more migrants in Italy

(Italian Government, 2024) and this phenomenon

contributes to the increase in the diversity of society

which raises new challenges not only for the inclusion

of newcomers but for the removal of barriers to access

to Italian social and health services. One significant

obstacle is communication in a new language, which

in social and health care environments could be a risk

to migrants' psychological and physical well-being as

they often find it difficult to understand clinical terms

essential to understanding how they can use Italian

health services useful for managing their physical and

mental health status.

In this context the research within the project

PG4I, Persuasive games for Integration, have

designed and developed a mobile app to support

learning of Italian language. The app is addressed to

unaccompanied foreign minors who needs to learn

Italian to communicate with doctors who take care of

them.

2 BACKGROUND

In a world where communication is central, the

inability to communicate represents a significant

obstacle to the integration of newcomers into local

society. An increasing number of studies, as reported

also in this literature (Ahmad et al., 2013), have

addressed this problem in order to overcome social

exclusion, or at least support individuals in their

learning path through innovation and non-formal

learning approach. According to (Peguero, 2024),

which describes a case study on a ‘Mobile Language

Learning App’ for young refugees, the positive

impact of mobile apps, which offer interactive and

always-accessible resources to improve their

language skills, is highlighted.

Therefore, to enable migrants to adapt to new

contexts with greater confidence, facilitating

language proficiency, social connections and a sense

of belonging, the European Council piloted the

(Rocca, 2017) in Italy from February to April 2017, a

tool consisting of 80 resources, including guidelines,

tips, evaluation tools, teaching materials and

activities to support language learning as a tool for

health. It was shown that around 80 per cent of the

participants found these mobile devices and activities

to be easy to use and understand.

In fact, several mobile learning apps have already

been developed to teach Italian language such as

Atatya, Presente and Fare parole 1⁄2, and particularly

Migreat, Rebuild, Workeen and Drops, which are

among the most used by migrants (Torsani and

Ravicchio, 2021) (Buono et al., 2019).

Design Thinking Process for a Gamiﬁed Mobile App to Improve Migrants’ Well-Being and Inclusion

945

In addition, the site of the Ministry of Work and

Social Policy has set up the Portal Integration

Migrants, which offers a collection of freely

accessible courses, apps and online games to learn

Italian (Torsani and Ravicchio, 2021).

However, these solutions do not focus

specifically on sociosanitary terms by using a playful

approach to facilitate the social inclusion and mental

and physical well-being of migrants. Given that the

digital revolution plays an essential role in improving

the quality of life of migrants and the potential of

mobile apps is important and enables the integration

of migrants within the social network of our cities,

our project wants to distinguish itself from existing

state of the art solutions, as it innovatively involves

migrants actively in the application design process by

combining the use of storytelling and gamification

setting the game in the football scenario an

environment familiar to them.

This development methodology will allow us to

identify and meet the needs of migrants, aligning the

process of teaching the new language with the

cultural diversity of the target users of our project.

3 DESIGN THINKING PROCESS

Design Thinking (Denning, 2013) (Figure 1) is an

iterative, nonlinear process designed to understand

users, their needs, and the context in which they will

use the application. This method is based on five main

phases: Empathize, Define, Ideate, Prototype, and

Test. Through this approach we were able to

introduce an innovation in this research: putting

migrants at the center of the design and development

process of the gamified app. This involvement

allowed us to develop an innovative, intuitive, and

easily usable solution for the target users in a way that

truly meets the health needs of migrants as also

highlighted by Eriksson (2005).

Figure 1: Design thinking process.

The first phase is useful to empathize with

targeted people to understand their needs,

expectations, motivations, and interest in the IT

solution. In this project studying the target users was

essential since their cultural background and

experiences were starkly different from those of the

researchers.

The second phase aims at defining the core

problem to be tackled, the third phase is focused on

the ideation of the solution, which will be prototyped

and tested in the other two phases.

3.1 Empathize

The design of the application required some meetings

with the target group to create a collaborative and

constructive atmosphere in order to gather some

information about their interests and to create an

empathetic connection with young adolescents in

fact, as pointed out by (Zipfel et al., 2022), co-design

is valuable for developing effective health solutions.

The first meeting was focused on outlining the

goals of the PG4I project and gathering desired

outcomes from the ten young migrants: three English-

speaking, four French-speaking, and three Arabic-

speaking, with a cultural mediator facilitating

translations.

It is important to emphasize that, due to the

vulnerability of the unaccompanied minors involved

and the legal regulations in force (Art.8 GDPR,

2016), it was not possible to collect further detailed

personal data.

Moreover, as they were diffident children, they

were not inclined to share their personal data, also in

view of the legal procedures for the protection of

minors.

In fact, during the presentation, they expressed

concerns about participating in the project, as their

previous involvement had been superficial, and they

had never seen a project come to completion.

To solve this problem, additional meetings were

scheduled to motivate and engage them.

The first additional meeting included Michele

Salomone, a radio commentator who follows the Bari

football team, who told interesting stories about

football and famous players from their home

countries. In addition, another meeting included the

participation of Walid Cheddira, a player of

Moroccan origin who played for the Bari football

team.

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3.2 Define

Based on opinions gathered from both migrants and

center workers, the content of the mobile app was

focused on the main interest of the young migrants:

the football and the healthcare issue that was the focus

of the research project, as the title suggests “Pervasive

games for a healthy integration”. In addition, the

screen prototype of the mobile app was presented, and

some feedback were collected about the content and

the app interface.

3.3 Ideate

To support the acquisition of a basic Italian

vocabulary, the content has been organized into mini

games to train listening, reading, and writing skills.

The approach of using mini games is well-

documented in literature to foster micro-content and

specific skills (Smith and Snchez, 2010)

(Anonymised). The mini games might include tasks

such as correctly composing an Italian sentence to

enhance writing skills, recording a voice response to

a question about a football scene or a conversation

with doctors to improve speaking abilities, as well as

strengthening listening and reading skills (Figure 2).

Additionally, simulations of themed dialogues in

the football and healthcare domains could be very

beneficial. For example, a user might take on the role

of a player who must score a goal or explain typical

football-related injuries to a doctor.

Multilingual exercises with pronunciations of

various phrases and words, also available in French

and English, would facilitate understanding the

activity requirements, particularly since most of the

minors are illiterate.

These exercises should be of short duration to

avoid boring or tiring the user, aiming to keep the

minor's attention high. The app leverages the self-

explanatory nature of images and feedback to support

learning.

Figure 2: An example of mini games to train listening,

reading, writing skills.

3.4 Prototype

This idea has led to the development of the first

prototype of Play4Health (Figure 3), an app that

transforms a simple dictionary for learning medical

terminology of the Italian language into a gamified

application set in the football scenario, with the

purpose of addressing an innovative perspective

using the design thinking process, combining digital

storytelling and gamification.

Specifically, the user interacts through his or her

cell phone, solving mini puzzles during the narrative

and receiving rewards that encourage him or her to

continue playing, in line with the objectives of

gamification as mentioned by (Kiryakova et al.,

2014). This playful approach makes learning

complicated concepts in healthcare more enjoyable,

simple, and engaging.

To enable users to use vocabulary in more

complete linguistic contexts, a storytelling section was

developed to propose possible dialogue scenarios.

Again, the content relates to the two topics identified

during the empathy phase: football and healthcare.

To maintain the minigame approach, the structure

of each story is structured with multiple paths, each

consisting of three episodes made up of four or five

steps that require the user to interact to advance the

story. From the home screen, the user chooses the

story to immerse themselves in each story features an

avatar that engages them in a dialogue. To progress in

the story, the user must provide responses and is

guided by positive and negative audio and visual

feedback, using colors and animations to ensure the

message is clear.

An example of storytelling is depicted in Figure

3. It involves a coach welcoming the user and inviting

him or her to play. The first thing is to introduce the

basic rules of football, such as the number of players in

a typical match, the players’ roles, and the correct

positioning of players on the field. The user interacts

with his device, responding to the avatar by choosing

the correct answers. After, the avatar invites the user to

step onto the field and apply the rules just reviewed in

the next episode's match.

Figure 3: An example of storytelling.

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947

Solving the mini-games by interacting through his

or her device, the young migrant understands the

story that evolves as he or she completes the paths but

it is important to make use of game elements

(Figure 4), such as levels, scores, and rewards that

once unlocked will always be viewable in specific

sections of the app, to motivate and engage the user

in learning non-minor concepts such as “social-

sanitary” topics in a playful context, such as the game

of football.

The use of storytelling makes the learning process

more fun and challenging, but the idea of awarding

stars as rewards at the end of each path consolidates

the achievement of the goal of the serious game

encouraging users to continue playing and following

the various paths designed to improve language skills

in a personalized way and with various levels of

difficulty.

Figure 4: An example of gamification.

3.5 Test

The testing phase of the iterative "design thinking

process" was carried out by performing the following

sequence of tests:

- Debug Test: system test to detect and fix bugs

in the application. Since the development of

the Play4Health app software is written in Java

17, built with the Gradle 7.2 tools and Android

SDK 31, all accessible with the Android IDE

Studio Bumblebee 2021.1.1, for the app’s

debugging tasks, both the virtual device Pixel

3 XL, known as Android Virtual Device

(AVD), available in the development

environment among emulators, and a physical

Android device, the phone LG K30 were used.

- Alpha Test: an informal usability test with the

support of the IT department’s help desk users,

teachers and students involved in the PG4I

project who interacted with the application to

identify malfunctions that needed to be

corrected and some terms and non-intuitive

interactions that needed further simplification.

- Beta Test: usability testing with target users

has proven to be very useful to identify further

misalignments between the requirements

defined in the early stages of the iterative

process such as empathizing, ideation and

prototyping than implementation. The aim is

to assess the usability and effectiveness of the

research result, and to collect feedback from

the target users of the project with a view to

identifying areas for improvement. In this

regard we have set up a further and final

meeting with the target group of the design

thinking process to which the final app was

made available and they were immediately

ready and eager to try the app born from their

needs and for which they themselves have

been co-designers.

From the analysis of the tests carried out, it was

immediately evident that the familiar and social

influence of mobile devices have in our lives, as they

are accessible, effective and interactive. It made easy

for users to understand how to use the various

functionalities of the application without any

particular problems in interacting with the device.

Users found the app’s interface easy to navigate

and therefore the main features were accessible and

understandable for everyone.

In addition, game elements such as challenges,

levels and awards made learning fun and engaging,

allowing teenagers to maintain a high degree of

interest and participation. During the test it was

immediately evident how the interactive and playful

methodology facilitated the memorization of non-

minor concepts such as those of the "socio-medical"

context in fact users have shown a significant

improvement in understanding and use of these new

terms during the completion of mini-games.

Digital storytelling was particularly appreciated

by the migrants as the stories and scenarios with the

medical avatars and footballers during football

matches were perceived to be realistic and relevant.

The users have pointed out the clarity and simplicity

of the terms used during short and natural

conversations with avatars in the narrative.

Many of the target users have unexpectedly

appreciated how the playful value has made learning

these daily but complex concepts less stressful and

more enjoyable, thus considering as strengths the

simplicity and clarity of the functionalities that the

application offers them.

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4 CONCLUSIONS

This research study has illustrated how the innovative

use of the "design thinking process" approach

centered to the young migrant led to the creation of

an effective and engaging educational application for

adolescents who need to learn complex social and

health concepts.

The app combines digital storytelling and

gamification to make learning about health concepts

less stressful and more enjoyable. In fact, the

application not only allows to improve skills and

Italian language understanding, with particular

attention to the essential medical terminology to

know, but it allows to remove the barriers to access to

Italian health services, thus facilitating social

inclusion and promoting the psycho-physical well-

being of migrants through an interactive application

that uses football as a vehicle for playful and

engaging learning.

In view of further developments, based on the

target users’ feedback, co-designers of the app, to

reach a wider set of users, a common idea was to

adapt interface to different types of screens and

device resolutions, perhaps the most used by

migrants. In this regard, the app's activities could also

be designed for young migrant women as it is

primarily health-centered in a more male-dominated

context.

Instead, to ensure a better user experience, we

could also make the storytelling narrative

multilingual (possibly in French and English) so that

it can be used in different medical and educational

contexts. Many target users have also suggested that

additional in-depth functionality could be added on

some social health services or the possibility of

introducing more personalized medical avatar

conversation activities. To achieve this, a future

proposal could involve having probands independent

testers evaluate the application during the beta testing

phase, in addition to the migrants co-designers.

Furthermore, it would be advantageous to monitor

the app's usage in real-time to obtain more interesting

data about the app's influence for future research

studies.

In conclusion, this study demonstrates that

technological innovation combined with an iterative

approach that puts users at the center by considering

them as co-designers overcame one of the initial

limitations of Living Lab's inclusive design thinking:

the participants showed great enthusiasm for the

active involvement and the final result obtained.

This approach not only increases the involvement

and satisfaction of the end-users, as it allows their

opinions to be valued, but also enables the creation of

a solution that effectively meets essential

psychophysical needs by creating a real and

meaningful solution for access to health services and

inclusion.

ACKNOWLEDGEMENTS

This work was partially supported by the project

"PG4I - Pervasive Game for Integration ...per una

sana integrazione," funded by Horizon Europe Seeds

at the University of Bari. The authors wish to express

their heartfelt gratitude to the young people hosted at

the "Centro Interculturale Abusuan," as well as to the

center's coordinator, Mr. Koblan Amissah, and its

dedicated staff for their invaluable contributions.

Special thanks also go to Mr. Michele Salomone, the

radio commentator, for his support throughout the

project.

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