This graduation project is performed for the Dutch Medicines Evaluation Board (MEB) in collaboration with VU University Medical Center (VUmc), Department of Obstetrics and Gynaecology. In many situations pregnant women need to use a medicine during pregnancy, especially when they are under medical supervision at VUmc due to their (history of a) complex pregnancy. For instance to treat an underlying chronic disease or pregnancy related conditions. In every decision about medication use, the necessity needs to be weighed against the potential risks of the medicine, as well as the risks when not taking the medicine for both mother and child. Literature research has shown that pregnant women often overestimate the risks associated with medicines and therefore do not take their medicines as prescribed. Current information sources, such as patient leaflets and online websites, usually stress the risks and show reluctance towards the use of medicines during pregnancy, while they lack the benefits of medicines. User research has shown that pregnant women are very afraid of the potential risks and only want to take a medicine when there is a clear benefit for their child. Usually they have a lot of trust in their gynaecologist and follow their advice to use a particular medicine. However, women easily start to doubt whether their medicine is really safe due to negative information from others or in the media, or because they do not clearly remember the benefits of the medicine. As a result, they seek confirmation and reassurance by searching information via Google or in the patient leaflet, where they often only find unnerving information that increases their concerns. Based on these research insights, the goal was to design a product-service system, including a digital application that informs pregnant women about the use of medicines during pregnancy and allows them to make an informed decision and feel confident to use a medicine during pregnancy. The final design, ‘Mijn Medicijn – Zwangerschap’ is an application that pregnant women can consult at any time when they are in doubt of the safety of their medicine. It provides balanced and transparent information about both the potential risks and the benefits of medicines for the mother and unborn child. This allows pregnant women to understand why a medicine may be important for their situation, which is expected to make them feel more confident to use the medicine during pregnancy. Additionally, the app shows what medicines can or should not be used during pregnancy for a certain complaint or condition. The gynaecologist plays an important role in the design as well, by providing an information flyer and stimulating the patient to use the app. Furthermore, when advising a medicine, the gynaecologist explains the relevance of the medicine by using the same benefit-risk information in a desktop version of the app. An evaluation study with an interactive prototype showed that pregnant women highly value the product service system in general as well as the patient-friendly information, which would support them in making decisions about medication use.

This report is the result of a graduation project about Schistosomiasis, a neglected tropical disease caused by the Schistosoma parasite. And about a new technology to detect the parasitic infections. More specifically, to detect the urinary Schistosoma type, called S. haematobium.

Within Africa, a large number of countries are affected by this parasite. The transmission happens via water and is almost impossible to stagnate. It influences children and adults by reducing their ability to grow, learn or work on full capacity. Both the economy and living conditions of entire communities suffer from this worm, which lays its eggs in the human bladder. Ghana is an example of an endemic country in which the entire population is at risk of infection. By the support of the government, they have established a nationwide control programme, with annual Mass Drug Administration (MDA) in all the high risk areas to control the morbidity. Ghana was therefore selected as main scope within this project.

The new technology detects the parasitic infection by counting the number of eggs in urine samples. This new technology is faster, easier and more reliable than current methods and able to add value for different types of users. A literature study and three weeks of user research in Ghana revealed the diagnostic needs of five user groups: researchers, control programmes, urban hospitals and rural health facilities in low and high endemic areas.

The greatest value can be added when designing for researchers and rural health facilities. So, a product is designed to fit the main requirements of both user groups. This resulted in one product for both, but with an additional application on a tablet for the researchers: The EC (Egg Counter). The product is easy to use and maintain for remote facilities. Those areas are confronted with a lack of resources and specialist. The EC enables lower educated people to execute diagnoses and takes away the need for specific medical equipment. For researchers, the additional application will facilitate digitalised data collection. The product is robust and portable as the researchers will take it with them on field trips, for large-scale community screening. The product will be much faster than the current procedures, saving a lot of time in the field and thereby money.

The EC is designed for Ghana, with a side focus on Nigeria. With some small adjustments and a slightly different implementation plan, the same product can serve these different countries. But more development and research is required until it is suitable for implementation in the other endemic countries.

This project aims at improving the experience of children during blood drawing procedure at Sant Joan de Déu Barcelona Children’s Hospital.
Blood test is a procedure that creates stress and anxiety for patients, and it can result in a very traumatic experience for children. This brings other issues that make the blood draw more complicated, therefore, it is important to reduce their fear and anxiety.
A design for experience approach was used to carry out the project, which focuses on the experience of the user and involves the patients and stakeholders in the design process in order to design a relevant solution for them.
The final design proposal consists in a story around the blood drawing procedure. The key purpose of the story is to change the meaning of the blood test into something positive and to give support throughout the process, by giving them some tools to cope with anxiety and fear. This should reduce the need to force and restrain the patients.
The story gives a challenge to the children to complete all the steps of the blood test to get a Superkid badge. Each step involves an element that brings physical and mental benefits. These are thought to strengthen the kid’s confidence, help them to take initiative and to relax.
Reducing the fear and anxiety of patients makes the blood drawing procedure smoother and faster. From the patient’s point of view, this will result in a more positive experience and a less traumatizing event. From the parent’s perspective, this would also improve their experience and create a less stressful situation, which would make them gain reliability on the hospital. From the professional’s perspective, the procedure would be easier and smoother. If the patient doesn’t offer resistance, it would be easier to find the vein and poke correctly. Time and workload savings would result in a reduction in delays and a smoother patient flow, which is beneficial for the hospital. A better experience of the patients (and parents) would also result in a higher patient satisfaction, which leads to financial benefits.

Move On is a graduation project which is focused on redesigning the HandsOn game, a therapeutic game for arm-hand rehabilitation which is developed at Roessingh Research and Development (RRD). The HandOn game is a ‘mixed reality’, i.e. a video game played by interacting with physical objects. It trains grasping and horizontal reaching movements in a rehabilitation context. The game is mostly used by adults aged 50+ with hemiparesis, weakness at one side of the body, due to stroke. Design Assignment:
The goal of the HandsOn redesign is to include training vertical reaching movement and motivate stroke patients in starting, enduring and repeating the game.Design method:
The Persuasive Design Method is used to structure the redesign process (Siriaraya, n.d.). First the “transfer effect’ is determined, being the therapeutic effect to be aimed for by the game. Second, the “user real world” is analyzed involving the user, its motives and values and its context. Thirdly, in the game design phase the persuasive game will be iteratively designed with the aim to increase an experience of a game world in the player. Subsequently, this game world experience is designed in such a way that it facilitated realization of the transfer effect (phase 1). Finally, an ‘evaluation’ is conducted on whether the game design causes the ‘transfer effect’.Transfer effect:
To determine the transfer effect regular arm and hand therapy exercises are analyzed, therapists are interviewed and a literature study is conducted. It can be concluded that arm and hand rehabilitation exercises can be decomposed in various elements. Every rehabilitant needs a unique combination of these elements, which a therapist is able to estimate.
-An optimal rehabilitation effect can be reached through tailoring the game for the abilities of the player.
Long term motivation, for about three months, can be reached by:
-Communicating to the rehabilitant what he has reached within therapy through progress feedback
-Showing the relevance of exercises by real life simulation
Motivation during play can be reached by:
-A challenging, but not too challenging, task
-Multi-sensory feedback
-A clear start and end of the task, to work towards to

User real world:
The user real world, i.e. the user-experienced rehabilitation context, is analyzed through interviews with rehabilitants, which confirmed the motivational factors exposed in the research for the transfer effect.
The greatest wish of all rehabilitants is to live independently again.
This inspired a game theme focused on daily life tasks that rehabilitants were used to do at home.

Game design:
An effective, motivating game for arm and hand rehabilitation broadly exists of three steps: 1. Tailoring trough game settings, 2. game play which includes moving physical objects and 3. Reflection through progress feedback.
Based on these steps, three design directions were developed: gamifying daily chores, a game revolving around tea and a game about chores in- and outside the house. These design directions were evaluated with healthcare professionals, and two were chosen to elaborate into concepts.
In the ‘Tea Time’concept, the player runs a teahouse and should serve orders, physical objects, to his customer, being coasters placed on a table.
In the ‘Joblocks’concept, the player simulates different chores in- and outside the house with the use of ambiguous objects.
Both concepts are evaluated on their therapeutic and motivational effect and feasibility. Tea Time was choosen, since it is indicated to be most feasable.
A prototype of Tea Time was created for testing.

Evaluation:
The prototype’s game experience and motivation towards therapy were tested by four rehabalilitants. They played the game three times in three weeks and filled in questionnaires and were interviewed about motivation and game experience.
Two therapists reviewed the prototype for points of improvement.
It can be concluded that the game creates motivation towards arm and hand rehabilitation. Game experience stayed almost the same over three weeks, which indicates players can play the game for weeks without getting bored.
Game experience itself was ranked neutral. Game experience can be increased by more accurately tailoring the game’s challenge for the individual rehabilitant.
Recommendations are made for an improved game, which has main focus on better tailoring physical challenge by:
-objects that vary in shape and weight
-more placement possibilities of coasters
-more variety in time limit
And better tailoring cognitive challenge by:
-Multisensory cues for playing
-Possibility to reduce sensory stimuli
-Adding an easier level

It is expected that the new recommended prototype will meet the therapeutic requirements and motivates and challenges rehabilitants.

Malaria is a life-threatening parasitic disease and the leading cause for high morbidity rates in developing countries. In Nigeria, the chosen context of this study, over 90% of the population is at risk of malaria infection, leading to 60% of the outpatient visits in Nigerian healthcare facilities. Accurate diagnostics are not available for the mass and drugs can be bought without prescription, leading to misdiagnosis, overtreatment and drug resistance.

The Excelscope is a smart malaria diagnostic device that leverages the functionalities of a smartphone to capture magnified images of a blood smear and provide a remote or automated diagnosis. The concept was developed by students from the faculty of Industrial Design Engineering and is currently under development of a research consortium. The Excelscope aims for increasing accessibility to accurate malaria diagnostics. Three scenarios for the diagnostic analysis of a blood sample (remote, semi-automated and automated) were the starting point of this research.

The technology analysis evaluated the three defined scenarios for remote or point-of-care diagnostics. Based on an initial analysis, the assumption was made that the semi-automatic scenario was most feasible in the context and best accepted by healthcare professionals (doctors, nurses, lab scientists). Furthermore, the technology analysis briefly discussed definitions related to eHealth, resulting in several ideas for applications for the Excelscope. Finally, a study into similar technologies for malaria diagnostics was done. An integrated system for imaging and automated parasite detection has not been launched on the market yet, although several organizations and companies are working on similar technologies.

The context analysis consists of four chapters: Nigeria, her healthcare system, malaria and -diagnostics. Next to literature research and expert interviews, Insights were gained during a one-month field study in Ibadan, Nigeria. During the field study, healthcare facilities were visited and caregivers participated in semi-structured interviews. The context analysis resulted in a country profile (including general aspects about economy, living standard and health), an overview of the healthcare system and insights on each tier of the healthcare system. Coverage of malaria diagnostics can significantly increase when a device is implemented in primary healthcare centres, pharmacies, medicine stores or medical outreaches. However, the Excelscope has to meet the minimal infrastructure at these places: little or no access to reliable water, lack of internet connection, low-level medical staff and ‘robust’ environments.

Current ways of diagnosing malaria were studied as well and evaluated according to WHO’s ASSURED checklist. Microscopy and rapid diagnostic tests are the recommended methods for confirmation of a suspected case of malaria. However, both methods lack on different aspects, such as affordability, availability or accuracy. In development of the Excelscope, the checklist can be used as guidelines for basic requirements. However, aspects related to context (infrastructure and accessibility) and user (behaviour, attitude and trust) are essential in order to develop an effectively used device.

Throughout this project, emphasis has been placed on the user. The goal of this study was to find barriers and enablers for use and acceptance of the Excelscope by healthcare professionals in Nigeria. During the interviews with stakeholders in Nigeria, the different scenarios were discussed, as well as local perspectives on malaria management in general. Through the interviews, six potential target groups were defined: patent medicine vendors, pharmacists, medical doctors, nurses, laboratory scientists and medical volunteers (community health workers). For each of the target groups, suggestions have been given for smartness of the device, values and mHealth applications.

The study is concluded with a ‘roadmap’ wherein all findings are connected in a framework of technology, context and user. The framework can be used for defining a target group or anticipating on necessary developments in order to increase.

Currently 30% of all knee prosthesis patients do not return to work after surgery. This is partially caused by the insufficient guidance of the patient's care providers. the most important care providers in this are the occupational physician and orthopaedic surgeon. The current collaboration is experienced by both the occupational physician and orthopaedic surgeon as impersonal, uninvolved and inefficient. This leaves the patients to feel insecure and uncertain before and during rehabilitation. The developed platform combines all information concerning the patient's function recovery and work reintegration in one overview available for care providers and patient. The platform stimulates direct communication and mutual support based on their separate areas of expertise.