The aim of this graduation project is to increase the effectiveness of lifestyle interventions, focused on vitality, for employees with a low socioeconomic status (SES). This project explores and maps out the organizational ecosystem of municipal reintegration company DZB Leiden to determine areas for improvement. These improvements should in-turn increase the effectiveness of lifestyle interventions at DZB Leiden. There are large differences in personal health as a consequence of different lifestyles between people with low or high socioeconomic status. By increasing the effectiveness of lifestyle interventions we might be able to decrease these differences. Low SES is often related to a poor lifestyle through poorer food choices, reduced physical activity, drinking and smoking habits. These habits have negative implications for the people with low SES as well as for the company they work for. Increased absenteeism, increased chance for non-communicable diseases, reduced productivity and a shorter life expectancy are some of the consequences that people with low SES have to cope with. DZB Leiden is a municipal reintegration company of the municipality of Leiden. DZB works with employees with a low SES in their sheltered workshops on a daily basis. They are there for anyone who has difficulty with keeping up with the daily work practices and offer them a safe environment to grow and thrive. People working in the sheltered workshops often cope with multiple disabilities. A healthy lifestyle can contribute on dealing with these disabilities and improve their way of life. Thus, increasing the effectiveness of lifestyle interventions should provide an improved quality of life as well as increasing the desirability of these employees. Multiple lifestyle interventions have been introduced at DZB Leiden, however these interventions have not always been successful. The interventions are often poorly executed, or simply forgotten, and dilute quickly due to daily issues that receive priority. Exploratory research has been performed to define two research scopes, which have the potential to contribute to increasing the effectiveness of lifestyle interventions. These research scopes reside within the interpersonal and organizational ecosystems introduced by Bronfenbrenner in 1977. This graduation thesis explores the organizational ecosystem of DZB in-depth through semi-structured interviews and a stakeholder analysis. A strategy has been devised to improve different areas of the organizational system of DZB uncovered by the performed in-depth research. The performed research resulted in multiple findings for improving the effectiveness of the lifestyle interventions. These findings have been translated into design criteria for the devised strategy. One of these findings is the potential Team Fit has within DZB to increase awareness for vitality and introduce lifestyle interventions successfully. Therefore, Team Fit is used central in the devised strategy. This strategy is substantiated by the development of a future vision for DZB to strive towards. A strategic and tactical roadmap are introduced to guide DZB towards this future vision. These roadmaps show the goals that should be worked towards, the strategy necessary to achieve these goals, the tactics on how to achieve the strategy and the operationalization of the tasks that need to be performed. The devised strategy aims to set up a vitality network with municipal reintegration companies and healthcare providers via the collaboration of DZB and SPARK. Finally, the proposed strategy was evaluated with the current interim director of DZB and Team Fit. The aim of the evaluation was to determine if the proposed strategy meets all three key attributes of feasibility, desirability and viability towards valuable design. The evaluation shows that the proposed strategy in its current state is both feasible and desirable. However, further research is needed to determine if the strategy is viable and can survive in the long run. For the strategy to be viable it is recommended that a learning cycle for the interventions is implemented and research is conducted on the interpersonal ecosystem and incorporated into the proposed strategy. The graduation project consists of a total of four deliverables. Through a stakeholder analysis a power-interest matrix and stakeholder maps have been created which shows the involved parties, their interest in vitality as well as how much power they have to help realize this. Two roadmaps have been created via design roadmapping which allows us to strategically and tactically map out what is necessary to increase the effectiveness of lifestyle interventions. Finally, recommendations for DZB are made on how to improve the strategy.

This report outlines a project that aimed to increase engagement with patient reported outcome measures (PROMs) for patients at an outpatient clinic. The target group was people living with HIV (PLHIV). This study was made possible thanks to the client, Amsterdam UMC, who are undertaking a larger research project that aims to improve the quality of life (QoL) of PLHIV. The project included a comprehensive literature review and user research that involved shadowing of nurses in order to explore the clinic’s context. At this point PROMs started being introduced at the outpatient clinic. To identify design opportunities, attitudes towards PROMs, and initial impressions of PROMs, semi-structured interviews were done with patients and nurses. To further the discussion of PROMs three provotypes were made and presented to participants during the interviews. The main takeaways related to patients not knowing the value or purpose of PROMs or lacking the motivation to complete them. From these takeaways design criteria were identified by making the design goal and interaction vision, which led to the development of four concepts by research through design, brainstorming, and role-playing. A Harris profile was done on the four concepts and one of them was selected to move forward to design and implementation. The concept was a card game, and it was further iterated on by using accessibility guidelines and persuasive game design. The objective was to make a game that, while being accessible, would help change patient behavior regarding PROMs. A lo-fi mock-up was created for the game to test the different game elements with people, leading to refinement of the concept and turning it into a high-fi prototype that was tested with the target group, PLHIV. The results were positive, with patients showing enthusiasm for the game, but with some room for improvement. Patients found the game to be compassionate and useful in learning about PROMs. The game was also tested with a peer navigator who offered many insights from the perspective of patients who are not open about their diagnosis and on how the card game could be used in relation to their role at the outpatient clinic. These findings highlight the potential of using gamification to create inclusive learning tools (i.e. the card game) in the health sector to increase engagement with other health tools (i.e. PROMs) and the importance of continued work to optimize these tools for patients with chronic illnesses such as HIV.

The domain of triathlon seems promising for Cadomotus, a company specialising in helmets, bags, and shoes. Right now, they are known for high-end ice-skating equipment, but the triathlon market seems a great fit and they want to expand further there. A new triathlon specific product would solidify Cadomotus in the market as truly understanding triathletes’ desires and demands. A user-centered design process was used, meaning that athletes were involved in every crucial step. A double diamond design process was used. The results of the discovery phase were synthesised into a user-journey with 23 different design opportunities. Together with the company and users these were narrowed down to one design brief. A creative session started the developing phase. Here four different concepts were generated, prototyped and evaluated. One of them was chosen for further development in the delivery phase. The delivery phase consisted of an iterative process going from paper to high-fidelity prototypes. This concept was put through a final usage evaluation, and its insights led to the Talaria. A new triathlon specific cycling shoe. The reaction of users to the design was mostly positive. “I dare to say that I have almost mastered this element of transitioning and then directly getting into cycling, but this would work even quicker” - Sem. The Talaria addresses two concrete needs: getting in and out quicker and stop the shoe from spinning during the second transition. The quicker athletes can get in or out of shoes, the better they can perform during their race. Especially in elite short-course racing this is vital. The spinning shoes are a phenomenon where the shoe hits the ground and starts spinning, which in turn can cause the bike to ‘jump’, creating stress and a potentially unsafe situation.

Space Mission Sanitas is a game-based health intervention to help cardiac patients maintain their physical activity level after cardiac rehabilitation. Often people find it hard to maintain their physical activity level after cardiac rehabilitation. They face different barriers that lower their motivation, resulting in an unhealthy lifestyle with low physical activity. This project is done in collaboration with the Capri Hartrevalidatie centre. The target group for this project are the participants that are rehabilitating here. The people that come to the rehabilitation training are often open to a lifestyle change but need guidance on how to achieve this. A part of the participants are people with a low socio-economy position(SEP), for them, it is even harder to maintain their physical activity after rehabilitation. To integrate physical activity into the daily life of cardiac patients, a game-based health intervention is designed and tested in this project. All participants in cardiac rehabilitation can take part in this game, including participants with a low Socioeconomic position(SEP). When designing the game, the barriers of people with a low SEP were considered. The game is a tool to motivate physical behaviour in the gamified world so that the experienced physical activity for the game will motivate people to perform this behaviour in the real world. To design this game-based health intervention, a user-based literature study and a context field study were conducted. A deeper understanding of the participants’ drivers and barriers view on physical activity and needs and motivation during and after rehabilitation were gained. By combining the insights, a behaviour analysis and a user persona could be made of the target group. A design brief, including a design goal, vision and design opportunities were set up. The design goal of this project is to develop a persuasive game that supports the maintenance of physical activity in cardiac patients’ daily life by stimulating their sense of competence, relatedness, and autonomy. From the behaviour analysis, the three elements: competence, relatedness and autonomy resulted in important factors of motivation for physical activity. In the ideation and conceptualization phase of this project, the game-based health intervention got its shape. Co-creation sessions, interviews and expert validations were conducted to find the best concept direction. This led to the final design: Space Mission Sanitas. Space Mission Sanitas is a game where six teams are challenged during the cardiac rehabilitation period to achieve their weekly fuel goal. This fuel goal needs to be reached to provide their space shuttle with enough fuel to complete the overall mission. The fuel goal can be seen as a metaphor for a weekly physical activity goal since the goals are related to physical exercise they can practice in their daily life context. Every week during the training, they will evaluate which team has achieved their fuel goal and every week they will draw and select a new fuel card for the coming week. Finally, an evaluation cycle of one week, showed that the game had a positive effect on people their sense of competence, relatedness, and autonomy. This suggests that the game has a promising effect on the maintenance of physical activity after rehabilitation. In future research, the game will be tested over a period of six weeks to measure the actual effect on people’s physical activity maintenance. The variety of insights gathered in this project can be used in future CR research and CR health interventions.