This report aims to present an overview of the design thesis based on Centering Your Story, presenting the research and design activities conducted during the course of the thesis project and how it helped shape decisions and final design.
The project started with a literature review exploring the field of psychiatric care and youth with severe and enduring mental health problems as well as learning about the meaning, causes and impact of stagnation in treatment.
Firstly, characteristics of youth with Severe and Enduring Mental Health Problems were identified in order to gain insights into the challenges they face, their vulnerability and factors that influence them.
Secondly, the phenomenon of stagnation was examined with the focus on causes for stagnation and treatment failure in order to understand the root of the problem.
Additionally, literature on collaboration in therapeutic settings was reviewed to gain insights into the lack of collaboration, what might help facilitate open communication and better collaboration.
Since The Story is a crucial part of the design thesis and the final design, there is a section reflecting on what it should consist of and what the different existing definitions of narratives contain that could contribute to the story in the design.
A selection of the research done by Curium was analysed and insights were gathered. Youth and parents emphasize the importance of considering background and environmental factors. Additionally, a personal vision from the youth is needed for creating the story as well as giving youth a voice and autonomy.
Subsequently, design directions were defined, and refined with the Curium project group. After being translated into conceptual directions, they were presented at co-creation I to the project group. Then, ideas were generated, based on criteria and inspired by suggestions from the co-creation. Three elaborate ideas were chosen to conceptualise.
The concepts were presented to the Curium project group, and feedback was used for refining concepts and designing mock-ups. The concepts and mock-ups were then presented and tested with the target group in co-creation II. The feedback given by the target group was used to combine concepts and design the final prototype for the design thesis.
Finally, the prototype was designed: Verbonden. Verbonden is a playful and creative way of mapping personal stories and the shared story of youth, parents and practitioners who are experiencing stagnation in treatment. The goal is to break tension, empower youth and help users gain a better understanding of each other by mapping their stories. ... Read more

This project focused on women experiencing involuntary urine loss. It is estimated that one in four (Linde et al., 2016; Pedersen, et al., 2017), to one in three women experience urinary incontinence (Loohuis et al., 2022). Despite the negative impact on women’s quality of life (Van Geelen & Hunskaar, 2005; Van Gerwen et al., 2009) and the availability of effective medical treatments (Nightingale, 2020) only a minority seeks medical support for their symptoms (Diokno et al., 2004; Hannestad et al., 2002; Kinchen et al., 2003; O’Donnell et al., 2005; Sykes et al., 2005). This knowledge served as the initial problem from which this project started.
To understand the context and to be able to redefine the problem, three research questions where defined:
•How do women between 35-65 years old experience urinary incontinence symptoms and cope with them?
•How does the process of seeking (medical) treatment and support unfold for women between 35-65 years old experiencing incontinence symptoms, and what are the patterns, barriers and triggers in this process?
•What are the wishes and needs of women between 35-65 years old with incontinence symptoms and how could they be supported?
These three research questions structured the project and guided the context analysis. This context analysis showed that understanding women’s wishes and needs was the most important part of the project, as it helped to identify gaps in existing support and highlighted the inadequacy of current interventions. The recognition of the insufficient support available led to a broader understanding of the concept of support, extending beyond medical treatment, for example, protective equipment, toilet access, information and social support. It was recognised that the experience of the condition was negatively affected through these forms of current support: characterised by: stigmatised, frustrating, unsupportive, unwanted and limiting.
This resulted in the following problem statement: Current interventions for managing involuntary urinary leakage do not fully support women. This causes a gap between the interventions that should support women and the challenges associated with the condition, allowing its challenges and impact to persist.
The inadequacy of current support can be explained by the following key characteristics:
•Current interventions fail to connect with/ reach women.
•Do not align with women’s needs and preferences.
•Existing solutions focus only on isolated aspects of the condition.
•Some solutions unintentionally reinforce difficulties.
•Simply do not exist.


Based on this problem statement the following design goal was defined: My design goal is to enable women to feel in control, supported and empowered in their management of urinary incontinence. Which aimed to bridge the gap between the available support and the actual needs of women managing urinary incontinence. This goal was supported by the following sub-goals:
•By fostering confidence and satisfaction in managing leakage among women.
•By creating a more positive association with urinary incontinence and the related products.
•By creating a clear understanding of urinary incontinence and the treatment options.
Inspired by findings of the context analysis a concept proposal was defined, aimed to minimise the practical challenges associated with leakage and the use of protection, to address the need for information and to redefine the interaction and experience of supportive interventions for urinary incontinence. Through co-creation sessions and prototype the concept proposal was further defined, resulting in BIJDEHAND.
This concept was assessed by evaluation tests, which showed that it was evaluated as positive, supportive and desirable while also revealing areas for improvement.
The final concept is not a definitive solution to the problem definition, but an example of how support could be provided for women experiencing involuntary urine loss. In addition, this project demonstrates how the intended user can be actively involved throughout the design process to understand and design for their wishes and needs.
... Read more

Navigating consequential decisions is a difficult task in and of itself, especially when they have a significant impact on one's life. This is especially true in the complex world of healthcare, where the importance of choices is magnified. The complexities of these issues can make it difficult for patients and their loved ones to effectively address them while dealing with increased stress and uncertainty. Medical professionals are also under immense pressure to ensure the well-being of their patients.

In such scenarios, the indispensable role of decision support tools (DSTs) becomes apparent. These invaluable resources aid both patients and healthcare professionals in selecting the optimal treatment option by carefully considering the risks and benefits involved. DSTs play a vital role in empowering individuals to make well-informed decisions by providing relevant information and facilitating comprehensive analysis. These tools enable the evaluation of various treatment options or potential outcomes. Some DSTs are data-driven, relying on prognostic algorithms. By utilizing analytical methods and algorithms on clinical data, they can offer predictions on survival rates, chances of recurrence, and estimated quality of life, particularly in diseases such as cancer.

Although data scientists have worked consistently to develop algorithms and guarantee the validity of the data used, there has been a noticeable lack of focus on defining the qualities of appropriate interaction with decision support tools. Numerous critical aspects remain unclear, such as identifying the appropriate qualities of interaction with a DST, determining the optimal delivery method for these tools, determining the optimal point in the care path to introduce them, specifying the relevant data to be provided to the DST, and deciding what information should be delivered to empower patients in their decision-making process. Furthermore, the integration and practical implementation of DSTs within the time limitations and complex dynamics of the medical context have been widely disregarded.

In this graduation project, we adopt a speculative design perspective to explore the future of data-driven healthcare. We aim to imagine how DSTs can become meaningful and sustainable components of the care path. Through a process of futurology, we envision an alternative future (or present) to contribute to the doctor and patient (as human actors) seeing the DST (the non-human actor) literally as partners in making decisions. ... Read more

Problem Background:
Cardiovascular disease (CVD) is the most common cause of death in the world (Johnston et al., 2016). One of the main causes for cardiovascular mortality is a myocardial infarction (MI) (Jneid et al., 2013; Mishra & Ramavataram, 2021; Verburg et al., 2019). A myocardial infarction is an event in which the heart muscle is damaged because of a complete or partial absence of oxygen supply (Mishra & Ramavataram, 2021)

The healthcare system is pressured by the enormous number of CVD cases (Kaushik et al., 2020). Digital care has gained recognition in the past decade because of its potential to release some pressure from the healthcare system. With the potential of digital care in mind, Leiden University Medical Center (LUMC) has developed a concept called “The MI Box” which provides patients who have had an MI with self-monitoring devices (The Box, 2021).
During the hospitalisation phase of the MI care trajectory, there is little time to involve patients in their care because healthcare professionals (HCPs) need to work as quickly as possible to avoid as much heart damage as possible. This is causing patients to have a bad discharge experience. The MI Box shows potential to involve patients more after the discharge as the concept shows the monitored values to patients. However, it can be difficult for patients to understand these values and how to use them for self-care activities, especially because of the little involvement during hospitalisation. If LUMC wants to satisfy its aim to change from monitoring to coaching, it is crucial to provide patients with enough support to work with their monitored values and perform self-care activities.

Increasing patient involvement is an essential first step before shared decision making (SDM) can be realised. SDM is a suitable approach for the change towards coaching as it invites patients to make their own care choices. In the MI care trajectory, the implementation of SDM is currently lacking. Therefore, further analysis of SDM is needed. A tool that is valuable for the analysis and increasement of SDM, and which is used in this thesis, is the Metro Mapping tool (Metro Mapping, n.d.).

Besides, because the MI Box causes care to be transferred to a patient’s home environment, it is necessary to consider the home context of a patient as care activities do not happen in a controlled hospital environment. Currently, little is known about the context in which the MI Box is used. Therefore, more knowledge about the context is necessary to consider what support means would be suitable to offer to patients to make them more empowered to perform self-care activities.

Research Question:
How to shift from monitoring to coaching with the MI Box?

Research activities:
-Literature research;
-Interviews: HCPs (n=5), MI patients (n=4), MI Box users (n=2);
-Context mapping;
-Metro Mapping.

Design Goal:
The goal is to increase patients’ confidence to perform self-care activities by increasing patients’ involvement and guidance with the use of the MI Box.

Final Concept:
“UnBoxing the MI Box” ... Read more

You, I and almost everyone deal with illness under a certain condition. As digital health is becoming ever more widespread nowadays, this change shapes a new understanding of our medical experience. Consider how these new digital tools might affect patient experience becomes more crucial for everyone’s life. Four studies, aiming at understanding and enhancing the patient experience, thus become the foundation of this project.

However, the transition of academic research knowledge into practical design information often faces obstacles (Zielhuis et al., 2022a). Challenges include effectively teach-ing freshmen (Hoadley & Cox, 2008), selecting the right formats, and successfully conveying academic knowledge in a practical context (Stappers and Giaccardi, 2017). As a result, despite the fact that the primary research potentially enables healthcare designers to enhance the digital patient experience, whether practitioners can benefit from these academic findings is still unclear. Therefore, to further transfer the primary research to support design education and best practices for improving patient experience in digital health, as well as increase the accessibility and applicability of the primary research (Daniluk and Koert, 2015; Cook, D. A., 2007), an exploration starts.

Desk research and literature research are done to define the project’s scope and make a concrete goal. Design guidelines are considered since they play a crucial role in leading designers to success. Through learning and following effective design guidelines, designers can significantly enhance the quality of their design outcomes (Fu, Yang, & Wood, 2016). To transform the primary research into design guidelines, nine qualities should be considered in the creation and evaluation process. Additionally, the website is an appro-priate method of transferring information (Daniluk and Koert, 2015; Cook, D. A., 2007). When creating a website, usability, accessibility, and consistency need to be considered.

It is defined that the primary research should be transformed into design guidelines based on a website platform, the design goal therefore is defined as: To transform the primary research into a good and usable web-based design guide, enabling healthcare designers to utilize the primary research to improve the digital patient experience. To achieve this goal, design activities should be conducted to ensure the website’s usability, consistency, and accessibility, with the guide content’s clarity, efficacy, and credibility.
Through design activities such as walkthroughs and case studies, an initial minimum viable (MVP) website is developed. An evaluation workshop makes clear that the website partially meets
its design objectives and suggests a need for improvement in content clarity and efficacy and website usability. Following this feedback, an iteration is developed, resulting in a complete website design. A small-scale usability test validates the in-crease in content clarity, credibility, and efficacy, with overall usability slightly declining. Hence, the website is iterated again.
In conclusion, there was proof that the final design met the goal of having expected clarity, efficacy, credibility, color accessibility, and internal and external consistency. The final SUS score was 59.5 out of 100, which was acceptable but implied room for improvement (Bangor, Kortum, & Miller, 2009). ... Read more