The expansion of remote home care has been driven by technological advancements, a growing elderly population living independently, and the impact of the COVID-19 pandemic. Remote care services offer opportunities to improve accessibility and efficiency. However, these advancements also introduce challenges related to trust. Trust is essential in remote home care, influencing interactions, social wellbeing, and care outcomes. A lack of trust can lead to inefficiencies, miscommunication, and hesitation to share critical health information, ultimately reducing the effectiveness of remote care.
This thesis explores how trust can be improved through service design, focusing on creating a service vision for the client of this thesis, Syntilio. Syntilio is a company developing digital platforms for triage. Given the complexity of trust in healthcare, elements from systemic design are applied to integrate multiple perspectives throughout the research and design process.

Trust in remote care operates on multiple levels. At the micro level, it is shaped by the relationship between care providers and receivers, relying on perceptions of ability, benevolence, and integrity, as described by Mayer et al. (1995). At the meso level, trust concerns technology’s reliability, usability, and security, following the Technology Acceptance Model (TAM) by Davis (1989). While macro-level trust in institutions and healthcare policies influences public perception, this project focuses on trust at the micro and meso levels, where design interventions can have a direct impact.

Qualitative research identified key factors contributing to both trust and distrust in remote care. Care providers often struggle to trust triage technology due to incomplete, scattered, or outdated information, making decision-making more difficult. Care receivers experience uncertainty due to limited knowledge about their care providers, the alarm system’s functionality, and a lack of communication during alarm events. This uncertainty leads to anxiety and hesitation in using remote care services. Addressing these issues is key to improving trust in remote care interactions.

A service vision was developed through brainstorming and co-creation workshops. Prototypes are made from the touchpoints. The Introduction Booklet provides care receivers with clear information about their care providers and the alarm system, reducing initial uncertainty. The Talk Tool enables structured interactions between care receivers and providers while also allowing updating of personal and medical information. The Stay Connected Application helps care receivers manage their medical data, improving accuracy and reducing administrative burdens on care providers. The Alarm Live View is a build-in feature in the application that provides follow-up information for care receivers, reducing anxiety during alarm emergencies.
The Smart Alarm Dashboard enhances triage efficiency by providing sufficient, organised and updated data for care providers.

User testing and iterative design resulted in an interactive service blueprint outlining functionality. The implementation roadmap, developed with Syntilio, includes investigation, implementation, and continuous improvement. The service is expected to improve remote care by reducing false alarms, enhancing communication, and strengthening relationships between care providers and receivers. The service could be scaled to new remote care centres and into other healthcare fields, such as post-surgical monitoring and chronic disease management.

Gait impairments negatively affect patients’ walking ability, without which they tend to suffer from a higher risk of falling and a lower quality of life. Repetitious training is necessary for patients to regain and maintain this ability. Compared with the conventional rehabilitation process, gamified rehabilitation has the potential to provide patients with a more engaging experience with helpful feedback. Extensive research has focused on the game design and rehabilitation technologies, however, less attention is paid to the personalization and adaptation within the game. In this thesis, we propose a generic adaptation scheme to support physiotherapists in conducting gait training. The scheme features the parameterized generation of the levels which can be steered dynamically based on the player model and therapists’ intervention. Two difficulty adjustment methods are adopted to provide patients with a personalized rehabilitation experience, which are (i) parameters- progression schemes manipulating multiple parameters in two systematic ways for creating levels with appropriate difficulty, and (ii) meaningful integration of separate rehabilitation exercises for providing variety in difficulty transition. Our goal is to assess how adaptive steering of a procedural game level generator can support a physiotherapist in achieving the desired rehabilitation goals. We implemented our design in a standalone prototype for conducting gait training in a three-dimensional overground body weight support system RYSEN. A set of mini-games was first developed through a mapping from therapy goals to the movement challenges in the gameplay. The difficulty adjustment methods were adopted in these games. Apart from the automatic game system, the prototype provides a real-time interface for therapists, which ensures their control of the rehabilitation session. Nine physiotherapists took part in the evaluation with their focus on the difficulty adjustment. The results show that our approach can assist physiotherapists in providing (i) helpful diversity for patients in everyday gait training, (ii) adequate challenge levels for a wider group of patients in various gait exercises, (iii) useful game controls to tailor the level of challenges for patients when necessary.

The main goal of this thesis is answering the question: “How can immersion be achieved in an outdoor experience, using synergy between narrative, puzzles and location?”

From literature research the following definition of immersion is formed: Immersion is a state where the interactor feels as if they were located in a different reality or world with an overarching specific theme. A narrative, interactions and location each contributes to this.

To find out what the players experience during an escape room, two indoor games and two outdoor games are played and evaluated to see what does and does not work for their immersion. The main takeaway is that the narrative, and the interaction play a major part in immersion.

After finding out what is considered immersive, an outdoor escape experience is built to function as a case study. Here, designs are tested and iterated upon to find out what improves players immersion even more.

Two final tests are held to find out if the entire experience is as immersive as can be. From these tests conclusions will be drawn to see how each individual aspect of the experience influences the total experience.

The conclusion of this thesis is that there is a synergy between narrative, puzzles and location. As having a location that fits the story, or the other way around, works great for storytelling and immersion levels. Also if the puzzles have a matching theme, Players experience more immersion, fun and excitement.

This graduation project is related to macular degeneration. Macular degeneration affects the macula, a central pit on the retina which is responsible for the highest visual acuity due to the densely packed cone photoreceptors. Symptoms of macular degeneration can vary in the early stage from blurred vision to abnormal dark adaptation (Jager et al., 2008) however in late stage macular degeneration symptoms can be much more invasive including partial and complete loss of the central vision. In order to cope with the loss of central vision patients could prescribe to what is called eccentric viewing. Eccentric viewing is a technique where the peripheral vision is used to see. Using eccentric viewing as a method to cope with macular degeneration requires, for optimal results, practice. This can be done through training. This project was originally aimed at designing a training method for eccentric viewing with the use of motivating game elements. By speaking to experts from Visio and Bartimeus as well as patients throughout the research phase it became apparent that eccentric viewing was not deemed necessary. Instead other problems were addressed which had a higher priority in solving. These problems include the lack of provided information after the official diagnosis, the attitude of the ophthalmologist during the diagnosis and the perceived gap between the diagnosis and the Low-Vision clinics. By creating a patient journey and examining the different problems that occur during that journey a choice was made to focus on a combination of the lack of information after the diagnosis and the gap between the diagnosis and the Low-Vision clinics. Six different topics of information were defined which play part in the lack of information. These six topics are: information about the condition, information about aids, make it easier, information about peer support, training / revalidation support and information about involved instances. Together these six topics cover most of the aspects surrounding macular degeneration. To convey this information to the target group a web-based medium is used. Due to the special target group guidelines have been defined which help in designing a website for visually impaired people. This has resulted in a framework where the necessary information can be placed in. Because of time restrictions one of the six topics which was defined was further developed. That topic is ‘Make it easier’. It resulted in a collection of tips from “experienced” macular degeneration patients on making Activities of Daily Living (ADL) easier to perform. In total 20 different tips were gathered through a brainstorm session, an online survey and telephone contact with Bartimeus. These tips were spread over three different themes: cooking, grocery shopping and public transport. Each tip was accompanied by an image, a descriptive text and a spoken quote. Finally an evaluation test has been conducted with two participants to verify whether the proposed design succeeded. The results from the evaluation show the potential success of the design but are not conclusive. Therefore further testing needs to be done with more participants over a longer period of time.

Yubu B.V., for whom the graduation project is carried out, provides a career orientation method (called Yubu) for high schools that uses serious games to motivate students to focus on choosing a study. Making decisions concerning a career is not something that stops after high school and therefore Yubu B.V. has taken interest in offering a career counselling program for students.

Research is carried out to find out how Yubu B.V. can be of service to students. Annual reports from governmental institutions revealed that HBO education (University of Applied Sciences) struggles the most with delayed students and student satisfaction for career orientation programs. Therefore, the decision was made to focus on HBO education. The outcome of the interviews with the target group revealed that an internship is considered an important moment in their career preparation because it provides a period in which students learn if a type of work suits them. Unfortunately, students struggle with finding a suitable internship because they are not certain about their abilities and interests and end up at the wrong company due to the lack of sufficient career orientation programs. Another problem is that it is very difficult to get an invitation for an internship interview resulting in a study delay for many students.

A serious game is designed that helps students to get an invitation for an internship interview that fits with their interests and values so that they have a bigger chance to get selected and enjoy the time they work for a company. The game is played in three steps. Students will do a self-reflection of which the results can be used to search for an internship and after they have found one they try to get an interview invitation from the company.

Students indicated to have an aversion for self-reflecting in general. However, a better self-image helps students in defining their ideal internship. To ensure that students will perform a self-reflection a model is designed for this specific purpose. This model helps students in defining their internship preferences, skills, motives and personal mission. For each of the categories students create playing cards. All of them together form a card deck that generates a character, which is a representation of themselves and is further used as their avatar in the game. Companies use the same model to create a vacancy so that it can be matched with the characters. With a mini-card game students filter through the offers by laying down cards and making combinations. Students can look at the results and can decide to apply for one or more. They will be placed in a queue together with other students who applied. Students can now compete with each other to earn a position at the front by strengthening their card deck (doing more reflecting). At some point the enrolment deadline expires and the few students at the top get the invitation.

Parts of the game are tested separately with the target group with positive responses as result. However, a large scale test needs to be carried out to find out how efficient the system is, by making real matches between students and offers. Furthermore, for the success of the game it is important that schools are involved because they can play an important role in setting up the game. Schools have databases of companies who need interns and can advise students to use the game.

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.