Visits to the pediatric outpatient clinic are often accompanied by stress and anxiety, not only in the child but also within the parents. Within current trends in healthcare, parents are becoming more and more involved in the treatment of their child. The Hospital Hero Foundation, that already developed an app to reduce hospital related fear and anxiety in children, therefore showed interest in the question of how to support parents with this more engaged role.

IMPORTANCE OF PARENTAL SUPPORT
Literature showed that outside of the hospital context, when healthcare professionals are not present, children depend on their parents to provide the needed support. Also, during the outpatient visit parents play a very important role: children tend to look at their parents in stressful situations to determine an appropriate response. For parents to be able to execute existing strategies to reduce stress in their child, they need to possess the necessary knowledge and skills. More importantly, parents need to be able to manage their own stress, to not transmit this stress onto their child.

CHALLENGS OF PARENTS
Observations in pediatric outpatient clinics and interviews with parents and healthcare professionals confirmed and added to the previously described findings. According to this research, parents would ideally be honest, calm and radiate trust when supporting their child. The outpatient trajectory of their child, though, comes with an increase in (perceived) responsibilities of the parent possibly causing parents to be stressed. In this context, parents are generally fully focused on their child, making them unaware of their own increasing stress levels. Challenges parents experience in the context of the pediatric outpatient trajectory of their child are (1) Engaging with their social environment, (2) Gaining information, (3) Taking care of oneself, (4) Seeing their child in pain, (5) Supporting their child and (6) Working together with healthcare professionals. Support mechanisms to help parents deal with these challenges are limited and often not received by parents.

MANAGING PARENTAL STRESS
To manage parental stress, an intervention that supports parents of pediatric patients (aged 4-10 years old) with their challenges in the context of outpatient visits was designed. The focus thereby was to help parents to take care of themselves. Several brainstorming activities were executed in the ideation phase. The created bulk of ideas converged into 3 concepts, which were compared based on insights gained in this project and interviews with stakeholders. The most favorable concept was further developed into the Final Concept: the Care Companion app.

THE CARE COMPANION APP
The Care Companion app is a standalone app offered to parents by the Hospital Hero Foundation. It offers parents both affirmations as well as general tips for situations and challenges they can possibly encounter in the outpatient trajectory of their child. Each tip consists of advice from an expert and an experience from another parent. The provided tips can be read, saved and shared. A short evaluation with parents and an expert showed promising results for the concept of the Care Companion app. ... Read more

Digitalisation is becoming increasingly important in discharging the healthcare sector as our society ages, and long-term treatments of chronically ill patients are becoming necessary. However, adopting digital tools has not been smooth due to individual, organisational, and technical barriers. To overcome these barriers, a user-centred approach, co-creation, improved communication, and the involvement of the right stakeholders could help smooth the transition.

The GoMedFlow concept tool is a digital tool for healthcare professionals and organisational employees of the Reinier de Graaf Gasthuis that aims to improve the workflow of care processes and stimulate the use of digital tools. By creating a clear overview of care paths, improvements and digital tools can easily be noticed and implemented.

Using context mapping, stakeholders' wishes and needs were gathered at different levels of knowledge. A questionnaire revealed that stakeholders want to spend more time improving digitalisation, but not all have the time to contribute. Observations and conversations in the hospital uncovered insights into workflows and concerns, and generative sessions were held to dive even deeper and gather more insights. A design brief, including a design goal, was created to provide direction to the design process.

A co-creation session was held to involve stakeholders in the design process. Two groups provided ideas based on pre-created scenarios, and two different concept directions were created using Adobe XD. Before the concepts were created, a new corporate identity was created for GoMedFlow. Both concepts were tested during a care table and individually with stakeholders of care tables, and many insights were gathered. The second concept stood out more, but aspects of the first concept were still considered.

In order to finalise the concept of GoMedFlow, it is tested both during a care table and individually with stakeholders. The feedback and insights gathered from these tests are then combined to create the final design of the thesis. Additionally, a project journey is created to provide insights into the design choices made throughout the project. A roadmap is also developed to display the further steps that are required for a successful implementation of GoMedFlow. The thesis concludes with future research perspectives and a reflection.
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The national and international healthcare systems are in a transition. The healthcare problems of the future ask for doctors who can deal with complex challenges, connect to their patients, support societal health, have skills for lifelong learning, and take care of themselves (Lemmens et al., 2019; Nooteboom et al., 2020; World Health Organization, 2022). Both international researchers and national institutions explain that supporting medical students in their process of Professional Identity Formation (PIF) prepares them for this future (Cruess et al., 2014; Jarvis-Selinger et al., 2012; van De Pol et al., 2020). PIF is a process of finding the right balance between the internalization of the values, norms and behaviours of the profession (professional side), and the development of a personal style and purpose (personal side). While the professional side is already part of many medical curricula, including the curriculum of University Medical Centre Utrecht (UMCU), attention to the personal side is lacking. Therefore, this project aims to support medical students in exploring their personal side of PIF.
An iterative approach with extensive involvement of students, teachers, medical professionals and educational experts, has led to the creation of the educational module AIO (Arts In Ontwikkeling/Doctor In Development). AIO is divided into four phases: hook the students for PIF education, create a safe atmosphere to open up, allow students to explore themselves, and support them in evaluating what their self-insights mean for their role as residents/medical professionals. These phases form the basis of the three-year course and are repeated within the exploration phase as well. The exploration phase consists of seven cycles of start workshop – challenge – end workshop. In the start workshop students are hooked and explore together by sharing stories, a variety of challenges to choose from enables them to further reflect on themselves, the end workshop allows sharing of the insights and supports them in using the self-insights to formulate a concrete takeaway. Most workshops are facilitated by older students instead of teachers, since they create a safe atmosphere to open up and can provide practical tips based on their experiences.
A pilot study showed that peer facilitators indeed play a key role in the education. Furthermore, the active and creative exercises were seen as extremely supportive in the exploration and sharing of experiences. Besides being desired by students, AIO addresses several requirements for medical education and is thereby viable for UMCU. The fact that AIO is a modular course, requires a limited amount of teachers, and has been designed for the organizational structure of UMCU makes it also feasible.
Besides supporting UMCU in integrating PIF into their new curriculum, the research and design of this graduation project can be used as inspiration for other (inter)national medical universities. Future research could investigate the long-term effects of the design as PIF is a longitudinal process. Still, the pilot showed that the designed education already addresses unmet needs, supports the resilience of residents and allows students to discuss the challenges the future of healthcare brings.
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This graduation project aims to contribute to an emotionally-safe, i.e. comfortable and trauma-free, hospitalization experience for children. Hospitalization can be emotionally threatening and traumatizing for children. Children have to undergo multiple medical examinations, in a setting that is unfamiliar to them. Resilience is needed to cope with the challenges that come with the hospitalization. A positive emotional state can help children manage fear, stress and anxiety. In this graduation project, the narrative interactive game-play intervention Hideaway was created to foster resilience and empower children during their short (3-7 days) stay in the hospital, building on the previously developed Hospital Hero app©.

In order to create a valuable design intervention, an iterative research and design process was followed. A literature study and a context mapping study were performed to gain insight into the emotional experience of children (4 to 14 years old) and contributory contextual factors. Data was collected using observations, conversations with (former) patients, parents and healthcare professionals, and interviews with experts specialized in psychological impact of hospitalization in children. Using activity booklets, hospitalized children were asked about their social contacts, emotions and desires. Make-and-say sessions with children and co-creation sessions with children were held to further determine the core intervention strategy.

From the research, multiple challenges that negatively influence children’s mental state were identified: accumulation of medical procedures, unfamiliar daily routine/environment, not being able to play. This is strengthened by lack of peer-interactions and restricted mobility (i.e. contact isolation, being bedbound). To help children cope with these challenges, an interactive storytelling-based game was designed, integrating peer-contact, social play and child-friendly coping tips. Hideaway invites children to work together in a collaborative digital game of ‘hide-and-seek’, thereby creating connection between peers in and outside the hospital, letting children explore and escape the hospital room, and empowering children.

A prototype of Hideaway was evaluated with children and healthcare professionals, showing a promising potential to evoke a positive emotional state in children and with that fostering resilience and empowerment. Research and design recommendations have been made to provide a bridge to future implementation of Hideaway.

The eHealth solution Hideaway facilitates playful peer-interactions and has the potential to stand in for missed daily peer-interplay. Hideaway provides a valuable addition to the Hospital Hero app©, expanding outpatient care support with hospitalization support, and could be applicable to other settings (e.g. pediatric rehabilitation).
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This thesis takes an inclusive design approach to understand the mismatches between people with visual impairment (PVIs) and the current payment infrastructure in the Netherlands. The research applies existing Inclusive Design and general UX design methods to the context of payment to reveal latent user needs and co-design solutions. Design for Emotion and Interaction Design methods were used to help the designer envisage and evaluate desirable payment flows. Moreover, while this project aims to improve payment accessibility for PVIs, it also serves as a case study to apply Inclusive Design methods to the context of payment.
The research reveals the inaccessibility interfaces of the current payment system often force PVIs to skip important steps of their payment, such as confirming the final amount. Moreover, POS machines and kiosks afford very different experiences for PVIs and sighted people. As a result, when PVIs seek help from sighted people, they often receive unreliable and inaccessible information. The project results in a secure payment transaction design proposal in which PVIs can experience control.
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With more and more companies focusing on innovating, whether it is because the market desires it or to outrun the competition, the importance and difficulty of the innovation process increases. Innovation is not the process of finding that one great idea anymore. It is a complex and company-wide endeavor that requires structured, organized, and encouraging processes. Portfolio management aligns the product development activities with the organization's strategy. The literature review in chapter 2 aims to gain a better understanding of the context and the portfolio management process. The three goals of the strategic portfolio management process were defined. First, achieving the right balance, the portfolio can be balanced on several parameters, among others are the lead time, risk, the number of products, and the spread across the funnel. Second, align with strategy, by creating an overview portfolio management allows aligning the research activities with the strategy set by the executive board. And third maximize the value, realize the most value out of the limited available resources. This thesis explores the practice of portfolio management within TNO, an independent research organization in the Netherlands. The focus lies on the usage and transfer of data needed in the portfolio management process, in this case, the strategic meetings and Flightmap, the digital tool used to manage the portfolio data. In chapter 3 a systematic analysis is presented of the implementation and use of portfolio management within TNO, including the reason for implementation, the position of portfolio management in the organization, the governance, and the process activities. To increase the efficiency of data presentation for the decision-making process the field of information transfer is explored in chapter 4. The interactions around and in strategic meetings as well as Flightmap are analyzed. Three problem clusters are identified: the lack of data tracking, the lack of a clear meeting focus, and the poor Flightmap user experience. To explore the solution space a diversity of design generative tools is used. After an ideation phase, a concept was created and improved through three iterative cycles including ideating, prototyping, and testing. Eventually, an integrated solution with three deliverables is presented in the form of a meeting format, an annual plan, and a Flightmap redesign. The solution contributes to four aspects: creating an overview on all levels of TNO’s portfolio management, creating strategic structure and awareness, providing an integrated solution to manage the portfolio on each level and enabling to make informed decisions on the balance, the status, and the impact. Since this solution represents a future vision, an implementation plan is presented to outline the steps towards the realization. The final design is validated through three activities. The solution was discussed in a team of directors meeting where the decision was made to use the status board, the portfolio review meeting, and the meeting format in the coming strategic meetings. Next to this, the Flightmap redesign was validated in two sessions with business developers. The concept was received extremely well. The final design was discussed in two sessions with experts from the strategy department. In the next Flightmap update a first version of the dashboards introduced in this thesis will be implemented. ... Read more

In 2020 the law ‘informed consent’ is renewed, with the aim to strengthen the patient’s position in the field of shared health decision making. Research showed that patients only recall 20% of the information provided by their medical specialist.Therefore other information materials are offered, to ensure the patient can comprehend the other 80% of health information. Nevertheless, these materials do not satisfy all patient’s needs concerning health information preferences. A qualitative research is conducted to gather knowledge of the health information preferences of non-muscle invasive bladder cancer patients. Based on these findings a tailored interactive animation is developed. The animation is used in a second qualitative research to learn if this material better meets the patient’s needs, compared to current resources as a traditional folder and 3D animation. ... Read more

The River Intellectuals network is an organization that wants to connect academic students to Balkan river conservation. In July 2019 the first Student for River Camp is organized. Students from the Balkan, and the rest of Europe, applied for a week of lectures and activities at the Soča river in Slovenia. It is identified that these students, in varying degree, lack the knowledge of the cultural and political system that drives corruption in hydropower development. To transfer this knowledge, the medium of serious game is chosen, due to its effective, engaging and reusable nature. The aim of this project is therefore to: Design a serious game that engages the students participating in the Students for Rivers Camp, educate them in the complex system of hydropower development, And Inspire them in using their expertise and ambition for Balkan river conservation. To achieve this, the problem is investigated first. The culture of corruption is the result of the Balkan’s turbulent past, and manifests itself in a combination of bribing, threatening, rule bending and nepotism. The story to tell is that of Government officials and Hydropower companies enriching each other, over the backs of the local communities. The banks who invest in the hydropower projects don’t know, or don’t want to know about this. Activists try to stop hydropower development by activating the local community. The corruption game uses a combination of game mechanics to simulate this story. There are several characters to play, each with different and confliction goals and rules. Some want to develop hydropower dams, others try to prevent that. A stack of event cards guide the players through the game. The game is finished with a group evaluation, and individual assignment. The corruption game has been successfully tested at the Students for River Camp. 42 students and lectures played it as part of the program. It has been evaluated positively in achieving its goal. The game have been referenced multiple times throughout the week by lecturers, students and organization alike. Plans have been made to develop the project further, doing a final iteration. The ambition is to spread the Corruption Game to NGO’s worldwide. ... Read more

The goal of this project is to increase the food literacy of people with low socioeconomic status by conveying food knowledge in an enjoyable, indirect, and unforced way. This master thesis proposes a mobile game which enables the target group to receive food literacy and report their diet through gameplay. The game is about dragon raising; it builds a connection between the game world and the real world by encouraging users to feed their dragons with what they buy and eat in real lives. The project started with literature research and a user survey in the supermarket to explore the factors that influenced people’s food choice. The result showed there were mainly two reasons why low SES people were not having healthy food behavior, unwilling to learn food knowledge or report diet: lack of motivation or lack of ability, which is in line with Fogg's Behavior Model. After further research on the characteristics of people with low SES and contextual factors that influence food behavior, the reason became more specific: 1. People didn't have motivation due to the lack of direct feedback about the short-term and long-term benefits of having good food behaviors. 2. People lacked the ability to learn food literacy or report their diet because they were hindered by more pressing matters in their daily life, e.g., financial difficulty, busy lives. Self-Determination Theory and Persuasive Game Design Model were applied together with Fogg's Behavior Model to help with analyzing the user characteristics and contextual factors. After that, the design guideline was made that the design should focus on simplifying the using and learning process (to increase ability) and deliver food knowledge in an attractive and enjoyable way that may relate to their basic needs (to enhance motivation). Before entering the design phase, an analysis of existing food informatics products, including dietary apps and gamified healthcare apps, was conducted to find the typical functional features and most frequently used game elements. Personas and scenarios of two types of user groups were also created based on the research results, leading to the design requirements. During the design phase, creative sessions were carried for idea-generating, followed by two rounds of prototyping test and iterations. Two game concepts with different game elements and design focuses were further developed and tested with users to check to what extent could the concepts meet the design goal and requirements. The final concept was created according to the insights from users' preference and feedback. In the last phase, the design concept was evaluated with experienced designers and dietitian in related fields to get critical feedback and suggestion. The recommendations and limitations were discussed as well in the end. ... Read more

Ethnically diverse neighbourhoods often lack in social cohesion. This means that people of different ethnic backgrounds often do not mingle with people outside their cultural circle, which leads into a poor public social experience. PhD student Francisco Xavier Fonseca has been developing a localized mobile game aimed at teenagers called Secrets of the South to fix this. The aim of this game is to improve social cohesion in ethnically diverse neighbourhoods by having players spend more time in public spaces while completing game challenges. This graduation project aims to create content for Secrets of the South to foster social interaction in ethnically diverse neighbourhoods.
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